Coping style, health beliefs, and breast self-examination

The psychometric properties of the Greek version of Champion's Health Belief Model Scale

BACKGROUND AND PURPOSE

Breast cancer is the leading female type of cancer in Cyprus. Therefore, there is a need for a valid and reliable tool to examine beliefs or practices about breast cancer and breast self-examination (BSE). The objective of this study was to translate the widely used Champion's Health Belief Model Scale into Greek and validate the tool among Cypriot women.

METHODS

Data analysis included descriptive statistics, reliability estimates, and confirmatory factor analysis with fit indexes for construct validity. Multiple regression, with dependent variables "frequency of practice of BSE in the previous year" and "intended frequency of BSE," was used to examine predictive validity. Ninety-four women were surveyed.

RESULTS

The six-subscale structure (confidence, benefits, susceptibility, barriers, seriousness, motivation) of the Greek version was verified, with a good model fit. Alpha coefficients ranged from .66 to .88, indicating internal consistency reliability of the tool. Regression analysis provided evidence of predictive validity, with barriers and confidence being significant predictors of BSE practice.

CONCLUSIONS

The Greek version of Champion's Health Belief Model Scale is a valid and reliable tool for use among Cypriot women that can be used to evaluate their beliefs about breast cancer and BSE and for planning interventions to improve these beliefs.

Understanding the process of adjustment to illness

This article examines the literature relating to adjustment to physical illness. Adjustment is invariably defined in the literature as some aspect of psychological function. However, in reality, adjustment is a process that begins at the presentation of symptoms and continues throughout the course of the illness and responds to changes in illness status. Physical illness can be conceptualized as a stressor, the demands of which depend upon the characteristics and severity of the illness. Recent research confirms that many of the factors known to be associated with the development of psychological disorders in the absence of physical illness are also relevant to the development of psychological problems in those with ill health. The prevalence of psychological disorders is also generally found to be considerably higher amongst those with a variety of health problems. Nonetheless, a considerable number of patients who experience even the most devastating of illnesses seem able to adjust to illness without experiencing clinically significant psychological problems. The processes by which these people are able to adjust and, in many cases, find positive meaning in their experiences, are important to understand. While a number of models have been put forward to explain various aspects of adjustment to chronic illness, an integrated approach that describes how the process of adjustment evolves is needed. Such an understanding will allow clinicians to improve interventions that facilitate adjustment and potentially prevent long-term problems. Facilitating a patient's adjustment to illness must be a priority in providing an optimal level of health care.

Breast self-examination practices among women from six ethnic groups and the influence of cancer worry

Diverse samples of women (N = 1364) from Brooklyn, New York, were interviewed regarding their breast cancer screening practices. Of interest here is the relation between cancer worry and adherence to breast self-examination (BSE) guidelines among the six ethnic groups identified--European American, African American, Haitian, Dominican and English-speaking Caribbean women. There was a significant difference in cancer worry by ethnicity. Logistic regression analysis indicated that education, cancer worry, and perceived efficacy of BSE significantly predicted adherence. Furthermore, there were significant differences among women of African descent in BSE adherence and cancer worry. These differences reflect the emerging need for researchers to empirically and methodically investigate ethnic and cultural factors, as well as emotions and affect in preventive health behaviors.

First-degree relatives of breast-cancer patients: cognitive perceptions, coping, and adherence to breast self-examination

The author assessed patterns of breast self-examination (BSE) related to cognitive appraisal, coping, and emotional distress in 80 women with first-degree relatives who were breast-cancer patients and 47 matched controls. Participants with first-degree relatives adhered to BSE better than did women with no family history of breast cancer, and women whose relatives had recurrent or metastatic disease performed more BSE than those whose relatives were currently disease free. Greater adherence to BSE was associated with lower levels of depression, more problem-focused coping, older age, and more education. In the women with first-degree relatives, BSE was also associated with higher perceptions of (a) control over prevention, (b) risk for breast cancer, and (c) higher levels of state anxiety. Perception of control, problem-focused coping, depression, and anxiety predicted 35% of the variance in adherence to BSE. The findings suggest that cognitive appraisal, coping strategies, and levels of emotional distress should be considered in designing programs for enhancing adherence to early detection procedures.

Factors associated with breast self-examination among jordanian women

The purpose of this cross-sectional, correlational, descriptive study was to investigate factors and beliefs that may be related to the practice of breast self-examination (BSE) among a group of Jordanian women. The sample consisted of 519 women from two major universities in Jordan. About 36% of the sample were university employees and 64% were graduate and undergraduate students. Stratified random sampling was used to enroll the undergraduate students while graduate students and employees were selected by convenience sampling. The study instrument was an adapted version of Champion's Revised Health Belief Model Scale (CRHBMS). The results were analyzed using a chi-square test and a stepwise multiple regression. The main findings indicate that although the majority of the sample population (67%) had heard/read about BSE, only a quarter of them reported that they had ever practiced BSE in the previous 12 months, and only 7% had performed it on a regular monthly basis. Confidence, motivation, susceptibility, and fewer barriers were variables that showed a positive association with BSE practice in the previous year, while benefits, susceptibility, and motivation influenced the intention to perform BSE in the future. Women's age, level of education, having heard or read about breast tumors, and personal history of breast tumors were also found to be significant predictors of BSE practice.

Utility of health belief model as a guide for explaining or predicting breast cancer screening behaviours

AIM

The purpose of this study was to assess the utility of HBM as a theoretical guide for predicting breast cancer screening and therefore for guiding intervention studies.

BACKGROUND

Breast cancer is the leading cause of death for middle age women (35-50) and the second leading cause of cancer deaths in all women in the United States (US). Early detection of breast cancer through screening is the only option available to women. However, less than half of all women in the US participate in screening. The health belief model (HBM), which specifies interactions of values and beliefs about health and their influence on choices, has been widely used to explain screening behaviour.

METHODS

An integrative research review analysed 16 published descriptive studies employing HBM. Literature was located through a search of research based studies listed in Cumulative Index of Nursing and Allied Health (CINAHL), Medline, and cancer literature databases and studies cited in other references between 1990 and 1999.

FINDINGS

Application of HBM was inconsistent. No study tested nonlinear relationships between variables as specified in the model. At best, the model explained 47% of the variance in screening behaviour when socioeconomic status was included. Otherwise predictive power was low, ranging from 15 to 27%.

CONCLUSIONS

While the model provides some description of the values, beliefs and behaviours of middle-aged women primarily, HBM does not appear to have the power to consistently predict behaviours. Further research is needed to provide more thorough depiction of the social, nonhealth care meaning of breast cancer.

Psychological distress, health beliefs, and frequency of breast self-examination

Although monthly breast self-examination (BSE) is recommended for early breast cancer detection, most women do not comply. Few studies have examined the impact of psychological distress on BSE frequency. Recent research suggests that it may be particularly important to examine the role of distress in the recently identified phenomenon of BSE overperformance (> 1/month). One hundred thirty-five healthy women with and without family histories of breast cancer completed sociodemographic, health belief, general and cancer-specific psychological distress, and BSE frequency questionnaires. The central finding of the study was that BSE underperformance and overperformance had two distinct sets of predictors: health beliefs, specifically barriers against BSE and low confidence in BSE performance, were related to BSE underperformance, while higher levels of psychological distress, particularly cancer-specific intrusive thoughts, were related to BSE overperformance. Findings underscore the need to evaluate BSE under- and overperformance separately and to develop problem-specific interventions to increase compliance with monthly BSE.

A prática do auto-exame da mama em mulheres de baixa renda: um estudo de crenças

Tem sido objeto de preocupação da literatura médica e, mais recentemente, da psicológica, a alta prevalência do câncer de mama nas mulheres. O diagnóstico precoce muito favorece na redução dos índices e, entre os meios de detecção, o "auto-exame da mama" se caracteriza como uma prevenção secundária, sem custos e segura. Pesquisas demonstram, contudo, que a prática do auto-exame da mama é insatisfatória, principalmente em mulheres de escolaridade e nível sócio-econômico baixos. Segundo a Teoria da Ação Racional (TRA), a maioria dos comportamentos humanos pode ser explicada em termos de crenças comportamentais ou normativas. Nesse sentido, a presente pesquisa teve por objetivo investigar as crenças modais salientes desse estrato populacional, desprovido de informações claras e serviços de saúde efetivos, através de um levantamento em uma amostra de 40 mulheres entrevistadas em ambulatórios públicos de João Pessoa (PB). As entrevistas continham itens sobre as vantagens e desvantagens do auto-exame da mama, conhecimentos e dados sócio-demográficos. A média de idade da amostra foi de 32,5 anos (DP = 11,37). As entrevistas indicaram um total de 132 crenças comportamentais, que foram categorizadas em nove dimensões e 166 crenças normativas, categorizadas em quatro dimensões. Estes resultados demonstraram que as crenças influenciam a adesão à prática do auto-exame da mama e servirão de base para que os profissionais que lidam com campanhas públicas de prevenção voltem sua atenção para esses aspectos e abordem conteúdos que promovam não só a prática do auto-exame da mama, mas outras estratégias preventivas nesta significativa população.