The purpose of this non-experimental correlational study was to test the proposed "Middle-Range Theory of Testicular Self-Examination (TSE) Adoption." 7,500 new cases of testicular cancer and 400 deaths from the disease were estimated in 2002 (Jemal, Thomas, Murray, & Thun, 2002). Advanced cases are curable; with early detection and treatment the survival rate is 99% (Discovery Health, 1999). Monthly TSE is an easy, cost effective means of early detection. The proposed model was developed by articulating and synthesizing Orem's Self-Care Deficit Theory (2002) and Prochaska and DiClemente's Transtheoretical Model of Behavior Change (1986). A convenience sample of 167 men, aged 18 to 68, completed a survey instrument. Data analysis was done using SEM. The a priori model could not be estimated. The model was refined using substantive theory and the literature. This approach was model generating and exploratory. The model was estimated and fit indexes (chi-square, 65.74, nonsignificant at 0.05; CMIN/DF = 1.37; comparative fit index = 0.97; RMSEA =.05, P test of close fit 0.54) indicated a good fit supporting the model plausibility. A Type I error may have resulted due to the model generating approach and fitting the model to the same data. Hypothesized relationships within the model and the theories comprising the conceptual framework were supported. Social support, age, health state, socioeconomic status, and family influence on health behavior were significant predictors of elements of self-care agency (SCA). Optimists demonstrated more SCA, and SCA was a significant predictor of decisional balance (DB) and self-efficacy (SE) for TSE. DB and SE were significantly related to Stages of Change, which predicted TSE performance. The model has implications for nursing as it helps to explain the adoption of testicular self-examination behavior and provides a template that can be used to assess and plan patient education. The model also has potential for use with adoption of other health behaviors.
