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Chanakira EZ, Thomas CV, Balen J, Mandrik O. A systematic review of public health interventions to address breast cancer inequalities in low- and middle-income countries. Syst Rev 2024; 13:195. [PMID: 39054497 PMCID: PMC11271015 DOI: 10.1186/s13643-024-02620-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/18/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Breast cancer is the most diagnosed cancer in the world, with a worse prognosis documented in low- and middle-income countries. Inequalities pertaining to breast cancer outcomes are observed at within-country level, with demographics and socioeconomic status as major drivers. AIM This review aims to aggregate all available evidence from low- and middle-income countries on public health interventions that can be utilized to reduce breast cancer inequalities within the breast cancer continuum. METHODS The study was a systematic review and narrative synthesis of available literature, with the literature search conducted between September and October 2021. The search was re-run in September 2022 to update the review. PubMed, Scopus, Embase, African Index Medicus and LILACS were searched, based on predetermined criteria. Randomized controlled trials, cohort studies and quasi-experimental studies were included for review, while studies without an intervention and comparator group were excluded. The Joanna Briggs Institute family of checklists was used for quality assessment of the included studies. Data pertaining to study design, quality control and intervention effectiveness was extracted. RESULTS A total of 915 studies were identified for screening and 21 studies met the selection criteria. Only one study specifically evaluated the impact of an intervention on breast cancer inequalities. Diverse, multi-level interventions that can be utilized to address breast cancer inequalities through targeted application to disadvantaged subpopulations were identified. Educational interventions were found to be effective in improving screening rates, downstaging through early presentation as well as improving time to diagnosis. Interventions aimed at subsidizing or eliminating screening payments resulted in improved screening rates. Patient navigation was highlighted to be effective in improving outcomes throughout the breast cancer continuum. CONCLUSION Findings from the systematic review underline the importance of early detection in breast cancer management for low- and middle-income countries. This can be achieved through a variety of interventions, including population education, and addressing access barriers to public health services such as screening, particularly among under-served populations. This study provides a comprehensive database of public health interventions relevant to low- and middle-income countries that can be utilized for planning and decision-making purposes. Findings from the review highlight an important research gap in primary studies on interventions aimed at reducing breast cancer inequalities in low- and middle-income countries. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42021289643.
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Affiliation(s)
- Esther Z Chanakira
- School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield, S1 4DA, UK.
| | - Chloe V Thomas
- School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield, S1 4DA, UK
| | - Julie Balen
- School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield, S1 4DA, UK
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
- Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Olena Mandrik
- School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield, S1 4DA, UK
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Mahboobighazaani F, Karimi M, Azadbakht M, Ghahremani L. The effectiveness of educational intervention based on the Health Action Model (HAM) in improving breast cancer screening behaviors. BMC Womens Health 2024; 24:21. [PMID: 38172783 PMCID: PMC10765812 DOI: 10.1186/s12905-023-02816-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
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.
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Affiliation(s)
- Fahimeh Mahboobighazaani
- Student Research Committee, Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Razi Ave, Shiraz, Iran
| | - Masoud Karimi
- Student Research Committee, Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Razi Ave, Shiraz, Iran
| | | | - Leila Ghahremani
- Student Research Committee, Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Razi Ave, Shiraz, Iran.
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Kamyab A, Mohammadkhah F, Asadi S, Ghalehgolab F, Khani Jeihooni A. The Effect of an Educational Intervention on Breast Cancer Screening of Rural Women: Application of the Theory of Planned Behavior. Cancer Control 2024; 31:10732748241266788. [PMID: 39052977 PMCID: PMC11282563 DOI: 10.1177/10732748241266788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 06/01/2024] [Accepted: 06/18/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Early diagnosis of breast cancer is a key factor affecting patient survival, so screening can reduce the burden of this disease. The present study aimed to investigate the effect of education based on the theory of planned behavior (TPB) on breast cancer screening in rural women. METHODS In this quasi-experimental study, 480 women referring to the health care centers in the cities of Fasa and Shiraz were divided into two groups, intervention (n = 240) and control (n = 240), using cluster random sampling method, in 2021-2022. We randomly selected two health care centers in Shiraz and Fasa and invited them to participate in the study. The demographic information questionnaire and a researcher-made questionnaire based on the TPB were used to collect the data. The intervention included 50-minute sessions on topics such as breast cancer basics, screening methods, barriers to mammography, and the role of peer groups. Data were collected before and 4 months after the intervention. RESULTS The results showed no difference between the two groups in awareness, attitude, perceived behavioral control, subjective norms, behavioral intention, and breast cancer screening performance before the intervention. Four months after the intervention, a significant increase was found in the intervention group in awareness (7.46 ± 1.50 to 18.54 ± 1.20), attitude (28.55 ± 4.62 to 58.69 ± 4.35), perceived behavioral control (22.52 ± 3.32 to 40.88 ± 3.84), and subjective norms (20.37 ± 3.34 to 21.99 ± 3.38). Instead, no significant difference in the mentioned constructs (P < 0.05) was observed in the control group. CONCLUSION This study demonstrated that TPB-based education enhanced awareness, attitude, perceived behavioral control, subjective norms, and behavioral intention towards breast cancer screening. The TPB empowers women in rural communities to prioritize their health and seek timely breast cancer screening. Continued efforts and improved access to screening services are crucial for improved outcomes.
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Affiliation(s)
- Amirhossein Kamyab
- Department of Community Medicine, School of Medicine, Fasa University of Medical Science, Fasa, Iran
| | - Fatemeh Mohammadkhah
- Department of Community Health, Child Nursing and Aging, Ramsar School of Nursing, Babol University of Medical Sciences, Babol, Iran
| | - Saeedeh Asadi
- Department of Gynecology, School of Medicine, Fasa University of Medical Science, Fasa, Iran
| | | | - Ali Khani Jeihooni
- Departement of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Kamyab A, Gholami T, Behdad K, Jeihooni AK. An application of a series of theory-based educational intervention based on the health belief model on skin cancer prevention behaviors in female high school students. Heliyon 2023; 9:e17209. [PMID: 37441393 PMCID: PMC10333432 DOI: 10.1016/j.heliyon.2023.e17209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 05/29/2023] [Accepted: 06/09/2023] [Indexed: 07/15/2023] Open
Abstract
Background Cancer is a leading cause of death globally and the second cause of death in developed countries. Having a rising incidence, skin cancer is the most prevalent cancer in Iran. Long-term UV radiations, particularly during childhood and adolescence, is a major cause of skin cancers. The Theory of Planned Behavior as the most precise indicator of behavior, contains motivational factors affecting behavior. This theory has been successful in predicting factors related to chronic diseases, especially cancer. As this model was successful in assessing sun-protective behaviors in previous studies, this study was designed to figure out how a theory-based educational intervention can affect the skin cancer prevention practices of Iranian female high school students. Methods This experimental investigation was carried out 2019-2020 using multistage cluster sampling method on 400 female high school students in Fasa, Fars, Iran. A questionnaire consisting of demographic data and a questionnaire including the components of the Theory of Planned Behavior was used to assess skin cancer preventative behaviors of both the trial and control groups of the study. An educational program based on the Theory of Planned Behavior was held for the experimental group for eight weeks regarding skin cancer preventive behaviors. The two groups completed questionnaires three months following the intervention for a second time. Results The study's findings revealed that prior to the intervention, there was no considerable distinction between the two study groups with regard to knowledge, attitude, subjective norms, perceived behavioral control, behavioral intentions, and skin cancer prevention behaviors; yet, three months later, the experimental group demonstrated increases in each of the mentioned variables with a significant difference. In contrast, the control group showed no discernible difference. Conclusions The findings of this investigation highlighted the success of the Theory of Planned Behavior for designing educational interventions aimed at encouraging skin cancer prevention in a population of female high school students.
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Affiliation(s)
| | - Tahereh Gholami
- Department of Public Health, School of Health, Fasa University of Medical Sciences, Fasa, Iran
| | - Kasra Behdad
- Department of Dermatology, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Ali Khani Jeihooni
- Nutrition Research Center, Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Dhakal R, Adhikari C, Karki P, Neupane N, Bhandari P, Gurung A, Shrestha N, Gahatraj N, Shrestha N, Koirala N, Subedi G. Attitude sustains longer than subjective norm and perceived behavioral control: Results of breast cancer screening educational intervention. PLoS One 2023; 18:e0281184. [PMID: 36763623 PMCID: PMC9916560 DOI: 10.1371/journal.pone.0281184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 01/17/2023] [Indexed: 02/11/2023] Open
Abstract
Breast malignancy is the most frequent carcinoma among females across the world and third-most in Nepal. Early diagnosis of breast cancer through breast health awareness and self-examination, in addition to mammography screening, is a highly feasible and useful technique in poorly resourced settings. However, their intentions, whether to modify behaviors or actions, remain debatable and less explained in the literature. So, we aimed to assess how long an educational intervention affects women's intention to do a breast self-examination (BSE) and mammography screening. After assessing feasibility, one ward was assigned to the intervention (IG; ward number 30) and control group (CG; ward number 33), and then with inclusion criteria, a total of 360 females (180 each in IG and CG) aged 40-75 years enrolled in the study. After the baseline assessment, participants in the IG were delivered an hour-long breast cancer screening-related lecture-discussion- demonstration session that included BSE and mammography, aided with a silicone dummy. The session was carried out by the female trained nurses. Outcome data were obtained at the baseline, 4, 8, and 12 months following the intervention. Attitudes, perceived behavioral controls (PBCs) and behavioral intents (BIs) of both mammography and BSE at baseline were similar in both IG and CG except in case of subjective norms (SNs). Intents of BSE remained effective for 4 months, whereas for mammography, it was effective only at 4 and 12 months. Moreover, attitudes toward both tests remained intact for 4, 8, and 12 months (p = < .05) consistently. With regards to PBCs, women having good control remained only for 4 months in both screening tests. Further, regarding SN, significant mean changes were observed at 4 and 12 months in BSE, and only at 4 months in mammography screening. The session was effective in sustaining BSE and mammography intentions for at least 4 months. To retain the effects longer (up to 12 months), additional educational strategies focusing on subjective norms and perceived behavioral controls of both tests are highly warranted.
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Affiliation(s)
- Rojana Dhakal
- Department of Nursing, School of Health and Allied Sciences, Pokhara University, Pokhara, Gandaki Province, Nepal
- * E-mail: ,
| | - Chiranjivi Adhikari
- Department of Public Health, School of Health and Allied Sciences, Pokhara University, Pokhara, Gandaki Province, Nepal
- Department of Public Health, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, Gujarat, India
| | - Prabha Karki
- Department of Nursing, School of Health and Allied Sciences, Pokhara University, Pokhara, Gandaki Province, Nepal
| | - Nirmala Neupane
- Department of Nursing, School of Health and Allied Sciences, Pokhara University, Pokhara, Gandaki Province, Nepal
| | - Pooja Bhandari
- Department of Nursing, School of Health and Allied Sciences, Pokhara University, Pokhara, Gandaki Province, Nepal
| | - Aditi Gurung
- Department of Nursing, School of Health and Allied Sciences, Pokhara University, Pokhara, Gandaki Province, Nepal
| | - Nisha Shrestha
- Department of Nursing, Pokhara Nursing Campus, Institute of Medicine, Tribhuvan University, Pokhara, Gandaki Province, Nepal
| | - Nandaram Gahatraj
- Department of Public Health, School of Health and Allied Sciences, Pokhara University, Pokhara, Gandaki Province, Nepal
| | - Niranjan Shrestha
- Department of Public Health, School of Health and Allied Sciences, Pokhara University, Pokhara, Gandaki Province, Nepal
| | - Niranjan Koirala
- Department of Natural Products Research, Gandaki Province Academy of Science and Technology, Pokhara, Nepal
| | - Govind Subedi
- Central Department of Population Studies, Tribhuvan University, Kritipur, Bagmati Province, Nepal
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Xin T, Jiang Y, Li C, Ding X, Zhu Z, Chen X. Using planned behavior theory to understand cervical cancer screening intentions in Chinese women. Front Public Health 2023; 11:1063694. [PMID: 36923041 PMCID: PMC10008845 DOI: 10.3389/fpubh.2023.1063694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/09/2023] [Indexed: 03/01/2023] Open
Abstract
Introduction Cervical cancer is still one of the cancers threatening the health of Chinese women with high morbidity and mortality. However, the participation rate of cervical cancer screening (CCS) among women is low due to various reasons, so it is crucial to understand the factors that influence women's willingness to be screened for cervical cancer. This study's goal was to understand the intention of cervical cancer screening in Chinese women using the theory of planned behavior (TPB). Methods An online questionnaire was administered to 286 women using a cross-sectional design. The questionnaire was created using the theory of planned behavior and included demographic characteristics as well as the basic structure of TPB. Results Descriptive, correlation, and multiple linear regression models were performed to identify factors associated with cervical cancer screening behavior. 286 respondents completed the survey (95.3%). The mean scores for behavioral attitude, subjective norm and perceived behavioral control (PBC) were 32.50 (SD = 3.30), 22.59 (SD = 2.80) and 29.57 (SD = 3.37). From the regression analysis, behavioral attitude (B = 0.110, p = 0.001), subjective norm (B = 0.234, p = 0.000) and perceived behavioral control (B = 0.171, p = 0.000) were statistically significant in terms of intention. Discussion This study provided a reference for improving the intention of cervical cancer screening in women.
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Affiliation(s)
- Tingting Xin
- School of Medicine, Jiangnan University, Wuxi, China
| | - Yuting Jiang
- School of Medicine, Jiangnan University, Wuxi, China
| | - Chunting Li
- School of Medicine, Jiangnan University, Wuxi, China
| | - Xian Ding
- Department of Anesthesiology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Zhu Zhu
- Department of Cardiology, Wuxi Second People's Hospital, Wuxi, China
| | - Xiao Chen
- Department of Anesthesiology, Affiliated Hospital of Jiangnan University, Wuxi, China
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The Effect of Educational Intervention on Knowledge, Attitude, and Practice of Women towards Breast Cancer Screening. Int J Breast Cancer 2022; 2022:5697739. [PMID: 35663837 PMCID: PMC9162849 DOI: 10.1155/2022/5697739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/12/2022] [Indexed: 11/18/2022] Open
Abstract
Background. Early identification of breast cancer may result in earlier treatment and a lower mortality rate. This fact has resulted in the development of screening programs to detect breast cancer in its early stages; thus, the current study sought to investigate the influence of educational intervention on knowledge, attitude, and practice about breast cancer screening in Izeh, Khozestan Province, Iran. Materials and Methods. This experiment was carried out on the women of Izeh city in 2019. This study included 120 women who were randomized into the experimental and control groups at random (60 in the experimental and 60 in the control groups). Before and two months after the intervention, data were collected using a researcher-created questionnaire by the control and education groups. The intervention program for the intervention group included eight educational sessions over the course of two months. The SPSS 20 statistical program was used to examine the data, as well as the paired
-test, independent
-test, and Chi-square. Results. There was no significant difference between the experimental and control groups’ mean scores of knowledge, attitude, and practice prior to the educational intervention, but a significant difference was observed after the intervention, with the experimental group obtaining significantly higher mean scores of knowledge, attitude, and practice (
).Conclusion. In the present study, the educational intervention on the knowledge, attitude, and practice towards breast cancer screening led to the increased scores of the experimental group compared to control group.
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Sun Y, Yuan J, Liu W, Qin B, Hu Z, Li J, He Y. Predicting Rural Women's Breast Cancer Screening Intention in China: A PLS-SEM Approach Based on the Theory of Planned Behavior. Front Public Health 2022; 10:858788. [PMID: 35480590 PMCID: PMC9035887 DOI: 10.3389/fpubh.2022.858788] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundIt was reported that the incidence of breast cancer (BC) was the highest among cancers worldwide. The breast cancer screening (BCS) program is regarded as an effective preventive measure. However, rural women's willingness to participate in the BCS program is relatively low. To provide measures to prevent BC, it is necessary for the government to identify the influencing factors of rural women's BCS intention.MethodsA cross-sectional study was conducted among 3,011 rural women by a convenience sampling method through face-to-face interviews on a self-designed questionnaire based on the theory of planned behavior (TPB). The partial least square structural equation model (PLS-SEM) was conducted to determine the predictors of BCS intention, and a multi-group analysis (MGA) of age was performed to identify if there were differences in all hypotheses between different age groups.ResultsThere were still rural women who have not been screened for BC in five years (41.7%). The research model of rural women's intention to accept this prevention against BC was rational. All of the hypotheses are supported. Especially, subjective norm (SN) (β = 0.345, p < 0.001) is found to be the strongest predictor followed by the perceived behavioral control 1 (PBC 1) (personal factors, including distance, transportation, busyness, etc.) (β = 0.165, p < 0.001), attitude (β = 0.152, p < 0.001), past behavior (PB) (β = 0.150, p < 0.001), knowledge (β = 0.121, p < 0.001), and perceived behavioral control 2 (PBC 2) (pain and cultural-social factors including embarrassment from a physician, etc.) (β = 0.042, p < 0.05). The advocacy and education (A&E), medical level and service attitude (ML&SA) of township health centers and village clinics can affect behavior intention (BI) via attitude, SN, and PBC. The results of MGA of age indicate that there are significant differences among rural women of different ages regarding the relationship between A&E and PBC 2 (p < 0.01) and the effect of PB on BI (p < 0.001).ConclusionThe TPB with the addition of PB, knowledge, ML&SA, and A&E can provide the theoretical basis for the policy intervention that aims to enhance the rural women's BCS willingness. MGA of age is conducive to promoting the implementation of the BCS policy. The findings are of great significance to improve rural women's health levels.
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Affiliation(s)
- Yanjun Sun
- Institute of Medical Humanities, Nanjing Medical University, Nanjing, China
- School of Marxism, Nanjing Medical University, Nanjing, China
| | - Jiawei Yuan
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Wuqianhui Liu
- The First School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Banghui Qin
- Institute of Medical Humanities, Nanjing Medical University, Nanjing, China
- School of Marxism, Nanjing Medical University, Nanjing, China
| | - Zhiqing Hu
- Institute of Medical Humanities, Nanjing Medical University, Nanjing, China
- School of Marxism, Nanjing Medical University, Nanjing, China
| | - Jianwei Li
- Department of Material and Child Health, Lianyungang Material and Child Health Hospital, Lianyungang, China
| | - Yuan He
- Institute of Medical Humanities, Nanjing Medical University, Nanjing, China
- School of Marxism, Nanjing Medical University, Nanjing, China
- Research Center for Social Risk Management of Major Public Health Events (Key Research Base of Philosophy and Social Sciences of Universities in Jiangsu), Nanjing Medical University, Nanjing, China
- *Correspondence: Yuan He
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A Critique of the Theory of Planned Behavior in the Cancer Screening Domain. ANS Adv Nurs Sci 2022; 45:179-193. [PMID: 35502990 DOI: 10.1097/ans.0000000000000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The theory of planned behavior (TPB) has been widely used to guide research in cancer screening-related behavior, but no critique of the TPB's application in this domain has been published. We used Fawcett and DeSanto-Madeya's 2013 framework to analyze and evaluate the theory. The theory was developed on the basis of antecedent knowledge regarding human behavior, and its concepts and propositions are comprehensively delineated. The TPB shows adequate internal consistency and impressive social and theoretical significance. Methodologically sound studies are called for to further test some theory propositions and to evaluate its pragmatic adequacy for promoting cancer screening in nursing practice.
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Keshavarzi A, Asadi S, Asadollahi A, Mohammadkhah F, Khani Jeihooni A. Tendency to Breast Cancer Screening Among Rural Women in Southern Iran: A Structural Equation Modeling (SEM) Analysis of Theory of Planned Behavior. BREAST CANCER: BASIC AND CLINICAL RESEARCH 2022; 16:11782234221121001. [PMID: 36091183 PMCID: PMC9452820 DOI: 10.1177/11782234221121001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Early detection of breast cancer is a crucial factor in surviving the disease. This study aimed to investigate the mammography screening based on the theory of planned behavior (TPB) among rural women in Fasa and Shiraz cities, Iran. Methods: This study is a cross-sectional study performed on 800 female clients referring to rural health centers in Fasa and Shiraz cities in southern Iran in early 2021. The authors decided to send and distribute the electronic questionnaire form through the WhatsApp application in collaboration with the health staff of rural health centers for the people covered by these centers. Data gathering tools were a questionnaire on demographic characteristics, a questionnaire based on constructs of TPB, and behavior of mammography screening. Using the structural equation model (SEM), the TPB constructs and demographic variables were entered into the model. Data analysis was executed employing SPSS software version 26 and Amos version 24 (IBM Co., Ann Arbor, MI, USA). Analyzing the data was carried out using the 1-way analysis of variance (ANOVA), logistic regression, and structural equation analysis. During data analysis, various model indicators such as the goodness of fit, including comparative fit index (CFI), goodness-of-fit index (GFI), root mean square error of approximation (RMSEA), and chi-square index/df were evaluated. The significance level in all tests was considered 0.05. Results: The knowledge, attitude, and perceived behavioral control were the predictors of intention and behavior of mammography screening among the women. Among demographic variables, age, literacy, being menopausal, cancer in family, city, and ethnicity contribute more to the variance variation in TPB constructs. In this study, 7.2% of Persians, 8% of Qashqai Turks, and 4.5% of Arabs are contemplating going to mammography screening. In total, 6.8% (54 people) of all individuals intended to go mammography screening, and 5.4% (43 people) had a history of mammography screening. Goodness-of-fit indices (χ2 = 18.45, df = 10, n = 800, χ2/df = 1.845, RMSEA = 0.032, GFI = 0.90, non-normed fit index (NNFI) = 0.91) of conceptual model of this study indicate the suitability of the model. Conclusions: The results of the study indicated that the constructs of the TPB can predict mammography screening behaviors in rural women. It has also demonstrated that mammographic behavior can be improved in rural women using education based on the TPB model, emphasizing critical psychological factors of creating or changing behavior.
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Affiliation(s)
- Ameneh Keshavarzi
- Department of Gynecology, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Saeedeh Asadi
- Department of Gynecology, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Abdolrahim Asadollahi
- Department of Health Promotion, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Mohammadkhah
- Department of Community Health, Child Nursing and Aging, Ramsar School of Nursing, Babol University of Medical Sciences, Babol, Iran
| | - Ali Khani Jeihooni
- Nutrition Research Center, Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Khani Jeihooni A, Jormand H, Saadat N, Hatami M, Abdul Manaf R, Afzali Harsini P. The application of the theory of planned behavior to nutritional behaviors related to cardiovascular disease among the women. BMC Cardiovasc Disord 2021; 21:589. [PMID: 34876014 PMCID: PMC8650365 DOI: 10.1186/s12872-021-02399-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nutritional factors have been identified as preventable risk factors for cardiovascular disease; this study aimed to investigate the application of the Theory of Planned Behavior (TPB) in nutritional behaviors related to cardiovascular diseases among the women in Fasa city, Fars province, Iran. METHODS The study was conducted in two stages. First, the factors affecting nutritional behaviors associated with cardiovascular disease on 350 women who were referred to Fasa urban health centers were determined based on the TPB. In the second stage, based on the results of a cross-sectional study, quasi-expeimental study was performed on 200 women covered by Fasa health centers. The questionnaire used for the study was a questionnaire based on TPB. The questionnaire was completed by the experimental and control groups before and three months after the intervention. Data were analyzed by SPSS software using logistic regression, paired t-test, independent sample t-test, and chi-square test. The level of significance is considered 0.05. RESULT The constructs of attitude, subjective norms, and perceived behavioral control (PBC) were predictors of nutritional behaviors associated with cardiovascular disease in women. The constructs predicted 41.6% of the behavior. The results showed that mean scores of attitude, subjective norms, PBC, intention, nutritional performance related to the cardiovascular disease before intervention were, respectively, 24.32, 14.20, 18.10, 13.37 and 16.28, and after the intervention, were, respectively, 42.32, 25.40, 33.72, 30.13 and 41.38. All the constructs except the attitude in the intervention group were significantly higher (p < 0.001) than the control group. CONCLUSION The results of the present study showed that the educational intervention based on the TPB would be consider an effective educational and promotinal strategy for the nutritional behaviors to prevent cardiovascular disease in women. Considering the role of mothers in providing family food baskets and the effect of their nutritional behaviors on family members, the education of this group can promote healthy eating behaviors in the community and family.
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Affiliation(s)
- Ali Khani Jeihooni
- Nutrition Research Center, Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
- Nutrition Research Center, Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hanieh Jormand
- Department of Public Health, School of Health and Autism Spectrum Disorders Research Center, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Negin Saadat
- Departement of Public Health, School of Health, Fasa University of Medical Sciences, Fasa, Iran
| | - Mahmood Hatami
- Department of Nursing, School of Nursing, Fasa University of Medical Sciences, Fasa, Iran
| | - Rosliza Abdul Manaf
- Department of Community Health, Faculty of Medicine & Health Sciences, Universiti Putra, Selangor, Malaysia
| | - Pooyan Afzali Harsini
- Department of Public Health, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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The effect of nutrition education based on PRECEDE model on iron deficiency anemia among female students. BMC WOMENS HEALTH 2021; 21:256. [PMID: 34167528 PMCID: PMC8223266 DOI: 10.1186/s12905-021-01394-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 06/08/2021] [Indexed: 01/08/2023]
Abstract
Background Iron deficiency anemia disrupts the concentration of adolescent girls; reduces their academic achievement, productivity, and physical strength, and increases the risk of infection. This research aim was to evaluate the effectiveness of the PRECEDE model nutrition education on iron deficiency anemia among female students of Fasa City, Fars Province, Iran.
Methods This quasi-experimental study was done on 160 students (80 experimental and 80 control groups) who were selected using a random sampling method in Fasa City, Fars Province, Iran, in 2018–2019. The educational intervention included six sessions based PRECEDE model for 45 or 50 min. A scale of this study consisted of two parts; demographic information, and PRECEDE constructs were used to determine the nutritional behaviors status concluding preventing iron deficiency anemia and hemoglobin, hematocrit, and ferritin blood level in two (before and 4 months after intervention) times. Results In the experimental group of the students the mean age was 13.85 + 1.72 years and in the controlled group was 13.60 + 1.81 years. Moreover, there was no significant difference in the PRECEDE constructs, and nutritional behaviors preventing iron deficiency anemia before the intervention in two groups of study. However, the experimental group showed a significant increase 4 months after the intervention. Also, there was no significant difference in the mean score of hemoglobin, hematocrit, and ferritin blood level between the two groups before the intervention. However, in ferritin level, a significant increase was shown in 4 months after the intervention in the experiential group. Conclusions Based on results, the nutrition intervention education base on PRECEDE model has a positive effect to improve iron deficiency anemia preventive behaviors in female students.
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Heidari Sarvestani M, Khani Jeihooni A, Moradi Z, Dehghan A. Evaluating the effect of an educational program on increasing cervical cancer screening behavior among women in Fasa, Iran. BMC WOMENS HEALTH 2021; 21:41. [PMID: 33509175 PMCID: PMC7844982 DOI: 10.1186/s12905-021-01191-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 01/21/2021] [Indexed: 11/30/2022]
Abstract
Background Cervical cancer is the second most common cancer and the fifth deadliest cancer among women in Iran. Educational interventions based on the proper behavior promoting models can lead to early diagnosis of cervical cancer.This study aimed to investigate the effects of educational intervention on performing Pap smear tests based on the Theory of Planned Behavior among women living in Fasa, Iran.
Methods A cross-sectional study was conducted on 700 participants. Thereafter, the educational intervention based on the results of cross-sectional study was conducted in a workshop form for 50 women as the intervention group and 50 women as the control group. Afterward, the data were entered into the SPSS statistical software and then analyzed via logistic regressions analysis, paired t test, independent t test, chi-square test, and McNemar test. Result According to the results, 45.7% of the patients had a history of performing a Pap smear test, and 20.7% of them regularly performed this test. The knowledge, attitude, subjective norms, and perceived behavioral control were the predictors of intention and behavior of Pap smear test among the women (P < 0.05). These components accounted for 57.4% and 31.6% of the intention and behavior variances, respectively. After the intervention, a significant increase was observed in the means of attitude, subjective norms, and perceived behavioral control in the intervention group compared to the control group. The results reveal no significant difference between these two groups regarding the behavioral intention (p = 0.41) and performance of the Pap smear test (p = 0.583). The number of the participants undergone the Pap smear test has increased from 10 to 26 in the intervention group by passing 3 months from the intervention. The results of McNemar test indicated that this difference was statistically significant. Conclusion The results indicated an increase in the women’s performance of the Pap smear screening test by appropriate planning, provision of educational packages based on the women’s needs, and using effective subjective norms. Trial Registration: Current Controlled Trials IRCT20160830029608N3:12/31/2018. “Retrospectively registered”.
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Affiliation(s)
| | - Ali Khani Jeihooni
- Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Moradi
- Department of Nursing, School of Nursing, Fasa University of Medical Sciences, Fasa, Iran.
| | - Azizallah Dehghan
- No Communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
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