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Eect of Health Belief Model on the Practices of Women
Regarding Detection of Breast Cancer
ABSTRACT
Background: Breast cancer is the main form of cancer affecting women and the fourth most common cause
of cancer mortality. The aim of this study was to evaluate the effect of health belief model on the practices
of women regarding detection of breast cancer. Research design: Quasi-experimental research design was
used in this study. Setting: The study was conducted at breast tumor early detection unit, Outpatient Clinic at
Benha University Hospital, Egypt. Sample: Purposive sample (the total numbers of women 100) from the
above mentioned setting. Tools: A self-administered questionnaire, Champion’s Health Belief Model
Constructs Scale (CHBMS) and an observation checklist for Breast Self-Examination (BSE) were used to
collect the data. Results of this study showed; the highest percentages (62%) of women were found
within age groups from 30 to 39 years old with mean age were 35.90±6.45, 53% of them had
secondary education, 93% of them didn’t do regular breast self-examination and 96% of them didn’t
have ever a mammogram, there were improvement in the studied women' knowledge scores
regarding detection of breast cancer after model implementation (P < 0.001). 36% of the studied
women had satisfactory practices before the model implementation, while increased to 74% after the
model implementation. In the pre model 36% of the studied women had positive health belief, and then this
percentage improved and become 64% after implementation of the model. Also there were statistically
significant relation between socio demographic characteristics of the studied women and their total
knowledge and practices after the model implementation. This study concluded that: The results of the
present study confirmed the positive effects of the health belief model on women's knowledge, behavior and
practice regarding breast self-examination and breast cancer. The study recommended that: Breast cancer
awareness models should be developed in Outpatient of Hospitals on a regular basis and similar study
can be replicated on a large sample and a comparative study can be done with women of different groups
Keywords: Breast Cancer, Practices of Women and Health Belief Model
1.Introduction:
Breast cancer is the most common type of cancer diagnosed among
women both in developing and developed countries. It is the second cause of death in
the world. Its annual incidence is rising globally each year, more than one million new
cases of breast cancer have been diagnosed in the world and for this reason, more than
six hundred thousand cases death occurs (Ahmed et al., 2016).
Breast cancer is a multi-factorial disease in which genetic and environmental
factors contribute to its occurrence. Established risk factors for breast cancer include
reproductive factors (early menarche, null parity, age at first pregnancy over 30 years,
use of high-dose hormonal contraceptives, late menopause and hormone replacement
therapy, increasing age, high breast tissue density and family history of cancer,
especially breast cancer. Additional factors that modulate breast cancer risk include
nutritional factors, physical activity, history and duration of breast feeding, obesity in
post menopause, smoking, alcohol consumption, exposure to ionizing radiation and
socioeconomic level (Dornelles et al., 2015).
A proximately one out of eight women worldwide develops breast cancer,
accounting for 12% of all new cancer cases and 25% of all cancers in women as of
2012. Annually; around 1.7 million women worldwide are diagnosed with breast
cancer. As such; breast cancer is responsible for the most frequent malignancy-causing
deaths and cancer-related mortality and morbidity in women, an epidemiological
profile mirrored in almost every country. However, in developing countries, where
health literacy, access to care, and resources are all scarce, these numbers become
particularly alarming. They contribute to major health disparities between the
developed and developing world, especially in that most women in developing nations
who develop breast cancer seek health care only when the cancer is at an advanced
stage (Doumit et al., 2017).
Screening prevention plays an important role in early detection of breast cancer
and decreasing its mortality rates. The recommended screening approaches for early
diagnosis of breast cancer are mammography, Clinical Breast Examination and breast
self-examination. Annual mammography screening is the best technique to discover
tumor before signs and symptoms appear and can prompt effective treatment
(Rezaeian et al., 2014).
Health beliefs paly a considerable role in women` tendency toward participating
in health promotion related behaviors. One of the well-known educational models in
health education is health belief model, which is a psychological and it is widely used
in the context of research studies concerned with predicting health-related behaviors.
Health belief model has six constructs concerned with behavior which include
perceived severity, perceived susceptibility, perceived benefits and barriers, cues to
action and self-efficacy (Moballeghi et al., 2014).
The Health Belief Model (HBM) has been used widely as a theoretical
framework in many studies related to breast cancer screening and evaluations of
breast-cancer screening behavior, such as breast self-examination or mammography
screening. Perceived susceptibility should focus on the vulnerability or risk of
developing breast cancer, whereas perceived seriousness should be concerned with
women’s perceptions of breast cancer complications if left untreated. Perceived
benefits from action refer to positive outcomes or feedback after mammogram
screening, whereas perceived barriers to action are obstacles that prevent
mammogram screening (Wang et al., 2014).
Nurses play an important role in teaching women about breast self- examination
and they are in an appropriate position to teach breast cancer awareness with no extra
cost. A female who was advised about BSE by health care providers demonstrated
greater knowledge, confidence and was likely to practice it routinely (Abd El-
Mohsen& El-Maksoud, 2015).
Significance of the study:
In Egypt; breast cancer is the most common cancer among women constitutes
29% of cancer cases treated at the national cancer institute and the most frequent
malignant tumor in women worldwide. In Egypt, it is representing 18.9% of total
cancer cases (35.1% in women and 2.2% in men) among the Egypt National Cancer
Institute’s (NCI) series of 10,556 patients during the year 2001, with an age adjusted
rate of 49.6 per 100,000 people (Qalawa et al., 2015).
Breast cancer has been considered as a major health problem among
females because of its high incidence in recent years. BSE is one of the most
important methods for early diagnosis of breast cancer. 95% of all breast cancers
can be diagnosed in the primary stage by BSE. Unfortunately, despite the relative
benefits of regular BSE, few women actually examine themselves. In fact, the
majority does not even know how to do a BSE (Mohamed et al., 2016).
Challenges for Egyptian doctors treating breast cancer include late detection
and the lack of awareness about the disease. According to the National Cancer
Institute in Cairo, many Egyptian women fail to seek medical treatment or preventive
screening, making it more difficult to treat cancers and by the time breast cancer is
detected in advanced stage (Abd El-Mohsen& El-Maksoud, 2015).
Many women are diagnosed in advanced stages of breast cancer due to lack of
information and awareness about breast cancer screening practices .hence, raising
awareness about breast cancer screening is a primary trend in our society.
HBM is One of the models that can be effective in enhancing women`s
knowledge, change their unhealthy practices, and improve their behavior regarding
early breast cancer detection which .so the researchers decided to perform the study to
evaluate the effect of health belief model on the practices of women regarding
detection of breast cancer (references missed ).
Aim of the Study:
The aim of this study was to evaluate the effect of health belief model on the
practices of women regarding detection of breast cancer.
Research hypothesis:
To fulfill the aim of this study the following research hypothesis formulated:
The health belief model will improve women's knowledge, practices and behavior regarding
breast cancer detection
2.Subjects and Methods
A – Research design:
Quasi experimental research design was utilized to conduct this study.
B- Setting:
The study was conducted at breast tumor early detection unit, Outpatient Clinic at
Benha University Hospital in Benha City, Egypt.
C- Sampling:
Purposive sample was used in this study. The total numbers of women attended at
breast tumor early detection Outpatient Clinic at Benha University Hospital was 100
through the last 6 months from the beginning of the study. They were chosen
according to certain criteria: Not diagnosed with breast cancer, accepted to participate
in the study.
D- Tools of data collection: The following tools were used for data collection:
Tool I : A structured interviewing questionnaire: It was designed by the
researchers after reviewing relevant literatures and it consisted of two parts:
Part 1: It was concerned with the studied women' socio-demographic characteristics
such as their age, educational level, marital status, residence, family income, family
history of breast cancer, regularly do breast self-examination and a mammogram.
Part 2: It was concerned with the studied women' knowledge regarding breast cancer.
These included 3 items contains 22 questions divided into 12 questions about risk
factors of breast cancer, 6 questions about breast cancer warning signs and 4 questions
screening methods.
Scoring system:
Each item scored 2 if answered correct and complete, scored 1 if correct and not
complete and zero if incorrect or don`t know. The total knowledge scores were
considered good if the score of the total knowledge ≥ 75 % (≥ 16), considered average
if it is equals 50- < 75% (11- < 16), and considered poor if it is less than 50% (< 11).
Tool II: Champion Health Belief Model Constructs Scale (CHBMC) adapted
from (Parsa et al., 2008) (pre/post model)
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Tool III: An Observational checklist was designed to assess and observe women’
performance of breast self- examination. This checklist consists of 9 practical steps
(Stand in front of a mirror and look at both breasts. Check for anything unusual, such
as nipple retraction, redness, puckering, dimpling, or scaling of the skin, and look for
nipple discharge. Press the hands firmly on the hips and lean slightly toward the
mirror as pull the shoulders and elbows forward with a squeezing or hugging motion
and look for any change in the normal shape of the bre. Looking in the mirror,
raise the arms and rest the hands behind the head, this allows seeing the underside of
the breasts. Place the left hand on waist, roll the shoulder forward and reach into the
underarm area and check for enlarged lymph nodes repeat the step for another side .
Raise the left arm, use the pads of three or four fingers of the right hand to examine
the left breast; use three levels of pressure (light, medium, and firm) while moving in
a circular motion, check the breast area using a set pattern. Beginning at the outer
edge of the breast use the flat part of the fingers, moving in circles slowly around the
breast, gradually make smaller and smaller circles toward the nipple, be sure to cover
the entire breast and check behind the nipple. Raise the right arm, use the pads of three
or four fingers of the left hand to examine the right breast, use three levels of pressure
(light, medium, and firm) during moving in a circular motion, and check the breast
area using a set pattern. Beginning at the outer edge of the breast use the flat part of
the fingers, moving in circles slowly around the breast and gradually make smaller
and smaller circles toward the nipple. Be sure to cover the entire breast and check
behind the nipple.
Scoring system:
Each step was scored from (0-2). Each correct and complete practical step was scored
as two grades, each correct but incomplete step was scored as one grade while
each incorrect step was scored as zero. The total practical scores were 18 divided
into two categories. Scores 9:/;-9/.referred to satisfactory practice while
scores :/;-</.referred to unsatisfactory practice.
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Ethical considerations
Personal communication was done with women to explain the purpose of
the study, assure their best possible cooperation and ensuring confidentiality of the
data. The researchers emphasized to women that the study was voluntary and
anonymous. The women had the full right to refuse to participate in the study or to
withdraw at any time without giving any reason.
Administrative approval
Official permission was obtained by submission of an official letter from the
Faculty of Nursing to the responsible authorities of the study settings to obtain the
permission for data collection.
Health belief model construction:
The current study was carried out on four phases, Assessment phase,
planning phase, implementation phase and evaluation phase.
1. Assessment phase: After obtaining official permissions to conduct the
study, the researchers interviewed each woman individually in both control
and intervention groups, then explained the purpose and procedures of the
study, and asked for participation. After obtaining consent to participate in
the study, the women were interviewed to assess their socio-demographic
characteristics and knowledge regarding breast cancer, the information
obtained during this phase constituted then baseline for further comparisons to
estimate the effect of health belief model implementation. Control group was
assessed first then intervention group in order to avoid cross contamination of
information between both groups. Average time for the completion of each
women interview was around (10-15 minutes).
2. Planning phase:
Based on the needs that identified from assessment phase and review of related
literatures, the researchers developed health belief model constructs about breast
cancer with simple Arabic language to suit women 'level of understanding,
which aimed to improve females' knowledge, modify their health beliefs, and
practices about breast cancer and screening measures. It emphasized the areas of
major deficiency in women’ knowledge about important regarding breast cancer
(breast anatomy and physiology, meaning of breast cancer, risk factors of breast
cancer, and warning signs of breast cancer, breast cancer screening methods, breast
self-examination, and mammogram method). The health educational program
involved six sessions which conducted to a small group (6) of the intervention group.
The program was implemented according to women 'physical and mental readiness.
The duration of each session lasted from forty five minutes to one hour including
periods of discussion according to their achievement, progress and feedback. Different
methods of teaching were used such as lecture group discussion and role play.
3. Implementation phase: The model was implemented in a period of six months,
from the beginning of October2018 to the end of March 2019. Implementation of the
model was carried out at breast tumor early detection unit in Outpatient Clinic in
Benha University Hospital. The subject material used has been sequenced through the
6 sessions (4 sessions for theory and 2 sessions for practices). The duration of each
session ranged from 30 to 45 minutes including times for discussion according to
women’ achievement, progress and feedback. Each group participated in six sessions
separately for 2 weeks (2 days/week; Saturday and Tuesday) from 9:00am to 12:00
mid- day, in addition to one week for pre and posttest. Sometimes the researchers
worked with two groups in the same day. At the beginning of the first session, an
orientation to the model and its purpose took place and general information about
breast anatomy & physiology and definition of breast cancer to increase women
motivation. In subsequent sessions, the researchers demonstrated and warning signs of
breast cancer (perceived severity) the risk factors of breast cancer (perceived
susceptibility) and emphasizing on screening methods of breast cancer (perceived
benefits) allowing group discussions to overcome any barriers (perceived barriers) to
healthy practices and (self-efficacy), After each session, a feedback about the previous
session was done as well as the objectives of the new topics were mentioned.
4. Evaluation phase: After the implementation of the model, the post-test was
done to the women to assess knowledge, practices and behavior by the same
format of the pre-test to evaluate the effectiveness of the implemented model. This
was done immediately after the model implementation.
Statistical Design
The collected data were verified prior to computerized entry; statistical
analysis was done by using the Statistical Package for Social Science (SPSS)
version 20. Data were presented in tables by using mean, standard deviation,
number, percentage distribution, and Chi- Square. Statistical significance was
considered at: P- Value > 0.05 insignificant, P- Value < 0.05 significant, and P-
Value < 0.001 highly significant.
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3.Results:
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Table (1): Shows the socio- demographic characteristics of the studied women. It was
clear that; 62% of studied women aged from 30 to 39 years old with mean age were
35.90±6.45, 53% of them had secondary education, while 69% of them were married,
and 79 % lived in rural area. This table also shows that; 65% of them had enough
income/month, 80% didn`t have family history for breast cancer, 93% of them didn’t
have breast self-examination regularly and 96% of them didn’t have ever a
mammogram
Figure (1) shows that; 41% of the studied women acquired their information about the
disease from social media, followed by 29% from relative and friends, while only
17% of them from health care provider.
Table (2): Shows that there was improving in studied women’ knowledge items after
model phase’s implementation. Regarding the risk factor of breast cancer 32% of the
studied women had complete correct answer before model compared with 58% at post
model. Concerning warning signs of breast cancer 26% of the studied women had
complete correct answer before model which increased to 60% in the post model and
19% of the studied women had complete correct answer regarding screening methods
before model then this percentage increased to 59% post model . In addition, the table
also shows that there were highly statistically significant differences in the items
related to the studiedwomen’ knowledge
Figure (2) shows that; 38% the studied women had good knowledge regarding
detection of breast cancer before model implementation, and then this percentage
increase to 64% post model implementation.
Table (3): Shows the scores of the items of breast cancer health belief model pre &
post model. The scores of susceptibility, severity, benefits, barriers, cues to action, and
self-efficacy were highly significant increased post model compared to the scores
premodel (P< 0.000).
Figure (3) shows the comparison between the pre- post total health belief score of the
studied women. In the premodel 36% of the studied women had positive health belief,
and then this percentage improved and become 64% after implementation of the
model
Figure (4) shows that; 36% of the studied women had satisfactory practices before the
model implementation, while increased to 74% after the model implementation (p
<0.001).
Table (4) shows that; there were highly significant difference between total women`
knowledge score and their level of education, marital status and family income after
the model implementation (p <0.001).
Table (5) shows that; there were high statistically significant difference between
women` total practices scores and their age, educational level and family history of
breast cancer post model implementation (p <0.001).
Table (6) shows that; there were positive statistically significant correlation between
studied women's total knowledge, practices and their total health belief post model (p
<0.001).
Table (1): Frequency distribution of the studied women according to their
socio-demographic data (n=100).
Socio-demographic data N. %
Age / years
≥20 14 14.0
30- 62 62.0
40+ 24 24.0
X±SD= 35.90±6.45
Educational level
Basic education 21 21.0
Secondary education 53 53.0
High education 26 26.0
Marital status
Single 20 20.0
Married 69 69.0
Divorced 11 11.0
Residence
Rural 79 79.0
Urban 21 21.0
Family Income
Enough and saved 24 24.0
Enough 65 65.0
Not enough 11 11.0
D%%
D%%
Family history of breast cancer
Yes 20 20.0
No 80 80.0
Regularly do breast self-examination
Yes 7 7.0
No 93 93.0
Have you ever had a mammogram done?
Yes 4 4.0
No 96 96.0
Figure (1): Percentage distribution of the studied women according to their source of
information regarding detection of breast cancer (n= 100).
social media
lecture
41%
17%
20%
29%
source of information
Table (2): Statistically differences between the studied women' knowledge scores
regarding detection of breast cancer (breast cancer risk factors, warning signs and
screening methods) pre and post implementation. (n=100).
Items
Pre- implementation (%) post- implementation (%)
X2 P-value
Complete Incomplete Don’t
know Complete Incomplete Don’t
know
Risk factors 32.0 13.0 55.0 58.0 8.0 34.0 47.36 >0.001**
Warning signs 26.0 34.0 40.0 60.0 19.0 21.0 64.06 >0.001**
Screening
methods 19.0 32.0 49.0 59.0 22.0 19.0 46.24 >0.001**
**Highly significant difference p 0.001˂
Figure (2): Percentage distribution of the studied women according to their
total knowledge score about breast cancer (n=100).
PoorAverageGood
20%
18%
64%
50%
32%
38%
Post- Program
Pre-Program
Table (3): Statistically differences between the health belief model items regarding
detection of breast cancer among women pre and post implementation
(n=100).
Health belief model
dimensions
Pre- implementation
(%)
post- implementation
(%) X2
P-value
Positive Negative Positive Negative
Susceptibility 34.0 66.0 69.0 31.0 43.57 >0.001**
Severity/seriousness 30.0 70.0 78.0 22.0 17.64 >0.001**
Benefits 19.0 81.0 61.0 39.0 67.24 >0.001**
Barriers 60.0 40.0 89.0 11.0 33.64 >0.001**
Cues to action 35.0 65.0 75.0 25.0 37.82 >0.001**
Self-efficacy 30.0 70.0 58.0 42.0 36.00 >0.001**
Total 36.0 64.0 77.0 33.0 40.35 >0.001**
**Highly significant difference p 0.001˂
Figure (3): Percentage distribution of total health belief model regarding breast cancer
detection of the studied women (n=100).
Post- programPre- program
33%
77%
64%
36%
Negative
Positive
Figure (4) Percentage distribution of the studied women' total practices score pre
and post implementation of model regarding detection of breast cancer (n= 100)
post- programpre-program
29%
61%
74%
36%
unsatisfactory
satisfactory
Table (4) statistically relation between socio-demographic data and the studied
women' total knowledge scores regarding detection of breast cancer pre and post
implementation (n= 100)
Socio-demographic
characteristics
Total Knowledge Pre Total Knowledge Post
Good Average Poor Good Average Poor
% % % % % %
Age / years
≥20 0.0 4.0 10.0 6.0 2.0.0 6.0
30-7.0 15.0 30.0 26.0 14.0 22.0
40+ 4.0 8.0 12.0 10.0 5.0 9.0
X2 = 3.22 P-value=0.19 X2 =9.52 P-value=0.04
Educational level
Basic education 3.0 8.0 10.0 11.0 5.0 5.0
Secondary education 11.0 14.0 28.0 30.0 10.0 13.0
High education 9.0 11.0 6.0 17.0 7.0 2.0
X2 =21.05 P-value=0.000 X2 =30.92 P-value=<0.001**
Marital status
Single 6.0 4.0 10.0 12.0 2.0 6.0
Married 13.0 16.0 40.0 46.0 12.0 11.0
Divorced 3.0 4.0 4.0 6.0 2.0 3.0
X2 =19.26 P-
value=<0.001** X2 =22.13 P-value=<0.001**
Residence
Rural 11.0 18.0 50.0 34.0 15.0 30.0
Urban 6.0 7.0 8.0 10.0 6.0 5.0
X2 =7.49 P-value=0.05 X2 =8.13 P-value=0.01
D%
%
D%
%
Family history of breast
cancer
Yes 3.0 7.0 10.0 11.0 5.0 4.0
No 15.0 10.0 60.0 43.0 6.0 31.0
X2 =1.31 P-value=0.31 X2 =1.86 P-value=0.39
Family Income
Enough and saved 11.0 3.0 10.0 21.0 1.0 2.0
Enough 10.0 14.0 41.0 47.0 7.0 11.0
Not enough 4.0 1.0 6.0 8.0 0.0 3.0
X2 =79 P-value=0.67 X2 =25.09 P-value=<0.001**
*Statistically significant difference p 0.05˂ **Highly significant difference 0.001˂
Table (5) statistically relation between socio-demographic characteristics and the
studies women total practices scores regarding detection of breast cancer pre and post
implementation (n= 100).
Socio-demographic
characteristics
Total Practices- Pre model Total Practices –Post model
Satisfactory Unsatisfactory Satisfactory Unsatisfactory
% % % %
Age / years
≥20 3.0 10.0 8.0 6.0
30-12.0 50.0 47.0 15.0
40+ 4.0 20.0 19.0 5.0
X2 =6.14 P-value=0.01 X2 =11.50 P-value=<0.001**
Educational level
Basic education 3.0 18.0 15.0 6.0
Secondary education 14.0 39.0 35.0 18.0
High education 9.0 17.0 18.0 8.0
X2 =92.16 P-value=0.000 X2 =47.36 P-value<0.001**
Marital status
Single 9.0 11.0 15.0 5.0
Married 19.0 50.0 53.0 16.0
Divorced 3.0 8.0 9.0 2.0
X2 =0.30 P-value=0.85 X2 =8.12 P-value=0.01
Residence
Rural 19.0 60.0 58.0 21.0
Urban 3.0 18.0 16.0 5.0
X2 =2.62 P-value=0.02 X2 =1.09 P-value=0.57
D%
%
D%
%
Family history of
breast cancer
Yes 9.0 11.0 16.0 4.0
No 18.0 62.0 41.0 39.0
X2 =92.16 P-value=0.000 X2 =31.36 P-value <0.001**
Family Income
Enough and saved 8.0 16.0 19.0 5.0
Enough 15.0 50.0 55.0 21.0
Not enough 3.0 8.0 10.0 2.0
X2 =1.28 P-value=0.52 X2 =0.49 P-value=0.62
*Statistically significant difference p 0.05˂ **Highly significant difference p 0.001˂
Table (6): Correlation between studied women's total knowledge, practices and their total health beliefs
(n=100).
Total Knowledge Total Practices
Items
Pre- model Post- model Pre - model Post- model
r p-value r p-value r p-value r p-value
Total health
belief
0.67 0.000** 0.76 <0.001** 0.17 0.12 0.42 <0.001**
4.Discussion
One of the effective models in prediction of cancer behaviors is the health belief
model. According to HBM, women should believe that even in the case of no
symptom of disease, they might have it (Masoudiyekta et al., 2015). the present
study aimed to evaluate the effect of health belief model on the practices of women
regarding detection of breast cancer.
Regarding to the socio-demographic characteristics of the studied women, this
study showed that; slightly less than two thirds of the studied women aged from 30 to
39 years old with mean age were 35.90±6.45 (table1). This finding was in the same
line with the study done by Hajian & Auladi (2015), they studied the awareness,
attitude, and practice of breast cancer screening women, and the associated socio-
demographic characteristics, in Northern Iran, and they reported that the mean age of
studied sample was 31.5 ± 9.3 years. Also; this finding was congruent with Shakweer
and Hamza (2016), they studied the practicing breast self-examination and early
detection of breast cancer on Helwan University, they reported that the mean age of
the women, was 33.3±1.9 years. This might be due women in this age should be told
about the breast cancer to prevent and detect the disease early. On the other hand; this
finding disagreed with Kamberi et al. (2017), they studied the breast cancer health
beliefs and the use of mammography among women randomly selected in Vlora,
Albania, they reported that half of the women belonged to the age group >50 years.
As regards educational level; more than half of the studied women had
secondary education (table1). This finding was agreement with Marmarà et al.
(2017), they studied the health beliefs, illness perceptions and determinants of breast
screening uptake in Malta, and they found that; three quarter of the women had a
secondary education level. Also this finding was consistent with Masoudiyekta et al.
(2015), they applying the health belief model in predicting breast cancer screening
behavior of women in Dezfu health centers, they found that; less than half of women
participating in the study had diploma. However, this finding was incongruent with
Shakweer and Hamza (2016), they reported that two thirds of the samples were basic
education. This in congruence to our result may be due to difference of sampling
criteria besides the educational level of two studies represented a large sector of our
country needed more efforts toward raising their awareness and promoting their
practices for early detection of breast cancer.
Concerning the marital status the present study revealed that; more than two
thirds of the studied women were married (table1). This finding was agreement with
Kamberi et al. (2017), they found that; the majority of women were married. Also;
this finding was congruent with Marmarà et al. (2017); Masoudiyekta et al. (2015),
they found that the majority of women were married.
More than three quarters of studied women lived in rural areas (table 1). This
finding disagreed with Aker et al. (2015), they studied the practice of breast cancer
early diagnosis methods among women living in Samsun, and factors associated with
this practice, and they found that two thirds of the women lived in the city
Concerning family history, the present study showed that; the majority of
studied women didn’t have family history of breast cancer (table 1). This finding was
in the same line with the study done by Khalili et al. (2014), they studied the status of
breast self-examination performance among women referring to health Centers of
Tabriz, Iran, and they found that the minority of women had the history of cancer in
their first and second grade family.
Concerning income/ month; slightly less than two thirds of studied women had
enough income per month (table 1). This finding was agreement with Marmarà et al.
(2017), they found that; more than half of women from average income families. Also
this finding was consistent with Khalili, et al. (2014), they found that; the majority of
subjects their family income was sufficient and relatively sufficient in their own view.
The most of studied women didn’t have regular breast self-examination and
didn’t have ever a mammogram (table 1). This finding was agreement with Kamberi
et al. (2017), they found that; more than half of the women didn't have a mammogram
and the frequency of breast self-examination is very low. This might be due to the
poor knowledge of women about breast cancer and lack of breast cancer model. On
the other hand, this finding disagreed with Wang et al. (2014), they made survey of
breast cancer mammography screening behaviors in Eastern Taiwan based on a health
belief model and found that; high proportion of women had received regular
mammography examinations.
The present study showed that; less than half of the studied women acquired
their information about the disease from social media and the minority of them from
health care provider (figure 1). This might be due lack of breast cancer programs and
the majority of studied women didn`t have family history for breast cancer. This
finding disagreed with Hajian and Auladi (2015), they reported that; the source of
information was health care workers and magazine, books and brochure were the most
common source.
Concerning the women` knowledge about detection of breast cancer it was
revealed that there were improvement in the studied women' knowledge scores
regarding detection of breast cancer (breast cancer risk factors, warning signs and
screening methods) after model implementation (table 2). This result in the same line
with Özerdoğan et al. (2017), they studied the educational study to increase breast
cancer knowledge level and scanning participation among women working at a
University in Eskişehir Osmangazi University, Turkey, they reported that there were
highly significant relationship was found in the statistical analysis of the study group’s
scores between the women’s knowledge levels before the training on breast cancer
(pretest) and their knowledge after the training (posttest) (p=0.001). This finding was
in agreement with Ylmaz et al. (2017), they studied the effects of training on
knowledge and beliefs about breast cancer and early diagnosis methods among
women in the Central Anatolia of Turkey, they found that the knowledge of breast
cancer among women was at a low level in the pre-test, it was significantly increased
in the post-test. This might be due to the present study demonstrated that HBM model
was effective on increasing women knowledge about breast cancer
Regarding to total knowledge score of women about breast cancer the present
study revealed that more than one third of the studied women had good knowledge
regarding detection of breast cancer before model implementation, and then this
percentage increase to slightly less than two thirds of them post model implementation
(figure 2). This finding was in the same line with Masoudiyekta et al. (2015). The
results of their study have confirmed the efficiency of educational intervention based
on HBM in increasing of knowledge and health beliefs about breast cancer. Also, this
finding was congruent with Yılmaz et al. (2017), they reported that, women did not
have sufficient knowledge and practice about screening activities related to BC before
the training. After the training scores in the breast cancer, screening knowledge scores
were increased while the knowledge of breast cancer among women was at a low level
in the pre-test, it was significantly increased in the post-test. It might be due to the
HBM model help women to acquire knowledge about disease and their level of
education helps them to acquire knowledge about the disease.
Regarding to the using of health belief model the present study showed that the
scores of susceptibility, severity, benefits, barriers, cues to action, and self-efficacy
were highly significant increased post model compared to the scores premodel (Table
3). This finding was consistent with Rezaeian et al. (2014), They studied the effects
of breast cancer educational intervention on knowledge and health beliefs of women
40 years and older, Isfahan, Iran, they reported that; women’s beliefs regarding to
breast cancer and mammography screening behavior increased after educational
intervention in all of the HBM components. This might be due to awareness and
education on breast health issues from HBM model changed women behavior toward
breast cancer detection
Regarding to the total score of health belief model regarding breast cancer
detection of the studied women the present study showed that in the premodel more
than one third of the studied women had positive health belief, and then this
percentage improved and become less than two thirds after implementation of the
model (Figure3). This finding was consistent with Yılmaz et al. (2017), they reported
that women' health beliefs post-test scores after the training were increased
significantly in all dimensions compared to the pre-test scores. Also, this finding was
in agreement with Aker et al. (2015), they reported that their study is consistent with
other reports that identified positive improvement in individual behavior after training
on early diagnosis methods. This might be due to the present study demonstrated that
HBM model was effective on increasing women beliefs about breast cancer
Regarding to total practices score of studied women, the present study revealed
that the more than one third of the women had satisfactory practice pre
implementation of health belief model (figure 4). The findings were supported by
Khalili et al. (2014), they showed that the status of BSE performance was very poor
between women. It might be due to inadequate and irregular education model about
breast cancer. While slightly less than three quarters of women had satisfactory
practices after implementation of model in the present study (figure 4). According to
Yılmaz et al. (2017), they reported that women did not have sufficient knowledge and
practice about screening activities related to breast cancer before the training, after the
training, scores in the breast cancer screening has been increase. It might be due the
HBM models can increase the breast cancer awareness and ensure the regular
performance of BSE of women.
In the current study there was highly significant difference between total
women` knowledge score and their level of education after the model implementation
(table 4). The findings were supported by Yılmaz et al. (2017), they reported that
breast cancer screening knowledge of women in the pre- and post-tests, had
significant relationship among the level of education of women. It might be due to the
level of education of women could help them in acquiring knowledge about breast
cancer.
In the current study shows that; there was high statistically significant
difference between women` total practices scores and their age post model
implementation (table 5). This finding was supported by Aker et al. (2015), they
reported that age is an effective variable on performance of BSE. It might be due to
the identification of age as an effective factor in the study it might be related to an
increase in breast cancer risk with advanced age, higher perception of risk of breast
cancer, and thus more compliance with early diagnosis methods.
In the current study shows that; there was high statistically significant
difference between women` total practices scores and their family history of breast
cancer post model implementation (table 5). According to Khalili et al. (2014), they
reported that the quality of BSE has a statistically significant correlation with family
history of breast cancer. It might be due to the women might be aware about disease
and BSE from the family history and it can affect their practices.
This study illustrates that; There were positive statistically significant
correlation between studied women's total knowledge, practices and their total health
belief post model (p <0.001) Table (6).This might be due to the present study
demonstrated that educational model was effective on increasing women knowledge,
practice and beliefs about breast cancer.
5. Conclusion
Based on the results of the present study and research hypothesis, the study
concluded that; The health belief model had significantly increased the knowledge,
improved health practice and enhancing the health beliefs regarding detection of
breast cancer among the studied women. More than one third of the studied women
had good knowledge regarding detection of breast cancer before model
implementation, and then this percentage increase to less than two thirds post model
implementations. More than one third of the studied women had positive health
beliefs, and then this percentage improved and become less than two thirds after
implementation of the model. More than one third of the women had satisfactory
practice pre implementation of model while less than three quarters of women had
satisfactory practices after implementation of model in the present study. There were
positive statistically significant correlation between studied women's total knowledge,
practices and their total health belief post model implementation.
Recommendation
The present study recommends that: Breast cancer awareness models should
be developed in Outpatient of Hospitals on a regular basis. A similar study can be
replicated on a large sample and a comparative study can be done with women of
different groups.
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