Breast Cancer Screening Paved with Good Intentions: Application of the Information–Motivation–Behavioral Skills Model to Racial/Ethnic Minority Women

Factors influencing breast cancer screening practices among women worldwide: a systematic review of observational and qualitative studies

BACKGROUND

The variation in breast cancer incidence rates across different regions may reflect disparities in breast cancer screening (BCS) practices. Understanding the factors associated with these screening behaviors is crucial for identifying modifiable elements amenable to intervention. This systematic review aims to identify common factors influencing BCS behaviors among women globally.

METHODS

Relevant papers were sourced from PubMed, Scopus, Embase, and Google Scholar. The included studies were published in English in peer-reviewed journals from January 2000 to March 2023 and investigated factors associated with BCS behaviors.

RESULTS

From an initial pool of 625 articles, 34 studies (comprising 29 observational and 5 qualitative studies) with 36,043 participants were included. Factors influencing BCS behaviors were categorized into nine groups: socio-demographic factors, health status history, knowledge, perceptions, cultural factors, cues to action, motivation, self-efficacy, and social support. The quality appraisal scores of the studies ranged from average to high.

CONCLUSIONS

This systematic review highlights factors pivotal for policy-making at various levels of breast cancer prevention and assists health promotion professionals in designing more effective interventions to enhance BCS practices among women.

Prediction of cervical cancer screening: application of the information-motivation-behavioral skills model

INTRODUCTION

Screening is an effective method for preventing cervical cancer. The present study aimed to determine the predictability of cervical cancer screening using the information-motivation-behavioral skills (IMB) model, as this model can help understand the factors that influence health-related behaviors.

METHOD

The present cross-sectional study examined 310 women aged 20 to 60 in Isfahan, Iran, between 2020 and 2021. To this end, comprehensive health centers and gynecology clinics of hospitals were randomly selected by lot. Women who met the study's inclusion criteria were selected via convenience sampling. An IMB skills questionnaire developed by researchers comprised the data collection tool. The data were analyzed using SPSS 22 software, descriptive and regression tests, and AMOS 24.0 software.

FINDINGS

Approximately 18.1% of the participants had never undergone routine cervical cancer screening. The regression model results indicated that the model components accurately predicted regular cervical cancer screening (P < 0.00). Path analysis revealed that information (β = 0.05, P = 0.002), motivation (β = 0.187, P = 0.026), and behavioral skills (β = 0.95, P < 0.001) were directly associated with regular cervical cancer screening. Furthermore, behavioral skills had the greatest direct effect on regular cervical cancer screening.

DISCUSSION AND CONCLUSION

The results demonstrated that the IMB model accurately predicted cervical cancer screening. Therefore, it is possible to improve cervical cancer screening in women by designing and implementing interventions based on this model's components, particularly those that improve behavioral skills.

The effectiveness of educational intervention based on the Health Action Model (HAM) in improving breast cancer screening behaviors

INTRODUCTION

Breast cancer disease is known as the most common cancer among women. Lack of knowledge and awareness is a leading cause of breast cancer, and since nearly all women are increasingly susceptible to this disease, training screening behaviors for early detection is proven essential in order to reduce breast cancer mortality. Therefore, the present study was designed to determine the effect of educational intervention based on the Health Action Model in improving breast cancer screening behaviors in women aged 30 to 69 in Kashan, Iran.

METHODS

This quasi-experimental study was conducted on 162 women aged 30-69 years old among the clients of Comprehensive health service centers in Kashan, Iran and they were assigned to intervention and control groups. The research instrument included a questionnaire assessed within three phases: baseline, 3-months, and 6-months, containing Health Action Model (HAM) structures and also three screening behaviors. The intervention consisted of a model-based education package and was carried out over 2 months. To evaluate the effect of the intervention, the mean of model structures and proportion screening behaviors in the third and sixth months were compared with the baseline phase. All analyses were carried out using SPSS, version 22.

RESULTS

The intervention and control groups were homogeneous regarding the structures of the HAM and the proportion of screening behaviors in the baseline phase (p > 0.05). In the 3-month (p < 0.05) and 6-month (p < 0.05) phases, the mean scores of the HAM constructs in the intervention group were found higher compared with the control group. Moreover, the proportion of clinical breast examinations in the intervention group was statistically higher than in the control group in the 3-month (p < 0.001) and 6-month (p < 0.001) phases. In addition, the proportion of mammography performed in the 3-month (p = 0.002) and 6-month (p < 0.001) phases were reported to be higher in the intervention group compared with the control group.

CONCLUSION

Overall, these results provide important insight into the effectiveness of the interventions based on the Health Action Model in promoting breast cancer screening behaviors and the determinants of such behaviors.

Effect of neighborhood and individual-level socioeconomic factors on breast cancer screening adherence in a multi-ethnic study

BACKGROUND

Although mammography can significantly reduce breast cancer mortality, many women do not receive their annual breast cancer screening. Differences in screening adherence exist by race/ethnicity, socioeconomic status (SES), and insurance status. However, more detailed investigations into the impact of neighborhood disadvantage and access to resources on screening adherence are lacking.

METHODS

We comprehensively examined the effect of individual social, economic, and demographic factors (n = 34 variables), as well as neighborhood level SES (nSES) indicators (n = 10 variables) on breast cancer screening adherence across a multi-ethnic population (n = 472). In this cross-sectional study, participants were surveyed from 2017 to 2018. The data was analyzed using univariate regression and LASSO for variable reduction. Significant predictors were carried forward into final multivariable mixed-effect logistic regression models where odds ratios (OR), 95% confidence intervals and p-values were reported.

RESULTS

Nineteen percent of participants were non-adherent to breast screening guidelines. Race/ethnicity was not associated with adherence; however, increasing age (OR = 0.97, 95%CI = 0.95-0.99, p = 0.01), renting a home (OR = 0.53, 95%CI = 0.30-0.94, p = 0.04), food insecurity (OR 0.46, 95%CI = 0.22-0.94, p = 0.01), and overcrowding (OR = 0.58, 95% CI = 0.32-0.94, p = 0.01) were significantly associated with lower breast cancer screening adherence.

CONCLUSION

Socioeconomic indicators at the individual and neighborhood levels impact low breast cancer screening adherence and may help to inform future screening interventions.

Deep learning performance for detection and classification of microcalcifications on mammography

BACKGROUND

Breast cancer screening through mammography is crucial for early detection, yet the demand for mammography services surpasses the capacity of radiologists. Artificial intelligence (AI) can assist in evaluating microcalcifications on mammography. We developed and tested an AI model for localizing and characterizing microcalcifications.

METHODS

Three expert radiologists annotated a dataset of mammograms using histology-based ground truth. The dataset was partitioned for training, validation, and testing. Three neural networks (AlexNet, ResNet18, and ResNet34) were trained and evaluated using specific metrics including receiver operating characteristics area under the curve (AUC), sensitivity, and specificity. The reported metrics were computed on the test set (10% of the whole dataset).

RESULTS

The dataset included 1,000 patients aged 21-73 years and 1,986 mammograms (180 density A, 220 density B, 380 density C, and 220 density D), with 389 malignant and 611 benign groups of microcalcifications. AlexNet achieved the best performance with 0.98 sensitivity, 0.89 specificity of, and 0.98 AUC for microcalcifications detection and 0.85 sensitivity, 0.89 specificity, and 0.94 AUC of for microcalcifications classification. For microcalcifications detection, ResNet18 and ResNet34 achieved 0.96 and 0.97 sensitivity, 0.91 and 0.90 specificity and 0.98 and 0.98 AUC, retrospectively. For microcalcifications classification, ResNet18 and ResNet34 exhibited 0.75 and 0.84 sensitivity, 0.85 and 0.84 specificity, and 0.88 and 0.92 AUC, respectively.

CONCLUSIONS

The developed AI models accurately detect and characterize microcalcifications on mammography.

RELEVANCE STATEMENT

AI-based systems have the potential to assist radiologists in interpreting microcalcifications on mammograms. The study highlights the importance of developing reliable deep learning models possibly applied to breast cancer screening.

KEY POINTS

• A novel AI tool was developed and tested to aid radiologists in the interpretation of mammography by accurately detecting and characterizing microcalcifications. • Three neural networks (AlexNet, ResNet18, and ResNet34) were trained, validated, and tested using an annotated dataset of 1,000 patients and 1,986 mammograms. • The AI tool demonstrated high accuracy in detecting/localizing and characterizing microcalcifications on mammography, highlighting the potential of AI-based systems to assist radiologists in the interpretation of mammograms.

Use a web-app to improve breast cancer risk factors and symptoms knowledge and adherence to healthy diet and physical activity in women without breast cancer diagnosis (Precam project)

PURPOSE

This study aimed to evaluate the preliminary effectiveness of an educational intervention using a web-app to improve knowledge of breast cancer risk factors and symptoms and adherence to healthy eating and physical activity among women without breast cancer diagnosis in Asturias (Spain).

METHODS

A pragmatic randomized pilot trial was conducted to evaluate the impact of a web-app-based intervention for women without breast cancer diagnosis. Women in the intervention group participated in a 6-month intervention web-app based on the Behaviour Change Wheel Model. The web-app includes information about breast cancer risk factors, early detection, physical activity and diet.

RESULTS

Two hundred and eighty-fifth women aged 25-50 were invited to join the study. Two hundred and twenty-four were randomly assigned to either the intervention group (IG = 134) or control group (CG = 90) according to their place of residence. Adherence among women in the IG increased significantly from pre- to post-intervention for eight of the 12 healthy behaviors and for the identification of six risk factors and six symptoms compared to women in the CG and, among whom adherence only increased for two behaviors, the identification of one risk factor and 0 symptoms. The intervention significantly improved the mean number of risk factors + 1.06 (p < 0.001) and symptoms + 1.18 (p < 0.001) identified by women in the IG.

CONCLUSIONS

The preliminary results of this study suggest that an educational intervention using a web-app and based on the Behaviour Change Wheel model could be useful to improve knowledge of breast cancer risk factors and symptoms and to improve adherence to a healthy diet and physical activity in women without a previous breast cancer diagnosis.

Analysis of Continuous Nursing Intervention on Aplastic Anemia Patients Based on the "Information-Motivation-Behavioral Skills Model"

Objective

To explore the effect of continuous nursing care based on the “information-motivation-behavioral skills model” (IMB) in the intervention of patients with aplastic anemia.

Methods

A total of 90 patients with aplastic anemia who were admitted to our hospital from June 2019 to January 2021 were included in the study. The patients were divided into an observation group and a control group according to the random number table, with 45 patients in each group. The control group received routine nursing care, while the observation group received continuous nursing care based on IMB on the basis of the control group. Patients were followed up for 3 months, and their health knowledge was assessed with our self-made health knowledge rating scale. Patients' medication compliance was assessed using the Morisky medication compliance questionnaire. The self-care ability was assessed with the self-made self-care ability scale in our hospital. The comprehensive quality of life assessment questionnaire (GQOLI-74) was used to assess the quality of life of patients. A self-prepared nursing satisfaction questionnaire was used to score patients' nursing satisfaction. The total effective rate of nursing was evaluated.

Results

The awareness scores of basic disease knowledge, medication knowledge, and daily self-care knowledge in the observation group were higher than those in the control group (P < 0.05). The scores of medication compliance in the observation group were higher than those in the control group (P < 0.05). The self-care abilities such as healthy diet, psychological adjustment, self-care skills, oral care, and perianal care in the observation group were higher than those in the control group (P < 0.05). The quality of life scores of patients in the two groups in the 3 months of nursing were higher than those when they were discharged from hospital (P < 0.05). The GQOLI-74 score of 3 months' nursing care in the observation group was higher than that in the control group (P < 0.05). The nursing satisfaction degree of the observation group (97.78%) was higher than that of the control group (82.23%) (P < 0.05). The total effective rate of nursing care in the observation group (97.78%) was higher than that in the control group (77.78%) (P < 0.05).

Conclusion

IMB-based continuous nursing care can significantly increase the awareness of health knowledge in patients with aplastic anemia, effectively improve medication compliance, significantly enhance self-care ability, and thus, improve the quality of life.

Breast Self-examination Among AKHA Women (Hill Tribe Group) in Chiang Rai, Thailand

The mortality rate of breast cancer has increased in worldwide and reported first rank of women cancer in Thailand. One an urgent concern of prevention and education on early detection is Breast Self-examination (BSE). This study aims to report the percentage of BSE and examine the associated factors with BSE among Akha women, the largest ethnic group in northern part of Thailand. A study was conducted with 296 Akha women by survey quantitative data. Descriptive statistic and Binary regression were used for analysis. The majority of the participants were 45-59 years old (51.70%), and illiterate (68.90%). The percentage of good BSE founded 19.60%. The participants who received breast information showed zero-point one three time more likely to report good BSE compared to those non receiving (OR 0.13; 95% CI 0.03-0.53). Factor of susceptibility, benefit of BSE, barrier of BSE, and BSE confident were association with BSE practice. Based on findings, we recommend implementing a new practical program such as BSE media in Akha Language to promote BSE in this ethnic group.

Breast cancer screening adherence rates and barriers of implementation in ethnic, cultural and religious minorities: A systematic review

Breast cancer is the most common cancer affecting women worldwide. Adherence to breast cancer screening guidelines is frequently lower in racial, ethnic and cultural minority populations and is affected by potential inequities or barriers to screening that these minorities face. Therefore, the aim of the present study was to collect information from different minority groups worldwide, assess adherence to breast cancer screening and evaluate barriers or limitations causing non-adherence, which should facilitate the development of effective interventions. A search was conducted through PubMed and Web of Science. Studies were considered as eligible if they met the following criteria: i) Female patients; ii) breast cancer screening program implemented in the country; iii) minority groups; iv) asymptomatic; v) report written in Portuguese or English; vi) study published from 2015 onwards. The Critical Appraisal Skills Programme checklist was used for qualitative studies and the Strengthening The Reporting of Observational Studies in Epidemiology checklist for cross-sectional studies. From the 348 initial articles, 86 were removed due to duplication and 19 were selected, analyzed and summarized, accordingly. Of the 19 studies included, 5.3% were classified as high quality, 52.6% as moderate to high and 42.1% as moderate. A total of 15 studies were cross-sectional and 4 were qualitative, collectively including 250,733 women. The rate of adherence to mammogram in different minorities was evaluated, obtaining a mean value of 49.7% in the last 2 years, and statistically significant barriers were selected and divided into sociodemographic; personal; ethnic, cultural and religious; and external factors. The characteristics of each population play a major role in the population's breast health practices. If the population, adherence rates, barriers and inequities are carefully studied, screening models may be customized and participation to breast cancer screening can be optimized, thereby reducing the high breast cancer-associated mortality.

A Model-Based Meta-Analysis of Willingness to Participate in Cancer Screening

Although early screening tests are beneficial for the detection and treatment of cancers, many people have failed to participate in screening tests. The present study aims to explore the theoretical underpinning of low participation in screening programs using the method of meta-analytic structural equation modeling. It was found that the health belief model is the most adopted theoretical framework. Moreover, the intended uptake of screening was positively predicted only by cues to action, health literacy, and perceived susceptibility. As a result, a health intention model, including the three significant variables, is proposed. The practical implications of the findings are that health communication campaigns should focus on enlightening and engaging the public through all necessary means to raise awareness and transfer knowledge in relation to screening procedures as well as cancers per se.

Cancer Screening Literacy among Vietnamese Population: Does Annual Checkup Improve Cancer Screening Literacy?

BACKGROUND

Colorectal, breast, and cervical cancers disproportionately impact the Vietnamese population. However, research on cancer prevention among this population was very limited. The purpose of this study is to examine the cancer screening literacy levels for these three types of cancers among rural Vietnamese and investigate correlates of cancer screening literacy.

METHODS

A sample of 226 Vietnamese men and women aged 25-70 years old was recruited from rural Vietnam and finished a self-administered questionnaire. Andersen's Behavioral Model was used to guide this cross-sectional study to identify modifiable variables. Bivariate analysis was used to explore the relationship between demographic factors and cancer screening literacy levels. Multiple linear regressions were also used to identify significant factors for cancer literacy levels.

RESULTS

Cancer screening literacy levels of Vietnamese men and women were low regarding all three types of cancers, especially HPV symptom questions. Only about 24% of women answered correctly on "most people with genital HPV have no visible signs/symptoms" and less than 18% answered correctly on "I can transmit HPV to my partner(s) even if I have no HPV symptoms." Findings suggested that having an annual checkup was associated with higher colorectal (β=.15, p <.05), breast (β=.25, p <.001), and cervical (β=.18, p <.01) cancer screening literacy.

CONCLUSIONS

Public health efforts should focus on encouraging annual checkups in the Vietnamese population. During the annual checkup, health care professionals should educate patients about importance of cancer screening and provide recommendations for regular cancer screenings to reduce cancer health disparities.

An educational intervention on based information, motivation and behavior skills model and predicting breast self-examination

Introduction

Breast self-examination recommend as a breast screening method in developing countries where there are limited access to other screening methods. Therefore promoting breast self-examination required to identify effective interventions and relevant factors.

Methods

This study was a quasi-experimental design carried out among 314 women 20-69 years in community cultural centers in Isfahan city, Iran. Sampling was conducted from April to 10 August, 2016. A structured questionnaire was used for data collection in before and after the educational intervention. Then participants were followed by phone call after one month for breast self-examination performance. We used descriptive statistical analysis (mean, standard division, frequency distribution), and also other statistical methods (Paired t-test, Pearson’s correlation and logistic regression).The data were analyzed using SPSS version 18 with considering a significant level less than 0.05.

Results

There was significant difference between mean scores of information, motivation and behavior skill before and after intervention (P < .0001). After one month following 205 of women (72.2%) reported to perform breast self-examination. Pearson’s correlation showed that breast self-examination significantly correlated with information (r = .305, p = .000), motivation (r = .128, p = .031) and behavior skills (r = .161, p = .006). Also the logistic regression results demonstrated that information (p < .001, OR = 1.071), motivation (p = .045, OR = .978) and behavior skills (p = .001, OR = 1.033) predicted breast self- examination.

Conclusions

Considering the results of this study, it appears that the use of educational interventions based on three constructs of information, motivation and behavior skills can be used to promote breast self-examination. Moreover these results can apply to improve breast self-examination among women by health care providers.

Effects of Model-Based Interventions on Breast Cancer Screening Behavior of Women: a Systematic Review

Background: Breast cancer is a great concern for women’s health; early detection can play a key role in reducing associated morbidity and mortality. The objective of this study was to systematically assess the effectiveness of model-based interventions for breast cancer screening behavior of women. Methods: We searched Scopus, PubMed, Web of Science, Science Direct, Cochrane library and Google scholar search engines for systematic reviews, clinical trials, pre- and post-test or quasi-experimental studies (with limits to publication dates from 2000-2017), Keywords were: breast cancer, screening, systematic review, trials, and health model. In this review, qualitative analysis was used to assess the heterogeneity of data. Results: Thirty six articles with 17,770 female participants were included in this review. The Health belief model was used in twenty three articles as the basis for intervention. Two articles used both the Health belief model and the Health Promotion Model, 5 articles used Health belief model and The Trans theoretical Model, 2 used Hthe ealth belief model and Theory planned behavior, 2 used the Health belief model and the Trans theoretical Model, 2 used the Trans theoretical Model, 1 used social cognitive theory, and 1 used Systematic Comprehensive Health Education and Promotion Model. The results showed that model-based educational interventions are more effective for BSE and CBE and mammography screening behavior of women compare to no model based intervention. The Health belief model was the most popular model for promoting breast cancer screening behavior. Conclusions: Educational model-based interventions promote self-care and create a foundation for improving breast cancer screening behavior of women and increase policy makers’ awareness and efforts towards its enhancement breast cancer screening behavior.

Role Playing for Improving Women’s Knowledge of Breast Cancer Screening and Performance of Breast Self-Examination

Background:

To enhance knowledge and performance of screening as a strategy to control breast cancer, use of effective teaching methods is necessary. The objective of this study was to determine the effect of role-playing on knowledge of breast cancer screening and performance of breast self-examination (BSE).

Methods:

A quasi experimental design was used. Women enrolled in community cultural centers (n=314) were randomly divided into two educational groups: role playing (intervention) and lecture (control). Data were collected using a structured questionnaire before and after intervention. Reliability of the questionnaire was determined as 0.80 by Cronbach’s alpha. The women were followed up regarding performance of BSE one month later.

Results:

Of the 314 women, 113 (36%) and 132 (42%) had low and medium levels of knowledge, respectively. More than a third (38.2%) reported that TV and radio were the most important information sources for breast cancer and screening. There were significant differences between mean scores of knowledge before and after the intervention in both groups, but change was greater with role playing (31.3±1.9 as compared to 23.5±1.3) (P=0.001). After a month of educational intervention, 75.7% and 69.8% of those in role playing and control groups had undergone BSE.

Conclusion:

It appears that application of a role playing method by providers improves women’s knowledge and behavior with respect to breast cancer screening.