Reliability and validity of the breast cancer screening belief scale among Turkish women

Association between sociodemographic factors and health beliefs related to breast cancer screening behavior among Northern Thai women: a hospital-based study

Early diagnosis of breast cancer is crucial for reducing mortality rates. The purpose of this study is to determine the impact of demographics/social determinants of health on beliefs about the practice of self-breast examination, using mammogram and ultrasound in the context of breast cancer screening among Thai women in a hospital-based setting for implying program planning and future research. A cross-sectional study was conducted in two health centers in Chiang Mai Province from August 2021 to December 2021, involving 130 Thai women ages 40 to 70 years. Data were collected by a survey using a questionnaire to gather sociodemographic information, and health beliefs about breast cancer and screening behavior utilizing the modified Thai version of Champion's Health Belief Model Scale (MT-CHBMS). Descriptive statistics, t-tests, ANOVA, and linear regression models were employed for examining association between sociodemographic factors and health beliefs about the practice of self-breast examination (BSE), using mammogram (MG) and ultrasound (UTS). Health insurance schemes were associated with Benefit-MG, Barrier-BSE, Barrier-MG and Barrier-UTS subscales. Additionally, monthly income was associated with Barrier-MG and Barrier-UTS subscales. The most common barriers reported were "embarrassment", "worry", and "takes too much time". To enhance breast cancer screening in Thailand, program planning and future research should focus on health insurance schemes, especially women with social security schemes, as they may be the most appropriate target group for intervention.

Translation, Adaptation, and Validation of the Modified Thai Version of Champion's Health Belief Model Scale (MT-CHBMS)

BACKGROUND

While breast cancer is the leading cause of cancer death among Thai women, breast self-examination (BSE), mammography, and ultrasound use are still underutilized. There is a need to assess women's beliefs about breast cancer and screening in different cultural settings. As a result, a tool to measure the beliefs that influence breast-cancer-screening practices is needed. Champion's Health Belief Model Scale (CHBMS) is a valid and reliable tool for assessing individuals' attitudes toward breast cancer and screening methods, but it has not been validated in Thai women. The study aimed to translate and validate the CHBMS for breast self-examination and mammography among Thai women and to modify the original scale by adding ultrasound items for breast cancer screening. In addition, the purpose of this study was to create a modified Thai version of the CHBMS which could be used to better understand patients' beliefs regarding breast cancer screening in Thailand, in order to develop practical and effective interventions suited to their beliefs.

METHODS

The CHBMS was translated into Thai, validated by a panel of experts, back-translated, modified by adding content about ultrasound for screening breast cancer, and pretested. Confirmatory factor analysis was used with a sample of 130 Thai women aged 40 to 70 years old.

RESULT

The final MT-CHBMS consisted of 64 items determining ten subscales: susceptibility, seriousness, benefits-breast self-examination, benefits-mammogram, barriers-BSE, barriers-mammogram, confidence, health motivation, benefits-ultrasound, and barriers-ultrasound. The MT-CHBMS demonstrated excellent internal consistency. The ten-factor model was best fitted to the data.

CONCLUSION

The MT-CHBMS was found to be a reliable and valid tool for measuring individuals' attitudes toward breast cancer and screening methods. The scale could be easily used by healthcare providers to determine the beliefs before planning appropriate interventions to increase early detection.

Factor structure and internal reliability of breast cancer screening Champion's Health Belief Model Scale in Yemeni women in Malaysia: a cross-sectional study

BACKGROUND

The reliability and validity of the Champion's Health Belief Model Scale (CHBMS) used in assessing the belief of women regarding breast cancer (BC) and breast cancer screening (BCS) have been examined on various populations. However, the use of this tool has not been adequately assessed for its validity in ethnic minorities. This study assessed the validity and reliability of CHBMS by analyzing the factor structure and internal reliability of the factors among Yemeni women in Malaysia.

METHODS

A survey was conducted among 103 female teachers from 10 schools. SPSS version 22.0 was utilized in analyzing the data. Descriptive statistics were computed for the socio-demographic characteristics. The Cronbach's alpha coefficients were used in assessing the internal reliability. The Exploratory Factor Analysis (EFA) was used to analyze the factor structure of the translated items. Parallel analysis was performed to determine the number of factors accurately.

RESULTS

The alpha coefficients of the factors had acceptable values ranging between 0.76 and 0.87. The factor analysis yielded six and five factors for breast self-examination (BSE) and mammography (MMG), with a total explained variance of 47.69% and 52.63%, respectively. The Kaiser-Meyer-Olkin (KMO) index values of 0.64 and 0.72, and the Bartlett's Test of Sphericity (P = 0.0001) for BSE and MMG, respectively, verified the normality distribution and the adequacy of the sample size for EFA. All the items on each factor were from the same construct that were consistent with the number of factors obtained in the scale development study. The items achieved adequate factor loadings that ranged between 0.47 and 0.88.

CONCLUSIONS

The translated version of the CHBMS is a validated scale used in assessing the beliefs related to BC and BCS among Yemeni women living in Malaysia. Healthcare workers could use the scales to assess women's beliefs on BC and BCS. This instrument could be used to test the effectiveness of the intervention programs.

Cross-Cultural Modification Strategies for Instruments Measuring Health Beliefs About Cancer Screening: Systematic Review

Background

Modification is an important process by which to adapt an instrument to be used for another culture. However, it is not fully understood how best to modify an instrument to be used appropriately in another culture.

Objective

This study aims to synthesize the modification strategies used in the cross-cultural adaptation process for instruments measuring health beliefs about cancer screening.

Methods

A systematic review design was used for conducting this study. Keywords including constructs about instrument modification, health belief, and cancer screening were searched in the PubMed, Google Scholar, CINAHL, and PsycINFO databases. Bowling’s checklist was used to evaluate methodological rigor of the included articles. Results were reported using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) approach with a narrative method.

Results

A total of 1312 articles were initially identified in the databases. After removing duplications and assessing titles, abstracts, and texts of the articles, 18 studies met the inclusion criteria for the study. Based on Flaherty’s cultural equivalence model, strategies used in the modification process included rephrasing items and response options to achieve semantic equivalence; changing subjects of items, changing wording of items, adding items, and deleting items to achieve content equivalence; adding subscales and items and deleting subscales and items to achieve criterion equivalence. Solutions used to resolve disagreements in the modification process included consultation with experts or literature search, following the majority, and consultation with the author who developed the scales.

Conclusions

This study provides guidance for researchers who want to modify an instrument to be used in another culture. It can potentially give cross-cultural researchers insight into modification strategies and a better understanding of the modification process in cross-cultural instrument adaptation. More research could be done to help researchers better modify cross-cultural instruments to achieve cultural equivalence.

Cross-Cultural Instrument Adaptation and Validation of Health Beliefs About Cancer Screening: A Methodological Systematic Review

BACKGROUND

The uptake of cancer screening is significantly associated with participants' health beliefs about cancer screening. Scales measuring health beliefs of cancer screening are available; however, the scales that were developed and validated for the US population may lack cultural appropriateness, which could compromise the reliability and validity of the scales when applied to different ethnic groups or populations.

OBJECTIVE

The aim of this study was to summarize, analyze, and compare the methods used in the cross-cultural instrument adaptation and validation processes of health beliefs about cancer screening.

METHODS

A systematic review design with narrative methods was used. Electronic databases, including PubMed, Google Scholar, CINAHL, and PsycINFO, were searched.

RESULTS

A total of 18 articles were eligible. Results showed (1) the translation methods included committee translation and back translation, which were further refined by using professional translators, using professional interpreters and/or involving the first author, using bilingual individuals, and involving bilingual investigators; (2) the modification methods included embedded and afterward modification; and (3) the validation methods included testing construct validity, internal consistency reliability, item-total subscale correlations, test-retest reliability, content validity, predictive validity, and face validity.

CONCLUSIONS

Back translation and afterward modification were most frequently used for translating existing instruments to another language. Validity and reliability were most frequently established by construct validity, content validity, face validity, predictive validity, internal consistency reliability, test-retest reliability, and item-total subscale correlation after instruments were translated.

IMPLICATIONS FOR PRACTICE

Clinicians should evaluate the translation and adaptation process for translated versions of instruments before using them to provide culturally appropriate and sensitive care.

Comparison of competitive cognitive models in explanation of women breast cancer screening behaviours using structural equation modelling: Health belief model and theory of reasoned action

INTRODUCTION

The efficacy of the theory of reasoned action (TRA), compared with the health belief model (HBM), has not been fully elucidated in screening practices.

METHODS

This population-based cross-sectional study was conducted with samples of 500 women aged 35-85 years, in the north of Iran. The data of demographic characteristics, awareness, health belief, subjective norms and screening behaviours were collected using standard instruments. Structural equation modelling (SEM) was applied to estimate the pathways of regression coefficients.

RESULTS

The model that incorporated the health belief and the standardised coefficient of the knowledge scores influenced significantly on the health belief perception (beta = 0.375), and consequently, the health belief directly affected screening behaviours (beta = 0.73). In contrast, In TRA model, while the direct effect of knowledge on intention was negligible it has a greater indirect effect by mediating health belief and subjective norms (indirect beta = 0.35) on behaviour intention. A high coefficient of intention was observed by subjective norms (beta = 0.626), and the intention has a great positive effect on screening behaviour (beta = 0.601). All fitting indexes were quietly improved in the TRA model as compared with HBM.

CONCLUSION

Thus, the unifying structure of knowledge, health belief, subjective norms and intention improves the predictor power in breast cancer screening behaviours.

Psychometric Properties of the Iranian version of Champion's Revised Health Belief Model Scale for Breast Cancer screening

Background:

Women's beliefs regarding breast cancer and its screening approaches were considered antecedents of their behavioral changes. Understanding of these beliefs in women requires a valid and reliable instrument. The present study seeks to translate the English version of the Champion's Revised Health Belief Model Scale (CRHBMS) into the Persian language and assess its psychometric properties.

Materials and Methods:

The study was conducted on 334 students at Urmia University of Medical Sciences, Iran, 2016. The 57-item CRHBMS was translated to Persian language, back translated, and tested. To test the face and content validity of the Persian version; item analysis, Content Validity Ratio (CVR), and Content Validity Index (CVI) were applied, respectively. Construct validity of the Persian scale was performed by Exploratory and Confirmatory Factor Analyses (EFA, CFA) using Kaiser-Meyer-Olkin and Bartlett's tests in SPSS 16 and LISREL8.72 software. The reliability of the translated scale was evaluated using Cronbach's alpha and test-retest approaches.

Results:

In the EFA, eight factors were extracted concerning breast cancer screening, and each item was loaded on its specific factor. These factors were self-efficacy, health motivation, benefits-mammography, benefits-Breast Self-Examination (BSE), barriers-mammography, barriers-BSE, susceptibility, and severity. The final 42-item scale was confirmed by the CFA, and all goodness of fit indices showed a proper fit of the model. Cronbach's alpha coefficient and test-retest correlation of the subscales ranged from 0.72–0.89 and 0.67–0.93, respectively.

Conclusions:

The study suggests that the Persian version of CRHBMS is a feasible scale for evaluating women's health beliefs regarding breast cancer and its screening behaviors.

Risk Assessment for Breast Cancer Development and Its Clinical Impact on Screening Performance in Iranian Women

Introduction

The aim of this study is to estimate the objective and subjective risk and to examine their associations with three forms of breast cancer screening.

Methods

This cross-sectional study was conducted with a sample of 800 women aged 35–85 years from the community setting and outpatient clinic in Babol, the north of Iran. The demographic, socio-economic characteristics and the risk factor profiles were collected through in-person interview. The health belief model (HBM) and visual analog scales were used to assess the women’s perceived risk of breast cancer. The practice of women regarding breast self-examination (BSE), breast clinical examination (BCE), and mammography were measured. We used the Gail model in estimating 5-year and lifetime risk. The logistic regression model was applied to determine the relationship of calculated and perceived risk on screening behaviors.

Results

The mean of estimated 5-year and lifetime risk were 0.89 ±0.89 and 8.87 ±3.84 percent respectively while the perceived personal risk on visual scale perception was much greater than the calculated risk. The high 5-year calculated risk was a predictor of mammography practice but not BSE and BCE; however, after adjusting the subscales of HBM and socio-demographic characteristics, its effect remained significant (adjusted OR=1.97(95% CI: 1.02–3.08)). The perceived risk from HBM in particular self-efficacy (p=0.001) remained positively significant on all forms of screening practice.

Conclusion

While the perceived risk from HBM scale was meaningful in screening performance, the calculated risk from the Gail model had a clinical impact on mammography behaviors independent of HBM scales.

Validity and Reliability of Health Belief Model Questionnaire for Promoting Breast Self-examination and Screening Mammogram for Early Cancer Detection

Background:

Early detection of breast cancer is essential in improving overall women’s health. The researchers sought to develop a comprehensive measure that combined the basic components of the health belief model (HBM) with a focus on breast self-examination (BSE) and screening mammogram amongst women.

Methods:

Questionnaire items were developed following a review of relevant literature of HBM on BSE and screening mammogram. The sampling frame for the study was Malaysian women aged 35 to 70 years old, living in Kuantan, Pahang and able to read or write in Bahasa Malaysia or English. As such, 103 women were randomly selected to participate in the study. Tests of validity using exploratory factor analysis (EFA) and reliability were subsequently performed to determine the psychometric properties of the questionnaire.

Results:

The EFA revealed nine factors (self-efficacy of mammogram, perceived barriers of BSE and mammogram, perceived susceptibility of breast cancer, perceived severity of breast cancer, cues to action for mammogram screening, perceived benefits of BSE, health motivation, perceived benefits of mammogram and self-efficacy of BSE) containing 54 items that jointly accounted for 74.2% of the observed variance. All nine factors have good internal consistency with Cronbach’s alpha ≥ 0.8. Fifty-four items remained in the final questionnaire after deleting 13 problematic items. The scale also showed good convergent and discriminant validity.

Conclusion:

The findings showed that the designed questionnaire was a valid and reliable instrument for the study involving women in Kuantan, Pahang. The instrument can help to assess women’s beliefs on BSE adoption and mammogram screening in health care practice and research.

Tools for the assessment of breast cancer screening beliefs in women: a literature review

Aim: This review aims to compare the development, characteristics and validity of three widely used breast cancer screening belief tools (the Champion's Health Belief Model Scale [CHBMS], the Breast Module of a Cancer Awareness Measures [BCAM] and the Breast Cancer Screening Beliefs Questionnaire [BCSBQ]). Materials & methods: Literature reports were retrieved from electronic databases, including PubMed, EMBASE, Web of Science and the Cochrane Library, and other references. All three tools had good reliability and validity. Certain significant differences between these tools should be noted. Results: CHBMS, BCAM and BCSBQ are valid and reliable instruments within certain populations. Due to the high heterogeneity among the targeted population, their characteristics and those of the instruments should be fully considered for clinical decision-making. Conclusion: The conclusion of this review contributes to the development of a more comprehensive and objective instruments based on the deficiencies of the existing studies.

Breast Cancer Screening Behaviors of First Degree Relatives of Women Receiving Breast Cancer Treatment and the Affecting Factors

Objective

First-degree relatives of women with breast cancer are under higher risk when compared with the general population. The aim of this study is to evaluate breast cancer screening behaviors of women who are first-degree relatives of women with breast cancer and factors affecting these behaviors.

Materials and Methods

This descriptive study included 240 patient relatives, who agreed to participate in the study through contact with first-degree relatives of 133 patients who were receiving breast cancer treatment at the Oncology and Chemotherapy unit of an university hospital in Turkey. Data were collected using the "Descriptive Characteristics Form," which consisted of socio-demographic characteristics, health history, breast cancer risk level and health beliefs as well as the "Breast Cancer Screening Behavior Evaluation Form".

Results

Out of the subjects, 17% reported doing breast self examination (BSE), 18% reported getting clinic breast examination (CBE) and 17% reported getting mammography. Logistic regression analysis showed that perceived susceptibility increased BSE by 0.57 times and increased mammography by 0.77 times. Physical exercise increased CBE by 0.21 times and increased mammography by 0.13 times.

Conclusions

It was found that women with familial breast cancer history (FBCH) had lower participation in screening behaviors. Higher susceptibility perception and regular physical exercise are the determinant variables. Women with a higher susceptibility can be led towards the screening and their participation can be increased. In women with family history, the development of healthy lifestyle behaviors like physical exercise should be supported.

Maltese Translation and Adaptation of Champion's Health Belief Model Scale and the Revised Illness Perception Questionnaire for Breast Screening Among Maltese Women

BACKGROUND AND PURPOSE

Translating, adapting, and piloting Champion's Health Belief Model Scale for Mammography Screening (CHBMS-MS) and Revised Illness Perception Questionnaire (IPQ-R) among Maltese women.

METHODS

The Maltese questionnaire (Maltese Breast Screening Questionnaire [MBSQ]) was developed through 9 steps. Bilingual women (n = 15) completed MBSQ at 2 time points.

RESULTS

During forward-backward translations (Steps 1-4), 4 English controversial terms were raised. Twelve experts agreed on terminologies during adaptation process (Step 5). Following face validity (n = 6; Step 6), 3 items were deleted. Following reconciliation (Step 7) and proofreading (Step 8), MBSQ consisted of 121 items. Pilot testing (Step 9) showed positive correlation (CHBMS-MS = .87, IPQ-R = .85; p < .001); high Cronbach's alpha (CHBMS-MS = .93, IPQ-R = .92); overall acceptable internal consistency (CHBMS-MS = .69-.83, IPQ-R = .75-.93); and acceptable test-retest reliability correlations: CHBMS-MS (Maltese = .62-.76; English = .61-.84), IPQ-R (Maltese=.63-.82; English = .61-.91; p < .001).

CONCLUSIONS

Maltese and English scale items demonstrated high reliability and validity preliminary values.

Effects of Interventions Based on Health Behavior Models on Breast Cancer Screening Behaviors of Migrant Women in Turkey

BACKGROUND

Antalya is a city receiving internal and external migration in Turkey, including migrant women in need of developing breast cancer screening behaviors.

OBJECTIVE

The aim of this study was to develop breast cancer screening behaviors of migrant women through nursing interventions based on the Health Belief Model and the Health Promotion Model.

METHODS

This quasi-experimental study was conducted with 200 women (100 women in the intervention group, 100 women in the control group) in Antalya. The intervention group received training, consultancy service, and reminders and was followed up at 3 and 6 months after interventions.

RESULTS

The rates of breast self-examination, clinical breast examination and mammography were higher at months 3 and 6 in women in the intervention group compared with the women in the control group. In the intervention group, perceptions of susceptibility and barriers decreased after the interventions, and benefit, health motivation, and self-efficacy perceptions increased. According to month 6 data, in the intervention group, the decrease of each unit in perception of barriers increased the rate of breast self-examination 0.8 times and the rate of mammography 0.7 times. An increase of each unit in health motivation increased the rate of clinical breast examination 1.3 times and the rate of mammography 1.5 times.

CONCLUSION

Interventions based on health behavior models positively affected breast cancer screening behaviors of migrant women. Health motivations and perceptions of barriers are determinants in performing the screening behaviors.

IMPLICATIONS FOR PRACTICE

Migrant women should be supported more by healthcare professionals regarding recognition of breast health and disease and in transportation to screening centers in their new location.

Assessment of Breast Cancer Risk and Belief in Breast Cancer Screening Among the Primary Healthcare Nurses

Breast cancer is the most frequently diagnosed cancer in women. Early detection of breast cancer is known to increase survival rates significantly after diagnosis. This research was carried out to determine the level of breast cancer risk among primary healthcare nurses and their belief in breast cancer screening. In this descriptive research, the data were collected in face-to-face interviews with the participants. The researchers contacted all primary healthcare nurses currently working in the province. The data collection tools included a questionnaire form on sociodemographic characteristics, breast cancer risk assessment form, and Champion's Health Belief Model Scale (CHBMS) for breast cancer screening. In data analysis, descriptive statistics, t test, and analysis of variance (ANOVA) were used. The mean age of nurses was 35 ± 3.6. The mean score for the breast cancer risk assessment form was calculated as 82.9 ± 18.7. The subscale scores for the CHBMS for breast cancer screening were as follows: susceptibility 7.3 ± 1.8, seriousness 19.5 ± 4.1, benefits of breast self-exam 15.5 ± 2.6, barriers to breast self-exam 15.1 ± 2.8, self-efficacy 40.3 ± 7.0, and motivation 19.5 ± 4.1. The risk of breast cancer was found to be low in the study group. The analysis of the subscale scores for the CHBMS for breast cancer screening revealed that nurses had a below-average susceptibility perception, a somewhat lower perception of seriousness, an above-average mean score for perceived benefits, a moderate barrier perception, a relatively high perceived self-efficacy, and motivation above average.

Result of randomized control trial to increase breast health awareness among young females in Malaysia

Background

Breast cancer is the most common cancer and the second principal cause of cancer deaths in women worldwide as well as in Malaysia. Breast self-examination (BSE) has a role in raising breast cancer awareness among women and educational programs play an important role in breast cancer preventive behavior. The aim of this study is to develop, implement and evaluate the effectiveness of Breast Health Awareness program based on health belief model on knowledge of breast cancer and breast-selfexamination and BSE practice among female students in Malaysia.

Methods

A single-blind randomized controlled trial was carried out among 370 female undergraduate students from January 2011 to April 2012 in two selected public universities in Malaysia. Participants were randomized to either the intervention group or the control group. The educational program was delivered to the intervention group. The outcome measures were assessed at baseline, 6, and 12 months after implementing the health educational program. Chi-square, independent samples t-test and two-way repeated measures ANOVA (GLM) were conducted in the course of the data analyses.

Results

Mean scores of knowledge on breast cancer (p<0.003), knowledge on breast self examination (p<0.001), benefits of BSE (p<0.00), barrier of BSE (0.01) and confidence of BSE practice (p<0.00) in the intervention group had significant differences in comparison with those of the control group 6 and 12 months after the intervention. Also, among those who never practiced BSE at baseline, frequency of BSE practice increased 6 and 12 months after the intervention (p<0.05).

Conclusion

The Breast Health Awareness program based on health the belief model had a positive effect on knowledge of breast cancer and breast self-examination and practice of BSE among females in Malaysia.

Trial registration

The ANZCTR clinical trial registry (ACTRN12616000831482), retrospectively registered on Jun 23, 2016 in ANZCTR.org.au.

Assessment of the effects of breast cancer training on women between the ages of 50 and 70 in Kemalpasa, Turkey

BACKGROUND

In both developed and developing countries; breast cancer is the major cancer observed in women. The aim of this study was to assess the effect of nursing and mammographic intervention on women with breast cancer between the ages of 50 and 70.

MATERIALS AND METHODS

A training program, which was quasi- experimental and had a pretest-protest design, was applied in Kemalpas?a district of Izmir, between October 2008 and August 2010. The target population was women between the ages of 50 and 70, who were registered in the list of 3rd Family Medicine Unit in Izmir's Kemalpas?a metropolis. A total of 106 women who were in conformity with the study criteria participated in the study. Research data were collected through home visits that included face-to-face interviews; Ministry of Health education material and video films were modified and used for the training. Data analysis was performed through 82 women who were paired at the first and the second phase.

RESULTS

It was observed that although the rate of breast self examination significantly increased after the training (p=0.022), the rate of clinical breast examination (p=0.122) and mammographic screening (p=0.523) did not. Differences in the stages of change after training were found to be statistically significant (p<0.001) and the group showed a progression in the stages of change in general (46.3%). In women mean scores of breast cancer awareness (p<0.000), severity (p<0.000), health motivation (p<0.000) and perception of the benefits of mammography (p<0.000) increased significantly and mean score of perception of mammography barriers decreased significantly (p<0.000) after the training.

CONCLUSIONS

After the training on breast cancer and mammography it was determined that nursing interventions provided positive progression of stages of change of women, affected health beliefs positively and significantly increased BSE incidences. However, it did not have a significant effect on CBE and mammographic screening.

Awareness, Attitude, and Practice of Breast Cancer Screening Women, and the Associated Socio-Demographic Characteristics, in Northern Iran

Background:

Breast cancer is the most common malignancy among women, with a high rate of mortality. The burden of disease and its serious outcome could be prevented by early detection.

Objectives:

Thus, the objective of this study was investigation the awareness, attitude and practice of breast cancer screening women.

Patients and Methods:

This cross-sectional study has conducted on 500 representative samples of women aged 20 - 65 years who referred to urban area of Babol health centers in 2012. The data have collected with standard questionnaire. The demographic data, the knowledge of risk factors and symptoms and sign, the health belief, and the practice of women in breast cancer screening have collected by interview.

Results:

The results show that only 14.8% of participants had a high level of knowledge for breast cancer risk factors and 33.8% at high level of awareness of symptoms and signs. The level of awareness has significantly associated with higher age (P = 0.03) and higher educational level (P = 0.04). Only 10.2% and 8.4% of women have performed breast self- examination (BSE) monthly and breast clinical examination (BCE) annually respectively. The practice of women with BSE has significantly associated with aging (P = 0.005), higher educational level (P = 0.007), higher knowledge (P = 0.001) and positive attitude toward perceived benefits and confidence and health motivation (P = 0.001).

Conclusions:

The low level of awareness and practice of breast cancer screening have found in this study, emphasized an extension of framework health educational program, particularly in younger and low educated women.

Female breast cancer mortality rates in Turkey

The main objective of this study was to analyze the mortality trends of female breast cancer in Turkey between the years 1987-2008. The rates per 100,000 age-standardized to the European standard population were assessed and time trends presented using joinpoint regression analysis. Average annual percent change (AAPC), anual percent change (APC) and 95% confidence interval (CI) was calculated. Nearly 23,000 breast cancer deaths occurred in Turkey during the period 1987-2008, with the average annual age-standardized mortality rate (ASR) being 11.9 per 100,000 women. In the last five years, significant increases were observed in all age groups, but there was no significant change over the age of 65. In this period, the biggest significant increase was in the 45-54 age group (AAPC=4.3, 95%CI=2.6 to 6.0).

Breast cancer risk and early diagnosis applications in Turkish women aged 50 and over

BACKGROUND

The aim of the study was to determine breast cancer risk and early diagnosis applications in women aged ≥50.

MATERIALS AND METHODS

This cross-sectional, descriptive field study focused on a population of 4,815 in Mansurog?lu with a 55.1% participation rate in screening. In the study, body mass index (BMI) was also evaluated in the calculation of breast cancer risk by the Breast Cancer Risk Assessment Tool (BCRA) (also called the "Gail Risk Assessment Tool") . The interviewers had a three-hour training provided by the researchers, during which interactive training methods were used and applications were supported with role-plays.

RESULTS

The mean age of the women participating in the study was 60.1±8.80. Of these women, 57.3% were in the 50-59 age group, 71.7% were married, 57.3% were primary school graduates and 61.7% were housewives. Breast-cancer development rate was 7.4% in the women participating in the study. When they were evaluated according to their relationship with those with breast cancer, it was determined that 73.0% of them had first- degree relatives with breast cancer. According to the assessment based on the Gail method, the women's breast cancer development risk within the next 5 years was 17.6%, whereas their calculated lifetime risk was found to be as low as 0.2%. Statistically significant differences (P=0.000) were determined between performing BSE - CBE and socio-demographic factors.

CONCLUSIONS

It was determined that 17.6% of the participants had breast cancer risk. There was no statistically significant difference between the women with and without breast cancer risk in terms of early diagnosis practices, which can be regarded as a remarkable finding. It was planned to provide training about the early diagnosis and treatment of breast cancer for people with high-risk scores, and to conduct population-based breast cancer screening programs.

Jordanian women's personal practices regarding prevention and early detection of breast cancer

BACKGROUND

Breast cancer, as a leading cause of mortality, is responsible for 12.5% of all deaths in Jordan.

OBJECTIVES

The aim of this study was to describe Jordanian women's personal practices and perceptions of breast cancer screening tests.

METHODS

A quantitative cross-sectional survey using a proportionate stratified sample of 331 women was conducted. The target population includes all Jordanian women living in high- and low-density neighborhoods. The population involved women from the 12 governorates areas.

RESULTS

Perception of susceptibility, confidence in performing breast self-examination (BSE) barriers of the group that had previously performed BSE were significantly higher than those who did not practice (t = 8.38, p = .02; t = 9.90, p = .00; t = -0.98, p = .01, respectively).

CONCLUSION

The results of this study provide information to policy makers and healthcare leaders who seek to improve breast cancer prevention and response to cancer control efforts.

Breast Cancer Risks and Effectiveness of BSE Training among Women Living in a District of İstanbul

OBJECTIVE

The purpose of this study to determine the risks associated with breast cancer in women who live in a neighborhood in Istanbul, and to evaluate the effectiveness of breast self-examination (BSE) training.

MATERIALS AND METHODS

This study was designed by using a half-experimental model, with women over the age of 18 who visited the community health center in a district of Istanbul, during March/April 2012. Sample selection was not implemented, and 169 women who voluntarily participated in the study were included. Data was collected by face-to-face interview technique with "Demographic Survey Form", "Breast Cancer Risk Assessment Form" and "BSE Training Assessment Scale". After risk assessment, women who wanted to learn BSE (n=109) were given a practical training program lasting approximately 20 minutes that was prepared together with expert consults.

RESULTS

32.1% of the participants regularly performed BSE. Out of those who do not use regular self-examination, 15.4% thought BSE was unnecessary, 44% was afraid to examine herself, and 40.7% did not know how to apply BSE. The mean breast cancer risk score was 135.64±61.33. There were statistically significant differences between breast cancer risk score and the educational status, marital status, and menstrual status. A statistically significant difference was found in pre- and post-training BSE Training Assessment Scale scores.

CONCLUSION

The breast cancer risk score was low among women included in this study. However, the vast majority of women did not perform BSE, and those who did were using either irregular or improper practice. It was detected that implementation of planned and in-person training programs were quite effective.

Turkish translation and adaptation of Champion's Health Belief Model Scales for breast cancer mammography screening

AIMS AND OBJECTIVES

To examine the translation and adaptation process from English to Turkish and the validity and reliability of the Champion's Health Belief Model Scales for Mammography Screening. Its aim (1) is to provide data about and (2) to assess Turkish women's attitudes and behaviours towards mammography.

BACKGROUND

The proportion of women who have mammography is lower in Turkey. The Champion's Health Belief Model Scales for Mammography Screening-Turkish version can be helpful to determine Turkish women's health beliefs, particularly about mammography.

DESIGN

Cross-sectional design was used to collect survey data from Turkish women: classical measurement method.

METHODS

The Champion's Health Belief Model Scales for Mammography Screening was translated from English to Turkish. Again, it was back translated into English. Later, the meaning and clarity of the scale items were evaluated by a bilingual group representing the culture of the target population. Finally, the tool was evaluated by two bilingual professional researchers in terms of content validity, translation validity and psychometric estimates of the validity and reliability. The analysis included a total of 209 Turkish women. The validity of the scale was confirmed by confirmatory factor analysis and criterion-related validity testing.

RESULTS

The Champion's Health Belief Model Scales for Mammography Screening aligned to four factors that were coherent and relatively independent of each other. There was a statistically significant relationship among all of the subscale items: the positive and high correlation of the total item test score and high Cronbach's α. The scale has a strong stability over time: the Champion's Health Belief Model Scales for Mammography Screening demonstrated acceptable preliminary values of reliability and validity.

CONCLUSION

The Champion's Health Belief Model Scales for Mammography Screening is both a reliable and valid instrument that can be useful in measuring the health beliefs of Turkish women.

RELEVANCE TO CLINICAL PRACTICE

It can be used to provide data about healthcare practices required for mammography screening and breast cancer prevention. This scale will show nurses that nursing intervention planning is essential for increasing Turkish women's participation in mammography screening.

Adherence to recommended breast cancer screening in Iranian turkmen women: the role of knowledge and beliefs

The aim of the current study was to investigate breast cancer screening performance among Iranian Turkmen women along with their knowledge and beliefs. A cross-sectional study was carried out in June to December 2011. Through clustered sampling method, 1080 Iranian Turkmen women completed the questionnaire including breast cancer screening adherence, knowledge, fatalism beliefs, and perceived threat using Champions Health Belief Model Scale (CHBMS).The mean age of the participants was 43.04 (SD = 11.80) years. Compliance rate in a regular basis based on national guidelines was 13.1%, 2.5%, and 0.9% for SBE, CBE, and mammography, respectively. A mere 4% have been provided adequately with information about breast cancer. Having knowledge was the best predictor of breast cancer screening adherence along with high educated husbands for SBE performing. Susceptibility and fatalism were low and were influenced by participants' educational level and age. In conclusion, Iranian Turkmen women had insufficient knowledge, low perceived susceptibility, high fatalistic belief, and very poor adherence to breast cancer screening. There is a need for providing breast cancer education programs among the Iranian Turkmen women to increase their adherence rate.

Health beliefs and practice of breast self-examination among young Cypriot women

PURPOSE

Breast cancer is the leading form of cancer affecting Cypriot women. This study is aimed at examining the factors influencing the choice of Cypriot women to perform breast self-examination (BSE).

DESIGN

A cross-sectional, descriptive, and correlational study, with a sample of 94 young Cypriot women, was conducted.

METHOD

The Greek version of Champion's Health Belief Model was used. Various statistical tests were implemented.

FINDINGS

Almost all women (91.5%) had heard about BSE, and 71.3% had performed it sometime in the past. The susceptibility factor was significant in influencing women's behavior, while barriers and self-confidence were associated with practicing BSE. Knowledge on BSE and a high level of education were positively related with the frequency of practicing BSE.

CONCLUSIONS

Proper education on BSE is important in shaping young women's attitudes. Any related health strategy should consider the concepts of Health Belief Model, especially the factors that make a female susceptible to breast cancer.

Sociodemographic determinants of nonattendance in a population-based mammography screening program in the city of Manisa, Turkey

Objectives. Community based breast cancer screening has decreased breast cancer mortality in women. This study examined the predictors of nonattendence for invitational breast cancer screening in relation to socioeconomic status in the city of Manisa, in western Turkey. Study Design. For the evaluation of the reasons for refusing to participate in the study, two districts were selected. 446 women aged between 50 and 69 years were selected from the program database by systematic random sampling. Methods. The questionnaire consisted of sociodemographic variables and the adapted version of Champion's Health Belief Model Scale. Univariete and multivariete logistic regression analysis were performed throughout the data analysis. Results. Being from an urban district and being from the western region were the risk factors for not participating in the screening program (P = 0.014, P = 0.023). A statistical significance was found between mammography-benefit, mammography-barrier and program participation (P = 0.044, P = 0.006). Although there were many more barriers for not participating in the screening program for the women of the slum district, the attendence rate of the slum district was higher than that of the urban district. Conclusions. Increased attendance may be achieved through enhancement of breast cancer awareness and by reducing some of the modifiable barriers.

Health Beliefs Concerning Breast Self-examination of Nurses in Turkey

PURPOSE

The purpose of the study was to evaluate the health beliefs regarding breast self-examination (BSE) and their relationship with age, educational status and history of breast cancer in the family among nurses working in a university hospital.

METHODS

A cross-sectional design was used, with a convenience sample of 381 nurses at a military university hospital in Ankara in Turkey. Data were collected by using a personal data form and the Champion's Health Belief Model Scale. Descriptive statistics, logistic regression, Mann-Whitney U test and Kruskal Wallis Test were conducted.

RESULTS

The proportion of nurses reported doing BSE regularly is 47.2%. Controlling variables such as age, body mass index, the age at first birth, breast cancer in the family history and educational background, we found that the subscales of the health belief model, BSE benefit (OR = 0.782), self-efficacy (OR = 0.919), and risk perception (OR = 0.114) have statistically significant effects on the risk of not making BSE.

CONCLUSION

It is important to be aware of the health beliefs of nurses regarding BSE so that their own health can be protected and improved. Beneficial attitudes and behaviors of nurses regarding BSE will enable them to provide more effective services to women regarding breast cancer. Understanding the nurses' health beliefs, attitude and behavior that are influential to make BSE will guide nursing practices towards early diagnosis of breast cancer at the societal level.

Barriers and opportunities for early detection of breast cancer in Gaza women

A survey of 100 women living inside Gaza (WIG) and 55 Gaza women residing outside Gaza (WOG) was conducted to investigate barriers and opportunities for breast cancer screening, and to better understand possible differences based on residency. The survey found that over 90% of both groups were willing to undergo a diagnostic mammogram for a breast complaint and 86% of WIG and 85% of WOG believed survival was increased with early detection. However, only 27% of WIG and 50% WOG were willing to undergo screening mammography. Religion and culture were not barriers to mammography for over 94% of WIG and 98% of WOG. Limited resources and lack of access to medical facilities were identified as barriers in up to 55% of WIG compared to 15% of WOG. Misconceptions about breast cancer were reported more frequently by WIG, including beliefs that breast cancer is not very common and that breast cancer can be contagious.

Health Belief Model Scale for Cervical Cancer and Pap Smear Test: psychometric testing

AIM

This study is a report of the development and psychometric testing of the Health Belief Model Scale for Cervical Cancer and the Pap Smear Test.

BACKGROUND

While the Champion Health Belief Model scales have been tested extensively for breast cancer and screening for this, evaluation of these scales in explaining the beliefs of women with regard to cervical cancer and the Pap Smear Test has only received limited attention.

METHODS

This methodological research was carried out in Turkey in 2007. The data were collected with 237 randomly selected women who met the criteria for inclusion and agreed to participate in this study. The Champion Health Belief Model scales were translated into Turkish, adapted for cervical cancer, validated by professional experts, translated back into English and pilot-tested.

FINDINGS

Factor analysis yielded five factors: Pap smear benefits and health motivation, Pap smear barriers, seriousness, susceptibility and health motivation. Cronbach's alpha reliability coefficients for the five subscales ranged from 0·62 to 0·86, and test-retest reliability coefficients ranged from 0·79 to 0·87 for the subscales.

CONCLUSION

The Health Belief Model Scale for Cervical Cancer and the Pap Smear Test was found to be a valid and reliable tool in assessing the women's health beliefs. Understanding the beliefs of women in respect of cervical cancer and the Pap Smear Test will help healthcare professionals to develop more effective cervical cancer screening programmes.

Current knowledge, attitudes and practices of women on breast cancer and mammography at Mulago Hospital

BACKGROUND

Breast cancer is the third commonest cancer in Ugandan women. Women present late for breast cancer management which leads to high mortality rates. The objective of the study was to assess the knowledge, attitudes and practices of Ugandan women concerning breast cancer and mammography.

METHODS

This was a descriptive cross-sectional study where 100 women reporting to the Radiology department were interviewed. We used consecutive sampling. Interviewer-administered questionnaires were used to collect opinions of the participants. For data analysis, answers were described as knowledge, attitude, practice and they were correlated with control variables through the chi-square. Bivariate and logistic regression analyses were also used.

RESULTS

Most of the women (71%) had no idea about mammography. More than 50% did not know about risk factors for breast cancer. The attitude towards mammography was generally negative. Regarding seeking for mammography; level of literacy, occupation and marital status were significant on bivariate analysis, however only level of literacy and employment remained the significant independent variables on logistic regression analysis. The main barrier to mammography was mainly lack of information.

CONCLUSION

Women in this study had inadequate knowledge and inappropriate practice related to mammography as a procedure for breast cancer investigation.

The validity and reliability of Champion's Health Belief Model Scale for breast cancer screening behaviors among Iranian women

Breast cancer is a global issue that continues to be the most diagnosed cancer in women. The incidence of breast cancer is increasing, and the incidence age for Iranian women is at least 10 years earlier than in western countries. Beliefs related to breast cancer have been found to be a factor in a woman's decision about breast screening behavior, and a valid and reliable questionnaire is necessary to the development of education interventions in this area. The aim of the current study was to translate the Champion Health Belief Model Scale to Farsi and to examine the psychometric properties of the Farsi version. A random sample of 606 employed women (20-69 years old) from Sanandaj, Iran, participated in the study. Construct validity of the Farsi version was supported through factor analysis. Nine factors emerged for breast self-examination (2 barriers factors, 2 benefits factors, 2 confidence factors, and 1 factor each related to seriousness, motivation, and susceptibly) and 6 factors related to mammography (barriers, seriousness, susceptibly, benefits, and 2 motivation factors). All items loaded on their respective factors except 1 item. It was concluded that the Farsi version of the Champion Health Belief Model Scale has the potential to measure beliefs related to breast self-examination and mammography with Iranian women. Further evaluation of the measure with different populations is warranted.

Hepatitis B screening in the Turkish-Dutch population in Rotterdam, the Netherlands; qualitative assessment of socio-cultural determinants

Background

Hepatitis B is an important health problem in the Turkish community in the Netherlands. Increased voluntary screening is necessary in this community, to detect individuals eligible for treatment and to prevent further transmission of the disease.

Methods

We investigated socio-cultural determinants associated with hepatitis B screening in male and female, first and second generation Turkish migrants, by means of Focus Group Discussions.

Results

Socio-cultural themes related to hepatitis B screening were identified; these were social norm, social support, sensitivity regarding sexuality, reputation, responsiveness to authority, religious responsibility, cleanliness and religious doctrine regarding health and disease, and the perceived efficacy of Dutch health care services. Motivating factors were the (religious) responsibility for one's health, the perceived obligation when being invited for screening, and social support to get tested for hepatitis B. Perceived barriers were the association of hepatitis B screening with STDs or sexual activity, the perception of low control over one's health, and the perceived low efficacy of the Dutch health care services. Reputation could act as either a motivator or barrier.

Conclusion

This study identified relevant socio-cultural themes related to hepatitis B screening, which may serve to customize interventions aimed at the promotion of voluntary hepatitis B screening in the Turkish-Dutch population in the Netherlands.

The knowledge and practice of breast self-examination among healthcare workers in Kayseri, Turkey

Breast cancer is the most common cancer type and cause of death among women in many countries. Monthly breast self-examination (BSE) is an effective diagnostic method for breast cancer. This study aimed to determine the knowledge level and practice frequency of BSE among healthcare workers in Kayseri, Turkey. Data were collected via a questionnaire that was prepared based on information in the literature. The questionnaire was composed of 2 sections: sociodemographic characteristics and practice and knowledge related to BSE. The sample group included 246 healthcare workers. Mann-Whitney U, Kruskal-Wallis H, (post hoc) Dunn, and chi tests were used in the analyses of data. The mean (SD) age of the respondents was 29.0 (5.6) years. Most (58.1%) were married, and a family history of breast cancer was reported by 12.2%. Of the respondents, 35% stated that they did not know how to conduct an examination of their breasts. Although 52.4% (n = 129) of the women reported that they performed BSE, only 17.0% (n = 22) reported doing so on a monthly basis. The practice of BSE was significantly associated with older, more educated medical secretaries; a positive personal history of breast problems; and a positive family history of breast cancer (P < .05). Healthcare workers had a low mean level of knowledge about the practice of BSE (mean [SD] score, 11.70 [10.07]; range, 0-40). The scores of the women who stated that they practiced BSE were significantly higher (P = .000) than those who reported that they did not. Healthcare workers need to improve their knowledge of and sensitivity toward BSE.

What factors affect influenza vaccine uptake among community-dwelling older Chinese people in Hong Kong general outpatient clinics?

AIM

This study aimed to identify the influenza vaccination rate among community-dwelling older Chinese people in Hong Kong general outpatient clinics and to identify the factors affecting their vaccine uptake.

BACKGROUND

Community-dwelling older Chinese people in Hong Kong underuse influenza vaccination. The first step to increase their vaccination rates is to understand the factors affecting their influenza vaccine uptake.

DESIGN

This was a retrospective and descriptive study.

METHODS

The sample comprised 197 subjects from five general outpatient clinics in the Kowloon East cluster of Hong Kong. A self-report questionnaire was used for data collection via individual face-to-face interviews.

RESULTS

Out of 197 subjects, 64.47% reported having received the vaccine within the previous 12 months. The regression model revealed that perceived benefits including 'vaccination prevents me from catching influenza (OR = 12.18, CI = 3.61-41.07, p < 0.001)', 'If I get vaccinated, I will decrease the frequency of medical consultation (OR = 8.12, CI = 2.70-24.38, p = 0.001)' and 'If I am vaccinated and still get flu, I will not be as sick with it (OR = 0.43, CI = 0.24-0.76, p = 0.004)', perceived barriers, which are 'the side-effects of influenza vaccination interfere with my usual activities (OR = 0.04, CI = 0.01-0.13, p < 0.001)', 'influenza vaccination is painful (OR = 2.73, CI = 1.55-4.81, p = 0.001)' and 'I am scared of needles (OR = 0.43, CI = 0.23-0.79, p = 0.007)' and recommendations from doctors (OR = 14.18, CR = 4.09-49.16, p < 0.001) and families (OR = 3.67, CR = 1.24-10.83, p = 0.019) interactively influenced the subjects' vaccine uptake.

CONCLUSION

Specific benefits and barriers affecting the influenza uptake of community-dwelling older Chinese people in general outpatient clinics have been identified. Specifically, recommendation from families plays a significant role in motivating the uptake of this Chinese ageing group.

RELEVANCE TO CLINICAL PRACTICE

We adopt strategies including personal invitation and reminders of influenza vaccination by doctors and educating doctors, older people and their families on influenza vaccination to increase the uptake of community-dwelling Chinese older people in general outpatient clinics.

Measuring mammography and breast cancer beliefs in African American women

Although intervention trials have demonstrated significant improvement in mammography adherence for African American women, many of the current measurement tools used in these interventions have not been assessed for validity and reliability in ethnic minorities. This study assessed the validity and reliability of Health Belief Model (HBM) variables that are often the target of mammography interventions. Scale validity and reliability was assessed for HBM scales in a sample of 344 low-income African American women. Validity was supported through exploratory factor analysis and theoretical prediction of relationships. Internal consistency reliability was .73 or above for all scales.

Health beliefs and breast self-examination in a sample of Turkish nursing students and their mothers

AIM

To describe health beliefs and breast self-examination practice of Turkish female nursing students and their mothers.

BACKGROUND

Breast cancer is the most frequently diagnosed cancer and the second leading cause of cancer deaths among Turkish women. Breast self-examination is one of the primary methods for early detection of breast cancer in asymptomatic women.

DESIGN

The study was designed as a cross-sectional and comparative survey. The data were obtained from 392 participants, including female nursing students (n = 196) and their mothers (n = 196) in Ankara, Turkey.

METHODS

Data were collected by using a personal data form and the Champion's Health Belief Model Scale. Descriptive statistics, paired samples t-test, chi-square test, reliability analysis, Pearson correlation coefficients and logistic regression analysis were conducted.

RESULTS

The percentage of nursing students who performed breast self-examination regularly was statistically higher than that of their mothers. The scores of health motivation, benefits and confidence were significantly higher in nursing students. The mothers' perceived susceptibility and barriers were significantly higher than their daughters. The frequency of breast self-examination practice was affected by the level of education, the mother's or daughter's monthly performance of breast self-examination and the level of perceived barrier to breast self-examination.

CONCLUSIONS

There were differences in health beliefs related to breast self-examination and its practice between nursing students and their mothers. The results of this study showed that monthly performance of breast self-examination was more common among women who graduated from high school and university, whose mother or daughter performed breast self-examination regularly every month and those with lower levels of perceived barriers.

RELEVANCE TO CLINICAL PRACTICE

It is essential that nurses be aware of the factors that contribute to monthly performance of breast self-examination. Cultural factors should be considered in planning educational programmes about breast self-examination practice. Interventions should be designed to enhance nursing students' proficiency in performing breast self-examination.

Health beliefs and breast cancer screening behaviors among female health workers in Turkey

The purpose of this study was to evaluate health beliefs and breast cancer screening behaviors in female health workers in Turkey. This descriptive study was conducted in various health centers located in Erzurum, Turkey. The sample consisted of 268 female health workers (physicians, n=51; nurses, n=169; and midwives, n=48). Data were collected by using a self-administered questionnaire and the Turkish version of Champion's Health Belief Model Scales (CHBMS). The mean age of participants was 31.31 (S.D.=6.89), and 49.9% of them were married. It was found that only 21.9% of the female health workers performed breast self-examination (BSE) regularly, and 12.5% of them had a mammogram. Physicians' health motivation and BSE self-efficacy perceptions were higher than the nurses and midwives. Susceptibility, health motivation to BSE, BSE benefits, BSE self-efficacy perceptions of female health workers who performed BSE were significantly higher than those who did not, and a result indicating that positive health beliefs are effective in stimulating performance of BSE of female health workers. Among the variables related with mammography, only susceptibility perceptions of female health workers who had a mammogram was significantly higher than those who had not had a mammogram.

Knowledge, Attitudes, and Behaviors of Female Teachers Related to Breast Cancer and Breast Examination in Southern Turkey

SUMMARY: BACKGROUND: The aim of this study was to investigate the knowledge, attitudes, and behaviors of female teachers related to breast cancer in Southern Turkey. MATERIALS AND METHODS: There are almost 5,000 female teachers working in Hatay, Turkey, and we aimed to reach 10% of this population. Our questionnaire consisted of 14 questions about personal information, 14 questions about knowledge related to breast cancer, and 14 questions about attitudes and behaviors of teachers. RESULTS: In all, 490 female teachers participated in the study. The mean age was 34.6 years, and most were married (77.1%). 62.9% of participants reported to have insufficient knowledge about breast cancer. The source of information was newspaper/TV in 84.6%, and medical health care providers in 22.8%. While all of the participants think that early diagnosis of breast cancer is important; 19% think personal hygiene is protective against breast cancer. Among all the participants, 53.7% have never practiced breast self-examination (BSE). Of those who practice BSE; 80.6% practice it as they remember, 12.5% practice it once a month. 38.4% of these learned BSE from a doctor, and 38.0% from TV. The reason for not practicing BSE was underestimation in 46.7% and lack of knowledge in 37.9%. 152 participants had a clinical breast examination (CBE) done, and 145 of these had it done by an expert doctor. A total of 86 participants had undergone mammography, while 67 of the over-40-year-old group had not. CONCLUSION: 3/5 of the female teachers think that they do not have enough knowledge related to breast cancer. More than half of them do not practice BSE, and only 12.5% of them practice BSE regularly.

Health beliefs related to breast self-examination in a sample of Turkish women

PURPOSE/OBJECTIVES

To examine health beliefs and sociodemographic and breast cancer-related variables influencing breast self-examination (BSE) practice.

DESIGN

Descriptive, cross-sectional.

SETTING

Two vocational training centers in Istanbul, Turkey.

SAMPLE

438 women were selected using a convenience sampling method. Participants had not had breast cancer and were not currently pregnant or breast-feeding. The mean age of participants was 33.51 years (range = 18-67).

METHODS

Willing participants were asked to complete a self-administered questionnaire and the Turkish version of Champion's Health Belief Model Scale. The sample was categorized into two groups: performers (i.e., women who performed BSE at least occasionally) and non-performers (i.e., women who had never performed BSE).

MAIN RESEARCH VARIABLES

Perceived susceptibility to and seriousness of breast cancer, perceived benefits of and barriers to BSE, confidence in the ability to perform BSE, health motivation, and frequency of BSE practice.

FINDINGS

Significant differences between performers and non-performers correlated to age, marital status, health insurance, regular gynecologic visits, and education about breast cancer and BSE. The mean scores of perceived benefits and confidence were noticeably higher in performers. Stepwise logistic regression analysis yielded three significant predictor variables.

CONCLUSIONS

Women who had more confidence in their ability to perform BSE, had health insurance, and were informed about breast cancer were more likely to practice BSE.

IMPLICATIONS FOR NURSING

Women in Turkey are at great risk for advanced breast cancer and metastatic spread because of their lack of knowledge. Nurses must provide information on breast cancer etiology, risks, prevention, and detection. To promote BSE practice among Turkish women, tailored health education and health promotion programs should be developed based on a specific understanding of women's health beliefs.

Reliability and Validity of the Champion's Health Belief Model Scale among Lithuanian Women

The rates of incidence and mortality of breast cancer in Lithuania are increasing and, although a mammography screening program is present, attendance rate is rather low. The aim of this study was to assess the reliability and validity of the revised Champion's Health Belief Model Scale in measuring Lithuanian women's beliefs about breast cancer and screening. The data were collected from 350 female citizens 40 to 69 years old living in the urban district, and having no history of breast cancer and no mammogram in the past. The Champion's Health Belief Model Scale was translated to Lithuanian, validated by professional judges, back-translated to English, and pretested. Analysis included descriptive statistics of demographic data, content and construct validity, using factorial analysis, internal consistency, reliability estimates, and using the Cronbach alpha technique. Factor analysis yielded 11 factors related to breast self-examination and 7 factors to mammography. All items on each factor were from the same construct. The motivation subscale split into the items related to general concern about health and preventive health practices. Alpha coefficients ranged from.61 to.92. Only the mammography barrier item "having a routine mammogram or x-ray of the breast would make me worry about breast cancer" loaded as a separate factor in factor analysis and showed low correlation with other subscale items. Participants in the mammography group showed lower perceived susceptibility in 3 items and perceived severity in 1 item. They reported having not enough privacy for breast self-examination, and were less confident in their skills to perform it. However, the women in the nonparticipating mammography group showed lower results in one benefit-mammogram item, and had more barriers for mammography in comparison with the participating group. We conclude that the Champion's Health Belief Model Scale is a reliable and valid tool for measuring the screening beliefs toward breast cancer among Lithuanian women. The model gave better results when the motivation items were subdivided into subscales related to general concern about health and related to preventive health practices and were considered separately. Mammography barrier item "having a routine mammogram or x-ray of the breast would make me worry about breast cancer" was deleted from the Lithuanian Champion's Health Belief Model Scale.

Adaptation of Champion's Health Belief Model Scale for Turkish women and evaluation of the selected variables associated with breast self-examination

The purpose of this study was to adapt Champion's Revised Health Belief Model Scale for Turkish women and to examine selected sociodemographic variables associated with breast self-examination (BSE). Data were collected from a total of 430 females who were living in one of the Health Center areas located in Izmir, a city in the west of Turkey. Champion's revised Health Belief Model Scale was translated into Turkish, validated by professional judges, translated back into English, and then tested. Factor analysis yielded 7 factors: susceptibility, seriousness, barrier 1, barrier 2, confidence, benefits, and health motivation. Significant correlations were found between 2 barriers. Therefore, 2 barriers were considered one barrier subscale. All the items on each factor were from the same construct. Cronbach alpha coefficients ranged from .58 to .89, and test-retest reliability coefficients ranged from .89 to .99 for the subscales. Women who received low scores on barriers reported greater frequency of BSE practice. Likewise, women having high scores on confidence, benefits, health motivation, susceptibility, and seriousness reported a greater frequency of BSE in the last year. The frequency of BSE practice was higher in high school and university graduates, women with a family history of breast cancer, and women with breast cancer and BSE training. The Turkish version of Champion's Revised Health Belief Model Scale was found to be a valid and reliable tool for use with Turkish women. It could be used to evaluate health beliefs about breast cancer and BSE among Turkish women.

Factors associated with breast cancer screening behaviours in a sample of Turkish women: a questionnaire survey

The purpose of this descriptive correlational study was to identify breast self-examination (BSE) and mammography rates and to examine variables related to the breast cancer screening behaviours in a sample of Turkish women. Data were collected from a convenience sample of 656 women, attending three health centres and two maternal and health centres, using an adapted version of Champion's revised Health Belief Model Scale. Results showed that 17% of the women reported performing BSE on a regular basis. Women, over the age of 40, 25% reported at least one mammography. Higher susceptibility to breast cancer, higher confidence for BSE, lower barriers to BSE, and having heard/read about breast cancer and BSE were significantly associated with performing BSE. Higher seriousness of breast cancer, higher benefits of having mammography, having heard/read about mammography, and having a gynaecologist as a regular physician were significantly associated with having mammography.