An application of an extended health belief model to the prediction of breast self-examination among women with a family history of breast cancer

Breast cancer knowledge and early detection among Hispanic women with a family history of breast cancer along the U.S.-Mexico border

BACKGROUND

Breast cancer is the leading cause of cancer-related death among U.S. Hispanic women. Hispanics are less likely than non-Hispanic White women to be diagnosed at an early stage and survive breast cancer.

METHODS

For this cross-sectional study, we assessed differences in breast cancer knowledge, attitudes, and screening practices between Hispanic women with (FH+) and without (FH-) a family history of breast cancer in three U.S.-Mexico border counties.

RESULTS

Among 137 Hispanic women age 40 and older, FH+ women had levels of knowledge and attitudes about breast cancer similar to those of FH- women. FH+ participants were more likely to have ever performed breast self-examinations, although levels of compliance with screening guidelines did not significantly differ between FH+ and FH- groups.

CONCLUSION

U.S. Hispanic women with a family history of breast cancer constitute an at-risk group for which adhering to preventive screening guidelines could substantially reduce breast cancer mortality.

Motivations and reasons for women attending a breast self-examination training program: A qualitative study

Background

Breast cancer is a major threat to Taiwanese women's health. Despite the controversy surrounding the effectiveness of breast self-examination (BSE) in reducing mortality, BSE is still advocated by some health departments. The aim of the study is to provide information about how women decide to practice BSE and their experiences through the training process. Sixty-six women aged 27-50 were recruited.

Methods

A descriptive study was conducted using small group and individual in-depth interviews to collect data, and using thematic analysis and constant comparison techniques for data analysis.

Results

It was found that a sense of self-security became an important motivator for entering BSE training. The satisfaction in obtaining a sense of self-security emerged as the central theme. Furthermore, a ladder motivation model was developed to explain the participants' motivations for entering BSE training. The patterns of motivation include opportunity taking, clarifying confusion, maintaining health, and illness monitoring, which were connected with the risk perception for breast cancer.

Conclusions

We recognize that the way women decide to attend BSE training is influenced by personal and social factors. Understanding the different risk assessments women rely on in making their health decisions is essential. This study will assist researchers and health professionals to gain a better understanding of alternative ways to deal with breast health, and not to be limited by the recommendations of the health authorities.

The role of self-efficacy in dental patients' brushing and flossing: testing an extended Health Belief Model

OBJECTIVE

In an effort to examine the decreasing oral health trend of Australian dental patients, the Health Belief Model (HBM) was utilised to understand the beliefs underlying brushing and flossing self-care. The HBM states that perception of severity and susceptibility to inaction and an estimate of the barriers and benefits of behavioural performance influence people's health behaviours. Self-efficacy, confidence in one's ability to perform oral self-care, was also examined.

METHODS

In dental waiting rooms, a community sample (N=92) of dental patients completed a questionnaire assessing HBM variables and self-efficacy, as well as their performance of the oral hygiene behaviours of brushing and flossing.

RESULTS

Partial support only was found for the HBM with barriers emerging as the sole HBM factor influencing brushing and flossing behaviours. Self-efficacy significantly predicted both oral hygiene behaviours also.

CONCLUSION

Support was found for the control factors, specifically a consideration of barriers and self-efficacy, in the context of understanding dental patients' oral hygiene decisions.

PRACTICE IMPLICATIONS

Dental professionals should encourage patients' self-confidence to brush and floss at recommended levels and discuss strategies that combat barriers to performance, rather than emphasising the risks of inaction or the benefits of oral self-care.

Mutually dependent health beliefs associated with breast self-examination in British female university students

OBJECTIVE

Whereas research suggests young women's beliefs about breast cancer (susceptibility/severity) and its early detection (barriers/benefits) reliably distinguish breast self-examiners from nonexaminers, this study assessed whether these impressions are interreliant, especially in the context of familial risk.

PARTICIPANTS

The sample comprised over 200 female undergraduates from a university in England, United Kingdom.

METHODS

Participants completed a self-administered survey on their attitudes concerning breast cancer and early detection. Data were analyzed using logistic regression analysis.

RESULTS

Nonexaminers were distinguished by a combination of greater perceived hindrances to self-examinations and stronger appraisals of breast cancer severity, and also by a permutation of fewer perceived benefits in self-examinations and lower perceived susceptibility to breast cancer. The latter interaction persisted after accounting for family history.

CONCLUSIONS

Interwoven attitudes may depict sophisticated efforts on the part of nonexaminers to justify inaction. Clinical implications for college health providers are considered.

Stroke education: promising effects on the health beliefs of those at risk

BACKGROUND

The effect of patient education on reducing stroke has had mixed effects, raising questions about how to achieve optimal benefit. Because past evaluations have typically lacked an appropriate theoretical base, the design of past research may have missed important effects.

METHOD

This study used a social cognitive framework to identify variables that might change in response to education. A mixed design was used to evaluate two approaches to an intervention, both of which included education. Fifty seniors completed a measure of stroke knowledge and beliefs twice: before and after an intervention that was either standard (educational brochure plus activities that were not about stroke) or enhanced (educational brochure plus activities designed to enhance beliefs about stroke). Outcome measures were health beliefs, intention to exercise to reduce stroke, and stroke knowledge.

RESULTS

Selected beliefs changed significantly over time but not differentially across conditions. Beliefs that changed were (a) perceived susceptibility to stroke and (b) perceived benefit of exercise to reduce risk. Benefit beliefs, in particular, were strongly and positively associated with intention to exercise.

CONCLUSION

Findings suggest that basic approaches to patient education may influence health beliefs. More effective stroke prevention programs may result from continued consideration of the role of health beliefs in such programs.

A different approach to breast self-examination education: daughters educating mothers creates positive results in Turkey

Breast cancer is a common cancer among women, and early detection is important for breast cancer mortality and morbidity. The aim of this study was to determine the effects of daughters teaching their mothers about breast self-examination (BSE) and its health beliefs. In the study's first stage, 168 university students were trained by the School of Health students about BSE through group training methods. Then, these trained university students were asked to train their mothers about BSE. Data were collected before the training and then again after the training (1 month later). The study instruments included questionnaire forms and the Champion Health Belief Model Scale. The results were analyzed using paired- and unpaired-sample t test, analysis of variance, bivariate correlation analysis, and stepwise multiple regression analysis. The results show that women's knowledge level increased 2-fold after training, and the knowledge level difference between pretraining and post-training was significant (P = .000). The mothers' background information (hear-read) and BSE practice (P = .006 and .006, respectively) before the training process were found to be significant predictors of sociodemographic and other variables influencing the mothers' knowledge levels. The training increased the perceived benefit (P = .032) and confidence (P = .000) significantly. It was found that there was a negative but significant correlation between perceived barriers and BSE knowledge after the education (P = .019). It was found that mothers' knowledge level about BSE was higher after the education. Furthermore, perceived barriers decreased while other subscales increased. Education from daughter to mother can be used as a BSE training approach to increase women's knowledge about BSE.

Breast cancer in Iran: need for greater women awareness of warning signs and effective screening methods

BACKGROUND

Breast cancer remains an important public health problem. This study aimed to investigate about female knowledge of breast cancer and self-reported practice of breast self-examination in Iran.

METHODS

This was a population-based survey carried out in Tehran, Iran. Data were collected via a structured questionnaire containing 15 questions on demographic status, history of personal and family breast problems, subjective knowledge about breast cancer covering its symptoms, the screening methods and practice of breast self-examination (BSE). A trained female nurse interviewed each respondent. Analysis included descriptive statistics and the Chi-squared test where necessary.

RESULTS

A total of 1402 women were interviewed. The mean age of respondents was 43.4 (SD = 14.4) years; most were married (85%), and without any personal (94%) and family history (90%) of breast problems. It was found that 64% of the respondents were familiar with breast cancer and 61% (n = 851) believed that 'the disease is relatively common among women in Iran'. Most women (44%) perceived a painless mass as a breast cancer symptom. Overall, 61% of the respondents stated that they knew about breast cancer screening programs and most indicated that electronic media (television 34% and radio 14%) were their source of information. Only 17% of women said that 'they were conducting regular breast self-examination'. The main reason for women not doing breast self-examination was due to the fact that they did not know how to do it (64%). The findings indicated that performing breast self-examination is significantly related to: age, marital status, education, knowledge of breast cancer and knowledge about breast cancer screening programs (p < 0.05), but not to personal (P = 0.2) and family (P = 0.7) history of breast problems.

CONCLUSION

This descriptive study provides useful information that could be utilized by both researchers and those involved in public health programmes. The findings indicated that the women awareness of breast cancer warning signs (painless lump, retraction of nipple, and bloody discharge) and effective screening methods i.e. clinical examination, and mammography were very inadequate. Thus, health education programmes to rectify the lack of women awareness is urgently needed. Indeed the focus of primary health care providers should be to raise awareness about breast care among women and to encourage them to report any unusual changes in their breasts to their family or care physicians.

Dynamics of health behavior regarding hospital waste management in Dhaka, Bangladesh: a dysfunctional health belief model

This article examined the usefulness of the Health Belief Model (HBM) and other confounding factors in determining health behavior of individuals involved in hospital waste management and tested four components of HBM in relation to demographic variables, knowledge, and occupational practices of the respondents. The study revealed that the waste pickers had a lower level of knowledge, attitude, and safe practices than nurses and sweepers. Perceived Susceptibility and Perceived Severity were moderately associated with safe occupational practices among the respondents (p < 0.05). In addition, respondents with higher levels of education and income were more likely to have higher levels of Perceived Susceptibility, Severity, and Benefits. The study findings indicate that individuals with greater economic vulnerability might be at greater risk for not using proper protective measures in handling or picking hospital wastes in Bangladesh.

Health beliefs related to breast self-examination in a sample of Turkish women

PURPOSE/OBJECTIVES

To examine health beliefs and sociodemographic and breast cancer-related variables influencing breast self-examination (BSE) practice.

DESIGN

Descriptive, cross-sectional.

SETTING

Two vocational training centers in Istanbul, Turkey.

SAMPLE

438 women were selected using a convenience sampling method. Participants had not had breast cancer and were not currently pregnant or breast-feeding. The mean age of participants was 33.51 years (range = 18-67).

METHODS

Willing participants were asked to complete a self-administered questionnaire and the Turkish version of Champion's Health Belief Model Scale. The sample was categorized into two groups: performers (i.e., women who performed BSE at least occasionally) and non-performers (i.e., women who had never performed BSE).

MAIN RESEARCH VARIABLES

Perceived susceptibility to and seriousness of breast cancer, perceived benefits of and barriers to BSE, confidence in the ability to perform BSE, health motivation, and frequency of BSE practice.

FINDINGS

Significant differences between performers and non-performers correlated to age, marital status, health insurance, regular gynecologic visits, and education about breast cancer and BSE. The mean scores of perceived benefits and confidence were noticeably higher in performers. Stepwise logistic regression analysis yielded three significant predictor variables.

CONCLUSIONS

Women who had more confidence in their ability to perform BSE, had health insurance, and were informed about breast cancer were more likely to practice BSE.

IMPLICATIONS FOR NURSING

Women in Turkey are at great risk for advanced breast cancer and metastatic spread because of their lack of knowledge. Nurses must provide information on breast cancer etiology, risks, prevention, and detection. To promote BSE practice among Turkish women, tailored health education and health promotion programs should be developed based on a specific understanding of women's health beliefs.

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.

Reassurance following breast screening recall for female survivors of Hodgkin's lymphoma

Female survivors of Hodgkin's lymphoma (HL) treated with mantle radiotherapy experience increased breast cancer risk related to radiation dose and age at diagnosis. In 2003, the Department of Health (DoH) in the UK recalled patients to explain this risk and offer screening. The aims of this paper are to describe women's emotional responses and knowledge of their personal risk following the recall. Women were interviewed before risk counselling and breast screening (Time 1, n=56) and again following screening and results (Time 2, n=50). Questionnaire measures of quality of life, anxiety, depression and cancer worries were completed at Time 2. No cases of breast cancer were identified. After the recall, 64% had learned more about late effects and 76% were reassured about their health. All but one woman intended to attend future screening. Women are keen to take advantage of screening and experience relatively little distress.

Health beliefs among African American women regarding genetic testing and counseling for sickle cell disease

PURPOSE

The Health Belief Model can help in understanding low acceptance of disease prevention and screening. We studied health beliefs of African American women to determine causes of low acceptance of genetic testing and counseling despite high prevalence of sickle cell disease and heterozygotes in this population.

METHODS

An anonymous questionnaire using a 12-question measure with a 5-point Likert scale response was administered to 101 African American women attending an obstetrics and gynecology clinic to determine knowledge of sickle cell disease, perception of risk, severity, likelihood of benefit and barriers to counseling.

RESULTS

The cumulative mean perceived scores on the 5-point Likert scale were 4.22 +/- 0.88 for severity of sickle cell disease, 4.10 +/- 1.03 for benefit of genetic testing, 2.28 +/- 1.00 for barriers to testing, and 2.62 +/- 1.06 for risk of having a child with sickle cell disease. High average level knowledge was associated with high perception of severity and benefit to screening (P < 0.05).

CONCLUSION

African American women have a relatively high belief of the severity of sickle cell disease and benefits of genetic counseling but frequently do not appear to believe that they are at risk of having a child with the disease. This should be taken into account in the design of educational and counseling strategies.

Breast cancer early detection, health beliefs, and cancer worries in randomly selected women with and without a family history of breast cancer

BACKGROUND

Early detection practices (EDP) consist of clinical breast examination (CBE) and mammography. Breast self-examination (BSE) is no longer generally recommended, but many women still perform it.

AIMS

To compare EDP, health beliefs, and cancer worries in women with and without a family history of breast cancer in a population-based sample.

METHODS

489 women aged 21-60 were randomly sampled from the entire Jewish female population of Israel; 61 (12.5%) had a family history of breast cancer. Participants answered questionnaires by phone, including demographic details, EDP performance, health beliefs, and cancer worries.

RESULTS

Rates of CBE were similar in women with and without a family history (p>0.05). For women over 40, rates of undergoing mammography screening were similar (p>0.05), but regular attendance was reported more by women with a family history (p<0.05). More women under 40 with a family history of breast cancer attended mammography (p<0.05), but only about 14% had ever undertaken mammography screening and 27% had ever undertaken CBE. More than 50% of the women had performed BSE, while significantly more women with a family history reported its over-performance (p<0.01). Women with a family history reported higher perceived susceptibility (p<0.01), higher cancer worries (p<0.05), and fewer barriers to mammography (p<0.05). According to logistic regression analysis, higher odds of EDP were significantly related to perceiving fewer barriers and having higher cancer worries. A positive family history was related to higher odds of women undergoing mammography. Perceived susceptibility was significantly related to higher odds of BSE only. Over-performance of BSE was significantly related to having a positive family history, higher susceptibility, and higher cancer worries.

CONCLUSIONS

(1) A high rate of women did not undergo CBE or mammography screening. Women under 40 with a family history of breast cancer who have never undergone CBE or mammography merit special attention. (2) The change in guidelines on BSE necessitates further study of its over-performance in relation to cancer worries. (3) Interventions are needed to promote attendance for CBE and mammography in younger women with a positive family history.

A prática do auto-exame das mamas em mulheres de uma comunidade universitária

Dados estatísticos atuais apontam para elevados índices de prevalência e mortalidade em mulheres acometidas pelo câncer de mama (INCA, 2004), o que poderia ser minimizado pela prática do auto-exame, visto que esta se caracteriza como elemento facilitador de diagnóstico precoce. Esta pesquisa teve como objetivo conhecer a prática do auto-exame das mamas em mulheres representantes da população da PUCRS. Para tanto foi utilizada uma abordagem mista (qualitativa e quantitativa), aplicando-se como instrumento um questionário semi-estruturado, em uma amostra de 215 mulheres. Os resultados mostraram que apenas 25% das mulheres pesquisadas referem adotar a prática do auto-exame das mamas periodicamente como cuidado preventivo. O estudo também evidenciou que todas essas mulheres reconhecem a importância desta prática, porém, muitas vezes não sabem ou não lembram de realizá-la, e outras vezes a praticam de maneira inadequada (com relação à freqüência).