Integrating the Health Belief Model and the Theory of Planned Behavior to Decode Willingness to Pay for Cancer Screening: Evidence From Community-Based Cross-Sectional Surveys in China.

BACKGROUND: Willingness to pay for cancer screening has been widely adopted to examine barriers to screening. This study integrated the Health Belief Model and the Theory of Planned Behavior to explore the correlational pathways linked to WTP-CS among Chinese community-dwelling residents. METHODS: A multistage stratified survey was carried out in a cancer early screening demonstration zone. Questionnaires assessed demographic, psychosocial, HBM, TPB variables, and WTP-CS. Hierarchical logistic regression identified correlates; bivariate correlation analyses described pairwise associations; path analysis tested the hypothesized HBM-TPB integration theoretical framework. RESULTS: A total of 4575 residents (mean age 70.63 years, SD = 7.85) were enrolled. Hierarchical logistic regression models showed incremental variance for WTP-CS reaching 34.5% across Model 1 to Model 4 (Δ McFadden R2 = 34.5%). Path analysis revealed adequate model fit (CFI = 0.94, RMSEA = 0.05) and explained 48.91% of the variance in WTP-CS. TPB components dominated both the direct and indirect pathways. Subjective norms showed the strongest positive association with WTP-CS (β = 0.313, p < 0.001). Perceived benefits displayed a positive indirect association with WTP-CS via perceived confidence and subjective norms (β = 0.062, p < 0.001). Age demonstrated a negative correlational linkage with WTP-CS through a sequential chain involving knowledge, perceived benefits, and attitude towards behaviors (β = -0.007, p < 0.001). The observed patterns supported the hypothesized pathways of the HBM-TPB integration framework. CONCLUSION: A potential intention-behavior gap was observed, as favorable WTP-CS did not necessarily correspond to higher actual screening participation. The HBM-TPB framework tentatively maps multi-layered direct and indirect correlational pathways between demographic, psychological, HBM, TPB variables and WTP-CS among Chinese community-dwelling residents. This framework may explore plausible socio-psychological correlational linkages associated with WTP-CS, expand empirical research, and deliver tentative, context-specific insights for subsequent investigations. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ID: ChiCTR2400088321.