Determinants of mammography adoption among iranian women: What are the differences in the cognitive factors by the stages of test adoption?

Overcoming obstacles to mammography screening: Examining the role of offline healthcare barriers and online patient-provider communication

Barriers to accessing offline healthcare may discourage patients from undergoing mammography screening. Online patient-provider communication (OPPC) offers a supplementary health resource that can complement traditional medical encounters and facilitate mammography screening. This study examines how offline healthcare barriers influence mammography screening, taking into account OPPC as an independent variable and cancer fatalism and patient activation as two mediators. Data from the 2017, 2018, and 2020 iterations of the Health Information National Trends Survey were used for this study. Results showed that OPPC was positively linked to mammography screening. Offline healthcare barriers had a negative association with patient activation and subsequent mammography behaviors. Moreover, offline healthcare barriers and OPPC were associated with mammography screening through serial mediation of cancer fatalism and patient activation. This study has important implications for encouraging mammography screening.

Decomposing socioeconomic disparity in the utilization of screening mammography: A cross-sectional analysis from the RaNCD cohort study

We aimed to examine the degree of socioeconomic inequality in screening mammography among Kurdish women of Iran. Data from the Ravansar Non-Communicable Diseases (RaNCD) Cohort Study were used. A total of 3,219 women aged 35-65 years were studied. The concentration index (CIn) was used to measure the magnitude of socioeconomic-related inequalities in screening mammography. Decomposition analysis was employed to calculate the contribution of each explanatory variable to the observed inequality. The participation rate for screening mammography was 19.7%. The CIn of screening mammography was 0.142 (95% CI: 0.0197, 0.0656), indicating that screening mammography is more concentrated among high-SES women. Socioeconomic status, education level and area of residence were the main contributors to the observed inequality, respectively. We found a pro-rich inequality in screening mammography among Iranian Kurdish women. For mitigating socioeconomic inequality in screening mammography policymakers should focus more on the poor and rural communities.

Breast cancer: a randomized controlled trial assessing the effect of a decision aid on mammography screening uptake: study protocol

Introduction

Breast cancer (BC) is the primary cancer among women. The World Health Organization recommends a bilateral screening mammogram every 2 years for women aged 50 to 74 years. However, it has been shown that there is an absence of information about the benefits and risks of screening. Shared medical decision-making is important to ensure patients are involved in the decision process. Decision aids can facilitative this decision-making process. This article presents a protocol to evaluate the effect of a decision aid on participation rates in the French organized BC screening program.

Methods and analysis

Design and setting. The design is a 2 arm randomized controlled study, performed in the Pays de la Loire region (French West Coast). Randomization will be based on general medicine practices (Primary Care).

Participants

Women aged between 50 and 74 years, eligible for BC screening. In this region, there are 75000 women, and 2800 general practitioners eligible for recruitment.

Intervention

In the « Decision aid for organized cancer screening » arm, the intervention will distribute invitation letters to eligible women combined with the provision of decision aid to these women and their general practitioners and an incentive to implement shared medical decision-making. In the « Standard organized cancer screening » arm, only the screening invitation will be sent to eligible women.

Primary endpoint

BC screening participation rates will be assessed after an 18-month follow-up period.

Statistical analysis

In this non-inferiority trial, the percentage of women who are up-to-date with their screening at 18 months after the intervention will be compared across arms using a generalized mixed linear model.

Discussion

The research team expect to demonstrate that providing a better explanation of the benefits and risks of BC screening is not at odds with screening participation. The study results should help policy makers thinking about implementing shared medical decision-making within the framework of organized BC screening programs in the future.

Ethics and dissemination

On 6 December 2021, the protocol received a favorable opinion from the French Committee for the Protection of Persons (2021-A01583-38). This study is registered with ClinicalTrials.gov, number NCT05607849. (Version 1, November 7, 2022; https://www.clinicaltrials.gov/ct2/show/NCT05607849). The study findings will be used for publication in peer-reviewed scientific journals and presentations in scientific meetings.

Design and Psychometric Evaluation of Mammography Behavior Predicting Scale (MBPS)

Background: Breast cancer disease is an important public health trouble in the world. Over the past 2 decades, incidences of breast cancer among Iranian women have shown an alarmingly rapid increase. Mammography screening can lead to early detection and management of breast cancer and it also plays an important preventive role in decreasing breast cancer, especially among women over 40 years old. Objectives: This paper aims at reporting the psychometric properties of a questionnaire on mammography behavior based on health action process approach (HAPA) model. Methods: This cross-sectional study was performed between May and September 2017, and was attended by 400 women aged 40 years and older, in comprehensive health service centers in Iran. The research subjects were selected by multi-stage cluster sampling. The instrument was designed basis on the constructs of HAPA and current literature. The scale’s psychometric properties were examined by exploratory factor analysis (EFA), infraclass correlation coefficient (ICC), and Cronbach’s alpha. Results: The results showed 45 items of the questionnaire, 41 items had important item-to-total correlations (P < 0.05), and they were placed in 8 factors that contributed 60.88% of the scale variance. Conclusions: The research findings contribute to the reliability and validity of the HAPA model for predictively evaluating mammography goals.

Knowledge and Factors Associated with Breast Cancer Self-Screening Intention among Saudi Female College Students: Utilization of the Health Belief Model

Breast cancer (BC) screening is vital, as it is linked to a greater likelihood of survival, more effective treatment, and better quality of life. One of the most extensively applied models for conceptualizing probable barriers and facilitators to the adoption of desired health behavior is the health belief model (HBM). This study aimed to assess the impact of health perception and knowledge on breast self-examination intention (BSE) using HBM. HBM measures specific factors (perceived susceptibility, severity, barriers, benefits, cues to action, and self-efficacy) that impact one's intention to use BSE. Data were collected from female undergraduate students (n = 680) using a cross-sectional design, stratified simple random sampling, and a self-administered structured online questionnaire. We used multivariable logistic regression to evaluate our assumptions for students who intended to self-examine for BC. For demographic factors, we modified the multivariate model. Most respondents (93%) were under the age of 24 years. Female students from health colleges (48.5%), in their fourth academic year (42.6%), and from the southern region (57.6%) accounted for the majority of the sample. Respondents with a family history of BC were 9.7% of the total. Categories for age, college, region, residency, and BSE intention showed significant differences in their average knowledge scores. The survey revealed that 72.4% were aware of abnormal breast changes. Three constructs of the health belief model (perceived benefit, perceived barriers, and self-efficacy) are good predictors of BSE intention. Theory-based behavioral change interventions are urgently required for students to improve their prevention practices. Furthermore, these interventions will be effective if they are designed to remove barriers to BSE intention, improve female students' self-efficacy, and enlighten them on the benefits of self-examination.

Development and validation of the psychometric properties of the perceived barriers of mammography scale

We aimed to develop and test the psychometric properties of the Perceived Barriers of Mammography Scale (PBMS-23). Based on a mixed method design researchers generated item pool through qualitative data and literature review and next, 500 women ages 40 to 69 years completed the questionnaire. Based on exploratory and confirmatory Factor Analysis, 23 items, researchers revealed eight domains of fate and destiny, breast conflict, defense avoidance, inconveniences/difficulties of mammography screening, contrasting/competing priorities, fear, distrust of mammography, and lack of knowledge with appropriate fitness for the data. PBMS-23 is valid and reliable instrument for assessing perceived barriers of mammography.

Cognitive determinants of weight control by dietary patterns among postmenopausal women with osteoporosis: An application of theory of planned behavior

Background: In this study, we aimed to assess the cognitive determinants of weight control behaviors by dietary patterns among postmenopausal women with osteoporosis.

Methods: This cross-sectional study, based on the theory of planned behavior (TPB) was conducted from July to December 2017 among 240 postmenopausal women with osteoporosis in Tabriz, Iran. A validated and reliable TPB-based instrument, namely Weight-CuRB, and the food frequency questionnaire (FFQ) were used.

Results: The results of exploratory factor analysis (EFA) indicated three dietary patterns (total variance explained=24.44%); healthy (n=71), mixed (n=78), and western (n=91). In addition, food items consumed by participants were classified into twenty-two food groups for dietary pattern analysis. In the healthy and western dietary patterns, attitude (β: 0.140, P <0.001) and subjective norms (SNs) (β: 0.498, P <0.01) were the only predictors of weight control behavior, respectively. In the women with healthy and western patterns, the TPB-based variables altogether explained 11% and 16% of variations in the behavior, respectively. Among all patients, the TPB-based variables explained 12.2% of variations in weight control behavior, within which SNs were the only significant predictor of the behavior (β=-0.199, P <0.01).

Conclusion: Our findings highlighted the remarkable role of dietary patterns in the associations between weight control and its cognitive determinants. Dietary patterns should be considered while designing weight control educational interventions among women with osteoporosis. In such interventions, promoting SNs and perceived behavioral control (PBC) should be considered as the core strategies to promote the behaviors among the patients who follow an unhealthy diet.

Determinants of mammography screening in Iranian women: A systematic review and meta-analysis

BACKGROUND

Mammography is the most effective method for early detection of breast cancer (BC), however, it has performed in low-level. The aim of this study was to investigate the determinants of mammography in Iran.

METHODS

This study was a systematic review which was performed based on articles published in both Persian and English languages among Iranian patients in the period of 2000 to 2020 by using keywords of "Iran and mammography". Papers were selected from national databases including (SID, Magiran) and international database including (Scopus, PubMed and web of science), finally related articles to mammography were reviewed.

RESULTS

Findings indicated that 35-50% of breast cancer can be detected in the early stages by mammography, however, it is in low rate of performance among Iranian women. Age, age of menarche, occupation, family history, marital status, family support, number of pregnancies, physician recommendations, perceived sensibility and severity, self-efficacy and perceived benefits are the most important predictors of performing mammography in Iran.

CONCLUSION

Due to the growing trend of breast cancer cases in the country and low mammography rates in Iranian population, high risk groups such as women with BC family history, low income level, low education level, older age and people with history of breast complications were more emphasized for performing mammography through health centers. Therefore, appropriate planning to reduce the barriers of mammography could be helpful.

Status of breast cancer screening strategies and indicators in Iran: A scoping review

Background:

Materials and Methods:

Results:

Conclusion:

The relationship between the fear of breast cancer, risk factors, and early diagnosis behaviors of women by age groups

PURPOSE

This study investigates the relationship between fear of breast cancer, risk factors, and early diagnosis behavior of women aged 20 or above.

METHOD

It is a descriptive cross-sectional study.

FINDINGS

It was found that 17.3% of the women conducted breast self-examination, 14.0% underwent clinical breast examination, and that 9.3% of them underwent mammography. The predictors regularly affecting early diagnosis behaviors were identified through logistic regression. Different predictors for breast cancer diagnostic behaviors were found in each age group.

PRACTICE IMPLICATIONS

This study is important in terms of taking into account the age factor in the practices aiming to increase the diagnostic behavior of healthcare personnel, especially nurses.

CONCLUSION

It was concluded that there were different predictors of breast cancer diagnostic behaviors in both age groups of the women in the study.

"It's beyond the pale to smoke hookah": perceptions of Iranian adolescents on social unacceptability of hookah smoking

Introduction

Globally, the popularity of hookah smoking, as a social and entertaining behavior, is increasing among adolescents and youths. The present study aimed to explore the perceptions of high school students on Social Unacceptability (Arabic/Persian term = Qabahat) of Hookah Smoking (SUoHS) in an Iranian context.

Methods

In this qualitative study, 31 student adolescents in Tabriz, Iran, were invited to participate in semi-structured individual interviews and focus group discussions (FGDs). Data were analyzed using interpretative thematic analysis.

Results

The unacceptability of hookah smoking was viewed at the “disreputability of hookah smoking and hookah smokers”. The students also explained SUoHS in the “incivility of hookah smoking and smokers in the society”, “disrespectfulness of hookah smokers and their families”, and “the consequences of hookah smoking”.

Conclusions

The SUoHS is rooted in the social values and norms within communities. To decrease hookah smoking levels among adolescents, school health nursing interventions should be tailored to bridge the gap between their recognition of SUoHS and subsequent behavior change through creating group dynamics highlighting the domains of social unacceptability of the behavior.

Inconsistent Mammography Perceptions and Practice among Women of Over 40 Years in Iran

Objective: This paper aims to report the relationship between perceptions of mammography and screening practices. Methods: This cross-sectional study was conducted between May and September 2017, involving 400 women of over 40 years old, who was referred to as urban health centers in Tehran, Iran. The subjects were selected by multi-stage cluster sampling. Women with inconsistent mammography perceptions and practices were identified the Pros and Cons of mammography behavior for perceptions and Transtheoretical model (TTM) stage of adoption for prior and intended screening practices. The research instrument included a self-administered questionnaire and data were analyzed using descriptive statistics and measures of central tendency, and the chi-square, T-tests, and correlation regression analysis. Results: The average age participant was 45.6±5.4. Consistent with the TTM and pros and cons of mammography, women in action tended to have more positive perceptions of mammography than women in pre-contemplation or contemplation (mean decisional balance: action= 16.8; SD, 1.4; contemplation=1.8; SD, 0.48; precontemplation= SD, 1.4;0.56; p<0.001). Conclusion: results of the current study indicate there are inconsistent mammography perceptions and practice among women in Iran, then we recommend that future intervention, consider setting factors in addition to standard perceptions focused counseling.

Perceived Barriers to Mammography Adoption among Women in Iran: A Qualitative Study

Background

Breast cancer is the most commonly diagnosed tumorous cancer and the second leading cause of cancer-related deaths among women worldwide. This study aimed to qualitatively explore the barriers to mammography adoption among Iranian women.

Methods

This study is a qualitative component of a large research project on exploratory sequential mixed method design, utilizing conventional content analysis. In total, 24 participants were selected from among women who had participated in the first phase of the study. Data were collected through in-depth, semi-structured interviews.

Results

Five main themes were extracted, consisting of unawareness of mammography, fear control, priority of mammography needs, inadequate competency of mammography centers, and a sense of losing family support.

Conclusion

Different perceived barriers within various levels (individual, intrapersonal, health systems, and community) play influential roles in women’s decisions to participate in breast cancer screening program, which indicates the cultural aspect of perceived barriers in different communities and countries. The study provides the basis for intervention planning in this regard.

Cognitive determinants of self-care behaviors among patients with heart failure: A path analysis

Background: Heart failure (HF) is a common clinical syndrome resulting from any structural or functional cardiac disorder that impairs the ability of ventricles to fill with or eject blood.Our aim in this study was to examine the possible direct/indirect effects of health belief model(HBM) constructs on self-care behaviors among HF patients. Methods: A secondary analysis was conducted on an HBM-based data set collected from 180 patients with HF who were recruited from a heart hospital in Tehran, Iran, during a prospective experimental study in 2008. A regression-based path analysis was conducted to examine the relationships between HBM constructs (as independent variables) and self-care behaviors (as dependent variable). Results: A conceptual path model was identified for the cognitive determinants of self-care behaviors among HF patients. Knowledge (β = 0.399), perceived barriers (β = 0.315) and susceptibility (β = 0.165) had direct effects on self-care (R2 = 0.512, P < 0.001). Perceived benefits, self-efficacy, severity and threat, locus of control and cues to action had indirect effects on self-care through the first three variables. Conclusion: HBM was found to be helpful in understanding direct and indirect associations between the cognitive determinants and self-care behaviors among HF patients. Based on this challenging path analysis, HF patients' knowledge and perceived barriers and susceptibility are suggested as the most core categories while designing HF educational programs. Better understanding on such associations may lead nurses and health practitioners in designing properly informed stage-specific educational interventions aiming to foster self-care behaviors among HF patients.

Assessing the mediating role of breast conflict on cognitive factors associated with adopting mammography

Breast conflict may represent a woman's unpleasant feelings toward her breasts, which may adversely affect her decision to undertake the procedures for an early detection of breast cancer. The purpose of the present study was to examine the mediating role of breast conflict in cognitive factors, as suggested by the Health Belief Model (HBM), for adopting mammography. In this explanatory cross-sectional study, multistage cluster sampling was employed to recruit 738 women in the age range of 40 to 69 years in Iran. Champion's revised HBM Scale for mammography adoption and the Women's Breast Conflict Scale were used to measure the variables of interest. Generalized structural equation modeling and hierarchical logistic regression were used for data analysis. Breast conflict was negatively associated with perceived barriers of mammography. Perceived barriers were inversely related to self-efficacy, which was positively related to mammography, suggesting the mediating role of perceived barriers and self-efficacy, connecting breast conflict to mammography indirectly. The mediating role of breast conflict in perceived barriers and self-efficacy suggests an indirect link between breast conflict and mammography. Clinicians and public health-care providers must pay attention to women's feelings in formulating and delivering appropriate interventions and consultations.

Personal, Interpersonal, and Organizational Predictors of the Mode of Delivery Among Urban Women: A Prospective Study With Socio-Ecological Approach

The aim of this prospective study was to investigate the predictors of choosing mode of delivery (MOD) among Iranian urban women applying the socio-ecological model. In 2015, a convenient sample of 530 pregnant women in urban regions of Urmia, Iran, was recruited to complete a socio-ecological approach-based questionnaire. Then, 1 week after childbirth, the women were followed up by telephone to be asked about their MOD (response rate = 81.88%). Logistic regression analysis showed that the odds of cesarean section (CS) among the women with university education, whose husbands were an employee in a governmental organization, who preferred a private hospital for delivery, and who selected the CS as the preferred MOD during pregnancy were significantly higher than their counterparts. Among all the factors, the socioeconomic status of the families was more influential in predicting the MOD among women. The cognitive factors like fear of childbirth may not be determinants for MOD if women are from privileged families.