Development and psychometric testing of a new instrument to measure factors influencing women's breast cancer prevention behaviors (ASSISTS)

Health Beliefs, Breast Cancer Awareness, and Prevention Behaviors of Turkish Nursing Students: A Cross-Sectional Study

Purpose: This study was conducted to examine the relationship between nursing students' breast cancer (BC) awareness, health beliefs, and BC prevention behaviors. Methods: This study sample consisted of 256 female students. Descriptive Information Form, Breast Cancer Awareness Scale (B-CAS), the Factors Affecting Breast Cancer Prevention Behaviors of Women (FABCPB) Scale, and the Champion's Health Belief Model Scale (CHBMS) were used to collect the data. Results: Breast self-examination was performed in 53.9% of the nursing students. The mean B-CAS score was 1.35 ± 0.58 and the mean FABCPB score was 102.84 ± 9.62. The mean scores of the sub-dimension scores of the CHBMS of nursing students were as sensitivity perception 7.93 ± 2.13, seriousness perception 22.58 ± 5.26, benefit perception 17.25 ± 3.17, obstacle perception 22.89 ± 6.24, confidence 37.71 ± 7.53, and health motivation 26.47 ± 4.41 points. A significant correlation was found between the scores of the nursing students on the B-CAS, FABCPB, and CHBMS scales. Conclusions: Nursing students' scores on the B-CAS and FABCPB were moderate, CHBMS sensitivity and obstacle perception sub-dimension scores were low, severity perception scores were moderate, and benefit perception, trust, and health motivation sub-dimension scores were high. As the BC awareness of nursing students increased, their cancer prevention behaviors and health beliefs increased.

Factors influencing breast cancer screening practices among women worldwide: a systematic review of observational and qualitative studies

BACKGROUND

The variation in breast cancer incidence rates across different regions may reflect disparities in breast cancer screening (BCS) practices. Understanding the factors associated with these screening behaviors is crucial for identifying modifiable elements amenable to intervention. This systematic review aims to identify common factors influencing BCS behaviors among women globally.

METHODS

Relevant papers were sourced from PubMed, Scopus, Embase, and Google Scholar. The included studies were published in English in peer-reviewed journals from January 2000 to March 2023 and investigated factors associated with BCS behaviors.

RESULTS

From an initial pool of 625 articles, 34 studies (comprising 29 observational and 5 qualitative studies) with 36,043 participants were included. Factors influencing BCS behaviors were categorized into nine groups: socio-demographic factors, health status history, knowledge, perceptions, cultural factors, cues to action, motivation, self-efficacy, and social support. The quality appraisal scores of the studies ranged from average to high.

CONCLUSIONS

This systematic review highlights factors pivotal for policy-making at various levels of breast cancer prevention and assists health promotion professionals in designing more effective interventions to enhance BCS practices among women.

The effects of women's insight levels on breast cancer prevention behaviors: a cross-sectional study

The aim of this study is to determine the effect of women's insight levels on their breast cancer prevention behaviors in primary health care services. A systematic sampling method was used to select a sample of 393 women in a province in Turkey. Socio-demographic Characteristics Form, Insight Scale and Scale for Determining Factors Affecting Women's Breast Cancer Prevention Behaviour were used as data collection tools. Data were collected face-to-face and then analyzed statistically using Student's t-test, one-way analysis of variance, Tukey HSD, Spearman correlation test and multiple regression analysis. The results showed that those who felt "healthy" had significantly higher mean breast cancer prevention behavior (p < .05). It was determined that there was a weak positive correlation between the level of insight and breast cancer prevention behaviors, and the increase in the level of insight had a significant positive effect of 0.37 ± 0.051 points on breast cancer prevention behaviors. It was found that there was a significant negative effect on prevention behaviors with 1.66 ± 0.796 points in those with a high education level and 1.58 ± 0.505 points in those with suspected disease. In conclusion, in this study, it was determined that insight level, education level, and awareness of early diagnosis affected the prevention behaviors of breast cancer.

Creation of a Métis-Specific Instrument for Cancer Screening: A Scoping Review of Cancer-Screening Programs and Instruments

Understanding the barriers to and facilitators of cancer screening programs among Indigenous populations remains limited. In the spirit of mutual respect, this co-led, collaborative project was carried out between the Métis Nation of Alberta and Screening Programs from Alberta Health Services (AHS). This scoping review assessed the cancer screening literature for available questionnaires and then identified themes and suitable questions for a Métis-specific cancer screening questionnaire. Literature searches on cervical, breast, and colorectal cancer screening programs and related concepts were conducted in electronic databases, including the Native Health Database, MEDLINE (Ovid), PsycINFO, PubMed, PubMed Central, CINAHL, MEDLINE (Ebsco), Psychology & Behavioral Sciences Collection, and Web of Science. Grey literature was collected from AHS Insite, Open Archives Initiative repository, American Society of Clinical Oncology, European Society of Medical Oncology, Google, and Google Scholar. 135 articles were screened based on the eligibility criteria with 114 articles selected, including 14 Indigenous-specific ones. Knowledge, attitude, belief, behaviour, barrier, and facilitator themes emerged from the review, but no Métis-specific cancer screening instruments were found. Thus, one was developed using existing cancer screening instruments, with additional questions created by the project team. A survey of the Métis population in Alberta will use this questionnaire and provide data to address the burden of cancer among Métis people.

Investigation of the Effect of Women's Breast Cancer Worry Levels on Breast Cancer Prevention Behavior

Objective

The aim of this study was to investigate the extent of worry about breast cancer (BC) amongst a sample of women and to examine the effect of this on behavior to prevent BC.

Materials and Methods

This cross-sectional study was conducted in 271 women aged 18 years and above who attended the Family Medicine Outpatient Clinic of a tertiary hospital and met the inclusion criteria. Data were collected using the following tools: Patient Information Form; Breast Cancer Worry Scale (BCWS); Breast Cancer Prevention Behaviors Identification Scale (BCPBIS); and Mammography Processes of Change Scale (MPCS).

Results

When evaluated according to BCWS scores (mean 8.43±3.36), the BC worry levels were found to be low. The behavior adopted for prevention was also found to be positive according to BCPBIS (mean 119±15.26) and MPCS (mean 82.38±12.81) scores. A significant correlation was found between the BCWS and both the BCPBIS and MPCS scores, and again between the BCPBIS and MPCS scores (p<0.001 for all). There was a correlation with three scale scores in those who had knowledge about BC, and those who had regular clinical breast examination (BE) (p<0.05 for all). The BCPBIS score was found to be higher in those aged between 41-65 years, those who had mammography, and performed p self-BE (p = 0.002; p<0.001; p<0.001, respectively). According to the MPCS score, mammography behaviors was found to be more positive in those who had regular gynecological examinations and those who had mammography (p = 0.08 and p = 0.011).

Conclusion

The participants generally had low BC worry levels and had adopted positive behavior for prevention. Being informed about BC and screening and having regular BE increased BC worry. Those with high BC worry, those who had mammography before, those who had knowledge about BC and screening, and those who regularly performed BE showed more positive behaviors toward preventing BC.

Measuring Safety Culture Using an Integrative Approach: The Development of a Comprehensive Conceptual Framework and an Applied Safety Culture Assessment Instrument

An exponential amount of academic research has been dedicated to the safety culture concept, but still, no consensus has been reached on its definition and content. In general, safety culture research lacks an interdisciplinary approach. Furthermore, although the concept of safety culture is characterised by complexity and multifacetedness, the safety culture concept has been characterised by reductionism, where models and theories simplify the concept in order to better grasp it, leading to confined approaches. In this article, the multifacetedness of safety culture is acknowledged, and the topic is addressed from a safety science perspective, combining insights from multiple academic disciplines. An integrative and comprehensive conceptual framework to assess safety culture in organisations is developed, taking into account the limitations of existing models, as well as the needs of the work field. This conceptual framework is called the 'Integrated Safety Culture Assessment' (ISCA), where the 'assessment' refers to its practical usability. The practical rendition of ISCA can be used to map the safety culture of an organisation and to formulate recommendations in this regard, with the ultimate goal of bringing about a change towards a positive safety culture. The comprehensiveness of ISCA lies in the inclusion of technological factors, organisational or contextual factors and human factors interacting and interrelating with each other, and in considering both observable or objective safety-related aspects in an organisation, and non-observable or subjective safety-related aspects. When using ISCA, organisational safety culture is assessed in an integrative way by using a variety of research methods involving the entire organisation, and by taking into account the specific context of the organisation.

Identification of women's breast cancer prevention behaviors and the associated factors: The case of the Southeastern Anatolia Region

In this study, the researchers investigated the factors that affect women's breast cancer prevention behaviors. The sample of this cross-sectional and descriptive study consisted of 406 participants aged 20 and older. The study was conducted in February-March 2021 within the administrative borders of a province located in the Southeastern Anatolia Region of Turkey. The data were collected via an online platform using Personal Information Form and the Scale of Factors Affecting Women's Breast Cancer Prevention Behaviors. The mean Scale of Factors Affecting Women's Breast Cancer Prevention Behaviors score of the participants was moderate as 107.20 ± 17.86. The frequency of breast cancer prevention behaviors was found to be lower in the participants with low literacy, those who were unemployed, those with low income, those living in villages and those who did not perform breast self-examination (p < 0.05). It is recommended to plan educational studies on breast cancer screening behaviors by considering regional differences.

Food Literacy and Its Associated Factors in Non-Dialysis Patients with Chronic Kidney Disease in China: A Cross-Sectional Study

PURPOSE

Nephrology professionals' understanding of food literacy (FL) and influencing factors is significant for nutrition management, which is key to controlling disease progress among non-dialysis patients with chronic kidney disease (CKD). However, few studies have explored FL in CKD patients. Hence, this study aimed to investigate the level of FL of non-dialysis patients with CKD and to analyze influencing factors in China.

PATIENTS AND METHODS

A total of 203 CKD patients without dialysis were recruited from August to December 2020 to participate in a cross-sectional study. Food literacy was assessed by a modified short food literacy questionnaire for adults. Related influencing factors were measured by the motivation for dietary self-control scale and the satisfaction with dietary behavior scale. Data were also collected regarding patients' health information-seeking behavior (four items), satisfaction and compliance with dietary advice from healthcare professionals (two items), and demographics and clinical diagnoses.

RESULTS

The mean age of patients was 44.5 years (range 18 to 75), and 42.5% were male. Most (50.2%) were in stages 1-2 of CKD. The mean FL score of these patients was 38.75±0.38. The multivariable linear regression analysis shows that secondary educational level (β=0.221, p=0.004), motivation for controlling diet (β=0.198, p=0.003), satisfaction with dietary behaviors (β=0.319, p<0.001), and health information-seeking behavior (β=0.146, p=0.019) were significant influencing factors.

CONCLUSION

Food literacy of Chinese CKD patients without dialysis should be improved. Patients with higher education levels exhibit more active information-seeking behaviors, have greater satisfaction with dietary behaviors, and their motivation for dietary self-control is more likely to be associated with better FL. Healthcare workers should be aware of factors influencing FL and attempt to integrate assessment of FL into routine food-related education for CKD patients.

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

Background:

Materials and Methods:

Results:

Conclusion:

Association Between eHealth Literacy in Online Health Communities and Patient Adherence: Cross-sectional Questionnaire Study

Background

eHealth literacy is significantly associated with patients’ online information behavior, physician-patient relationship, patient adherence, and health outcomes. As an important product of the internet, online health communities (OHCs) can help redistribute idle medical resources, increase medical resource utilization, and improve patient adherence. However, studies on eHealth literacy in OHCs are limited. Therefore, this study examined patients’ eHealth literacy regarding health information–seeking behavior and physician-patient communication in OHCs.

Objective

This study aimed to investigate the association between eHealth literacy in OHCs and patient adherence by employing social cognitive theory.

Methods

This was an empirical study, in which a research model consisting of 1 independent variable (patients’ eHealth literacy), 3 mediators (physician-patient communication in OHCs, patient health information–seeking behavior in OHCs, and patients’ perceived quality of health information in OHCs), 1 dependent variable (patient adherence), and 4 control variables (age, gender, living area, and education level) was established to examine the associations. Multi-item scales were used to measure variables. An anonymous online survey involving 560 participants was conducted through Chinese OHCs in July 2018 to collect data. Partial least squares and structural equation modeling were adopted to analyze data and test hypotheses.

Results

The survey response rate was 79.6% (446/560). The reliability, convergent validity, and discriminant validity were acceptable. Age, gender, living area, and education level were positively associated with patient adherence, and gender was positively associated with physician-patient communication and patients’ perceived quality of internet health information in OHCs. Patients’ eHealth literacy was positively associated with patient adherence through the mediations of physician-patient communication, internet health information–seeking behavior, and perceived quality of internet health information in OHCs.

Conclusions

Results indicate that physician-patient communication, internet health information–seeking behavior, and the perceived quality of internet health information are significantly associated with improving patient adherence via a guiding of eHealth literacy in OHCs. These findings suggest that physicians can understand and guide their patients’ eHealth literacy to improve treatment efficiency; OHCs’ operators should this strengthen the management of information quality, develop user-friendly features, and minimize the gap between the actual and perceived information quality.

The Claiming Costs Scale: A new instrument for measuring the costs potential beneficiaries face when claiming social benefits

It is a well-known feature of social protection systems that not all persons who are entitled to social benefits also claim these benefits. The costs people face when claiming benefits is considered an important cause of this phenomenon of non-take-up. In this paper, we developed and examined the psychometric properties of a new scale, the Claiming Cost Scale (CCS), which measures three dimensions of costs associated with claiming benefits. A multi-phase instrument development method was performed to develop the instrument. The item pool was generated based on a literature review, and presented to academic experts (n = 9) and experts by experience (n = 5) to assess content and face validity. In a second stage, centrality and dispersion, construct validity, convergent and divergent validity, and internal reliability of the instrument were tested. These analyses were based on two samples (n = 141 and n = 1265) of individuals living in low-income households in Belgium. Nine items were retained, which represent three factors (Information costs, Process costs and Stigma). The confirmatory factor analysis proved adequate model fitness. Both convergent and divergent validity were good, and internal consistency was adequate, with Cronbach's alpha ranging between .73 and .87. The findings showed that the CCS is a valid and reliable instrument for assessing the costs potential beneficiaries face when claiming benefits. Consisting of only nine items, the scale can be easily implemented in large-scale survey research or used in day-to-day work of service providers who are interested in understanding non-take-up of their service.

Impact of patient information behaviours in online health communities on patient compliance and the mediating role of patients' perceived empathy

OBJECTIVE

Patient health information seeking and physician-patient communication in OHCs proved to have impacts on patient compliance, but related studies from psychological perspectives are limited. This study aims to investigate the impact of patient health information seeking and physician-patient communication in OHCs on patient compliance.

METHODS

This study established a research model and proposed six hypotheses. An anonymous investigation was conducted using Chinese OHCs. Confirmatory factor analysis, partial least squares, and structural equation modelling were used to test the hypotheses.

RESULTS

We received 371 responses, and 316 of them were valid. Patient health information seeking and physician-patient communication frequency in OHCs had positive impacts on patients' perceived affective and cognitive empathies, which positively impacted patient compliance.

CONCLUSIONS

Patient compliance can be improved by patient health information seeking and physician-patient communication in OHCs and affective and cognitive empathies. Patients' perceived affective empathy is the preferred perspective to improve patient compliance.

PRACTICE IMPLICATIONS

Physicians should encourage patients to seek health information and communicate with them through OHCs, be concerned about patients' experiences, feelings, and attitudes, understand patients' demands and mental states, and show their patients that they can feel patients' pain. Increasing physician-patient communication frequency in OHCs can help improve patient compliance.

The psychometric properties of the Persian menopause rating scale

Background

To measure the severity of menopausal complaints and determine the pattern of menopausal symptoms, a valid and reliable instrument is needed in women’s healthcare. The Menopause Rating Scale (MRS) is one of the best-known tools in response to the lack of standardized scales. The purpose of this study was to examine the psychometric properties of the MRS in an Iranian example.

Methods

Participants were randomly selected from women referred to healthcare centers in Miandoab, West Azerbaijan, Iran. A total of 330 questionnaires were completed (response rate of 96.9%). Two samples were considered for analysis in the validation process. An exploratory factor analysis (EFA) was conducted on the first sample (n₁ = 165), and a confirmatory factor analysis (CFA) was done using a second study sample (n₂ = 165). The psychometric properties process was concluded with assessment of internal consistency and test-retest reliability.

Results

The EFA with Principal Component Analysis extracted three factors explaining 75.47% cumulative variance. The CFA confirmed a three-factor structure of the 11-items MRS. All fit indices proved to be satisfactory. The relative chi-square (χ2/df) was 3.686 (p < .001). The Root Mean Square Error of Approximation (RMSEA) of the model was .04 (90% CI = .105–.150). All comparative indices of the model, including the Comparative Fit Index, Normed Fit Index, and Relative Fit Index, were more than .80 (.90, .87, and .80, respectively). For the overall scale, Cronbach’s alpha was .931, whereas the alpha for the subscales ranged from 0.705–0.950. The intraclass correlation was .91 (95% CI = .89–.93), p < 0.001.

Conclusion

The results of the study indicate that the Persian model of the MRS is a valid and reliable scale. As a screening tool, the Persian MRS could be used to identify the pattern of symptoms among menopausal, premenopausal, and postmenopausal women to care for and educate them on how to identify and treat the symptoms.

Development and psychometric properties of the Digital Difficulties Scale (DDS): An instrument to measure who is disadvantaged to fulfill basic needs by experiencing difficulties in using a smartphone or computer

Today, some individuals may be at a disadvantage by experiencing difficulties in using a smartphone or computer to reach specific outcomes (e.g., looking for a job, searching for information on insurances) or in general (e.g., not knowing how to change the settings of an app or website). The aim of this study is to develop and examine the psychometric properties of a new instrument, called the Digital Difficulties Scale (DDS). A multi-phase method was performed to develop the questionnaire in the period from January 2019 to November 2019. The item pool was generated based on a literature review, informal observations and interviews. Then, this item pool was presented both to experts (n = 6) and non-experts (n = 492) to assess content and face validity. In a second stage, construct validity (both exploratory and confirmatory), convergent and divergent validity, internal consistency, and test-retest reliability of the questionnaire were tested. These analyses were based on a representative sample (n = 1000), and an independent sample for test-retest reliability (n = 44). Twenty-four items were generated and refined during content and face validity assessment. The exploratory factor analysis revealed three factors (Specific Digital Difficulties, General Digital Difficulties, and Worries about Future Digital Difficulties) containing sixteen items, together explaining 73.03% of the observed variance. The confirmatory factor analysis proved adequate model fitness. Both convergent and divergent validity were good, and internal consistency was excellent, with Cronbach’s alphas ranging between .93 and .97. Finally, our instrument demonstrated good test-retest reliability, with interclass correlation coefficients between .73 and .86. Consequently, the DDS can be used both in future research and practice, as it is a valid and reliable instrument to measure who is disadvantaged to fulfill basic needs by experiencing difficulties in using a smartphone or computer.

Exploring the Effects of Patient Activation in Online Health Communities on Patient Compliance

Background: Online health communities (OHCs) are one of the developments related to online health. Patient compliance plays a vital role in improving health treatment outcomes. Patient activation is associated with patient activities in OHCs, such as physician-patient communication and health information seeking. In other words, OHCs influence patient compliance. Therefore, identifying the relationship between patient activation in OHCs and patient compliance is important for improved health outcomes. Methods: This study established a research model consisting of one independent variable (patient activation), four mediators (physician-patient communication, health information seeking, perceived information asymmetry, and e-health literacy), one dependent variable (patient compliance) and four control variables (gender, age, education level, and status). Data were obtained through a web-based survey, involving a total of 387 valid participants in China. These data were analyzed and tested through structural equation modeling and partial least squares. Results: Patient activation positively affects patient compliance through the mediation of physician-patient communication, health information seeking, perceived information asymmetry, and e-health literacy. Perceived information asymmetry has no direct effect on patient compliance. However, perceived information asymmetry affects patient compliance through the mediation of e-health literacy. Conclusions: Patient compliance is significantly affected by patient activation. Thus, physicians can achieve higher patient compliance by improving patient activation. Guaranteeing and improving the information quality in OHCs is essential for physicians and OHCs operators. Physicians should pay extra attention in cultivating patients' e-health literacy through communications and health information-seeking behaviors to further improve patient compliance.

New Educational Model to Promote Breast Cancer-Preventive Behaviors (ASSISTS): Development and First Evaluation

BACKGROUND

The prevalence of breast cancer in Iran has increased. An effective approach to decrease the burden of breast cancer is prevention.

OBJECTIVE

The aim of this study was to develop and evaluate an educational model, called the ASSISTS, for promoting breast cancer-preventive behaviors in women.

METHODS

A multiphase method was used to develop the model designed to promote breast cancer prevention behaviors. A conceptual model was generated based on a secondary analysis of qualitative data. Then, a structural equation model technique was used to test the relationships among the model constructs.

RESULTS

The analysis revealed that 7 constructs could be extracted, namely, perceived social support, attitude, motivation, self-efficacy, information seeking, stress management, and self-care. Based on these constructs, a conceptual model was built and tested using structural equation modeling. The model fit was good, and the model confirmed significant relationships among the 7 constructs of breast cancer prevention.

CONCLUSION

Findings revealed that self-care behavior and stress management are influenced directly by attitude, motivation, self-efficacy, information seeking, and social support. In addition, women seek more information when they are motivated, have more self-efficacy, have a more positive attitude toward breast cancer prevention, and experience more social support.

IMPLICATION FOR PRACTICE

Cancer nurses can be at the forefront of breast cancer prevention. Because they can play a pivotal role in providing information, they can reduce women's stress and increase their self-care behavior. In addition, their social support can positively influence Iranian women's attitude, motivation, and self-care behavior. Furthermore, implementing educational programs based on this model might encourage women to practice preventive behaviors.

Psychometric properties of the Persian version of the Cancer attitude inventory

BACKGROUND

The Cancer Attitude inventory (CAI) was developed to measure attitudes toward cancer. The aim of the present study was to describe the development of the Persian version of the CAI and to evaluate its psychometric properties in an Iranian sample.

METHODS

The forward-backward method was used to translate the CAI scale from English into Persian. After linguistic validation and a pilot check, a cross-sectional study was performed and psychometric properties of the Iranian version of the questionnaire were assessed. The scale validation was conducted with a convenience sample of 820 laypeople. Construct validity was assessed through both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency was assessed through Cronbach's alpha analysis and test-retest analysis.

RESULTS

Five factors were identified in CAI: isolation, helplessness, fear of consequence, belief of control and independence, and fear of death. The results achieved from the CFA displayed that the data fit the model: the relative chi-square (× 2/df) = 2.98 (p < .001), and the root mean square error of approximation (RMSEA) = .07 (90% CI = .06-.07). All comparative indices of the model had scores greater than .80, demonstrating a good fit to the data. Cronbach's Alpha and the intra-class correlation coefficient (ICC) were .97, which is well above the acceptable threshold.

CONCLUSIONS

The results indicate that the Persian version of the CAI is practical, reliable and valid. Consequently, the instrument could be used in plans to create positive attitudes about cancer control and treatment among Persian people.

Development and psychometric properties of the methamphetamine decisional balance scale (METH-DBS) for young adults

BACKGROUND

Drug misuse is a major problem that has an extreme negative effect on people's health. Methamphetamine (MA) is frequently used by young adults, despite its harmful consequences. The Transtheoretical Model (TTM) has been known to be very effective in explaining both the achievement and cessation of several health-related behaviors. Therefore, in this study, the TTM was used toward the domain of immoderate MA use among young adults. This study aimed to test the validity and reliability of a decisional balance scale for MA use in young adults.

METHODS

A multi-phase scale development approach was used to develop the scale. First, 41 university students enrolled in a qualitative study that generated content for a primary set of a 40-item instrument. In order to produce a pre-final version of the instrument, face and content validity were calculated in the next step. The instrument validation was assessed with a sample of 250 university students. Then, the construct validity (exploratory and confirmatory), convergent validity, discriminate validity, internal consistency applying test-retest reliability, and Cronbach's alpha of the scale were measured.

RESULTS

Forty items were initially generated from the qualitative data. After content validity, this amount was reduced to 25 items. The exploratory factor analysis revealed four factors (self and other cons, coping and social pros) containing 21 items that jointly accounted for 55.24% of the observed variance. The confirmatory factor analysis indicated a model with appropriate fitness for the data. Cronbach's alpha coefficient for the dimensions ranged from .74 to .87, and the Intraclass Correlation Coefficient (ICC) ranged from .83 to .91, which is within acceptable ranges.

CONCLUSION

The findings showed that the Methamphetamine Decisional Balance Scale is a valid and reliable scale that increases our ability to study motivational factors related to MA use among young adult. Consequently, the instrument could be applied in both practice and future studies.

Exploring breast cancer preventive lifestyle and social support of Iranian women: a study protocol for a mixed-methods approach

BACKGROUND

It is widely accepted that a healthy lifestyle may decrease the probability of developing cancer. This study aimed to describe a study protocol that makes it possible to explore preventive health lifestyles of Iranian women and their received social support for the purpose of developing cultural strategies to increase breast cancer prevention.

METHODS

A mixed-methods study will be accomplished in two sequential parts. First, a cross-sectional study will be conducted in which 2,250 Iranian women are recruited by using a random multistage cluster sampling of 20 health care centers. Structured face-to-face interviews will be conducted to obtain information on the participants' health lifestyle and perceived social support. Data will be analyzed using both multivariate regression and structural equation modeling techniques. Then, a qualitative study will be conducted among employed women using a purposive sampling design. Data will be collected by means of focus groups and semi-structured interviews and will be analyzed using a conventional content analysis approach. The results of the quantitative and qualitative study will be used to develop breast cancer preventive strategies.

DISCUSSION

Researchers need to acquire knowledge regarding the lifestyle and perceived social support of Iranian women that will foster culturally competent approaches to promote healthy lifestyles to develop breast cancer preventive strategies. Examining breast cancer preventive lifestyles provides valuable information for designing applicable intervention programs for improving women's health.