Use of the health belief model in determining frequency of breast self-examination

The purpose of this research was to identify the relationships of attitudes about breast self-examination and breast cancer to the frequency of breast self-examination. The health belief model was used as a theoretical base. Likert scales were developed for the independent variables of susceptibility, seriousness, benefit, barriers, and health motivation; the dependent variable was frequency of breast self-examination. A convenience sample of 301 women was drawn from a large metropolitan city. Self-administered questionnaires contained the developed scales, a measure of frequency of breast self-examination, and demographic variables. Results supported the health belief model's prediction of frequency of breast self-examination (R = .51; p less than or equal to .01). In addition, the variables of seriousness, benefits, barriers, and health motivation discriminated groupings according to frequency of breast self-examination. Results support the relationship of the health belief model variable to the behavior of breast self-examination Nursing implications are discussed.     

Attitudinal variables related to intention, frequency and proficiency of breast self-examination in women 35 and over

A correlational study was conducted to identify attitudinal variables specified by the Health Belief Model that were related to intent, frequency, and proficiency of breast self-examination. The probability sample consisted of 380 women age 35 and over who were contacted via random digit dialing. Data were collected during in-home interviews. Results supported the combined ability of susceptibility, seriousness, barriers, health motivation, and control to predict intent to practice breast self-examination (R = .61, p. less than or equal to .001). In addition, frequency and total proficiency for breast self-examination were predicted by health motivations, susceptibility, and barriers using discriminant analysis. Results lend support to use of the Health Belief Model variables in predicting women's intention and actual behavior of breast self-examination.     

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.     

Breast self-examination and the health belief model: variations on a theme

Variables derived from the Health Belief Model (HBM) were studied in relation to breast self-examination (BSE) performance, which was measured in terms of both frequency and thoroughness. Data were collected from 202 adult women via self-administered questionnaires. Susceptibility and Seriousness were combined to form a "threat of breast cancer" variable, and two approaches were used to compute "net perceived efficacy of BSE." However, barriers and susceptibility in their original form explained more variance in BSE practice than did the combined variables. The negative relationship found between perceived barriers and BSE performance (r = -.44) is consistent with previous findings. Implications for research and practice are presented.     

Effects of health teaching in the workplace on women's knowledge, beliefs, and practices regarding breast self-examination

This study had two primary purposes: to examine the effects of group and individual teaching by nurses in the workplace on 140 female office employees' health knowledge, beliefs, and practices regarding breast self-examination and to identify factors associated with frequency of practice. Skill in technique, confidence in the skill, and frequency of breast self-examination increased significantly with both teaching formats, but there were areas of technique that needed further improvement. Perceived susceptibility to breast cancer and perceived benefits of breast self-examination increased significantly only with individual teaching; knowledge was not increased with either teaching format.     

乳腺增生症病人乳腺健康知识调查分析

目的 了解女性乳腺增生症病人乳腺健康知识及乳房自我检查的实施情况。方法 采用自行设计的问卷对850例女性乳腺增生症病人进行乳腺健康知识的调查及乳房自我检查实施情况的调查。结果 31．1％的乳腺增生症病人了解常见的乳腺疾病知识，58．5％的病人了解乳房自我检查知识，15．7％的病人掌握乳房自我检查的方法；不同职业、文化程度的乳腺增生症病人的乳房自我检查情况存在统计学差异（P〈0．01）。结论 加强妇女乳腺健康知识宣传，传授乳房自我检查的正确方法，有利于达到乳腺疾病早发现、早诊断、早治疗的目的。     

Ethnic differences in breast self-examination practice and health beliefs

Thirty-two African American nurses (AAN) and 78 Caucasian nurses (CN) were compared on breast self-examination (BSE) practice and health beliefs. Relationships between these variables were also examined. The Health Belief Model provided the framework for the study. The sample is a subset of 269 women from a larger study. AANs were recruited from a professional nurses' group. CNs were recruited from a list of female employees of a university medical centre. The results of t -tests revealed no significant group differences on BSE frequency ( P =0·06) or BSE proficiency ( P =0·10). Noted was that 42% of AANs compared to 20% of CNs examined their breasts 12 or more times during the year. AANs were more likely to consider BSE beneficial ( P =0·002) and to feel confident ( P =0·006) about doing BSE; CNs perceived more barriers ( P =0·001) to BSE. For AANs, BSE frequency and proficiency were positively related to confidence and inversely related to barriers; BSE frequency was also related to health motivation. For CNs, BSE frequency and proficiency were inversely related to seriousness. Implications include additional research to validate findings and to increase the knowledge base of all nurses regarding BSE.     

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.     

Factors related to women's practice of breast self-examination

Factors related to women's practice of breast self-examination (BSE) were studied in a sample of upper-middle-class women attending meetings of voluntary women's groups. Factors found to relate directly to frequency of BSE practice were high perceived benefits of BSE, low perceived barriers to BSE, and high self-concept. Correlations with perceived susceptibility/seriousness of breast cancer, age, perceived level of social support, and social network properties were not significant. A multiple regression analysis was done with BSE frequency as criterion variable: perceived threat (susceptibility/seriousness) and perceived benefits minus perceived barriers were entered hierarchically; age, self-concept, and total social support were entered as a group. Perceived benefits minus barriers was the only significant predictor variable, R2 = .27. These findings underline the importance of assessing detective behaviors such as BSE as potentially different from preventive behaviors.     

Comparison of two breast self-examination palpation techniques.

In this randomized clinical trial, we compared the vertical strip (VS) and the concentric circle (CC) patterns of breast palpation in order to determine which pattern provided the most thorough self-examination and the best lump detection in breast models. The sample consisted of 34 adult women from a Veterans Outpatient Clinic in the Northwest who were assigned according to breast size (large or small) to one of two groups. Subjects were pretested and randomly taught one method of palpation. Proficiency in the palpation technique, area covered, and number of lumps detected were evaluated. Interrater reliability for proficiency evaluation was 86%. During breast self-examination, the VS group covered significantly more area than the CC group (t = 2.72, p = 0.01). Breast size did not affect breast area covered. Lump detection using breast models did not differ between the two groups. Though this study did not support the conclusion that increased thoroughness leads to increased lump detection, there is support in the literature. Lack of difference in lump detection in this study may have been due to the constraints of the breast models used. However, further research is needed.     

Predictors of breast self-examination practice among elderly women

The purpose of the study presented in this article was to examine predictors of breast self-examination (BSE) practice among elderly female subjects in selected senior citizen centers. The health belief model served as the theoretical framework for the research study. Both the frequency of BSE performance and the technique subjects used to examine their breasts were measured by a questionnaire. Subjects who perceived few barriers to BSE had higher BSE technique scores. The findings also indicated that receiving instruction through a class on BSE was related to improved BSE technique. Perceived susceptibility to breast cancer and perceived benefits of BSE were not found to be significantly predictive of BSE practice.     

Jordanian nurses' knowledge and practice of breast self-examination

Title.  Jordanian nurses' knowledge and practice of breast self-examination.
Aim.  This paper is a report of a study to evaluate the knowledge and practice of Jordanian nurses in relation to breast self-examination.
Background.  Studies have shown that women who have learned about breast self-examination have positive attitudes toward breast cancer and practise breast self-examination more frequently, and that nurses who teach their clients about methods of early detection and breast self-examination are more knowledgeable about breast cancer screening and breast self-examination techniques than those who do not. Therefore, it is important to understand nurses' knowledge about breast cancer and its early detection.
Methods.  A cross-sectional design was used, with a convenience sample of 347 Registered Nurses at three large cities in Jordan (response rate 95%). Data collection took place in 2005 using a self-administrated questionnaire with three parts and based on the American Cancer Society's guidelines: demographics, knowledge, and practice of breast self-examination.
Results.  Nurses reported high levels of knowledge of breast self-examination (M = 7·6, sd . 2·7). A high proportion of nurses reported doing breast self-examination in the past 12 months (85%), but only 17·7% reported doing so on a monthly basis. None of the demographic characteristics was found to be associated with the practice of breast self-examination.
Conclusion.  More health education about monthly breast self-examination and prevention strategies is needed for nurses and their women patients, especially for Arabic women.     

城乡妇女乳腺癌早期检测知识的调查研究

[目的]了解乳腺癌病人疾病发现方式及乳房自查知识掌握情况,为护理人员提供正确的健康教育方式。[方法]分别对60例农村和城市乳腺癌病人进行问卷调查。[结果]农村妇女乳腺癌发现途径侧重于自我无意发现肿块占83.33%,10.00%是由于有自觉症状、疼痛、乳头溢液等,肿瘤多为Ⅱa期、Ⅱb期、缺乏掌握乳腺自我检查的知识。城市妇女自我无意发现肿块途径占56.67%,体检和自查发现肿块各占20.00%。肿瘤多为Ⅰ期、Ⅱa期。不能完全掌握乳腺自我检查的知识和技巧。[结论]医护人员应根据不同人群提供乳腺癌早期检测的知识和技能,建立符合我国国情的乳腺癌的早期检测方案。     

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.     

Testicular self-examination: teaching, learning and practice by nurses

Testicular cancer is increasing in incidence, is now the commonest solid tumour in men aged 20-34 years and has a better prognosis when detected and treated early. Testicular self-examination is an effective self-screening procedure that is easily taught, learnt and practised. The aim of this study was to discover the extent of the teaching, learning and practice of this procedure by nurses. The data were collected by means of a questionnaire which was sent out to 60 nurses of various grades in one Sussex hospital. Nurses' knowledge of testicular self-examination was found to be better amongst men than women, although over a half of female nurses did know of it. Their knowledge of groups at high risk of testicular cancer was incomplete. Whilst two-thirds of nurses saw the teaching of testicular self-examination as part of their role as health educators, very few had in fact taught it. It appeared that most male nurses do self-examine on a regular basis. The results indicate that nurses need to accept their responsibilities as health educators. Testicular self-examination should become an integral part of nurse training. Facilities and materials should be made available to assist nurses in disseminating such information.     

Is the hospital setting the place for teaching breast self-examination?

The purpose of this study was to investigate the effects of an instructional program for nurses educating them to teach breast self-examination (BSE) to hospitalized patients. Nurses' knowledge, attitudes, self-practice, and practice of teaching breast self-examination to patients were measured in a group who attended such a program and compared with those of a control group who did not attend. The researchers found that the instructional program increased nurses' teaching of BSE to their patients, but did not affect their own self-practice. Nurses' attitudes to teaching BSE were less favorable than for self-practice. Issues related to environments for teaching BSE are discussed.     

Factors affecting the nurse as a teacher and practicer of breast self-examination

The purpose of this study was to compare the knowledge, attitudes, confidence and practice of breast self-examination of a group of hospital-employed nurses and non-nurses, in an attempt to understand the factors which influence why nurses do not teach or practice breast self-examination more significantly. A 41-item questionnaire administered to 380 female hospital employees compared data on demographics, risk factors, practice, knowledge, perceived susceptibility and reasons for and against practice.

The findings show significant differences in knowledge levels and confidence between the nurse and non-nurse group. The differences between the two groups in frequency of practice, however, are extremely small.

The significance of these findings to nursing education is discussed.