Understanding breast cancer screening intentions in Malta among women aged 18–49: comparing the predictive ability of the health belief model and the Theory of Planned Behaviour

The aim of the present study was to identify psychosocial predictors of future breast screening intentions among Maltese women aged 18–49. Women residing in Malta with no history of breast cancer or prior screening (n = 166) were recruited online and through in-person outreach in early 2025. Measures include demographic variables and constructs from the Extended Health Belief Model (EHBM) and the Theory of Planned Behaviour (TPB). Hierarchical logistic regression examined predictors of certain versus uncertain intention to attend screening once eligible. Model fit improved across hierarchical blocks, with the full model producing a Nagelkerke pseudo-R2 of 0.566. Behavioural attitudes emerged as the strongest psychological predictor. Higher perceived benefits were linked with increased uncertainty among women with lower self-efficacy, indicating an interaction effect. The TPB-only model produced a Nagelkerke pseudo-R2 of 0.333 and demonstrated greater predictive specificity than the EHBM. Behavioural attitudes, transport access, and perceived benefits (in interaction with self-efficacy) were key predictors of future screening intentions. Combining TPB and EHBM constructs provided the most comprehensive prediction. Supporting intention formation among pre-eligible women may strengthen future screening uptake and enhance early detection efforts in Malta.