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

Approaches to improving symptom appraisal: a systematic literature review

OBJECTIVES

Poor symptom appraisal (detection, interpretation and response to symptoms) plays a major role in prolonged prediagnosis interval in various health conditions. Theories and models have been proposed to study the symptom appraisal process but how they could be employed to improve symptom appraisal remains unclear. We therefore aimed to review approaches to improving symptom appraisal in the literature and to develop a theoretical framework that could guide the development of approaches to improving symptom appraisal among individuals in the general population.

DESIGN

Systematic review.

DATA SOURCES

Medline, Web of Science, PsycINFO, Embase, CINAHL and Scopus were searched from inception to 30 March 2021.

ELIGIBILITY CRITERIA

We included original articles in English in which approaches to improve the detection, interpretation or response to symptoms for symptomatic individuals were described. We excluded articles in which approaches were developed to improve symptom appraisal among healthcare professionals.

DATA EXTRACTION AND SYNTHESIS

A predefined data extraction form was used to extract the development, characteristics and evaluation of approaches to improving symptom appraisal. This formed the basis for the narrative synthesis.

RESULTS

Of 19 046 publications identified from the literature search, 112 were selected for full-text review and 29 approaches comprising provision of knowledge of symptoms/signs and additional components (eg, symptom self-examination and comparison) for symptom appraisal were included in the synthesis. Less than half (41.4%) of these approaches were developed based on theories/models. Interestingly, despite the variety of theories/models adopted in developing these approaches, the components of these approaches were similar.

CONCLUSION

Symptom appraisal is an essential process in a patient's journey that can be targeted to facilitate early diagnosis but is largely unstudied. Building on the literature, we proposed a theoretical framework and approaches to improving symptom appraisal. This could facilitate early identification of a variety of health conditions in the general population.

TRIAL REGISTRATION NUMBER

CRD42021279500.

Variables Related to Breast Self-Examination: Model Generation

Using a prospective design, variables from several relevant social psychological theories that would predict breast self-examination were identified. The participants included a probability sample of 362 women who were 35 or older. Instruments were tested for validity and reliability. Data were collected from each participant twice, 1 year apart, using an in-person interview for Time 1 and a telephone interview for Time 2. Results of standardized path coefficients (beta) indicated that breast self-examination (BSE) at Time 2 was directly related to BSE at Time 1 (.76). Indirect paths for susceptibility (.40), health motivation (.46), and barriers (- .54) were identified. All paths mentioned were significant ( p ≤ .01). Findings have implications for interventions to increase BSE in women 35 and older.

Reliability and Validity of A Breast Self-Examination Proficiency Rating Instrument

A college laboratory was used as the setting to test the reliability and validity of a newly designed Breast Self-Examination Proficiency Rating Instrument (BSEPRI). The instrument was tested on two groups of nursing students, one instructed prior to testing and one not. BSE proficiency was scored individually for each subject as she demonstrated the procedure on a breast simulation model. Independent sample t tests were used to compare the groups. Mean scores of the instructed group were significantly higher than mean scores of the uninstructed group on the total test and on subscales of palpation and inspection. Criterion-referenced concurrent validity was assessed by correlating palpation scores with lump detection in a silicone model. Interrater reliability using percentage agreement between raters was high on 19 out of 23 criteria. Kuder-Richardson internal reliability coefficients ranged from .67 to .74.

An outline of the need for psychology knowledge in health professionals: implications for community development and breast cancer prevention

Knowledge of health and community psychology in health professionals influences psychosocial and community determinants of health and promoting participation in disease prevention at the community level. This paper appraises the potential of knowledge on psychology in health care professionals and its contribution to community empowerment through individual behavior change and health practice. The authors proposed a schematic model for the use of psychological knowledge in health professionals to promote participation in health interventions/disease prevention programs in developing countries. By implication, the paper provides a vision on policies towards supporting breast cancer secondary prevention efforts for community health development in Asian countries.

Predictors of mammography screening among Iranian women attending outpatient clinics in Tehran, Iran

Mammography utilization is low in Iran compared with other countries. Here a cross-sectional survey design was used to investigate psycho-social and individual factors associated with mammography among 400 women asymptomatic of breast cancer. The study was carried out at the four outpatient clinics of Tehran during the period from July through October, 2009. We found that mammography screening was related to higher self-efficacy and women's occupation. Future tailored interventions on potential psycho-social determinants and specific demographic factors are critical in increasing mammography screening rates among Iranian women.

Effectiveness of peer education for breast cancer screening and health beliefs in eastern Turkey

BACKGROUND

The primary site of cancer in Turkish women is breast cancer. The incidence of breast cancer is increasing in Turkey.

OBJECTIVE

The aim of the research was to educate women 40 years and older to increase their awareness on early detection and diagnosis, to facilitate the use of the early diagnosis methods, to improve the women's beliefs in relation breast cancer, and to increase the use of Cancer Early Diagnosis and Screening Centers available in the city.

METHODS

The target population of the research was 5000 women. Forty selected women were educated as peer educators. Twenty-five of them were selected as principal peer educator. Each peer educator was expected to educate 200 women. Peer trainers educated their peer and also arranged for the mammography appointment of the women who decided to have theirs taken. Data were obtained before and after the training by Champion's Health Belief Model Scale, questionnaire forms, and Cancer Early Diagnosis and Screening Centers data for mammography practice.

RESULTS

Breast cancer was detected in 8 women. Statistical analyses showed positive changes in women's health beliefs and breast self-examination knowledge. There were 20.4% of women (n = 1040) who did get mammograms, and 8% (n = 8) of women were found to have cancer in all of those screened.

CONCLUSION

Peer education was found to be effective for increasing the knowledge, beliefs, and practice of women related to breast cancer.

IMPLICATIONS FOR PRACTICE

Peers can reinforce learning through ongoing contact. Peer education can be used to improve early diagnosis of breast cancer and breast cancer awareness in asymptomatic women.

Mexican American women in a rural area and barriers to their ability to enact protective behaviors against breast cancer

Mexican American women in rural areas have less chance of surviving breast cancer than women in other ethnic populations (Boughton, 2000; Herman, 1996). This research sought to determine why such women do or do not enact behaviors to help them protect themselves from breast cancer. The extended parallel process model (Witte, 1994) provided a guiding theoretical basis for understanding perceptions, and 48 women, in discussion groups and surveys, were asked about self-exams, physician exams, and mammograms. Findings demonstrated that the women had high perceived self-efficacy and susceptibility regarding breast cancer but did not perceive it as severe (i.e., that it could cause death). These perceptions were positively and negatively related to behaviors that protect against breast cancer. Also, several barriers, such as lack of transportation, lack of access to health care, and lack of knowledge regarding breast self-exams, were found.

Understanding lesbians' healthcare behaviour: the case of breast self-examination

Lesbians' risk of breast cancer is a much-debated issue in health research because lesbians are believed to be at higher risk of the disease than are heterosexual women. This belief is based upon particular risk factors for breast cancer, which are said to be more prevalent in lesbians; and upon differences in preventive health behaviours: in particular, lesbians are said to be less likely to practise breast self-examination (BSE). This paper presents data collected as part of the UK Lesbians and Healthcare Survey (n = 1066) focusing on lesbians who report never practising BSE (n = 218, 20%) and the explanations they offer for their healthcare behaviours. It identifies six types of explanation for not practising BSE: (i) "I don't know what I'm looking for"; (ii) "I've never got into the habit"; (iii) "I'm frightened in case I find something"; (iv) "I don't think I'm at much risk"; (v) "I'm uncomfortable with my body"; and (vi) "My partner does it for me". These findings are important for increasing understanding of lesbians' healthcare behaviour and for developing health promotion materials relevant to their needs.

The effect of an educational intervention on promoting breast self-examination in older African American and Caucasian women

PURPOSE/OBJECTIVES

To test the efficacy of innovative, age- and race-sensitive, self-monitored, video breast health kits in increasing knowledge about breast cancer risk and screening and breast self-examination (BSE) proficiency.

DESIGN

Quasi-experimental pretest and post-test design.

SETTING

Dual-site study in community-based settings in the Northeast and Southeast United States.

SAMPLE

328 women (206 in the intervention group, 122 in the control group) aged 60 or older; predominantly African American (77%); mean education of 10.8 years; annual income below $10,000 (50%).

METHODS

Individual pretest and post-test interviews conducted by nurses at two-week intervals assessed knowledge about breast cancer risk and screening and BSE proficiency as demonstrated on vested breast models. Intervention subjects used video breast health kits in ethnic editions designed for the study. Control subjects received educational pamphlets.

MAIN RESEARCH VARIABLES

Dependent variables were knowledge about breast health and BSE proficiency measured by demonstration of inspection and palpation skills and detection of lumps in a simulation model.

FINDINGS

Three multiple analyses of covariance revealed statistically significant differences in outcome variables between the intervention and control groups.

CONCLUSIONS

The intervention was effective in increasing knowledge about breast cancer risk and screening and BSE proficiency in this sample of older women.

IMPLICATIONS FOR NURSING

These and other educational interventions designed specifically for age and race sensitivity may enhance cancer screening with vulnerable populations. Future studies with more diverse multicultural groups are needed to improve understanding of how to best influence breast health behaviors of older women.

Factors affecting women to practise breast self-examination

The aim of the study was to identify factors of decisive importance for women's motivation to perform breast self-examination (BSE), which could form the basis of an intervention programme. Interviews were conducted in 1994 with 48 women focusing on four different areas: 1) why the women examined did not examine their breasts, 2) the influence of their upbringing, 3) information or education previously received about the method of examination, and 4) other types of self-care. The findings were summarized under the following categories: feelings, experiences, and lifestyle. Anxiety/fear of discovering a lump and faith/trust in one's own ability to perform the examination were dominating factors influencing the practice or non-practice of BSE. However, there was a general need for knowledge, theoretical as well as practical, among the women studied. They also needed help to identify a strategy to enable them to remember to perform the examination. In order to make BSE a habit, education about BSE ought to be provided to girls at school. The important role of nurses in teaching women to examine their breasts themselves and in reminding them to perform the examination was emphasized.

Coping style, health beliefs, and breast self-examination

The purpose of this study was to determine the role of coping style in women's practice of breast self-examination (BSE). The framework was adapted from the Cognitive Transactional Model of Stress and Coping and the Health Belief Model. The convenience sample consisted of 269 women recruited from an employee list of a medical center and a membership list of a professional nurses' group. Survey booklets were distributed via interdepartmental or U.S. mail and contained measures of trait anxiety and defensiveness and questions related to health beliefs, BSE practice, and demographics. The sample was categorized by coping style (i.e., repressive, true high anxious, defensive high anxious, or true low anxious), and data were analyzed via MANOVAs, ANOVAs, and hierarchical regression. Results indicated that coping style predicted BSE practice (i.e., proficiency, frequency) and health beliefs of barriers, confidence, seriousness, and susceptibility. The findings provide nurses with information for developing interventions to foster BSE.

Social support and breast self-examination

Declining practice of breast self-examination (BSE) among women over the age of 55 years dramatically decreases the probability of early detection of breast cancer. About two-thirds of women who die of breast cancer are over the age of 55 years. Social support has been found to be associated with health behaviors. Although a woman's health may benefit from supportive relationships, the effect of diminished social networks on practices of BSE among older women has not been examined. Thus, the purpose of this study was to determine the relationship between social support and the frequency and accuracy of BSE practice. The sample consisted of 22 women, 55 years of age and older, who were having routine examinations at a small Midwestern gynecologic clinic. Social support was assessed by the Norbeck Social Support Questionnaire, and two tools assessed the accuracy and frequency of BSE. Social support was found to be significantly related to the frequency of BSE (r = 0.45, p < 0.05), but not to the accuracy of BSE (r = 0.28). The results also indicated that these women had lower social support scores compared with younger women. Planners of nursing intervention for BSE should consider health care providers as important resources in social support networks for the reinforcement of frequency and accuracy of BSE for older women.

Breast self-examination proficiency in older women: measuring the efficacy of video self-instruction kits

Older women represent the highest risk group for breast cancer but do not use screening at recommended frequencies. Age-sensitive screening programs addressing the developmental issues, unique value systems, and problems of access for all older women are critically needed. Television is an ideal medium for reaching isolated older women with health information and educational programs. This research explored the efficacy of using video self-instruction kits to increase breast self-examination (BSE) proficiency and knowledge about breast cancer among a sample of 62 women > 60 years of age. Participants were given breast health kits containing an instructional video, printed educational materials, a miniature lump model, and BSE skill checks. Before using the kits and 30 days later they were tested on measures of BSE proficiency and knowledge about breast cancer. Results indicate that the self-instruction programs had significant and positive impacts on the two BSE proficiency measures: skill demonstrations (t = 7.32, p < 0.0001) and lump detection using a simulation model (t = 4.23, p < 0.0001). Knowledge about breast cancer scores also improved from pretest to posttest. Implications for cancer nurses and direct outcomes from the research including newly designed instructional media materials are discussed.

Factors influencing registered nurses teaching breast self-examination to female clients

A university hospital-based study was conducted to explore factors that influence nurses teaching breast self-examination (BSE) to female clients, using the PRECEDE (Predisposing, Reinforcing, and Enabling factors in Educational Diagnosis and Evaluation) model as an organizing framework. Female registered nurses (N = 140) from adult inpatient and outpatient units completed a questionnaire that included items about frequency of BSE, knowledge of breast cancer screening and BSE technique, health motivation, confidence and competence in performing BSE, and teaching BSE. Data analysis compared the characteristics of nurses who reported teaching BSE with nurses who did not teach. Nurses in the teaching group had more work experience in nursing and were more likely to have a friend with breast cancer than were those in the nonteaching group. The teaching group had more knowledge about breast cancer screening and BSE technique and reported more confidence and competence in performing BSE.

An educational intervention to increase use of the Glasgow Coma Scale by emergency department personnel

Data from a large series of acutely injured patients revealed the Glasgow Coma Score was acquired in less than one half of those for whom it should have been documented. To improve these statistics, a five-part educational intervention based on an application of the PRECEDE-PROCEED model was developed. The study populations consisted of hospital-based nurse-managers and their emergency department nursing staff. Evaluation of the educational intervention's effectiveness suggested (1) simply conveying benefits of a particular patient care practice is insufficient to bring about immediate and permanent changes and (2) the most significant changes occurred in settings in which a formal policy and formal data collection procedures were established to accompany and reinforce the educational intervention. On-site advocacy and physician support are essential if changes in nursing practice are to occur in hospital emergency departments.

Breast self-examination beliefs: a descriptive study

Breast cancer is a major cause of morbidity and mortality among American women. Evidence indicates that regular breast self-examination (BSE) may reduce breast cancer mortality by 18%, yet the majority of women do not practice it. This study used a decision model to examine the BSE-related characteristics, beliefs, and behaviors of 52 working women age 21 to 65 years (mean 44.05 yrs). Nearly 29% of the sample performed BSE. They were more likely than nonperformers to be white, to have a close relative who had breast cancer, and to believe that breast problems could be detected through BSE. Fears, particularly fear of cancer, were more likely to affect performers' than nonperformers' BSE decision. Nonperformers were more likely to think that the first symptom of breast cancer would be a sensation of some type, and that a healthy lifestyle protected them from the disease. They also were more likely to think reminders would encourage them to perform BSE. The most often reported sources of information about BSE were health care providers and friends or relatives.

The role of breast self-examination in breast cancer screening

The efficacy of breast self-examination (BSE) behavior cannot be adequately evaluated until BSE proficiency is considered. Previous research supports the role of attitudinal and teaching interventions in increasing skills and frequency for BSE behavior, but more research using age-appropriate women and adequate outcome measures is needed. A preliminary analysis of data from 301 randomly selected women who were followed for 1 year after an initial teaching and/or attitudinal intervention is reported. Significant differences were obtained for attitudes toward breast cancer screening between scores before and after intervention using paired t test. Significant changes in proficiency and frequency also occurred after intervention, as well as percentage increases in nine individual BSE steps. Return demonstration scores and nodule detection are reported. Perceived barriers and confidence were significantly related to both frequency and proficiency 1 year postintervention using regression analysis. Knowledge was related to proficiency measures. Preliminary data suggest that BSE practice can be significantly improved through individually tailored attitudinal and teaching interventions.

Development and evaluation of the Osteoporosis Health Belief Scale

The Osteoporosis Health Belief Scale was developed to measure health beliefs related to osteoporosis. It is a 35-item self-report questionnaire based on the Health Belief Model which is specifically designed to assess beliefs related to exercise behaviors and calcium intake of elderly subjects. The instrument consists of seven subscales: Seriousness, Susceptibility, Health Motivation, Calcium Benefits, Calcium Barriers, Exercise Benefits, and Exercise Barriers. The instrument was tested on a sample of 150 elderly individuals. The psychometric properties of the scales are discussed along with recommendations for its use in research and practice.

The theory of reasoned action in prediction of breast self-examination: a comparison of two studies

The purpose of this article is to report the application of the theory of reasoned action (TRA) to predict breast self-examination (BSE) intention and frequency in two studies with middle-aged and older women. The sample in Study 1 consisted of 93 volunteers from church groups; the second sample consisted of 175 randomly selected subscribers to a large health maintenance organization. Questionnaires to measure attitudinal and subjective normative influences relevant to BSE were developed using guidelines specified by Ajzen and Fishbein (1980). The attitudinal components predicted BSE intention in both studies and BSE frequency in Study 1. In contrast, the subjective norm contributed significantly only to the prediction of frequency in Study 1. Findings demonstrate varying degrees of success for the TRA in predicting BSE intention and behavior. Explanations for the inconsistency in the predictive ability of the TRA can be related to differences between the two studies regarding sample and design characteristics.

Identifying women's descriptions of breast tissue for the promotion of breast self-examination

The purpose of this study was to identify women's descriptions of their breast tissue. Concrete objective descriptions of the breast, in women's own words, are important to formulate an intervention, based on a self-regulation framework, designed to promote breast self-examination. Descriptions were initially generated from open-ended interviews with 27 women scheduled for mammography. The initial descriptions were validated by an additional 25 women scheduled for mammography. The descriptions of the breast that are relevant to women are presented, conclusions for a subsequent intervention study drawn, and implications for practice addressed.

Breast self-examination in women 35 and older: a prospective study

A correlational study was conducted to identify attitudinal variables specified by the Health Belief Model that were related to frequency and total performance (frequency and proficiency) of breast self-examination (BSE). The probability sample consisted of 362 women, ages 35 and over, who were initially contacted via random digit dialing. Data were collected during in-home interviews by trained graduate assistants and by telephone interview 1 year later. Results supported the ability of past performance, perceived barriers, and knowledge to predict current total performance (combined frequency and proficiency). In addition, frequency for breast self-examination was predicted by past frequency, barriers, health motivation, control, being taught by a doctor, confidence, having BSE procedure checked, benefits, and susceptibility. Results lend support to use of attitudinal and experimental variables in predicting women's actual behaviors in relation to breast self-examination.

Overadherence with breast self-examination recommendations

Overadherence with breast self-examination (BSE) was studied to seek explanations for this phenomenon and to suggest individualized interventions for the performance of BSE. In a descriptive study, women attending BSE instruction (N = 264) were interviewed regarding their beliefs as well as peer and professional interactions about breast self-examination. Of these women, 29 (11%) were overadherent; they had the highest rates of breast disease and the least professional instruction and encouragement for BSE. Ironically, some women perform BSE repeatedly because they lack sufficient knowledge and confidence. Clinicians should assess women's knowledge of BSE as well as their skill to provide individualized clarification.

Self-confidence as a critical factor in breast self-examination

This study was conducted to determine predictors of breast self-examination (BSE) frequency. One hundred ninety-one women completed questionnaires about their personal experiences with BSE, their risk factors, and their perceived risks of breast cancer. Satisfaction with BSE ability and explanation of BSE technique significantly predicted frequency of BSE. Perceived risk, history of breast cancer, BSE demonstration, and a BSE handout did not affect BSE frequency. Of the five BSE teaching variables, only explanation of technique significantly predicted BSE satisfaction. Clinicians can promote BSE frequency by helping women feel confident about their abilities to perform BSE.

Early detection of breast cancer

Timely, comprehensive screening for breast cancer is a major, though often overlooked, component of primary health care for women. This article reviews the scientific rationale for screening and outlines the current recommendations of the American Cancer Society and the U.S. Preventive Services Task Force regarding the use of mammography, clinical breast examination (CBE), and breast self-examination (BSE). Nursing interventions to decrease barriers to effective screening are discussed, and an expanded role of nurses in breast cancer screening is proposed.

Effect of knowledge, teaching method, confidence and social influence on breast self-examination behavior

A descriptive study was conducted to identify the relationship of knowledge, teaching methods, confidence and social influence to intent, frequency and proficiency of breast self-examination. A probability sample of 380 women aged 35 years and over served as subjects for in-home interviews conducted by trained graduate assistants. Knowledge correlated significantly with intent and proficiency of breast self-examination but not with frequency. Confidence correlated significantly with all three dependent variables, while social influence correlated only with intent. Being taught individually with a return demonstration increased proficiency and frequency. Implications for clinical application and future research are suggested.

Instructional information and breast self-examination practice

The effects of four interventions on frequency and thoroughness of breast self-examination (BSE) were compared. The interventions provided different types of information, as derived from a self-regulation framework, to promote BSE practice. Women seeking BSE instruction (N = 204) were randomly assigned to interventions. No intervention effects on frequency were observed. However, exam frequency increased from pre- to postintervention and remained constant over 3 and 6 months follow-up. Interaction effects observed on thoroughness suggested that a positive effect of sensory information about the breast was conditional upon having had prior experience with BSE. Implications for research, theory, and practice are drawn.

Health beliefs, health locus of control, and the frequency of practice of breast self-examination in women

The relationship of health beliefs, health locus of control, and the frequency of practice of breast self-examination in women was explored through use of a survey. Health beliefs alone and health beliefs combined with internal health locus of control were found to predict the frequency of practice of breast self-examination in a sample of 48 women. The combined variables of health beliefs, internal health locus of control, religion, and occupation explained 80% of the variance in nonpractice and 73.3% of the variance for high practice. Moderate frequency practice was not a significant predictor of breast self-examination. Discriminant function analysis, canonical correlation, and analysis of variance were used in the data analysis.

Nursing's role in cancer prevention and detection. Vital contributions to attainment of the Year 2000 Goal

Currently there are 1.5 million practicing registered nurses in the US who could be utilized to assist in meeting the Year 2000 Goal to reduce cancer mortality by 50%. As the largest health professional group in this country, nurses are in more community settings and work with more people than any other health professional. In the last 10 years, nurses have shifted their orientation from tertiary prevention in the acute care setting and have increasingly become involved in primary and secondary prevention in both the hospital and the community. The nursing literature clearly reflects this new emphasis on incorporation of primary and secondary prevention concepts into nursing education and clinical practice. This article will focus on the traditional and nontraditional cancer prevention/early detection activities nurses have instituted in a multitude of settings (occupational, acute care, educational, and community) as well as pointing out the research that documents the effectiveness of these activities.

A conceptual framework to study the use of nursing care plans

Value-expectancy theory proposed by Lewin states that motivation for behaviour is based on the probability that a given action or behaviour will achieve a valued or desired outcome. Becker and Maiman elaborated on this theory and developed a model to study compliance by considering the influence of sociobehavioural determinants in the inter-relationship of motivating and modifying factors which dictate human behaviour. The Becker-Maiman framework was used to determine factors which influence the use of the nursing care plan by staff nurses. From interviews with staff nurses, surveys of nurses attending workshops on NCPs and review of literature a model was developed for use in examining the nursing care planning behaviour of nurses.