Mehdi Mirzaei-Alavijeh
1 
, Sohrab Ashayeri
2, Mehdi Moradinazar
3, Abdollah Saadatfar
3, Mahshad Taherpour
3 , Farzad Jalilian
4* 1 Social Development and Health Promotion Research Center, Health Policy and Promotion Research Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
2 Health Education and Promotion Department, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
3 Clinical Research Development Center, Motazedi Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
4 Family Health and Population Growth Research Center, Health Policy and Promotion Research Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
Abstract
Background: Prostate cancer (PCa) is the leading malignancy among Iranian men, with high morbidity often resulting from delayed diagnosis. Early detection through prostate-specific antigen (PSA) screening can significantly improve treatment outcomes. The present study aimed to identify the predictors of PSA screening using the Health Action Process Approach (HAPA). Methods: A cross-sectional study was conducted among 600 men aged 50–69 years without a history of PCa, selected through multistage cluster sampling from health centers in Kermanshah, western Iran. Data were collected between March and May 2023 using a structured, researcher-made questionnaire based on the HAPA. The questionnaire was reviewed by experts for content validity and pilot-tested for reliability. Crude and adjusted logistic regression analyses were performed to identify predictors of PSA screening behavior. Results: Among the participants, 7.7% (46 out of 600) had undergone PSA screening at least once. In the adjusted logistic regression model, academic education (AOR = 3.65, 95% CI: 1.09–12.15, p = 0.035), family history of PCa (AOR = 14.36, 95% CI: 5.83–35.32, p < 0.001), task self-efficacy (AOR = 1.20, 95% CI: 1.00–1.43, p = 0.041), and coping planning (AOR = 1.34, 95% CI: 1.06–1.69, p = 0.014) were identified as independent predictors of PSA screening uptake. Conclusion: Academic education, family history of prostate cancer, task self-efficacy, and coping planning were key predictors of PSA screening. Brief, theory-driven interventions should target high-risk and lower-education groups to improve screening and early detection.