Using the health belief model to predict breast self examination among Saudi women

Breast cancer screening patterns and associated factors in Iranian women over 40 years

Screening is a key component of breast cancer early detection programs that can considerably reduce relevant mortality rates. The purpose of this study was to determine the breast cancer screening behavioral patterns and associated factors in women over 40 years of age. In this descriptive‑analytical cross‑sectional study, 372 over 40 years of age women visiting health centers in Tabriz, Iran, in 2023 were enrolled using cluster sampling. The data were collected using the sociodemographic characteristics questionnaire, breast cancer perception scale, health literacy for Iranian adults scale, and the Breast Cancer Screening Behavior Checklist. The obtained data were analyzed in SPSS version 16 using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (univariate and multivariate logistic regression analyses). In total, 68.3% of all participants performed breast self‑examination (BSE) (9.9% regularly, once per month), 60.2% underwent clinical breast examination (CBE) (8.9% regularly, twice per year), 51.3% underwent mammography (12.3% regularly, once per year), and 36.2% underwent sonography (3.8% regularly, twice per year). The findings also showed that women with benign breast diseases were more likely to undergo CBE (OR = 8.49; 95% CI 2.55 to 28.21; P < 0.001), mammography (OR = 8.84; 95% CI 2.98 to 10; P < 0.001), and sonography (OR = 18.84; 95% CI 6.40 to 53.33; P < 0.001) than others. Participants with low and moderate breast cancer perception scores were more likely to perform BSE than women with high breast cancer perception scores (OR = 2.20; 95% CI 1.21 to 4.00; P = 0.009) and women who had a history of benign breast disease were more likely to perform screening behaviors than others (OR = 2.47; 95% CI 1.27 to 4.80; P = 0.008). Women between the ages of 50 and 59 were more likely to undergo mammography (OR = 2.33; 95% CI 1.29 to 4.77; P = 0.008) and CBE (OR = 2.40; 95% CI 1.347 to 4.20; P = 0.003) than those ≥ 60 years. Given the low participation of women in regular breast cancer screening, it is suggested that health care providers highlight the need for screening at the specified intervals in their training programs. In addition, health authorities are recommended to use reminder systems to remind women, especially those over 40 years of age, of the best time for breast screening. Moreover, health care providers must seek to improve breast cancer knowledge, attitudes, and perceptions of women who visit health centers, which are the first level of contact with the healthcare system for the general population.

Practice of breast self-examination and associated factors among women of reproductive age in the North Shoa Zone, Oromia, Ethiopia, 2022: a convergent mixed-methods study

OBJECTIVE

To assess practice of breast self-examination (BSE) and associated factors among women of reproductive age in the North Shoa Zone, Oromia, Ethiopia.

DESIGN

Community-based cross-sectional study with a convergent mixed-methods approach.

SETTING

The study was conducted in the North Shoa Zone of Oromia, Central Ethiopia, between 1 May 2022 and 30 June 2022.

PARTICIPANTS

1076 women of reproductive age were selected using simple random sampling technique for the quantitative study. For the qualitative part, a total of 46 women were approached purposively to elicit rich ideas and insight into the issue. The quantitative data were collected using an interviewer-administered questionnaire, and focus group discussions were used for the qualitative part. Quantitative data were analysed using SPSS V.26. An adjusted OR with a 95% CI was employed. Thematic analysis approach was applied for the qualitative data analysis.

OUTCOME MEASURES

Participants were interviewed to respond whether they practised BSE.

RESULTS

Overall, 192 (18.2%; 15.7%-20.5%) of the participants had ever performed BSE. Having a family history of breast cancer (BC) (adjusted OR (AOR)=6.9, 95% CI 4.6 to 10.3), being knowledgeable on BSE (AOR=3, 95% CI 1.9 to 4.3), having high perceived susceptibility (AOR=1.7, 95% CI 1.2 to 2.5), having high self-efficacy (AOR=1.5, 95% CI 1.1 to 2.3) and having a high perceived benefit to BSE (AOR=1.5, 95% CI 1.1 to 2.3) were significantly associated with increased odds of BSE practice.Four main themes emerged from the qualitative analysis: BC and BSE-related knowledge, perceived benefits of treatment, barriers to BSE practice and enablers of BSE practice.

CONCLUSION

The practice of BSE in this area was considerably low. The North Shoa Zonal Health Office and other stakeholders should disseminate instructional materials that cover the techniques and benefits of regularly performing BSE. Healthcare professionals should engage in the community to address the obstacles women face in practising BSE.

Exploring enablers and barriers to breast self-examination among women in the North Shewa Zone, Oromia, Ethiopia: a qualitative study

Breast cancer (BC) is the leading cause of cancer death worldwide and the second most common cancer overall. Breast self-examination (BSE) is one of the cheapest methods used for the early detection of BC in asymptomatic women. More than 90% of cases of BC can be detected by women themselves. This reality stresses the importance of BSE as the key BC detection mechanism. However, in Ethiopia, most of the BE studies were not conducted among women in the general population. Therefore, this study aimed to explore enablers and barriers to breast self-examination among women in the North Shewa Zone, Oromia. A descriptive qualitative study design was conducted from August 1, 2022, to September 30, 2022. Five focus group discussions (FGDs) were conducted with 46 women from one selected district in the North Shewa Zone, Oromia. A Purposive sampling technique was used to select participants for FGD. The audio-recorded data were transcribed verbatim to "Afan Oromo". Transcribed data were translated into English. The data were manually coded into themes and analyzed manually by using inductive thematic analysis. The findings of the study were discussed under five themes of enablers and three themes of barriers. The five themes of enablers were knowledge about BC, knowledge about BSE, experience of BSE practice, perceived susceptibility, and perceived benefit of BSE practice. The four themes of barriers were low knowledge of BSE practice, misconceptions about BSE practice, and fear of detecting BC. These findings suggest that targeted health education programs, collaboration between healthcare providers and local stakeholders, and the availability of support services can play a crucial role in overcoming barriers and encouraging BSE practice for early detection of breast abnormalities.

Breast Self-Examination Practice and Its Determinants among Women in Indonesia: A Systematic Review, Meta-Analysis, and Meta-Regression

Breast cancer (BC) is a heavy burden for Indonesian healthcare, but there is still no thorough evaluation for Breast self-examination (BSE) practice as routine BC screening. In this study, we aimed to synthesize the pooled prevalence data of BSE practice, compare BSE practice prevalence between Java Island and non-Java Islands in Indonesia, and identify the determinants that we thought could affect the BSE practice in the Indonesian population. Intensive searches were conducted in Cochrane Library, PubMed, Google Scholar, and SINTA (Indonesian Web of Science and Technology Index) from September 2017-2022. We utilized Review Manager 5.4 for conducting the meta-analysis. We found the overall national prevalence of BSE practice was 43.14% (95% CI: 36.08, 50.20, p < 0.00001). BSE practice in Java Island was higher compared to non-Java Island (44.58% vs. 41.62%). The highest prevalence of BSE practice was found among university students, with a 49.90% prevalence. Good knowledge, good attitude toward BSE, family history of BC, family support, and BC information exposure were all statistically associated with a higher determinant of BSE practice. We concluded that BSE practice in Indonesia is still low, especially in non-Java Islands. Integrative and collaborative programs should be established to promote BSE as routine screening for BC.

Validation of an Eastern Armenian breast cancer health belief survey

With the fourth highest breast cancer mortality rate in the world, breast cancer prevention and early detection is a priority for Armenia. The Ministry of Health recently initiated efforts to expand access to breast cancer screening. However, little is known about the population's understanding and perception of breast cancer screening programs. This cross-sectional telephone-based study sought to develop and validate an Eastern Armenian language version of the Champion's Health Belief Model Scale (CHBMS) for future use. The English-language CHBMS survey was first rigorously translated by two Armenian nationals and evaluated for face validity. Telephone surveys were then administered to randomly-selected women of approximately screening age (35-65 years) with no prior history of breast cancer living in Armenia's capital between 2019-2020 (n = 103). The translated survey's psychometric properties were evaluated, examining (1) content equivalence, (2) test-retest reliability and (3) internal consistency. Content equivalence and test-retest reliability of the Armenian CHBMS were characterized using correlational analysis with Pearson's coefficient ranging from 0.76-0.97 (p<0.001) and 0.72-0.97 (p<0.001), respectively, for all five CHBMS domains. The translated survey's internal consistency was comparable to the original English-language CHBMS with a Cronbach's alpha greater than 0.7 for all five domains (0.75-0.94 (p<0.001). The translated Eastern Armenian version of CHBMS is a valid, internally-consistent, and reliable research tool that is ready for imminent use among screening-age women to investigate breast cancer perceptions and beliefs as the Armenian government seeks to expand screening access.

Prediction of Breast Self-Examination Behavior Among Omani Undergraduate Students Using Champion's Health Belief Model

Introduction

Breast cancer (BC) is a most common and frequently occurring malignancy of women worldwide. Breast self-examination (BSE) is important for the early detection and prevention of BC and to limit the morbidity and mortality. Young students are ideal people to understand and motivate other women to perform BSE.

Objective

BSE behavior of undergraduate students was predicted using Champion's Health Belief Model Scale (CHBMS).

Methods

A descriptive cross-sectional design was adopted. This study was conducted in all nine colleges of Sultan Qaboos University, , Oman. Three-hundred eighty-one female undergraduate students were selected through convenient sampling technique. The health belief towards BSE was predicted using CHBMS.

Results

The mean and SD of beliefs about the benefits of performing BSE showed 10.84 and 3.2, respectively. Mean and SD of confidence in performing BSE indicated 56.24 and 10.8. Likewise, the mean and SD of barriers in performing BSE are 13.58 and 4.2. Source of information is found to be a statistically significant predictor of barrier in performing BSE at p < .05.

Conclusion

If the self- confidence of women in performing BSE improves, the women will uptake BSE more frequently thereby they can be prevented from developing the adverse consequences of advanced stages of breast cancer.

Determine knowledge and belief of Somalian young women about breast cancer and breast self-examination with champion health belief model: a cross-sectional study

BACKGROUND

Breast cancer (BC) is an important reason for mortality rates in Somalian women. In Somalia, many women are late in applying to the hospital for the diagnosis of BC. Breast self-examination (BSE) is considered an important early detection method for BC in encouraging women to learn to practice BSE, especially for women in developing countries. This study purposed to determine knowledge, and belief of BC and BSE and BSE practice among women in Mogadishu, Somalia using the champion health belief model (CHBM).

METHODS

This cross-sectional study was conducted on 413 women who were between 18 and 49 years of age. The data were collected by using sociodemographic variables (age, marital status, education level, income status), Champion's Health Belief Model Scale (CHBMS), and an introductory questionnaire with questions about BC and BSE and between October 2020 and January 2021 in Mogadishu, Somalia. Further descriptive statistics, the Mann-Whitney U test, and Kruskal-Wallis analysis test were used to assess data that were not normally distributed.

RESULTS

Average age of participants was 22 ± 11.21 years. Only 35.4% of participants had information about BC, 37.8% had heard about BSE before, 25.2% knew BSE, and only 17.2% had done it. Income status, marital status, and age of first birth family were significantly associated with perceived sensitivity, health motivation, convenience, perceived benefits, and self-efficacy for BSE. Overall, the total scores of CHBMS were significantly higher among those who had heard and knowledge about BSE and practiced clinical breast examination (CBE). For the sub-dimensions of perceived sensitivity, health motivation, perceived benefits, barrier, and self-efficacy BSE with hearing about BSE, practicing BSE, knowing to practice BSE, knowing early detection methods of BC and practice CBE significant differences were observed (P < 0.005).

CONCLUSION

This study showed that BSE practice among Somalian women was very low, and they don't have sufficient knowledge about BSE and BC. Furthermore, this study revealed that many CHBMS significantly related to BSE practice in Somalian women, suggesting that BSE health education programs with CHBMS.

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.

Breast Self-Examination: Knowledge, Practice, and Beliefs Among Females in Jordan

Introduction

Worldwide, breast cancer is one of the most common types of cancer. It is the leading cause of cancer-related deaths among females in Jordan.

Objectives

The current study aimed to evaluate breast cancer knowledge levels and practice and assess health beliefs regarding the model supporting self-breast examination (BSE) in a group of females aged between 20 and 60 in Jordan.

Methods

Descriptive, cross-sectional, correlational design was used; Two hundred females participated in the study, employing convenient sampling. The adjusted version of the Champion's Health Belief Model Scale (CHBMS) was utilized to collect the data.

Results

Most participants were married (F = 128, 64%), and the mean of the participants' age was (36.18, SD = 10.87). About 73 participants (36.5%) don't practice BSE; however, 53 participants (26.5%) plan to practice BSE in the future monthly. The logistic regression model showed that the impact of confidence as positive predictive value on practicing BSE in the last year (B = 0.141, p < .001) and this year (B = 0.130, p < .001) was statistically significant.

Conclusion

Implications for practice include identifying culturally specific barriers and improving health education programs to trigger breast self-examination utilization.

An examination of variables associated with breast cancer early detection behaviors of women

Background

Breast cancer is a worldwide common public health problem, and it is quite important to know the factors preventing the early detection behaviors to fight against it.

Objective

The aim of the study was to examine the effect of some sociodemographic variables associated with women's breast cancer detection behaviors and their breast cancer knowledge and fear levels.

Methods

The cross-sectional study was conducted with 363 women aged 40-69 who had presented to Cancer Early Diagnosis and Education Centers (CEDEC).

Results

The average age of women is 54.8±7.1. The mean score of breast cancer knowledge (CBCKT) was found as 10.72±2.34, and the breast cancer fear score was found as 27.6±6.5. The percentage of women who regularly breast self-examination (BSE) was 17.4%, clinical breast examination (CBE) was 13.5% and mammography was 42.7%. BSE and having a higher education correlated 6.25-fold. A 6.5-fold correlation was found between BSE and having a family history of breast cancer, and a 6.24-fold correlation between BSE and having information about breast cancer. In CBE, the related variables that affected women receiving information 4.42 times and going to CEDEC 5.3 times. It was found that employment (4.58) of women affected the mammography detection behavior mostly. While women's CBCKT score affected BSE behavior 1.16 times, fear of breast cancer was a variable that affected mammography behavior 2.1 times. It was determined that high CBCKT scores of women increased BSE behaviors 1.16 times, and high breast cancer fear scores increased mammography behavior 2.1 times.

Conclusions

Early detection practices of women are not sufficient in our study. An increase in the knowledge level of women and consideration of the variables determined to be effective in early detection behaviors will allow increasing detection behavior.

Breast cancer knowledge among health professionals: A pre-post-knowledge-based intervention study

Introduction

Breast-cancer-related morbidity and mortality can be reduced by following worldwide-accepted screening guidelines and by appropriate education and training of health professionals on risk identification and screening. The study aimed to determine the significance of educational sessions in improving health professionals' knowledge about breast cancer, particularly screening modalities that can benefit the patients.

Method and Materials

An interventional study was conducted among 260 health professionals, including medical students, nurses, and allied health professionals. The intervention was an educational session on breast cancer risks and screening guidelines. Health professionals' knowledge about breast cancer risk, presentation, and screening were tested by a structured questionnaire before and after the educational session. Data were analyzed using Statistical Package for the Social Sciences 26. Chi-square was used to identify differences in pre and post-test. P value was considered significant at <0.05.

Results

There is a significant difference between pre-session and post-session responses in all areas of knowledge about breast cancer, with much improved outcomes after the educational session.

Conclusion

Health professionals lack knowledge about breast cancer risk factors, screening tools, presentation, and management. Regular education sessions improve these knowledge gaps and help early detection and treatment of women at risk of breast cancer.

Worldwide review with meta-analysis of women's awareness about breast cancer

OBJECTIVE

To summarize the awareness levels of breast cancer (BC) worldwide and investigate factors associated with BC awareness to determine differences in awareness between China and other countries.

METHODS

This systematic review followed the PRISMA guidelines and included 92 articles up to July, 2021. We calculated percentages for BC awareness levels and conducted subgroup analysis and cumulative meta-analysis.

RESULTS

A total 84% (95% confidence interval [95%CI]: 78-90%) of women knew about BC; however, only 51% (95%CI: 37-66%) and 40% (95%CI: 24-56%) of women were aware of BC symptoms and BC risk factors, respectively. The most commonly known BC symptom was breast lump (71%, 95%CI: 62-80%), and BC family history was the most well-known BC risk factor (61%, 95%CI: 54-69%). Subgroup analysis showed lower awareness levels among Chinese and Asian women than women from other countries. Cumulative meta-analysis showed no obvious progress in BC awareness levels over time. We investigated 15 awareness-related factors, the most frequent of which were education level (61.8%), occupation (29.4%), and age (26.5%).

CONCLUSION

BC awareness levels remain low. Improving BC awareness is critical, especially in developing countries.

PRACTICE IMPLICATIONS

Effective education programs are urgently needed to improve women's BC awareness.

A comparison of behavioural models explaining cervical cancer screening uptake

BACKGROUND

Cervical cancer represents a very high burden of disease, especially in Low- and Middle-income economies. Screening is a recommended prevention method in resource-poor settings. Cervical cancer screening (CCS) uptake is influenced by various psycho-social factors, most of which are included in behavioural models. Unlike demographic characteristics, these factors are modifiable. While few studies have compared these models in terms of their capacity to predict health behaviour, this study considers three health behaviour theories to assess and compare the predictors of CCS behaviour and intention.

METHODS

A survey was conducted among 607 sexually active women in the South Indian state of Karnataka. Data was collected regarding socio-demographic factors, health literacy, knowledge on CCS, and the socio-cognitive factors related to CCS that are represented in the Health Belief Model (HBM), Theory of Planned Behaviour (TPB) and Theory of Care-Seeking Behaviour (TCSB). Logistic regression analyses tested to what extent each of the theoretical models explained cervical cancer screening (CCS) intention and regular screening behaviour, comparing the variance explained by each of the models.

RESULTS

CCS intention was best explained by the TPB, followed by the HBM. Of the constructs included in these models, positive attitude towards the screening procedure and perceived benefits contributed most significantly to screening intention, followed by fear, anxiety or embarrassment related to the disease or screening procedure, and context specific barriers.

CONCLUSION

Health behavioural models such as the TPB and HBM can help to identify the main socio-cognitive factors explaining the intention of women to participate in CCS. As such, they can inform interventions to target specific determinants of screening intention and behaviour, and enhance their effectiveness by addressing women's screening attitude, perceived benefits, and emotions as well as reducing context specific barriers to screening.

Barriers and Facilitators Influencing Arab Muslim Immigrant and Refugee Women's Breast Cancer Screening: A Narrative Review

Introduction:

This narrative review identifies barriers and facilitators influencing breast cancer screening among Arab Muslim immigrants and refugees. Low participation rates create health inequities in breast cancer screening among this population.

Method:

A systematic search of peer-reviewed empirical articles was performed. PRISMA, CASP, and MMAT checklists were used to appraise the studies.

Results:

Results include 3 themes: individual, health care system and health providers, and cultural factors.

Discussion:

Lack of fluency in the new country’s language, lack of knowledge, and poor exposure to breast cancer screening may contribute to the Arab Muslim women’s vulnerability to undiagnosed or delayed breast cancer diagnosis.

Mammography Self-efficacy Scale and Breast Cancer Fear Scale: Psychometric Properties of the Arabic Versions Among Saudi Women

BACKGROUND

Early screening for breast cancer (BC) is critical for improving health outcomes and reducing mortality. Research has shown that self-efficacy and fear of BC can influence patients' screening behaviors. Validated measures to assess these constructs among Saudi women are lacking.

OBJECTIVE

The aim of this study was to assess the psychometric properties of the Arabic versions of the Champion Mammography Self-efficacy Scale (CMSES) and Champion Breast Cancer Fear Scale (CBCFS) in a sample of Saudi women.

METHODS

The CMSES and CBCFS were back-translated into Arabic using an established translation protocol. Reliability was assessed using Cronbach's α coefficients. Construct validity was evaluated using exploratory and confirmatory factor analytical procedures.

RESULTS

The findings from the factor analysis confirmed the unidimensional structure of both scales as reported by the original authors. Additionally, both scales exhibited high internal consistency (Cronbach's α coefficients) of .91 for the modified CMSES-Arabic and .94 for the CBCFS-Arabic.

CONCLUSIONS

This article provided initial evidence of reliability and construct validity for the modified CMSES-Arabic and the CBCFS-Arabic.

IMPLICATIONS FOR PRACTICE

Nurses and other allied health professionals can now use these measures to better understand how self-efficacy and fear of BC are related to compliance with cancer screening among Saudi women and in other Arabic-speaking contexts. The scales could also be useful for developing and testing the effectiveness of interventions aimed at improving mammography testing rates.

Public willingness to adhere to COVID-19 precautionary measures in Sudan: an application of the Health Belief Model

INTRODUCTION

coronavirus disease (COVID-19) is a highly infectious disease caused by the novel coronavirus (SARS-CoV-2). Several public health and social protective measures that may prevent or slow down the transmission of COVID-19 were introduced. However, these measures are unfortunately being neglected or deliberately ignored by some individuals.

METHODS

a cross sectional online based survey was conducted to identify possible factors influencing public willingness to adhere to precautionary measures and preventive guidelines against COVID-19 during the lockdown periods in Sudan. The questionnaire was used to collect socio-demographic data of study participants, their health beliefs and willingness regarding adherence to precautionary measures against COVID-19 based on the constructs of the Health Belief Model.

RESULTS

a total of 680 respondents completed and returned the online questionnaire. Significant predictors of the willingness to adhere to the precautionary measures against COVID-19 were gender (β= 3.34, P<0.001), self-efficacy (β= 0.476, P<0.001), perceived benefits (β= 0.349, P<0.001) and perceived severity (β= 0.113, P=0.005). These factors explained 43% of the variance in respondents' willingness to adhere to COVID-19 precautionary measures. Participants who were female, confident in their ability to adhere to the protective measures when available, believing in the benefits of the protective measures against COVID-19 and perceiving that the disease could have serious consequences were more likely to be willing to adhere to the protective measures.

CONCLUSION

female respondents and respondents having higher self-efficacy, higher perceived benefits and higher perceived severity were more likely to be willing to adhere to the protective measures against COVID-19 in Sudan.

The impact of consanguinity on women's attitudes toward molecular testing of breast cancer in Saudi Arabia

Background: Breast cancer is the most common cancer in adult women in Saudi Arabia; however, awareness about molecular testing for breast cancer is insufficient. The authors aimed to assess knowledge and attitudes to determine sociodemographic factors that correlate with perceptions of genetic testing among Saudi women. Materials & methods: This cross-sectional community-based study used a questionnaire to investigate the relationships between various social and economic factors. Results: There was a significant difference in interest in undergoing molecular testing between women in consanguineous and non-consanguineous marriages. Conclusion: The data show that consanguinity adds an extra layer of complexity to other sociodemographic barriers that hinder the efficacy of early breast cancer detection and prevention programs in Saudi Arabia.

Factors influencing transmission of tuberculosis in Ngeu Nata culture among Ngada community in Kupang, East Nusa Tenggara, Indonesia: Cross sectional study

Background

Eating “sirih/Betel” (Ngeu Nata) as a culture in Ngada society can become one of the primary source of Tuberculosis (TB) transmission due to share leaves and betel liquid reservoirs together with other people. If one of the people who share leaves is a TB patient, it can transmit TB to other person. The purpose of this study was to identify the factors that influence TB transmission in Ngeu Nata culture using the health belief model approach.

Design and Methods

This study used cross-sectional, involving 110 respondents, selected by consecutive sampling. The respondents were Bajawa ethnicity, age 36-67, at least consume Betel one a day together with other person in Ngada district, East Nusa Tenggara.

Results

The results showed that most respondents had high transmission behavior in betel eating culture (51.8%). Factors related to TB transmission behavior: medical history of TB (p=0.028), knowledge about TB (p=0.038), the perceived of severity of TB (p=0.037); the perceived of benefits (p=0.039) and the perceived of barrier (p=0.038). The dominant factor was knowledge, (OR 2,365 (95% CI) 1,015-5,510).

Conclusions

Implication: nurses should include aspect of Ngeu Nata cultural in designing TB education for Bajawa ethnicity in order to prevent TB transmission in Ngada district, East Nusa Tenggara.

Examination of Breast Cancer Screening Knowledge, Attitudes, and Beliefs among Syrian Refugee Women in a Western Canadian Province

Background

Women living in the Arab world present low breast cancer screening rates, delayed diagnosis, and higher mortality rates.

Purpose

To further explore the Muslim Syrian refugee women’s breast self-examination (BSE), utilization of clinical breast examination (CBE) and mammography.

Methods

A cross-sectional descriptive exploratory study design was used. The sample consisted of 75 refugee women. Data were collected using Champion’s Health Belief Model Scale, the Cancer Stigma Scale, and the Arab Culture-Specific Barriers to Breast Cancer Questionnaire. Descriptive, Pearson correlation and logistic regression analyses were used to analyze the data.

Results

A minority of women had BSE (32%), CBE (12%) and mammograms (6.7%) anytime during their lifetime. Women’s breast cancer screening (BCS) knowledge ranked at a medium level (M = 10.57, SD = 0.40). Low knowledge score, BSE information, policy opposition, responsibility, barriers to BSE, and seriousness were found to be statistically significant in women’s BSE practice. BSE benefits and religious beliefs significantly predict CBE Age, education, knowledge, responsibility, susceptibility, social barriers, and religious beliefs were statistically significant in women’s mammography use (p < .01).

Conclusions

Participants’ breast cancer screening practices were low. Health beliefs, Arab culture and stigma about cancer affected women’s BCS practices. Faith-based interventions may improve knowledge and practices.

Determinant of breast self-examination with health belief model approach in student of 17 high school Makassar in 2019

OBJECTIVE

This study aims to analyze the determinants of BSE practice with the health belief model approach in student of 17 High School Makassar in 2019.

METHODS

This research design is cross-sectional. The sample in this study was 232 out of total 402 female students of class X and XI randomly selected. Then, data were analyzed using chi-square and logistic regression.

RESULT

Result analysis indicates that the variables related to BSE practice are perceived benefits (p value=0.036) and perceived barriers (p value=0.000). While variables that is not related to the BSE practice is perceived threats (p value=0.074). After further analysis, it was found that perceived barriers were the most influential variables on BSE practice in student of 17 High School Makassar.

CONCLUSION

School authorities through youth health tutors or school health units need to apply counseling session for BSE education to student.

Determinants of Breast Cancer Screening Practice among Women in Indonesia: A Nationwide Study

Background:

Breast cancer remains the leading cause of death for women globally, including in Indonesia. Breast cancer screening plays a vital role in reducing deaths caused by breast cancer. However, breast cancer screening rate is still low and studies on determinants for breast cancer screening is limited in Indonesia. This study aimed to identify the determinants of breast cancer screening among women in Indonesia.

Methods:

This population-based study was conducted among 827 women who lived in either rural and urban areas, using a stratified sampling design where were based on province and locality combinations. Data were analysed using a binary logistic regression model to assess the associations between independent and dependent variables.

Results:

As many as 827 women with an average age of 29.91 (± 11.14) years old participated in this study. The overall breast cancer screening among women was 18.74%. Knowledge of breast cancer risk factors, signs, and symptoms (adj.OR = 1.75, 95%CI: 1.20 – 2.56), age of 35 to 39 years old (adj.OR. = 1.52, 95% CI: 1.02 – 2.26), and household income of ≥6,000,000 IDR (≥457 USD) (adj.OR. = 5.19, 95%CI: 1.43–18.84) were associated with breast cancer screening attendance. In contrast, Christian women had a significantly lower breast cancer screening rate that women from other religions (adj. OR. = 0.45, 95%CI: 0.24 – 0.85).

Conclusion:

The overall breast cancer screening attendance was poor among Indonesian women population. Age, household income, religion, and knowledge of breast cancer risk factors were identified as the determinant factors for breast cancer screening.

Breast self-examination practice and its determinants among women in Ethiopia: A systematic review and meta-analysis

BACKGROUND

The survival rate from breast cancer is lowest in African countries and the distribution of breast self-examination practice of and its determinants are not well investigated in Ethiopia. Therefore, this systematic review and meta-analysis was designed to determine the pooled prevalence of breast self-examination and its associated factors among women in Ethiopia.

METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed for this systematic review and meta-analysis. The databases used were; PUBMED, Cochrane Library, Google Scholar, CINAHL, African Journals Online, Dimensions and Summon per country online databases. Search terms used were; breast self-examination, breast cancer screening, early detection of breast cancer and Ethiopia. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of studies. The meta-analysis was conducted using STATA 15 software. The pooled meta-analysis was computed to present the pooled prevalence and relative risks (RRs) of the determinate factors with 95% confidence intervals (CIs).

RESULTS

We identified 2,637 studies, of which, 40 articles (with 17,820 participants) were eligible for inclusion in the final meta-analysis. The pooled estimate of breast self-examination in Ethiopia was 36.72% (95% CI: 29.90, 43.53). The regional distribution breast self-examination ranged from 21.2% (95% CI: 4.49, 37.91) in Tigray to 61.5% (95% CI: 53.98, 69.02) in Gambela region. The lowest prevalence of breast self-examination was observed among the general population (20.43% (95% CI: 14.13, 26.72)). Women who had non-formal educational status (OR = 0.4 (95% CI: 0.21, 0.77)), family history of breast cancer (OR = 2.04 (95% CI: 1.23, 3.39)), good knowledge of breast self-examination (OR = 4.8 (95% CI: 3.03, 7.6)) and favorable attitude toward breast self-examination (OR = 2.75, (95% CI: 1.66, 4.55)) were significantly associated with practice of breast self-examination.

CONCLUSIONS

Only a third of women in Ethiopia practiced breast examination despite WHO guidelines advocating for this practice among all women of reproductive age. Intervention programs should address the factors that are associated with breast self-examination. Population specific programs are needed to promote breast self-examination.

A path analytic model of health beliefs on the behavioral adoption of breast self-examination

BACKGROUND

In Malaysia, breast cancer accounted for 34.1% of all female cancer cases with women presenting breast cancer at late stages. Breast cancer has a higher five-year survival rate if detected early. An increase of approximately 30% in the five-year survival rate is indicated if breast cancer is detected at stage III compared to stage IV. Thus, survival rate of breast cancer can be increased by creating awareness and encouraging breast cancer screening amongst women. Breast self-examination (BSE) is highly recommended for breast cancer screening due to its simplicity with no incurred cost. The Health Belief Model is used in this study to explain and predict the adoptive behavior of BSE amongst women in Kuantan, Pahang.

MATERIALS AND METHODS

This study employed a multi-stage sampling method using a simple proportion formula at 5% type 1 error, p < 0.05 and absolute error at 2% which resulted in a sample of 520 participants. The data for the study was obtained using a validated bilingual self-constructed questionnaire and the model constructed using Mplus software.

RESULTS

Perceived severity, benefits and barriers were found to significantly influence the behavioral adoption of BSE. Married women aged from 45 to 55 years and knowledge were found to significantly moderate the relationship between perceived benefits and behavioral adoption of BSE. Further, self-efficacy was found as the core construct that mediates the relationship between married women aged 45 to 55 years and the behavioral adoption of BSE.

CONCLUSION

Self-efficacy is found in the study to influence the behavioral adoption of BSE. This is undeniable as self-efficacy can promote confidence in initiating and maintenance of behavioral change if the perceived change is beneficial at an acceptable cost.

Women's Breast Cancer Knowledge and Health Communication in the United Arab Emirates

In the United Arab Emirates (UAE), women’s participation in breast cancer screening is low, and women are commonly diagnosed in advanced stages. This study investigated women’s attitudes towards breast cancer screening, their use of health services in the UAE emirate of Ras Al Khaimah, and their preferred medium for breast cancer information. In this qualitative study, six focus groups were conducted with Emirati (n = 28) and non-Emirati (n = 26) women as Ras Al Khaimah is a highly multi-cultural region. Women were separated into different age groups (25–34, 30–44, 44+) so as to obtain perspectives of young (n = 16), middle (n = 19), and older women (n = 19). The focus group transcripts were analysed using thematic analysis. Women recognised that any breast change should be checked by a doctor, and that women with symptoms or those at higher risk may need to have breast screening earlier than the recommended starting age. However, participants wanted more information from doctors or other health personnel. Women had observed breast cancer information and campaigns advertisements in multiple media but recommended greater use of social media and WhatsApp to disseminate information. Overall, women had positive attitudes towards breast cancer screening but wanted more breast cancer awareness campaigns year-round and better access to screening.

Structural equation modeling to detect predictors of breast self-examination behavior: Implications for intervention planning

AIM

Breast cancer is the most frequent malignant tumor among Chinese women. Breast self-examination (BSE) is a simple, effective method for early detection of screening and it is essential for the prevention and control of breast cancer. The aim of this study was to create a hypothetical model to determine the factors influencing women's BSE behavior in Eastern China.

METHODS

A survey was conducted using an online questionnaire and targeting 1200 women aged 18-70 years in Eastern China. Collected data were analyzed using ibm spss 25.0 and amos 24.0 software.

RESULTS

The final model showed a desirable fitness to sample data. A direct positive relationship exists between knowledge on risk factors and BSE. A direct positive association was found between positive attitudes and BSE, while negative attitudes have a direct negative impact on BSE. Objective factors not only had a significant direct impact on BSE, but also directly affected the positive attitudes. Positive attitudes play an intermediary role between objective factors and BSE.

CONCLUSION

Knowledge on risk factors about breast cancer, attitudes toward BSE and objective factors are new predictors which may influence BSE by using the structural equation modeling method.

Self-care behaviors in high-risk women for breast cancer: A randomized clinical trial using health belief model education

BACKGROUND

Breast cancer is the most common cancer in Iranian women. The number of people with this disease is increasing across the world. Positive family history is one of the risk factors for developing breast cancer. However, early detection is the main method to fight this disease. This study was conducted to examine the effect of education based on the health belief model (HBM) on self-care behaviors among first-degree relatives of patients with breast cancer.

METHODS

This clinical trial was conducted in 2016 on 80 women in Tehran city, Iran. Data were collected using a three-part questionnaire regarding demographic data, the HBM, and self-care behaviors. The educational program based on the HBM was held in 4 ninety-minute training sessions through lectures, group discussions, question and answer, image presentations, and PowerPoint presentations. The questionnaires were completed before and 2 months following the intervention by intervention and control groups. Data were analyzed using descriptive and inferential statistics through the SPSS16 software.

RESULTS

The mean score of the HBM constructs before the intervention in the groups had no statistically significant differences (P > 0.05). Eight weeks after the intervention, the mean score of the constructs of the HBM in the intervention group significantly increased and a statistically significant increase in the mean score of self-care in the intervention group compared to the preintervention was found, so that the self-care behavior score in the intervention group was 0.69 ± 0.09 before the intervention and was changed to 0.74 ± 0.09 after the intervention (P < 0.0001).

CONCLUSION

Our results suggest that education based on the HBM was effective in promoting self-care behaviors among first-degree relatives of breast cancer patients. Therefore, education based on HBM may have an important implication for breast cancer prevention in Iran.

Determinants of screening methods utilization among Iraq/Sulaimani women

PURPOSE

This study aims to find out the participation rate of women in the utilization of screening methods to determine the relationship of sociodemographic health characteristics and breast cancer (BC) awareness with the utilization of screening methods. The authors' study aims to examine the relationship between women's belief and the utilization of screening methods.

DESIGN/METHODOLOGY/APPROACH

A cross-sectional study was conducted in three health centers from December 13, 2016 to June 12, 2017. A questionnaire was constructed for data collection about sociodemographic characteristics, screening awareness and medical and health background variables. Additionally, BC awareness measure and champion health belief model scales were used to measure women's perceptiveness about BC.

FINDINGS

Despite the awareness among 78.9% of women regarding clinical breast examination (CBE) as a screening method, only 9.5% women utilized it for screening. Due to prescription by physicians for diagnosis of BC, 23.6% women had done mammography at least once in their life. Having jobs and a good education significantly influenced the utilization of CBE as a screening method. The logistic regression analysis found that old age, family history of BC, good knowledge about BC, perceived susceptibility, low rate of perceived barriers to mammography and CBE predicted participation in screening.

ORIGINALITY/VALUE

Enhancing knowledge about BC and screening, emphasizing the susceptibility to BC and the benefits of screening will help in better participation. Importance should be given to illiterate and unemployed women.

Using the Health Belief Model to Predict the Uptake of Mammographic Screening Among Saudi Women

Background

Breast cancer (BC) is known to be the second leading cause of cancer deaths after lung cancer in Saudi Arabia. Early detection using screening methods can improve disease outcomes. In Saudi Arabia, the rates of BC screening are very low although it is a country that provides free healthcare services. This discrepancy between the availability of free healthcare services and women not utilizing these services necessitates an in-depth understanding of the health-related beliefs and barriers towards BC screening among Saudi women. 

Objective

We aimed to use the Health Belief Model (HBM) to predict the uptake of mammographic screening among Saudi women. The secondary objective was to determine the knowledge, attitudes, and practices related to BC and mammography screening.

Research methodology 

This was an analytical cross-sectional study using a self-administered questionnaire, which consisted of sociodemographic data, family history of BC, general information about BC, and the Champion’s Health Belief Model Scale (CHBMS). The study was conducted among Saudi women visiting the King Khalid University Hospital in Riyadh from September 2018 to February 2019. The data were analyzed using SPSS Statistics software version 26.00 (IBM, Armonk, NY).

Results

A total of 401 females participated in the study; the median age of the subjects was 49 years [interquartile range (IQR): 43-53 years]. Among them, 69.6% were married and 21.1% had a family history of BC. There was a statistically significant association of younger age, marital status, and a positive family history of BC with women undergoing mammographic screening (p<0.05).

Of the participants, 61.6% knew about the warning signs of BC, while only 59.9% were aware of the risk factors associated with it. The binary logistic regression did not show any significant association between CHBMS and mammogram screening. We concluded that the CHBMS components cannot be used in isolation to predict the risk of not undergoing mammogram screening. However, barriers and motivation components along with the knowledge and other factors can be used to predict mammogram screening.

Conclusion

Among our cohort of Saudi women, 62.1% had general awareness about BC, and younger age, marital status, and positive family history of BC were significantly associated with women undergoing mammography screening. The CHBMS components cannot be used in isolation to predict the risk of not undergoing mammogram screening, while barriers and motivation components along with the knowledge and other factors can be used to predict mammogram screening.

Psychosocial Aspects of Female Breast Cancer in the Middle East and North Africa

Breast cancer, the most common cancer among women in the Middle East and North Africa (MENA) region, is associated with social and psychological implications deriving from women's socio-cultural contexts. Examining 74 articles published between 2007 and 2019, this literature/narrative review explores the psychosocial aspects of female breast cancer in the MENA region. It highlights socio-cultural barriers to seeking help and socio-political factors influencing women's experience with the disease. In 17 of 22 Arab countries, common findings emerge which derive from shared cultural values. Findings indicate that women lack knowledge of breast cancer screening (BCS) and breast cancer self-examination (BSE) benefits/techniques due to a lack of physicians' recommendations, fear, embarrassment, cultural beliefs, and a lack of formal and informal support systems. Women in rural areas or with low socioeconomic status further lack access to health services. Women with breast cancer, report low self-esteem due to gender dynamics and a tendency towards fatalism. Collaboration between mass media, health and education systems, and leading social-religious figures plays a major role in overcoming psychological and cultural barriers, including beliefs surrounding pain, fear, embarrassment, and modesty, particularly for women of lower socioeconomic status and women living in crises and conflict zones.

Knowledge and health beliefs of reproductive-age women in Alexandria about tetanus toxoid immunization

BACKGROUND

Maternal neonatal tetanus is a substantial public health problem in many developing countries. In 2017, nearly, 30,848 newborns died of neonatal tetanus; thus, high immunization coverage remains a necessity. This study aims to assess knowledge and health beliefs of reproductive-age women in Alexandria about tetanus toxoid immunization.

METHODS

A cross-section survey of 700 females attending health offices in Alexandria was done using an interview questionnaire to collect data regarding women's knowledge and beliefs about tetanus toxoid vaccine (TTV) and maternal and neonatal tetanus (MNT). Nine health offices were selected using multi-stage random sampling.

RESULTS

Most of studied women (83.6%) had poor knowledge of MNT and TTV. The highest percentage of women had low perception of susceptibility to MNT (48.0%), moderate perception of severity of MNT (57.4%) and barriers to TTV (58.9%), high perception of benefits of TTV (86.6%), and high self-efficacy in taking the vaccine (76.2%). Less than one-third of the sampled women (27.7%) were immune by (TT2+). Logistic regression models showed that the place of antenatal care, level of knowledge, perceived barriers, and socio-economic level were significant predictors of immunity status (p = 0.008, p = 0.032, p = 0.011, and p = 0.001, respectively).

CONCLUSION

Women lacked information about MNT/TTV and may even have been discouraged by their private obstetricians from taking the vaccine. Perceived barriers to receiving tetanus toxoid vaccination were shown to be an important predictor of immunization behavior.

Factors affecting mammography screening behaviour among rural Vietnamese women

OBJECTIVES

To identify factors associated with mammography screening behaviour and its predictors among rural Vietnamese women.

METHOD

A predictive correlational study involving 120 women aged ≥ 40 years was conducted in the suburbs of Hanoi, Vietnam, in July 2018 by using Breast Cancer Awareness Measurement and the Champion Health Beliefs Model Scale. Mammography screening behaviour was assessed by asking participants about their previous mammography experience.

RESULTS

Only 16.7% of participants had undergone mammography screening. High education levels, high monthly family income, having family members or friends with breast cancer, and receiving physicians' recommendations increased the likelihood of participants screening for breast cancer. Mean scores on perceived susceptibility and perceived barriers differed significantly between participants who had and those who had not undergone screening (t = 4.31; p < .001; t = -5.05; p < .001, respectively). Perceived susceptibility and perceived barriers significantly increased the predictive power of the hierarchical logistic model (critical value = 6.16; [df = 2]; p = .046). Perceived barriers were the most significant predictors of screening behaviour (odds ratio 0.84; 95% CI, 0.71-0.99; p = .039).

CONCLUSION

Efforts are necessary to increase mammography awareness in the community and promote screening rates in Vietnam.

The relationship of socio-demographic characteristics and knowledge of breast cancer on stage of behavioral adoption of breast self-examination

Background/aim

In Malaysia, breast cancer is the most common cancer among women. As such, early diagnosis and screening practices are important to increase the survival rate. Breast self-examination (BSE) is one of the main screening methods for breast cancer. Socio-demographic characteristics and knowledge of breast cancer are amongst the crucial roles in determining women's behavioral adoption in performing BSE. This study aims to assess the relationship of socio-demographic factors and knowledge of breast cancer on the stage of behavioral adoption of BSE among Malaysian women in Kuantan, Pahang.

Materials and methods

A cross-sectional study was conducted on 520 women from three different government health clinics in Kuantan and IIUM Family Health Clinic from February to April 2018. Data were collected using a self-administered questionnaire on socio-demographic factors and knowledge of breast cancer and its effect on the behavioral adoption of BSE.

Results

Significant difference was found between socio-demographic characteristics and behavioral adoption of BSE. However, only breast screening and the best time for screening were found to be significant with the behavioral adoption of BSE and knowledge of breast cancer.

Conclusion

It is found that most women in Kuantan, Pahang perform BSE but were still unaware of the importance of performing BSE for early breast cancer detection. This study was expected to enhance women's awareness of the benefits of performing BSE.

Breast Cancer knowledge and perceived barriers to help seeking among pre-clinical and clinical female medical students of King Edward Medical University, Lahore: a cross-sectional study

BACKGROUND

Breast cancer is the most common form of cancer in women and second most common cancer after lung cancer. The prognosis of breast cancer depends on early detection and intervention which in turn relies upon awareness. Health workers in all communities are responsible for educating the population at risk. This study evaluates the knowledge regarding breast cancer, personal judgment of confidence, perceived barriers to help seeking and breast self-examination practices among Pakistani female medical students and studies the impact of clinical training on the studied variables.

METHODS

Descriptive cross-sectional study design using self-administered validated questionnaires (BCAM-Breast Cancer Awareness Measure designed by Cancer Research UK) was employed. Female medical students enrolled in clinical and pre-clinical classes of King Edward Medical University, Lahore were targeted and questioned regarding symptoms, risk factors and their practices regarding breast cancer. Possible barriers to seeking help were also studied.

RESULT

The mean number of symptoms correctly identified was 6.7 ± 3.2 (5.5 ± 3.2 for pre-clinical and 7.8 ± 2.9 for clinical students) and for risk factors it was 4.3 ± 2.1 (3.7 ± 2.1 for pre-clinical and 4.7 ± 2.2 for clinical students). The difference in the level of perception of two groups was found to be significant (p < 0.001 for symptoms and p < 0.001 for risk factors). 38.7% of the subjects responded that they check their breasts rarely, 33.1% were fairly confident while 8.6% were very confident about detecting a change in their breast, 50.0% never noticed a change in their breast, and 77.4% will contact a doctor within a week or less of finding a change in their breast. Confidence about detecting a change significantly improved (p < 0.001) after the start of clinical training.

CONCLUSION

This study suggests that clinical training may have improved knowledge of female medical students regarding breast cancer; yet the knowledge related to the symptoms and risk factors of breast cancer and frequency of breast self-examination of female medical students is less than anticipated.

Breast Cancer Screening Behaviors in Women Aged 40 Years and Over in a Semi-Urban Region in Turkey: Relationships with Health Beliefs

In this study, we aimed to determine the breast cancer screening behavior of women and to investigate the relationship between health beliefs and screening behaviors. The study was cross-sectional. It was conducted between April 2017 and June 2017 with 416 women aged ≥40. The Sociodemographic Information Form and the Champion's Health Belief Model Scale were used to collect data. In the statistical analysis, the number, percentage, mean, standard deviation, Pearson chi-square test, and multivariate binary logistic regression analysis were used. The rates for participating women performing breast self-examination, having clinical breast examination, and undergoing mammography were 11.8%, 8.9%, and 11.3%, respectively. Perceived susceptibility, seriousness, self-efficacy, benefits, health motivation, and perceived barriers were found to have strong associations with screening behaviors (p < 0.05). In this study, we found that few women performed breast self-examination, had clinical breast examination and mammography. In the present study, women perceived barriers related to both performing breast self-examination and undergoing mammography.

Adaptation and Validation of the Health Belief Model Scale for Breast Self-Examination in Mexican Women

OBJECTIVES

In Mexico, breast cancer is often not detected until it is already at an advanced stage. Many women know about breast self-examination (BSE), but few do it correctly. BSE can assist in the early detection of breast cancer, and a valid and reliable instrument to help determine the factors of the Health Belief Model that affect the practice of BSE in Mexican women would thus be advantageous. This study evaluates the psychometric properties of the Spanish version of the Health Belief Model Scale (HBMS) for BSE and identifies the factors that influence its practice.

METHODS

A cross-sectional design was used; 738 Mexican women aged 20 years and older who attended a tertiary public hospital were evaluated. The HBMS of Champion was translated into Spanish. Focus groups of women were consulted, and experts' judgments were gathered to determine content validity.

RESULTS

In the exploratory factor analysis, a structure of 6 factors was obtained, and Cronbach's alpha scales ranged between 0.65 and 0.84. BSE practice was associated with age (odds ratio [OR] 1.05; confidence interval [CI] 1.03-1.07), self-efficacy (OR 1.16; CI 1.12-1.20), barriers (OR 0.953; CI 0.912-0.996), and health motivation (OR 0.907; CI 0.837-0.983).

CONCLUSION

The Spanish version of the HBMS is an adequate, valid, and reliable instrument for the Mexican population that allows us to evaluate their beliefs about breast cancer and BSE, and it should also be applicable to other Spanish-speaking people. Perceived barriers, self-efficacy, and health motivation in particular should be considered in the development of health promotion programs for Mexican women.

Validity and Reliability of the Newly Developed Malay-Language Health Belief of Bloating (HB-Bloat) Scale

Abdominal bloating (AB), a common complaint that affects quality of life and disturbs psychological well-being, is largely a behavioral-driven disorder. We aimed to develop and validate a new health belief of bloating (HB-Bloat) scale in the Malay language. The initial item pool was developed based on the theory of planned behavior, empirical literatures, expert review and in-depth interviews. Using the population with bloating (diagnosed based on the Rome IV criteria and pictogram), exploratory and confirmatory factor analytical approaches (EFA and CFA, respectively) were utilized to explore and confirm the domains in the new scale. There were 150 and 323 respondents in the EFA and CFA, respectively. There were 45 items in the initial scale, but it was reduced to 32 items after content validity and pre-testing. In EFA, 17 items with three (3) structure factors (attitude 4 items, subjective norm 7 items, and perceived behavior control 6 items) were identified. Total variance explained by the EFA model was 40.92%. The Cronbach alpha of the three (3) factors ranged from 0.61 to 0.79. With CFA, the three factors model was further tested. Five problematic items were identified and removed. The final measurement model fit the data well (root mean square error of approximation (RMSEA (90% CI) = 0.054 (0.038, 0.070), Comparative Fit Index (CFI) = 0.941, Tucker–Lewis Fit Index (TLI) = 0.924, and standardized root mean squared residual (SRMR) = 0.044). The construct reliability of the final measurement model ranged from 0.76 to 0.84. As a conclusion, the new HB-Bloat scale is a valid and reliable tool for assessment of health beliefs in bloating.

Exploring the Influencing Factors on Breast Self-Examination Among Myanmar Women: A Qualitative Study

Introduction: Breast self-examination (BSE) is the most sensitive and cost-effective method to diagnose breast cancer at an early stage in healthcare resources’ limited setting. However, the practice of BSE is low in Myanmar. Although various international studies were conducted to clarify the influencing factors in irregular BSE practice, there is a range of different factors and the answer is not yet clear. Hence, this study is aimed to explore the influencing factors on the practice of breast self-examination among Myanmar women.Methods: A qualitative exploratory-descriptive study was conducted on eight women through in-depth semi-structured interviews between February 2020 and March 2020. The samples were women who lived in the rural area of Myanmar and purposive sampling technique was used. Data were analyzed using Colaizzi’s method, which consisted of seven stages.Results: Four themes emerged as the results of the in-depth interview, namely knowledge of breast cancer, knowledge regarding breast self-examination, barriers to performing regular BSE and ways to improve BSE practice.Conclusion: This study showed that the women were inadequate in knowledge and practice regarding BSE and breast cancer. Some barriers of BSE practice are rooted in the inadequate skill of BSE and the women’s attitude.  Greater understanding about breast cancer and improving the confidence of women in BSE will lead to better prognosis. Hence, healthcare authorities and providers should encourage a formal health education program and the results from this study hope to be useful in future rural health education programs of BSE practice.

Breast Self-Examination Practice and Associated Factors Among Secondary School Female Teachers in Gammo Gofa Zone, Southern, Ethiopia

Introduction

Nowadays, breast self-examination (BSE) is a breast cancer screening method that identifies breast mass by the woman herself. However, it is not widely practiced due to various problems. This study aimed to assess the magnitude of BSE practice and associated factors among female secondary school teachers in Gammo Gofa Zone, South Ethiopia.

Methods

An institution-based cross-sectional study was conducted among 247 female secondary school teachers, from March 1 to 30, 2018. Participants were selected using the lottery method. A self-administered questionnaire was used for data collection. Data were cleaned, coded, and entered into Epi data manager 4.4 and analyzed using SPSS version 21. Binary logistic regression was employed.

Results

Of 82 respondents, 34.3% had ever performed BSE. Among these, only 32 (13.4%) had practiced BSE monthly (regularly). Being knowledgeable on BSE [AOR=2.84, 95% CI (1.41, 5.72)], ever heard about BSE [AOR=2.26, 95% CI (1.07, 4.77)], being married [AOR=4.09, 95% CI (1.64, 10.22)], having less perceived barrier to BSE [AOR=2.62, 95% CI (1.26, 5.46)], having high perceived confidence [AOR=3.63, 95% CI (1.79, 7.39)] and motivation to BSE [AOR=3.29, 95% CI (1.15, 9.45)] were significant predictors of BSE practice.

Conclusion

In this study, one in three women had ever practiced BSE, whereas about one in seven women regularly practiced BSE. The main reasons for not practicing BSE were: not knowing how to perform BSE and forgetfulness (for regular practice). Therefore, integrated work on behavioral change communication and interferences that focus on improving knowledge of BSE, and skills on how to perform BSE is needed. Additionally, the identified domains of the health belief model (perceived barrier, perceived confidence, and perceived motivation) may be the most effective strategies that should be considered by Gammo Gofa Zonal health and educational offices.

Adaptation and validation of the Arabic version of self-efficacy scale for mammography. A report on psychometric properties

Objectives:

To culturally adapt and validate a mammography-specific self-efficacy (MSSE) scale into Arabic for the Saudi Arabian context.

Methods:

A methodological study aimed at tool translation and adaptation conducted in primary healthcare centers in As Madinah, Saudi Arabia between March 2016 and May 2016. The MSSE scale was translated and adapted into Arabic using standard procedures. Content and face validity were investigated. Confirmatory factor analysis and reliability analysis were used to determine the scale’s psychometric properties.

Results:

The scale showed a good internal consistency (Cronbach’s alpha=0.88). The confirmatory factor analysis supported the scale’s single-factor structure and the goodness-of-fit indices confirmed the model’s good fit (comparative fit index=0.961, Tucker-Lewis index=0.943, root-mean-square error of approximation=0.076, and standardized root-mean-square residual=0.045). Women who had a mammogram in the last 2 years scored significantly higher on the scale (39±6.2) than women who had never received a mammogram (35.88±7.2; p=0.009).

Conclusion:

The study confirmed that the scale’s Arabic version has good psychometric properties, using reliability analysis, confirmatory factor analysis, and extreme groups validation. The scale is likely to be useful for evaluating interventional studies aimed at improving mammography screening participation rates.

Knowledge, Attitudes, and Practices of Breast Cancer Screening Methods Among Female Patients in Primary Healthcare Centers in Najran, Saudi Arabia

The aim of the present study was to evaluate the knowledge, attitude, and practice of breast cancer screening methods among female patients attending five primary healthcare centers in Najran, Saudi Arabia. A cross-sectional survey was conducted on 500 female patients, and a direct interview questionnaire was used to collect data. Our results indicated a low knowledge about breast cancer, breast self-examination, mammogram and clinical breast examination was 54.4%, 56%, 90.4%, and 83.8%, respectively. Nineteen percent of patients demonstrated a high knowledge of breast self-examination. Breast self-examination was performed by 35% of patients, whereas 15% of patients received mammograms and 19.8% clinical breast examinations. The most common barrier for screening methods of breast cancer was that patients were unaware of half of the screening methods. A total of 20.6% of women did not perform breast self-examinations because they were not well trained, and 26.4% of women did not receive clinical breast examinations because there was no female doctor available. The main source of information among the women patients was social media (52.4%), whereas 8.8% received information through their healthcare provider. In summary, the majority of women demonstrated poor knowledge about breast cancer and screening methods. Additional effort should be put forth through women's healthcare providers to increase the awareness of breast cancer screening. That means we need to continue emphasizing the importance of primary healthcare for early detection of breast cancer in the early stages.

Determinants of breast self-examination practice among women in Surabaya, Indonesia: an application of the health belief model

Background

Breast cancer has become one of the most common causes of mortality among Indonesian women. Many women in Indonesia present with late-stage breast cancer, negatively affecting prognosis and treatment outcomes. Better prognosis of breast cancer will be achieved if it is diagnosed in an earlier stage, thus efforts to detect breast cancer earlier are important. Breast Self-Examination (BSE) is considered as an important first step to encourage women to actively be responsible for their own health, especially for women in low-and middle-income countries with limited resources and access to other forms of preventive healthcare (e.g., screening programs). The present study aimed to predict BSE practice among women in Surabaya, Indonesia using the Health Belief Model (HBM).

Methods

This investigation was a cross-sectional survey which was distributed among 1967 women aged 20–60 years. The Indonesian version of Champion’s Health Belief Model Scale (I-CHBMS) was used to explain self-reported BSE practice. Logistic regression analysis was used to examine the association of HBM variables with BSE practice.

Results

44.4% of the respondents indicated they had performed BSE. Further, the results indicated that the HBM variables were significantly associated with BSE practice. Specifically, higher perceived benefits and self-efficacy, lower perceived barriers and less cues to action were unique correlates of BSE practice. The result also showed that perceived severity and susceptibility were not associated with BSE practice.

Conclusion

This study indicated that several HBM constructs significantly associated with BSE practice among Indonesian women, suggesting that BSE health education programs should emphasize the perceived benefits of BSE, focus on increasing women’s self-efficacy to address and overcome perceived barriers in performing BSE, and help them in identifying personally relevant cues to action.

Effect of Health Education on Female Teachers' Knowledge and Practices Regarding Early Breast Cancer Detection and Screening in the Jazan Area: a Quasi-Experimental Study

Educational programs are important tools for breast cancer prevention. The purpose of this study was to assess the effectiveness of health education in improving the knowledge and practices of female teachers regarding screening tools and the early detection of breast cancer. A two-group quasi-experimental design was conducted among 150 female teachers, who were selected from 75 schools of the Jazan General Administration of Education. Schools were chosen by a simple cluster randomization method and non-randomly assigned to either the intervention or control group. Eligible participants were recruited by a simple randomization method, proportional to the total number of teachers at each school. Those in the intervention group (n = 75) were compared to the control group (n = 75) at baseline, as well as at 6 weeks and 3 months post-intervention. Knowledge of breast cancer screening tools was measured using a modified version of the Breast Cancer Knowledge test. Breast self-examination, clinical breast examination, and mammography practices were also measured. Compared to the control group, the intervention group showed a statistically significant increase in knowledge and practice levels at both 6 weeks and 3 months post-intervention. Thus, the results of this study provide evidence that group health education programs are effective in improving breast cancer knowledge and practices in female teachers. Clinical Trial Registration number: NCT03398057 .

Using the Stage-Based Approaches to Predict Breast Self-Examination Among Rural Vietnamese Women

A stages-of-change approach would be helpful to understand cancer screening behaviors. This study aimed to identify the compliance and determinants of breast self-examination (BSE) based on transtheoretical model (TTM) and health belief model (HBM). A cross-sectional study was conducted with 296 rural Vietnamese women using a self-administered questionnaire consisting of Champion's HBM scales, breast cancer knowledge (BCK), integrated connection to neighborhood storytelling networks (ICSN), and TTM stages of BSE. A generalized ordered logistic regression was conducted to identify factors associated with TTM stages of BSE. About 61% of women did not currently perform BSE. Perceived benefit was significant in all stages changes. When changing to the action stage, perceived benefits, self-efficacy, and BCK were significant. When changing to the maintenance stage, perceived susceptibility, benefits, self-efficacy, and ICSN were significant. Determinants influencing BSE behavior were different in each TTM stage, indicating that educational programs should be introduced with stage-matched strategies to increase BSE.

Predictive Power of PEN-3 Model Constructs in Breast Cancer Screening Behaviors among Teachers: A Cross- Sectional Study in Central Iran

Objective

Identifying the factors influencing screening is necessary to promote early detection of breast cancer. This study aims to determine the predictive power of PEN-3 model structures in breast cancer screening behaviors among teachers of Isfahan city in Iran.

Materials and Methods

This cross-sectional study was conducted on 192 female teachers in Isfahan selected by the multi-stage random sampling method. A questionnaire based on PEN-3 model was used for data collection. Statistical analysis was conducted using SPSS version 20 (multiple linear regression analysis, independent t-test, Pearson correlation coefficient), and p<0.05 was considered statistically significant.

Results

The mean score of behavior, perceptual, enabling and nurturer factors in early detection of breast cancer was 36.5±30.5, 74.6±8.9, 65.5±19.9 and 68.1±20.7, respectively. The mean score of behavior in early detection of breast cancer in women with individual and familial history of breast disease was significantly higher than that of those who did not have such history. Perceptual and nurturer factors as the best predictors of screening behaviors were associated with screening behaviors.

Conclusion

The study results indicate that nurturer and perceptual factors were the best predictors of breast cancer screening behaviors among teachers. Therefore, attention to these constructs in developing educational interventions is highly recommended.

Effectiveness of modified health belief model-based intervention to reduce body mass index for age in overweight junior high school students in Thailand

Purpose

The purpose of this paper is to determine the effectiveness of a modified HBM-based intervention to reduce body mass index (BMI) for age in overweight junior high school students.

Design/methodology/approach

A cluster-randomized controlled trial was conducted in the first and second years of a junior high school in the center of Thailand. In total, 24 classrooms were randomly assigned to a modified health belief model intervention arm (HBMIA), and 24 classrooms were randomly assigned to a traditional school health education arm (control). In total, 479 students who were overweight (BMI forage = median +1 SD, aged 12–15 years) participated in the study. The HBMIA used the health belief model (HBM) as a motivator for behavioral strategies that included modifying diet and participating in physical activity. BMI, health knowledge and behavior for preventing obesity were recorded at baseline and at six months. A multilevel regression model was performed to calculate mean difference between HBMIA and control group.

Findings

The students who participated in the HBMIA showed a decrease in BMI of 1.76 kg/m2, while those who participated in the control showed an increase in BMI of 1.13 kg/m2, with a mean difference of –2.88 kg/m2(95% CI =–3.01 to –2.75), an improvement in health knowledge (mean difference 27.28; 95% CI =26.15–28.41) and an improvement in health behavior (mean difference 23.54; 95% CI =22.60–24.48).

Originality/value

A modified HBM-based intervention to reduce BMI for age is effective in overweight junior high school students.

Using the health belief model to assess beliefs and behaviors regarding cervical cancer screening among Saudi women: a cross-sectional observational study

Background

Cervical cancer in Saudi Arabia is ranked as the third most frequent gynecological cancer among women. The Pap smear test is a screening test that can be used as a primary prevention tool for cervical cancer, and prophylactic vaccination against HPV is also considered to be a factor in decreasing the prevalence of the disease. This study aimed to assess women’s beliefs about cervical cancer and the Pap smear test. In addition, the relationship between cervical cancer and the social and demographic characteristics was also evaluated.

Methods

A descriptive cross-sectional study was performed among Saudi women living in Riyadh in 2018. Women were randomly selected, and the total sample size was 450. A predesigned self-administered questionnaire that included the Health Belief Model scale was used to collect data. Data were analyzed using SPSS 21.0. P values < 0.05 were considered as statistically significant in this study.

Results

Among the 450 participants, the Pap smear test uptake was 26% and the HPV vaccine uptake was less than 1%. A low education level and family history for cervical cancer were significantly associated with the belief of high susceptibility for developing cervical cancer (p < 0.05). The seriousness of the disease was recognized by 38%, and the benefit of screening was recognized by 82% of the participants. In addition, 27% of the participants perceived barriers to obtaining a Pap smear test.

Conclusions

This study showed a high level of perception regarding benefits and motivation, and a low incidence of perceived barriers among women regarding cervical cancer screening. However, these attitudinal aspects did not translate into practice, as reflected by the low uptake of the screening test. Our findings imply that concerted efforts are needed to promote cervical cancer screening programs in Saudi Arabia. In view of the planned implementation of Saudi vision 2030, which emphasizes on prevention, we recommend launching a national cervical cancer screening program, to be available and accessible to all women in primary health care centers and hospitals.