Rethinking agency for genetic testing intention among Latinos: Determining predictors of intention for carrier screening and cancer predisposition testing.

Abstract

Attitudes and clinical processes have been well studied in genetic testing contexts; however, studies tend to underutilize theoretical frameworks, especially among Latino groups. Behavioral intention is a consistent predictor of uptake of behavior and has many theoretical roots. Using the Integrated Behavioral Model, we modeled the relationships between attitudes, norms, and perceived agency with behavioral intention for both carrier screening (CS) and cancer predisposition testing (CPT) for a Latino-only cohort. Using structural equation modeling, we ran both measurement and structural models. An initial measurement model used confirmatory factor analysis for each latent variable (attitude, norms, and agency) and their indicators of the Integrated Behavioral Model. Factor loadings less than 0.50 were removed, and we subsequently ran a structural model with the outcome of intention to use CS and CPT. Agency was the most consistent predictor for both testing types (b = 0.381, P < .01 - CS; b = 0.559, P < .01 - CPT), with attitudes being negatively associated with CS (b = -0.313, P < .05), whereas norms were positively associated (b = 0.350, P < .01). Many interventions among Latino groups tend to focus on education and attitude change. Our findings suggest that more effort should be made to address agency to empower patients for improved genetic testing access.