Effectiveness of An Educational Intervention of Breast Cancer Screening Practices Uptake, Knowledge, and Beliefs among Yemeni Female School Teachers in Klang Valley, Malaysia: A Study Protocol for a Cluster-Randomized Controlled Trial

Evaluation of a pre-post quasi-experimental educational intervention on breast cancer awareness among pharmacy professionals in Karachi, Pakistan

Introduction

Cancer, particularly breast cancer, is a major contributor to mortality and a significant impediment to life expectancy. In 2020, breast cancer accounted for 11.7% of all cancer cases and caused approximately 685,000 deaths worldwide, surpassing lung cancer in prevalence. The study aims to evaluate the impact of an educational intervention on breast cancer awareness among pharmacy students by comparing their understanding before and after the program.

Method

A pre-post quasi-experimental study was designed to assess knowledge and awareness of breast cancer, breast self-examination (BSE) practices, and attitudes toward breast cancer among female university students in Karachi, Pakistan. Participants completed a pre-session questionnaire, attended an awareness workshop and video tutorial, and then completed a post-session questionnaire 2 weeks later.

Results

Of 1,200 participants, 1,015 of them completed both the pre- and post-intervention questionnaires. Key demographic features included 83.9% of the participants being in the 18-24 age group, 26.8% being married, and only 14.2% having a family history of breast cancer. Before the intervention, 60.7% of the participants were not involved in regular breast self-exams due to a lack of awareness. Post-intervention results showed a significant increase in awareness, with 35.9% rising to 94.9%. The use of screening methods increased from 46.7 to 94.8%. Knowledge of breast cancer improved from 51.2 to 96.7%, and the general perception rose from 48.2 to 93.4%. Attitudes toward self-examination also shifted positively, indicating a significant change in perception.

Interpretation and conclusion

The study concludes the baseline knowledge of breast cancer among female students was inadequate but improved significantly from over 40% to over 90% following the educational intervention. The intervention positively influenced the general perception and attitudes toward breast cancer. These findings highlight the need for regular educational sessions to enhance awareness, improve healthcare outcomes, and reduce mortality rates, particularly in developing countries.

A Prospective Questionnaire-Based Study Evaluating Genetic Literacy and Impact of Brief Educational Intervention Among Breast Cancer Patients in a Low- to Middle-Income Country

INTRODUCTION

A significant proportion of breast cancer cases are hereditary and are potentially preventable. However, adoption of the preventive measures remains a significant challenge, particularly because of to lack of knowledge and awareness in low- to middle-income countries.

METHODS

This prospective study conducted at a high-volume tertiary care cancer center in North India to assess the knowledge, awareness, and attitudes of female breast cancer patients and impact of a brief educational intervention. The study involved three phases: pre-interventional assessment, educational intervention, and post-interventional assessment utilizing a structured questionnaire.

RESULTS

The study involved 300 newly diagnosed breast cancer patients; 16.7% were familial. At the outset, 87.0% patients had low knowledge of risk factors, 90.3% about screening, and 32.7% about treatment. Awareness levels were low: 13.7% aware of familial risk and 2.7% of breast cancer genes. Affordability of genetic testing was low (15.2%), and interest in testing for self and family members was limited (32.0% and 26.3%). Following educational intervention, a significant positive percentage change was noticed in knowledge (risk factors: 12.8%, screening: 36.2%, treatment: 82%), awareness (familial risk: 66.7%, BRCA gene: 12.3%), and attitude (testing for self: 17.8%, family: 19.5%).

CONCLUSIONS

This study highlights the significant knowledge gaps among breast cancer patients regarding genetics. The educational intervention led to notable improvements in knowledge, awareness, and attitudes, underscoring the importance of tailored patient education in breast cancer care.

Cognition of the warning symptoms and risk factors for cancer among Chinese college students: a cross-sectional study based on a summer social practice activity

BACKGROUND

To investigate the cognition of cancer warning symptoms and cancer risk factors among Chinese college students, analyze the influencing factors, and explain the correlations between cancer cognition and cancer symptom discrimination, cancer fear and psychological distress.

METHODS

Chinese college students were recruited in this cross-sectional study funded by a summer social practice activity in Yunnan Province, China. Cognition rates of cancer warning symptoms and cancer risk factors were evaluated using Cancer Warning symptoms Cognition Questionnaire (CWSCQ) and Cancer Risk Factors Cognition Questionnaire (CRFCQ), respectively. Factors associated with cognition of cancer warning symptoms, and factors associated with cognition of cancer risk factors were evaluated using multiple linear regression analysis. Interactions between cancer cognition, cancer symptom discrimination, psychological distress, and cancer fear were evaluated by structural equation modeling.

RESULTS

There were 846 effective samples, with an effective rate of 80.9%. The cognition rates of cancer warning symptoms were from 47.9% to 84.4%, which were affected by cancer symptom discrimination, education, attitudes towards cancer screening, living expenses, drinking history, and ways to obtain cancer knowledge (p < 0.05). The cognition rates of cancer risk factors were from 46.3% to 91.3% in participants, which were affected by education, cancer symptom discrimination, psychological distress, attitudes towards cancer screening, life satisfaction, cancer history in relatives and friends, ways to obtain cancer knowledge, smoking history, and nursing history for cancer patients (p < 0.05). Cancer cognition and cancer symptom discrimination showed intermediary effects on psychological distress and cancer fear (p < 0.001).

CONCLUSIONS

The overall cancer cognition situation among Chinese college students is not optimistic, which highlights the necessity of improving the cancer health literacy among Chinese college students. With the increasing morbidity and mortality rates of cancer, it is necessary to raise awareness of early detection, and early treatment of cancer among the general public. Health education interventions are helpful to improve cancer health literacy.

From Awareness to Action: A Review of Efforts to Reduce Disparities in Breast Cancer Screening

Breast cancer is a significant public health concern, and addressing disparities in breast cancer screening is crucial for improving early detection and reducing mortality rates. This review article examines efforts to bridge the gap between awareness and action in reducing disparities in breast cancer screening. A systematic approach was employed to gather relevant literature using various databases. The selected studies encompassed a range of interventions, including policy changes, community-based programs, culturally competent interventions, technological advancements, and patient navigation. The review highlights the importance of policies and legislation in improving access to screening services and the impact of community-based initiatives in addressing disparities. Culturally competent interventions, tailored messaging, and language support were found to be effective in improving screening rates among diverse populations. Technological advancements, such as telemedicine and mobile health applications, were identified as promising approaches to increase access to screening services. Patient navigation programs effectively addressed barriers to screening and improved screening rates. The review also discusses evaluating efforts, limitations, and the need for continuous improvement. Future directions and recommendations include addressing gaps in the existing literature, proposing research directions, and providing recommendations for policymakers, healthcare providers, and researchers. By implementing these recommendations and working collaboratively, we can strive for equitable access to breast cancer screening for all populations, ultimately leading to improved outcomes and reduced disparities.

Breast cancer knowledge and practices amongst women in Algeria

PURPOSE

The present study aims at investigating how Algerian women feel about Breast Cancer (BC) and Breast Self-Examination (BSE) in terms of knowledge and attitude and to determine the factors associated with performing BSE and its reluctance.

METHODS

We carried out a cross-sectional survey between October 14, 2021 and November 14, 2022, targeting Algerian females aged more than 18 years and living in the country using a self-administered questionnaire.

RESULTS

A total of 436 participants were involved in this study among which 41.28% were aged between 21 and 30 years and 34.86% were aged between 31 and 40 years. The average level of correct responses with regard to knowledge about BC was estimated at 51.31%, whereas it was 32.93% concerning knowledge about BC risk factors. Family history was the less reported incriminating factor for developing BC among the asked women (7.34%). Concerning alarming signs of BC, the current study revealed that Algerian women were less knowledgeable about breast dimpling-puckering (44.27%), breast inward traction (50.23%), breast redness (54.13%), and nipple position change (54.13%). In terms of belief in the utility of BSE in the early detection of BC, almost all the participants (97.98%) were convinced of its utility, whereas 96.33% of them showed an interest in learning more about it. In what concerns the early screening tests, approximately, four-fifth of the participant (77.52%) heard about them, while 94.72% believed that its early detection could reduce the disease's severity and mortality.

CONCLUSION

These findings revealed an insufficient level of knowledge concerning BC, especially in regard to its risk factors and some alarming signs as well as a lack of knowledge about BSE and other BC screening tests; hence the necessity of awareness campaigns about this disease that should target categories with the lowest level of knowledge.

Clinical and psychosocial constructs for breast, cervical, and colorectal cancer screening participation: A systematic review

Research has identified a wide range of psychosocial factors associated to choosing to engage in ongoing cancer screenings. Nevertheless, a systematic review of the theoretical frameworks and constructs underpinning studies on breast, cervical, and colorectal cancer screening participation has yet to be conducted. As part of the action-research project “Miriade,” the present study aims to identifying the main theoretical frameworks and constructs adopted in the literature over the past five years to explain cancer screening participation. According to the PRISMA guidelines, a search of the MEDLINE/PubMed and PsycINFO databases was made. Empirical studies conducted from 2017 to 2021 were included. The following keywords were used: breast OR cervical OR colorectal screening AND adhesion OR participation OR engagement AND theoretical framework OR conceptual framework OR theory. Overall, 24 articles met the inclusion criteria. Each theoretical framework highlighted clinical and psychosocial constructs of cancer screening participation, focusing on the individuals (psycho-emotional functioning and skills plan) and/or the health services perspectives. Findings from the present study acknowledge the plurality of the theoretical frameworks and constructs adopted to predict or promote breast, cervical, and colorectal cancer screening adhesion and the need for new research efforts to improve the effectiveness of cancer screening promotion interventions.

Attitude sustains longer than subjective norm and perceived behavioral control: Results of breast cancer screening educational intervention

Breast malignancy is the most frequent carcinoma among females across the world and third-most in Nepal. Early diagnosis of breast cancer through breast health awareness and self-examination, in addition to mammography screening, is a highly feasible and useful technique in poorly resourced settings. However, their intentions, whether to modify behaviors or actions, remain debatable and less explained in the literature. So, we aimed to assess how long an educational intervention affects women's intention to do a breast self-examination (BSE) and mammography screening. After assessing feasibility, one ward was assigned to the intervention (IG; ward number 30) and control group (CG; ward number 33), and then with inclusion criteria, a total of 360 females (180 each in IG and CG) aged 40-75 years enrolled in the study. After the baseline assessment, participants in the IG were delivered an hour-long breast cancer screening-related lecture-discussion- demonstration session that included BSE and mammography, aided with a silicone dummy. The session was carried out by the female trained nurses. Outcome data were obtained at the baseline, 4, 8, and 12 months following the intervention. Attitudes, perceived behavioral controls (PBCs) and behavioral intents (BIs) of both mammography and BSE at baseline were similar in both IG and CG except in case of subjective norms (SNs). Intents of BSE remained effective for 4 months, whereas for mammography, it was effective only at 4 and 12 months. Moreover, attitudes toward both tests remained intact for 4, 8, and 12 months (p = < .05) consistently. With regards to PBCs, women having good control remained only for 4 months in both screening tests. Further, regarding SN, significant mean changes were observed at 4 and 12 months in BSE, and only at 4 months in mammography screening. The session was effective in sustaining BSE and mammography intentions for at least 4 months. To retain the effects longer (up to 12 months), additional educational strategies focusing on subjective norms and perceived behavioral controls of both tests are highly warranted.

A Systematic Review of Patient Education Strategies for Oncology Patients in Low- and Middle-Income Countries

INTRODUCTION

Patient education can facilitate early cancer diagnosis, enhance treatment adherence, and improve outcomes. While there is increasing cancer burden in low- and middle-income countries (LMICs), there is little research to inform successful patient education in these regions. This systematic review summarizes the existing literature on oncology education and evaluation strategies in LMICs, identifies best practices, and highlights areas which require further investigation.

METHODS

The review was conducted using PRISMA guidelines and an a priori protocol. Four databases (Ovid Medline, Cochrane Libraries, Embase, and Cabi) were searched in December 2021. Two independent reviewers evaluated studies for inclusion. Using a coded data extraction form, information was collected about the study site, intervention characteristics, and evaluation methods.

RESULTS

Of the 2047 articles generated in the search, 77 met the inclusion criteria. Twenty-four countries were represented; only 6 studies (8%) were in low-income countries. The most common education methods included technology-based interventions (31, 40%) and visual pamphlets or posters (20, 26%). More than one education method was used in 57 (74%) studies. Nurses were the most frequent educators (25, 33%). An evaluation was included in 74 (96%) studies, though only 41 (55%) studies used a validated tool. Patient knowledge was the most common measured outcome in 35 (47%) studies.

CONCLUSIONS

There is limited empiric research on oncology patient education in LMICs. The available data show heterogeneity in education approaches and gaps in evaluation. Further research to determine successful patient education and evaluation strategies is urgently needed to improve treatment cancer outcomes in LMICs.

The Effect of Educational Intervention on Knowledge, Attitude, and Practice of Women towards Breast Cancer Screening

Background. Early identification of breast cancer may result in earlier treatment and a lower mortality rate. This fact has resulted in the development of screening programs to detect breast cancer in its early stages; thus, the current study sought to investigate the influence of educational intervention on knowledge, attitude, and practice about breast cancer screening in Izeh, Khozestan Province, Iran. Materials and Methods. This experiment was carried out on the women of Izeh city in 2019. This study included 120 women who were randomized into the experimental and control groups at random (60 in the experimental and 60 in the control groups). Before and two months after the intervention, data were collected using a researcher-created questionnaire by the control and education groups. The intervention program for the intervention group included eight educational sessions over the course of two months. The SPSS 20 statistical program was used to examine the data, as well as the paired $t$ -test, independent $t$ -test, and Chi-square. Results. There was no significant difference between the experimental and control groups’ mean scores of knowledge, attitude, and practice prior to the educational intervention, but a significant difference was observed after the intervention, with the experimental group obtaining significantly higher mean scores of knowledge, attitude, and practice ( $P=0.05$ ).Conclusion. In the present study, the educational intervention on the knowledge, attitude, and practice towards breast cancer screening led to the increased scores of the experimental group compared to control group.

Predicting Rural Women's Breast Cancer Screening Intention in China: A PLS-SEM Approach Based on the Theory of Planned Behavior

Background

It was reported that the incidence of breast cancer (BC) was the highest among cancers worldwide. The breast cancer screening (BCS) program is regarded as an effective preventive measure. However, rural women's willingness to participate in the BCS program is relatively low. To provide measures to prevent BC, it is necessary for the government to identify the influencing factors of rural women's BCS intention.

Methods

A cross-sectional study was conducted among 3,011 rural women by a convenience sampling method through face-to-face interviews on a self-designed questionnaire based on the theory of planned behavior (TPB). The partial least square structural equation model (PLS-SEM) was conducted to determine the predictors of BCS intention, and a multi-group analysis (MGA) of age was performed to identify if there were differences in all hypotheses between different age groups.

Results

There were still rural women who have not been screened for BC in five years (41.7%). The research model of rural women's intention to accept this prevention against BC was rational. All of the hypotheses are supported. Especially, subjective norm (SN) (β = 0.345, p &lt; 0.001) is found to be the strongest predictor followed by the perceived behavioral control 1 (PBC 1) (personal factors, including distance, transportation, busyness, etc.) (β = 0.165, p &lt; 0.001), attitude (β = 0.152, p &lt; 0.001), past behavior (PB) (β = 0.150, p &lt; 0.001), knowledge (β = 0.121, p &lt; 0.001), and perceived behavioral control 2 (PBC 2) (pain and cultural-social factors including embarrassment from a physician, etc.) (β = 0.042, p &lt; 0.05). The advocacy and education (A&amp;E), medical level and service attitude (ML&amp;SA) of township health centers and village clinics can affect behavior intention (BI) via attitude, SN, and PBC. The results of MGA of age indicate that there are significant differences among rural women of different ages regarding the relationship between A&amp;E and PBC 2 (p &lt; 0.01) and the effect of PB on BI (p &lt; 0.001).

Conclusion

The TPB with the addition of PB, knowledge, ML&amp;SA, and A&amp;E can provide the theoretical basis for the policy intervention that aims to enhance the rural women's BCS willingness. MGA of age is conducive to promoting the implementation of the BCS policy. The findings are of great significance to improve rural women's health levels.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Educational interventions on breast cancer in men and women: a necessity in primary healthcare

Breast cancer (BC) is one of the most common diseases in the global population. It most commonly presents in women; however, there has been an increase in the number of men diagnosed with the disease, although at a lower rate. Its specific characteristics and associated risk factors mean that preventative measures are considered to be one of the most important methods of avoiding BC. Therefore, education is a fundamental part of this process. The objective of this study is to report on the educational interventions on BC carried out in healthcare between 2016 and 2021. To this end, an integrative review was carried out using the following databases: PubMed (NCBI), Science Direct, Scopus, SciELO and Google Scholar, using the keywords 'breast cancer', 'intervention education', 'prevention' and the Boolean operator 'AND'. Quantitative, full-text articles in English, Spanish or Portuguese were included. Finally, 19 articles were selected for analysis and it was found that, with regard to educational interventions on BC carried out in healthcare, one article included men and women and the remaining 18 included only women, with interventions carried out in sessions, workshops, in stages and using dynamic techniques. Therefore, there is a pressing need for educational interventions on BC for men and women at all stages of life; however, priority should be given to the young population in order to allow for early prevention. These interventions do not generate costs for the health sector, but they have a positive effect by increasing knowledge and promoting self-care.

Female medical and nursing students’ knowledge, attitudes, and skills regarding breast self-examination in Oman: a comparison between pre- and post-training

PURPOSE

Breast cancer is one of the most common cancers in women worldwide. Educational and awareness programs impact early practices of breast self-examination, resulting in the early detection of cancer and thereby decreasing mortality. The study aimed to assess the levels of knowledge and awareness of breast cancer and breast self-examination among medical and nursing students in Oman and to compare their knowledge, attitudes, and skills after a training program.

METHODS

This quasi-experimental study was carried out for female 90 medical and 80 nursing students in Oman in November 2019. A pre-test questionnaire was given before the training program and a post-test questionnaire was administered after the training program. Students’ knowledge, attitude, and skills regarding breast cancer and breast self-examination were compared. Scores for skills of practicing breast self-examination were compared between lecture and activity group and lecture-only group.

RESULTS

Pre-test and post-test data were collected from 170 female students. Significant improvements were observed in the post-test scores for students’ knowledge, attitude, and skills after the intervention (P<0.001). The mean scores for skills of practicing breast self-examination after the lecture and the activity were higher than those obtained after the lecture only (P=0.014 for medical students and P=0.016 for nursing students).

CONCLUSION

An educational training program on breast cancer and breast self-examination with an emphasis on skills can motivate participants to perform breast self-examination regularly, and may therefore help students to train other women to perform breast self-examination for the early detection of breast cancer.