Can the Theory of Planned Behavior help explain attendance to follow-up care of childhood cancer survivors?

OBJECTIVE: Childhood cancer survivors are at high risk for late effects. Regular attendance to long-term follow-up care is recommended and helps monitoring survivors' health. Using the Theory of Planned Behavior (TPB) we aimed to 1) investigate the predictors of the intention to attend follow-up care, and 2) examine the associations between perceived control and behavioral intention with actual follow-up care attendance in Swiss childhood cancer survivors. METHODS: We conducted a questionnaire survey in Swiss childhood cancer survivors (diagnosed with cancer aged <16 years between 1990 and 2005; ≥5 years since diagnosis). We assessed TPB-related predictors (attitude, subjective norm, perceived control), intention to attend follow-up care, and actual attendance. We applied structural equation modeling to investigate predictors of intention, and logistic regression models to study the association between intention and actual attendance. RESULTS: Of 299 responders (166 (55.5%) females), 145 (48.5%) reported attending follow-up care. We found that subjective norm, i.e. survivors' perceived social pressure and support, (Coef.0.90, p<0.001) predicted the intention to attend follow-up; attitude and perceived control did not. Perceived control (OR=1.58, 95%CI:1.04-2.41) and intention to attend follow-up (OR=6.43, 95%CI:4.21-9.81) were positively associated with attendance. CONCLUSIONS: To increase attendance, an effort should be made to sensitize partners, friends, parents and health care professionals on their important role in supporting survivors regarding follow-up care. Additionally, interventions promoting personal control over the follow-up attendance might further increase regular attendance.