Developing a Health-Based

Abstract

The primary aim of this research was the development of a typology of respondents based on their "control identity"– i.e., perceived sense of control over themselves, their environment, and aspects of their health, including perceived vulnerability to disease and perceived value of health promotion. Testicular cancer and testicular self examination (TSE) were selected as the disease focus, with the realization that, if successful, the typology could be applied across a variety of diseases. The constructs of "realistic vs. unrealistic control" and "internal vs. external locus of control" provided the theoretical foundation to initially define the control-identity types that were then verified through cluster/segmentation analyses. Testicular cancer rates are rising among 15-54 year old men with the majority of those cases affecting males under the age of 35. Regular screening techniques for the disease, most notably testicular self-examination, are rarely performed among surveyed males. If testicular cancer is caught in its early stages, the survival rate is approximately 95%; however, if diagnosed in later stages, survival rates drop below 50%. The lack of published psychosocial behavioral research in this area has contributed to a general misunderstanding by men of the disease and its preventative/screening measures. If continued, this lack of screening for testicular cancer can only lead to increasing incidence and mortality rates. This exploratory study developed a Control Identity Survey, a 41-item questionnaire soliciting information on perceived vulnerability, value of health promotion, health control beliefs, and intention to perform testicular self-examination (TSE). The survey was administered via in-person and internet data collection methods to 300 men between the ages of 18-35. A principal components factor analysis of the survey’s key control variables (realistic vs. unrealistic illusory control constructs and internal v. external locus of control) defined the underlying structure of the data. The resulting factors were then used to create indices for use in the cluster analysis process. From this cluster analysis, control-identity groups were identified and profiled. Given the control-identity types, perceptual mapping techniques were then applied to model how each type of respondent perceives their vulnerability to testicular cancer, the value of testicular self-examination, and overall health control beliefs. This study equated perceptions with an individuals’ ‘outcome expectancy’, or attitude. The findings confirmed the following: •The hypothesized four-group control-identity typology was verified among men based on the variables of health control beliefs, perceived vulnerability, and perceived value of health promotion. The groups were labeled: 1) Realistic Externals, 2) Realistic Internals, 3) Unrealistic Internals, 4) Unrealistic Externals. •Unrealistic Externals perceive the value of TSE to be significantly lower than other types. •Unrealistic Externals perceived their control over health outcomes to be lower than all other types. •Each control-identity type structures perceptions of health control beliefs, vulnerability, and the value of health promotion similarly in a 3-dimensional perceptual mapping space, but the location of “self” within the concept set differs by control-identity type. •Realistic Internals scored the highest among types on value of health promotion, but not significantly so compared to the other groups, with the exception of the Unrealistic Externals, who least value health promotion. •The two “Realistic” types (Internal & External) scored significantly higher on perceived Vulnerability than did the two "Unrealistic" types (Internal & External), with the "Internals" v. "Externals" not differing significantly. •Unrealistic Internals scored highest on perceived self-efficacy (I-Control), but not significantly higher than Realistic Internals, which appears consistent with the fact that "internals" have a higher sense of health-related self-efficacy than do "externals". •Implications for social marketing and for the development of future behavioral intervention strategies are suggested. The methods used in this research could have wide application across the cancer continuum from primary prevention and screening to treatment and end-of-life decisions. From this research, it is clear that men differ significantly in their “control identity”-- the extent to which they perceive themselves as having an internal v. external and/or realistic vs. unrealistic sense of control over their health. Consistently, the control-types differed on perceptions of their own vulnerability to disease, their perceived value of health promotion, and their individual health control beliefs. The resulting typology appears to have exceptional potential for future research across a variety of health related behaviors and diseases. As well, the typology holds promise as a cost-effective way to tailor evidence-based decision aids for each of the control-identities. Since there is little reported success in promoting sustainable TSE among males, it is suggested that building on the control-identity approach will aid testicular cancer and TSE researchers in developing more effective, tailored messages for their study designs.