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Understanding the nuances: alcohol consumption and breast cancer risk in UK women aged 40-65


The behavior change wheel (Michie et al., Citation2014) – see http://www.behaviorchangewheel.com/

25.08.2023 - In a recent study by Davies et al. (2023), an in-depth exploration was conducted on the ways of communicating the association between alcohol consumption and breast cancer (BCa) to women aged 40-65 in the UK. Beyond just disseminating information, the research sought to understand the intricacies involved in women's perceptions, motivations, and behaviour concerning alcohol consumption, highlighting several challenges and intervention opportunities.


The study revealed three main themes:

  1. Perceptions of alcohol health communication: Participants frequently saw alcohol health communication as judgmental and ambiguous. They often dismissed such information, mainly when it failed to acknowledge the perceived benefits of drinking. Contrary to the potential risks associated with alcohol consumption, many participants attributed BCa risk to luck or fate. Such attitudes pose challenges for interventions solely focused on imparting knowledge, underscoring the need for non-judgmental, relatable, and contextually relevant health messages (Meyer et al., 2019).

  2. Socio-cognitive biases and life challenges: Unrealistic optimism, a bias where individuals perceive their personal health risks as lower than others, emerged prominently. This bias potentially reduces their motivation to adjust their drinking habits. Additionally, midlife challenges such as menopausal symptoms and the socio-psychological impacts of the COVID-19 pandemic influenced their drinking behaviours. Notably, participants highlighted the relief they found in "mummy drinking" social media groups, emphasising the role of alcohol in fostering social connections. Such platforms can both provide crucial support and inadvertently promote excessive drinking (Bosma et al., 2022; Wright et al., 2021).

  3. Intervention considerations: The study suggests a dual intervention approach: empowering women with clear, unambiguous information and acknowledging their perceptions. Pure statistical data may not suffice to motivate behaviour change. Instead, a holistic understanding of risk perceptions and insights from models like the COM-B and Protection Motivation Theory (PMT) could prove invaluable. Emphasising personal experiences and stories could resonate more with midlife women, leading to increased awareness and potential behaviour modification.

Implications and forward steps:

Using the COM-B model as a foundation, the research team actively works with women within the target age group to co-develop intervention content. The objective is to address barriers and facilitators identified in the study. A bespoke website is in the works to deliver the intervention, incorporating features such as goal-setting, self-monitoring, and community support.


Beyond this specific intervention, the findings offer broader insights for health initiatives targeting mid-life women. The study highlights the potential impact of personal stories and testimonials on behaviour change. For instance, the surge in mammogram bookings following Kylie Minogue's BCa diagnosis in 2005 offers evidence of the power of personal narratives (Chapman et al., 2005).


In conclusion, Davies et al.'s study emphasises the complex interplay of perceptions, biases, and life circumstances in influencing women's attitudes towards alcohol and BCa risk. As the quest continues to understand and mitigate BCa risk factors, nuanced, empathetic, and multi-faceted interventions will likely yield the most impact.


 

Both the COM-B model and the Protection Motivation Theory (PMT) are theoretical frameworks used in understanding health behaviours and designing interventions to influence them.

1. COM-B Model:

The COM-B model stands for "Capability, Opportunity, Motivation - Behavior" model. Developed by Susan Michie and colleagues, it is a comprehensive framework used to understand behaviour in terms of interactions between three components:

  • Capability (C): This refers to an individual's psychological and physical capacity to engage in an activity, including the necessary knowledge and skills.

  • Opportunity (O): This encompasses all external factors that either promote or hinder behavior, including the physical environment and social influences.

  • Motivation (M): This refers to all brain processes that energise and direct behaviour. It can be further divided into reflective processes (such as making conscious decisions or plans) and automatic processes (like habits and emotional reactions).

The central idea is that for a behaviour to occur, all three components (Capability, Opportunity, and Motivation) must be aligned. Therefore, for a successful behaviour change intervention, the COM-B model suggests that these components must be effectively targeted.


2. Protection Motivation Theory (PMT):

The Protection Motivation Theory was originally developed to understand the impacts of fear appeals on health behaviours. It has since evolved to offer insights into understanding individuals' motivations to adapt or adopt protective health behaviours. PMT suggests that people protect themselves based on two primary processes:

  • Threat appraisal: This involves evaluating the severity of a potential threat and one's vulnerability to that threat. It takes into account the perceived rewards or benefits of the risky behavior.

  • Coping appraisal: This considers whether a person believes they can take action against the threat (self-efficacy) and whether that action will be effective in averting the threat (response efficacy).

In the context of the study by Davies et al. (2023), the COM-B model provides a lens through which to view the barriers and facilitators affecting women's drinking behaviours and the link to breast cancer. In contrast, the PMT offers insights into how these women perceive and react to threats, such as the risk of developing breast cancer due to alcohol consumption, and their beliefs in their ability to mitigate these threats.

Both models are essential as they offer complementary insights. While the COM-B model focuses on the broader components necessary for behaviour (or behaviour change) to occur, the PMT delves deeper into the cognitive processes behind individuals' responses to perceived threats and their coping mechanisms.


 

Reference: Emma L. Davies, Julie Bennett, Lauren Matheson, Jo Brett & Eila Watson (2023). Shouldn’t We Know This Already? UK Women’s Views About Communicating the Link Between Alcohol Consumption and Risk of Breast Cancer. Health Communication. DOI: 10.1080/10410236.2023.2245208.

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