Graduation Year

2026

Document Type

Thesis

Degree

M.S.P.H.

Degree Name

MS in Public Health (M.S.P.H.)

Degree Granting Department

Public Health

Major Professor

Deborah Cragun, Ph.D.

Committee Member

Marleah Dean Kruzel, Ph.D.

Committee Member

Tuya Pal, Ph.D.

Keywords

Cancer risk management, NCCN Guidelines, Behavioral predictors

Abstract

Introduction: Although National Comprehensive Cancer Network (NCCN) guidelines provide cancer screening or risk reduction recommendations for individuals with germline pathogenic and likely pathogenic variants (GPVs) in actionable hereditary cancer genes, guideline adherence remains inconsistent, and the behavioral contributors to this gap remain understudied. To identify behavioral factors related to adherence across inherited cancer risk genes, this study used the COM-B model, which posits that capability, opportunity, and motivation shape health behaviors.

Methods: IMPACT study participants, all with GPVs in a variety of actionable genes, completed surveys (N=575). Minimal adherence was based on gene-specific NCCN guidelines. COM-B constructs (capability, opportunity, motivation) were measured with 37 Likert items, yielding eight behavioral factors; knowledge was scored separately (0–10). Additional variables included cancer distress, health literacy, demographics, years since testing, and gene penetrance. Bivariate analyses informed a logistic regression controlling for age, insurance, years since testing, and gene penetrance, with COM-B variables added stepwise.

Results: Among 575 participants, 55.7% were minimally adherent to guideline-recommended behaviors. In the final multivariable model, higher motivation related to positive outcomes was the strongest predictor of adherence (OR = 2.14, 95% CI: 1.55–2.97, p < .001). Greater knowledge scores were also associated with increased adherence (OR = 1.15, 95% CI: 1.05–1.26, p = .002), as was longer time since genetic testing (OR = 1.06, 95% CI: 1.01–1.12, p = .019). Moderate-penetrance gene status was associated with lower adherence compared with high-penetrance genes (OR = 0.66, 95% CI: 0.44–0.99, p = .046). Age at counseling, insurance status, and other COM-B variables were not significantly associated with adherence in the multivariable model.

Conclusion: These findings suggest that reinforcing the benefits of recommended cancer risk management behaviors and supporting patient knowledge about hereditary cancer may be targets for interventions to improve adherence. Additional research is needed to further assess whether adherence increases with time or whether those who are adherent remain more engaged with research.

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