Methods of motivating the practice of breast self-examination: a randomized trial

Older Women and the Practice of Breast Self-Examination

Breast self-examination (BSE) for breast cancer is used by only a fraction of the women who might benefit from it, and some studies show that older women who are more at risk for breast cancer are less likely to use it. This article reports a community study of women ( n = 528) who were trained in BSE in women's group meetings, provided a behavioral management intervention, and followed for two years. The intervention consisted of monthly postcard cues for BSE and lottery ticket rewards whenever a BSE record was returned indicating a BSE had been done. During the second year, the intervention was withdrawn. Results show that although women over 50 are no more likely to report having done more BSEs than women under 50 prior to entering the study, they did tend to do more BSEs during the intervention year and were significantly more compliant during the follow-up year. A more detailed analysis by age decade showed the highest rates of compliance in both years were for women ages 60–69 and 70–87. An analysis of attitudinal, history, and sociodemographic factors indicated that the only consistent predictor of BSE practice other than age and the intervention was the woman's confidence in BSE.

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.

[Barriers in the breast cancer screening and the role of nursing: an integrative review]

Mammographic breast cancer screening is a fact in developed countries. Nursing acts in different ways in this process, having an important role in the barriers related to non-adherence to screening, but its effectiveness is little proven, with limited number of clinical trials about this topic. An integrative review of the literature in PubMed and LILACS (Latin American Literature) was conducted, aiming to evaluate controlled clinical trials about nurse's role in breast cancer screening. It was used the key words breast cancer screening, clinical trials and nurse. From 110 publications in PubMed, 18 were clinical trials and showed the nurse's role in breast cancer screening. None publication was observed in LILACS database. This review shows the effectiveness of nursing in breast cancer screening, presenting new nurse's role in the multidisciplinary team that qualify actions related to women's health.

Breast self-examination training: a brief review

A review of the literature on breast self-examination training indicated that any training in breast self-examination improves compliance, confidence, and proficiency; the evidence is unclear about the relative effectiveness of group or individual training; practice on breast models and on the woman's own breasts should be included in breast self-examination training; additional training sessions improve compliance and proficiency; reminders increase compliance, but the effect ceases when the reminders cease; and it is particularly important for older women to search their breasts slowly and thoroughly. Several other new approaches to breast self-examination training are discussed.

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.

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.

Effects of a procedural/belief intervention on breast self-examination performance

The purpose of this study was to test the effect of a theoretically based nurse-delivered intervention on BSE behavior. A 2 x 2 prospective, randomized, factorial design yielded four groups: control, belief intervention, procedural intervention, and procedural/belief intervention. A total of 301 women were randomly selected from a target population. One year following intervention, significant differences in self-reported proficiency, observer-rated proficiency, and sensitivity (lump detection) were found between the Procedural and Control Group and the Procedural/Belief and Control Group. Significant increases were found on observer-rated proficiency and sensitivity for the Procedural/Belief Group when compared to the Belief Group. In addition, a significant increase was found in the Procedural/Belief Group on nodule detection, when compared to the Procedural Group alone.

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.

Training breast self-examination: a research review and critique

Despite an increase in knowledge about breast cancer, a relatively low percentage of women practice breast self-examination (BSE) regularly and competently. This article reviews the BSE literature with a focus on training of BSE components, discrimination training, and the effectiveness of training procedures. Methodological issues such as the absence of control groups, lack of criteria for termination of training and reliance on self-reports of BSE frequency are identified weaknesses of BSE training studies. A theoretical analysis of BSE highlights potential difficulties in maintaining regular practice of BSE. Recommendations regarding training of proficient BSE skills and promoting regular practice of BSE are offered, and suggestions for further refinement of BSE training and directions for future research are discussed. Promising avenues of research in BSE training technology include discrimination training (on real or simulated breast tissue) together with computerized assessment of skill proficiency.

Contributions of public health to patient compliance

This paper discusses the contributions of public health to compliance in five areas: clinical trials, smoking cessation, dietary compliance, breast cancer screening and hypertension control. Public health programs have been based on a number of theoretical foundations, most notably, social learning theory and the health belief model. Social marketing, community organization, and, more recently, consumer information processing models also are important. The strongest public health programs embody an ecological approach, with interventions directed not only at individuals, but also at groups, communities and changing institutional norms. Among the most important contributions of public health interventions are: multiple levels of intervention and evaluation, tailoring to target audiences, use of social support and community organization for behavior change. Together, community health and clinical compliance-enhancing strategies can exert a synergistic impact on health behavior change.

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.

The Toronto Breast Self-Examination Instrument (TBSEI): its development and reliability and validity data

The Toronto Breast Self-Examination Instrument (TBSEI) was developed out of the need for a self-administered survey that is reliable and valid. This article describes the development of the TBSEI, its dimensions, and reliability and validity data to support its continued use. To analyze the reliability and validity properties of the three TBSEI scales, we surveyed 729 Toronto, Ontario women. The TBSEI was found to have good face and content validity, internal consistency reliability (0.91, 0.69, 0.85), and test-retest reliability (0.89). Age norms for each of the three scales are also provided. These results are consistent with previous research findings in breast cancer and breast self-examination research.

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.

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.