A study of breast self examination beliefs: implications for worksite education programs.

1. There is convincing evidence that the mortality rate for breast cancer could be decreased if women would perform breast self examination (BSE) regularly. 2. The effectiveness of BSE educational programs depends on an accurate understanding of beliefs and attitudes that affect a woman's decision to perform or not perform regular BSE. 3. Using a decision model called the Multiattribute Utility Model as a guiding framework, four variables were identified as having significant influence on a group of working women's BSE decision: daily activities as another means of knowing, health consequences, likelihood of disease, and too much time to do. 4. Incorporating the knowledge gained from this study into the BSE educational programs at worksites will maximize the likelihood that program participants will increase their participation in BSE as an early detection technique.     

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.     

Breast screening education at Australian and Thai worksites: a comparison of program effectiveness

To determine whether a nurse-led breast screening educational program in the workplace improved the breast screening practices and attitudes of women. Worksites are potentially cost-effective and convenient for breast cancer screening education due to their ability to educate several women at one time. This was a collaborative study between industry, university and health services in Australia and Thailand. This was a pre post test group comparative design. Three worksites in Australia and three in Thailand were assigned to one of three groups: treatment (group education), pamphlet only, or control. All groups were assessed pre-education and again 3 months post-education on breast screening attitudes and practices using a mail-out self-report questionnaire. Women were significantly more likely to practice breast self-examination (BSE) following group education, and were more confident in their ability to detect a breast lump. There was a significant increase in breast screening discussion on the workplace for the Thai group following the group education program. An increase of 25% more women saw having a mammography as a priority. The Thai women had less access to free mammographic screening. They also had more negative attitudes and poorer knowledge regarding BSE and physical breast examination (PBE) than the Australian group, with the education program having a more positive impact on them than the Australian group. Relative breast screening attitudes and practices for the treatment, pamphlet and control groups are also presented. This study provides educators and health promotion professionals with further information on the beliefs and practices of women working in both Australian and Thai industries about breast screening. Education programs such as this one can have a positive impact on attitudes and practices including increased likelihood and confidence in practising BSE, promoting women to have a PBE, and promoting discussion of breast screening at the workplace. The findings suggest that Australian women have greater opportunities to ensure their breast health than Thai women, and that there may be a greater need for programs such as this in countries such as Thailand.     

Factors involved in nurses' teaching breast self-examination

It has been demonstrated that breast self-examination (BSE) is a reliable method for early detection of breast abnormalities when practiced regularly and correctly. In addition, it has been found that a woman is likely to be more proficient if she has been taught BSE by a physician or nurse. In a hospital-based study, nurses were surveyed regarding both their personal practice and their teaching of BSE to patients. Although the nurses revealed themselves to be highly compliant in terms of performing the procedure themselves, only 40% included BSE in their patient teaching. The nurses' teaching of BSE was found to be unrelated to their age, BSE practice, or personal risk for breast cancer. Nurses agreed that BSE was a valuable tool in the prevention of deaths from breast cancer. They also believed themselves to be susceptible to breast cancer despite good health and low-to-medium risk sources. We suggest that nurses' ambivalent attitudes towards breast cancer and BSE may influence their teaching behavior.     

Using a community-based outreach program to improve breast health awareness among women in Hong Kong

OBJECTIVE: To evaluate the effectiveness of a community-based health education program via a mobile van to promote the awareness of breast cancer and breast self-examination (BSE) practice among women in Hong Kong. DESIGN: One group pretest/posttest design. SAMPLE AND MEASUREMENTS: Seven hundred and seventy-seven women in Hong Kong completed a self-administered questionnaire before and after a breast health education program from May 2002 to March 2003. RESULTS: About half were aware of breast health and breast diseases (53.7%) and breast screening methods (48.6%) before the intervention. It was found that women who had received instruction on BSE practice, and those who were aware of breast screening methods, breast health, and breast diseases were more likely to have had prior BSE practice. Most indicated their willingness to practice BSE regularly (93.3%) and to pass on the BSE knowledge to their relatives and friends (92%) in the posttest. CONCLUSIONS: The outreach health education program has successfully reached women living in the 18 districts in Hong Kong. It appears to be useful in raising the awareness of breast health and BSE practice among the women, but longer term follow-up is required to ascertain its sustainability.     

Relationship of self-concept, health locus of control, and perceived cancer treatment options to the practice of breast self-examination

Breast cancer remains one of the most prevalent forms of cancer for women in the United States. Recognition of the fact that no more than 40% of women practice breast self-exam (BSE) is of major concern in that BSE has been identified as one method of early detection. The factors that encourage or discourage women to perform BSE need to be identified. The current study investigated the relationships between women's practice of BSE, self-concept, locus of control, and knowledge of treatment options for breast cancer. One mammogram screening center provided the 235 subjects who completed the questionnaires. Subjects who practiced BSE more frequently had a slightly higher self-concept score and were more aware of breast cancer treatment options (r = 0.16, p less than 0.05). Weak correlations were found between chance locus of control and BSE frequency of practice (r = 0.22, p less than 0.05). The majority of subjects reported irregular BSE practice, both as to whether they practiced BSE on a monthly basis and as to the time of the month for BSE.     

Registered nurses' knowledge and practices of teaching and performing breast exams among elderly women.

This study was designed to identify registered nurses' knowledge and beliefs regarding breast cancer in elderly women, and to identify the practices of registered nurses in performing breast exams and teaching breast self-examination (BSE) to this client group. Correlational analysis using Pearson moment correlation showed a weak inverse relationship between nurses' attitudes toward the elderly and performing and teaching breast exams. As the nurse's negativism about aging increased, the incidence of teaching and performing exams decreased. A strong relationship was found between thorough and regular examination of the nurse's own breasts and performance of the exam on elderly women. As predicted, nurses were more likely to perform than teach exams. Using logistic regression, it was found that nurses who were employed full-time, married nurses, nurses who reported encouragement for themselves to do the exam, and nurses who were confident in examining themselves were more likely to examine the breasts of the elderly women. Nurses were more likely to teach BSE when they had a family history of breast cancer, spent greater than 50% of their time on direct care, reported belonging to a nursing association, were confident in detecting a lump in their own self-exams, and had a baccalaureate degree or higher.     

Acculturation and breast self-examination among immigrant Latina women in the USA

This article is an extension of previous work, which identified acculturation as an important variable in predicting breast self-examination (BSE) in this sample of women. Here, acculturation is further examined as an intervening factor in predicting BSE. This paper presents the association between level of acculturation to mainstream culture in the USA and the practice of BSE among a population of low-income immigrant Mexican and Puerto Rican women (n = 111) in an urban area of the Midwest in the USA. The majority of women (84.7%) scored a low level of acculturation and 85% did not practice correct BSE. The crude odds ratio indicated that Latina women having a high level of acculturation (15.3%) were twice as likely to practice correct BSE than women with low acculturation. We would suggest that a clearer understanding of the variables that define the performance of BSE will assist in enabling nurses globally to incorporate assessments in their practice that will lead to more successful interventions.     

Health beliefs,perceived self-efficacy,and breast self-examination among Thai migrants in Brisbane

BACKGROUND: Women in Thailand have a relatively low risk of developing breast cancer; however, death rates from breast cancer are increasing. Rates in many migrant groups are also known to be on the increase. Little is known about breast cancer screening, particularly breast self-examination (BSE), among Thai migrant women in other countries. In Australia, non-English-speaking-background migrants are known to be low users of preventive health services. AIMS: To investigate, using the health belief model (HBM) and self-efficacy as a theoretical framework, the use of BSE in a recent migrant group, Thai women in Australia, and to identify sociodemographic variables that influence the women's regular use of BSE. METHODS: In 1998, a cross-sectional study was conducted among 145 Thai women in Brisbane recruited through a snowball-sampling method, which used personal contacts and key persons within the Thai community. The study was approved by the University Human Ethics Review Committee. Data were collected through designed closed-ended questions. RESULTS: Only 25% of the women performed BSE regularly. HBM indices were strongly associated with BSE. Beliefs in high personal susceptibility to breast cancer strongly increased the likelihood of BSE. After adjusting for potential confounding factors, cues or triggers to undertake BSE and self-efficacy, or the ability to do BSE were found to be important determinants of regular BSE. Study limitations, including data collection methods, are discussed. CONCLUSION: A low percentage of women practised BSE regularly. The HBM is a useful framework for identifying factors influencing the use of BSE. Strategies that increase the confidence of women to undertake preventive health behaviour or increase self-efficacy are likely to increase their regular screening for breast cancer.     

Screening for breast cancer in England: past and future

The NHS Breast Screening Programme (NHSBSP) began in 1988. It aims to invite all women aged 50-70 years for mammographic screening once every three years. The programme now screens 1.3 million women each year, about 75% of those invited, and diagnoses about 10,000 breast cancers annually. Although some have questioned the value of screening for breast cancer, the scientific evidence demonstrates clearly that regular mammographic screening between the ages of 50 and 70 years reduces mortality from the malignancy. Screened women are slightly more likely than unscreened women to be diagnosed with breast cancer. The cancers in screened women are smaller and are less likely to be treated with mastectomy than they would have been if diagnosed without screening. For every 400 women screened regularly by the NHSBSP over a 10-year period, one woman fewer will die from breast cancer than would have died without screening. The current NHSBSP saves an estimated 1400 lives each year in England. The screening programme spends about pound sterling 3000 for every year of life saved.     

Evaluation of a breast examination facilitation device

Breast self-examination (BSE) is recommended in order to help women detect possible breast cancer early in its development Correct BSE performance has been shown tobe positively associated with breast lump detection ability Few women, however, report practising BSE, citing reasons such as dislike of touching one's own breasts, fear of finding a lump, lack of confidence in their-ability to perform BSE The purpose of this study was to test a breast examination facilitation device (BEFD) for women, which would provide a teaching/screening tool, as well as a shield between breast and fingers for women who are reluctant to touch their breasts A sample of 36 registered nurses in the United States was asked to perform BSE on three separate occasions using a BEFD made of latex, paper or cloth on which a wedge pattern for BSE had beenimprinted Subjects found the BEFD to be a useful tool for teaching/learning BSE, and expressed a clear preference for the latex material One size of BEFD is not adequate for all women A smaller size for women who wear A and B cup-size bras, and a larger size for women who wear C cup size and above, would be more acceptable     

Breast self examination: use of a visual reminder to increase practice.

1. Breast cancer, the most common type of cancer affecting women and the second leading cause of cancer death in women, will affect more than 10% of the female population of this country. 2. Breast self examination (BSE), known to be an effective component of a three part breast health program which includes physical examination and mammography, is not practiced consistently by American women. 3. A convenient memory aid serving as a visual stimulus, combined with appropriate educational materials, is effective in increasing both the knowledge of breast health and the frequency of BSE practice.     

Effectiveness of breast self-examination nursing interventions for Taiwanese community target groups

BACKGROUND: Because of the increasing morbidity and mortality from breast cancer, the Health Department in Taiwan in 1992 has identified early detection of breast cancer as one of the national health objectives. The effectiveness of Breast Self-Examination (BSE) in detecting breast cancer depends not only on frequency, but also on accuracy. This study explored the effects of nursing intervention on the BSE intention, BSE frequency and BSE accuracy among beauticians as community target groups. DESIGN: This study was comprised of two stages. In the first stage, 198 beauticians in Taipei County were surveyed. Those women with perceived barrier scores > or =15 points in the first stage were selected for the second stage with the quasi-experimental design. The experimental group was provided with BSE instruction for the enhancement of BSE competence, personalized strategies to reduce barriers to BSE and monthly telephone reminders after BSE instruction class for 3 months. The study instruments were Champion's BSE questionnaire, Lashley's 15 BSE steps and BSE items of social norm referenced Lierman et al. RESULTS: The mean age of the 198 beauticians was 28 (+/-8.6), the mean year of education was 10 (+/-2.4) and 60% of participants were married. The results of the study indicate that the program significantly increased BSE frequency, BSE accuracy, perceived benefit of BSE, perceived competence in BSE and decreased perceived susceptibility to breast cancer and perceived barriers to practice BSE. Multiple regression analysis indicated that the perceived competency, susceptibility and social normative influence accounted for 25% of the variance in BSE intention. Perceived competency and social normative influence accounted for 15% of the variance in BSE frequency, while intention, social normative influence and perceived competency accounted for 21% of the variance in BSE accuracy.     

Evaluation of a Danish teaching program in breast self-examination

This study investigated the effect of a BSE training program on women's knowledge, attitudes, and behavior regarding BSE. Postal questionnaires were sent to 629 women who had participated in 1998-2000 in the BSE training program run by Ribe County, Denmark, and to a local matched control group of the same size selected through personal registration numbers. Response rates were 77% and 56%, respectively. A significantly greater number of women who had attended BSE training reported that they knew how and when to do BSE, and what they should do if they discovered breast changes (97% compared to 66% in control group). Similar proportions in each group felt confident of finding any breast changes (57%) and believed that routine BSE can influence the chances of recovery from breast cancer (90%). There were also no significant differences between the intervention and control groups in the reporting of anxiety as a result of performing BSE (24% and 17%, respectively). The intervention group was significantly more likely to perform BSE regularly (66% compared to 52% in control group) and to use a more correct technique (44% compared to 20% in control group). It was concluded that a formal training program increases the likelihood of regular BSE performance with a correct technique.     

Knowledge, barriers, and facilitators of Korean women and their spouses in the contemplation stage of breast self-examination

The aim of this study was to identify the knowledge, barriers, and facilitators of breast self-examination (BSE) in Korean couples in the contemplation stage. The study design was based on assumptions from the Health Belief Model and Transtheoretical Model that contemplators perceiving benefits as greater than barriers are likely to move to the next stage. Participant couples, with wives having never practiced BSE but with an intention to do so, were drawn from churches. Qualitative research was conducted with focus group methodology including both husbands and wives in the groups. Data transcribed from audiotapes were analyzed to identify common themes. Knowledge of breast cancer and BSE included "perceiving risks of getting breast cancer," "behaviors used to stay healthy and detect breast cancer," and "skills in BSE"; barriers to BSE included "lack of sensitivity to breast cancer," "fear of getting bad news," "lack of information," and "shortage of time"; and facilitators of BSE included "making BSE a monthly routine," "continuous systematic interaction from healthcare professionals reaching out to the community," and "encouragement and help from husbands." To improve compliance with BSE, women in the contemplation stage need specific and correct knowledge delivered by diverse materials, reminders, and the inclusion of husbands as facilitators.     

Effectiveness of teaching breast self examination during office visits

In a randomized clinical trial a comparison was made of two BSE teaching interventions delivered by primary providers during office visits in a group nursing faculty practice. Patients who reported no regular BSE (n = 121) received either individualized teaching focused on reducing perceived barriers and reinforcing benefits of BSE, or routine teaching limited to usual instruction in BSE technique. Patients reporting frequent/monthly BSE during the past year were comparison subjects (n = 81). Self-reported data on BSE behavior were obtained in questionnaires administered before the interventions and via telephone interviews three months after the visit. Analysis using chi square showed that, contrary to expectation, individualized and routine teaching were equally effective: 61.4% of the individually taught and 63.5% of the routinely taught reported frequent or monthly practice at followup. Both groups were significantly more confident in technique and ability to detect change in the breast. The previously non-practicing women remained significantly less likely than comparison subjects to be performing BSE monthly at followup. The perceived benefit of BSE giving peace of mind predicted non-practicers most likely to change.