Adaptation of Champion's Health Belief Model Scale for Turkish women and evaluation of the selected variables associated with breast self-examination

The purpose of this study was to adapt Champion's Revised Health Belief Model Scale for Turkish women and to examine selected sociodemographic variables associated with breast self-examination (BSE). Data were collected from a total of 430 females who were living in one of the Health Center areas located in Izmir, a city in the west of Turkey. Champion's revised Health Belief Model Scale was translated into Turkish, validated by professional judges, translated back into English, and then tested. Factor analysis yielded 7 factors: susceptibility, seriousness, barrier 1, barrier 2, confidence, benefits, and health motivation. Significant correlations were found between 2 barriers. Therefore, 2 barriers were considered one barrier subscale. All the items on each factor were from the same construct. Cronbach alpha coefficients ranged from .58 to .89, and test-retest reliability coefficients ranged from .89 to .99 for the subscales. Women who received low scores on barriers reported greater frequency of BSE practice. Likewise, women having high scores on confidence, benefits, health motivation, susceptibility, and seriousness reported a greater frequency of BSE in the last year. The frequency of BSE practice was higher in high school and university graduates, women with a family history of breast cancer, and women with breast cancer and BSE training. The Turkish version of Champion's Revised Health Belief Model Scale was found to be a valid and reliable tool for use with Turkish women. It could be used to evaluate health beliefs about breast cancer and BSE among Turkish women.     

Translation and validation of champion's health belief model scale with Korean women

The Champion's Health Belief Model Scale (CHBMS) is a reliable and valid instrument developed for American women to measure beliefs about breast cancer and breast self-examination. The purpose of this study is to translate the CHBMS into Korean and to validate the scale among Korean women. The CHBMS was translated using a back-translation technique. A convenience sample of 264 women was recruited from a continuing education center, a community health center, and a university in 3 South Korean cities. The participants were asked to complete the translated Korean version of the CHBMS questionnaire. The data obtained were analyzed using a principal component analysis with varimax rotation for construct validity. Loading criterion was set at.45. Cronbach's alpha was computed for the reliability of the scale. From the analysis, two items from the Benefits domain and four items from the Motivation domain were deleted from the original scale. Thus, the final Korean version of the CHBMS (CHBMS-K) consisted of 36 items that were clustered to 6 subscales: susceptibility (5 items), seriousness (7 items), benefits (4 items), barriers (6 items), confidence (11 items), and motivation (3 items). Cronbach's alpha reliability coefficients for the 6 subscales ranged from.92 to.72. The CHBMS-K was found to be reliable and valid in scale for use with Korean women. It can be used in planning and testing interventions to improve breast self-examination beliefs and practice.     

Validation evidence for Turkish adaptation of Champion's Health Belief Model Scales

Instruments using Health Belief Model constructs in breast cancer screening in previous studies were developed and tested by Champion for American women, and since then, these have been revised twice. Champion's Health Belief Model Scale (CHBMS) has been translated and tested in various studies in other countries and cultures. Also, the current study examined the validity and reliability of the Turkish adaptation of the CHBMS among Turkish women. The instrument was translated using a back-translation technique, which includes the use of a panel of experts and interpreters to translate the items from the source language to the target language and then back-translate them to the source language. The study was conducted in Ordu, a city in north Turkey. A total of 266 Turkish women aged 20 and older working as primary schoolteachers were included in the sample. Analyses included internal consistency, reliability, factor analysis, and known group techniques. After the analysis, 3 items from the Barriers domain, 1 from the Seriousness domain, and 2 from the Motivation domain were deleted from the original scale. So, the final Turkish version of the CHBMS (CHBMS-T) consisted of 36 items that were clustered into 6 subscales: susceptibility (3 items), seriousness (6 items), motivation (5 items), benefits of breast self-examination (BSE) (4 items), barriers to BSE (8 items), and confidence/self-efficacy of BSE (10 items). Internal consistency ranged from 0.69 to 0.83. Construct validity was supported by exploring the factor structure of the instrument using factor analysis and testing known-group techniques. Psychometric testing demonstrated satisfactory internal consistency and validity of the instrument for this group of women. It can be used in planning and testing interventions to improve BSE beliefs and practice.     

Health beliefs and self breast examination in black women

The relationship between health beliefs and practice of breast self examination (BSE) in a sample of 179 black women, 20 to 49 years of age, was investigated. Health beliefs were operationalized by employing Champion's revised Health Belief Model Scale (1993) to collect data. Data analyses included multiple regression analysis to examine BSE behavior in relation to selected demographic attributes and health beliefs. Results indicated that health beliefs were much stronger in determining BSE performance for a given individual than were demographic characteristics. The frequency of BSE was related to increased perceived seriousness of breast cancer, benefits of BSE, and health motivation. Frequency of BSE was inversely related to perceived barriers.     

Health beliefs, health locus of control, and women's mammography behavior

Research has shown that routine mammography screening can significantly reduce mortality from breast cancer. The use of mammography screening, however, remains well below national goals. In an effort to understand the factors that influence women's mammography behaviors, this study explored the relation between health beliefs, locus of control, and women's mammography practice. Survey instruments used were Champion's health belief scales and the Multidimensional Health Locus of Control (MHLC) scales. The study used a convenience sample of 25 African Americans and 72 white women ages 35 to 84. Findings showed that women who participated in mammography screening were significantly more likely to perceive greater benefits, greater health motivation, and fewer barriers to screening than those who did not participate. These same three variables were similarly associated with greater frequency of receiving mammograms. It also was found that perceived benefits and health motivation were significantly correlated with shorter duration of time since the last mammogram. No support was found for perceived susceptibility, perceived seriousness, and health locus of control as predictors of women's mammography behavior. Implications for nursing research in further examining the MHLC and the Health Belief Model construct of susceptibility as they relate to mammography behavior are identified. Practice implications for nurses are suggested.     

Factors related to practice of breast self-examination in rural women

The purpose of this study was to examine variables related to breast self-examination (BSE) in rural women. The sample of convenience consisted of 347 women who were members of selected county-extension homemaker clubs. Champion's Health Belief Model Scale was used to measure susceptibility, seriousness, benefits, barriers, health motivation, sociodemographics, and knowledge variables and frequency of BSE. Multiple regression analysis indicated that the Health Belief Model concepts accounted for 26% of the variance in BSE practice. Women who perceived more benefits of BSE in reducing the severity of breast cancer were more likely to report more frequent BSE. Women who perceived fewer barriers to performing BSE and those who scored high on health motivation were also more likely to report performing monthly BSE. Pearson product-moment correlation indicated a significant positive relationship between the variables of BSE knowledge and BSE practice (r = 0.1216; p = 0.023). The lambda statistics showed weak or no association between the demographic variables of age, race, marital status, religion, education, personal experience with breast disease, and friend's experience with breast disease and BSE practice. These findings suggest that perhaps educational programs emphasizing benefits of BSE may be implemented for women represented in this sample in an attempt to increase the number of women practicing BSE. Assessment of women's perceptions of potential barriers would allow nurses to plan appropriate strategies that could reduce the barriers. Finally, assessment of women's general health practices may identify women motivated toward good health. These women may be likely to complete monthly BSE if encouraged to do so.     

Instrument development for health belief model constructs

Research was conducted to develop valid and reliable scales to test the Health Belief Model (HBM). The dependent variable chosen for scale development was frequency of breast self-examination. Independent variables were constructs related to the HBM: susceptibility, seriousness, benefits, barriers, and health motivation. Analyses for construct validity and theory testing included factor analysis and multiple regression. Chronbach Alpha and Pearson r were used to compute reliabilities. Scales that were judged valid and reliable were susceptibility, seriousness, benefits, barriers, and health motivation.     

The effectiveness of a nurse-delivered breast health promotion program on breast cancer screening behaviours in non-adherent Turkish women: A randomized controlled trial

Background

Few studies have investigated breast health programs to promote rates of having a mammography, clinical breast examination and breast self-examination among non-adherent Turkish women.

Objectives

To determine the effectiveness of a breast health promotion program on mammography and clinical breast examination use, breast self-examination frequency and proficiency (breast self-examination skills and lump detection), breast health knowledge and health beliefs about breast cancer screening in a sample of Turkish women.

Design

Experimental (pretest-posttest control group).

Setting

A community-based setting in Istanbul, Turkey.

Participants

190 Non-adherent women (intervention group = 97, control group = 93) aged 41 and older, residing in Istanbul, Turkey.

Methods

The intervention group (n = 97) received a 120-min breast health promotion program based on health belief model including a breast health education, film, breast self-examination instruction, and a booklet, a calendar, a card designed specifically for the study. The control group (n = 93) received general information except breast health. Data were collected before the program, immediately after the program, and at 3- and 6-month post-program. The outcome measures are the mammography, clinical breast examination, and breast self-examination frequency, breast self-examination proficiency, breast health knowledge, and health beliefs (perceived susceptibility to breast cancer, benefits to mammography and breast self-examination, barriers of mammography and breast self-examination, confidence in performing breast self-examination).

Results

The breast health promotion program significantly increased breast self-examination frequency and proficiency and breast health knowledge. No significant differences existed in mammography and clinical breast examination rates between the two groups at 6 months. The program was effective in increasing perceived susceptibility to breast cancer, perceived benefits of mammography and breast self-examination, and confidence of breast self-examination. No significant difference was found between the two groups for perceived barriers to mammography.

Conclusions

The breast health promotion program was effective in increasing breast self-examination frequency and proficiency in a sample of Turkish women. In addition, it appears to be useful in raising the knowledge of breast health, enhancing confidence in performing breast self-examination, and increasing most health belief levels.     

Reliability and validity of the mammography screening beliefs questionnaire among Chinese American women

Cancer is the leading cause of death for Asian American women, and the breast is a primary site of cancer in Chinese women. Although a number of studies have used constructs from the Health Belief Model (HBM) to examine their relation to mammogram screening, the validity and reliability of the instruments on HBM constructs among Chinese women have not been consistently examined. The purpose of this study was to describe the psychometric properties of a culturally sensitive questionnaire for measuring Chinese women's beliefs (susceptibility, seriousness, benefits, and barriers) related to breast cancer and mammogram screening. The items developed for the questionnaire were drawn from a comprehensive literature review and focus groups. The instrument was translated using back translation technique and evaluated by a panel of professional experts and lay experts. A total of 220 Chinese American women ages 40 to 85 years residing in a suburban Midwestern community were included in the sample. Psychometric testing demonstrated satisfactory internal consistency and validity of the instrument for this group of women. The Cronbach alpha for the subscales ranged from.77 to.90. Construct validity was supported by exploring the factor structure of the instrument using confirmatory factor analysis and testing correlations with mammography compliance.