Breast Self-examination Proficiency Research Articles

Effects of Health Belief Model-Based Education on Health Beliefs and Breast Self-Examination in Nursing Students

Objective:This study was carried out to investigate the effect of an education program based on the health belief model (HBM) on nursing students’ health beliefs and on their practices of breast self-examination (BSE).Methods:This research was a semi-experimental intervention study with a single group, pretest and posttest design. The sample of the research consisted of 48 students in the 3rd year of study. Data were collected before the education program and 6 months and 1 year after the training. A sociodemographic information form, the breast cancer knowledge form, the HBM scale, and the BSE proficiency rating instrument were used. Descriptive statistics and repeated measures ANOVA were used to examine the relationships among the variables.Results:Implementing the educational program was found to be statistically insignificant for the HBM. Knowledge about breast cancer and BSE skills increased after the training. The percentage of students practicing regular BSE was determined as 14.6% before training, 45.8% after 6 months, and 28.1% after 1 year.Conclusions:The education provided to the students increased their HBM scores, knowledge about breast cancer, and BSE skills. However, the frequency of regular BSE was still quite low after training.

The effectiveness of a nurse-delivered breast health promotion program on breast cancer screening behaviours in non-adherent Turkish women: A randomized controlled trial

Background Few studies have investigated breast health programs to promote rates of having a mammography, clinical breast examination and breast self-examination among non-adherent Turkish women. Objectives To determine the effectiveness of a breast health promotion program on mammography and clinical breast examination use, breast self-examination frequency and proficiency (breast self-examination skills and lump detection), breast health knowledge and health beliefs about breast cancer screening in a sample of Turkish women. Design Experimental (pretest–posttest control group). Setting A community-based setting in Istanbul, Turkey. Participants 190 Non-adherent women (intervention group = 97, control group = 93) aged 41 and older, residing in Istanbul, Turkey. Methods The intervention group ( n = 97) received a 120-min breast health promotion program based on health belief model including a breast health education, film, breast self-examination instruction, and a booklet, a calendar, a card designed specifically for the study. The control group ( n = 93) received general information except breast health. Data were collected before the program, immediately after the program, and at 3- and 6-month post-program. The outcome measures are the mammography, clinical breast examination, and breast self-examination frequency, breast self-examination proficiency, breast health knowledge, and health beliefs (perceived susceptibility to breast cancer, benefits to mammography and breast self-examination, barriers of mammography and breast self-examination, confidence in performing breast self-examination). Results The breast health promotion program significantly increased breast self-examination frequency and proficiency and breast health knowledge. No significant differences existed in mammography and clinical breast examination rates between the two groups at 6 months. The program was effective in increasing perceived susceptibility to breast cancer, perceived benefits of mammography and breast self-examination, and confidence of breast self-examination. No significant difference was found between the two groups for perceived barriers to mammography. Conclusions The breast health promotion program was effective in increasing breast self-examination frequency and proficiency in a sample of Turkish women. In addition, it appears to be useful in raising the knowledge of breast health, enhancing confidence in performing breast self-examination, and increasing most health belief levels.

Video breast health kits: testing a cancer education innovation in older high-risk populations.

The Breast Health Kit for Women Over 60 project was a 3-year study funded by NCI to develop and field test video self-instruction programs designed to increase breast cancer screening for older black and white women. Impact of kit use on knowledge about breast cancer risk/screening, breast self-examination (BSE) proficiency, and mammography use was assessed with 439 women in Massachusetts and Georgia. BSE proficiency was measured by demonstration of inspection/palpation skills and detection of lumps in a simulation model. Analysis with a noncompliant mammography user subsample (N = 143) tested the effectiveness of kit use on mammography screening. The sample was predominantly black (76%) with mean age of 71.6 years and mean education of 10.6 years. Analyses of covariance revealed that women who used the kits had significantly better knowledge about breast cancer risk/screening (F = 23.6, P < or =.001) and were more proficient at BSE than kit nonusers as measured by both skills (F = 47.9, P < or =.001) and detection of lumps (F = 36.8, P < or =.001). No significant differences were found between subsample groups in receiving a poststudy mammogram, but a trend toward having mammograms was noted in the subsample who used the kits (chi(2) = 1.7, P < =.09). Age and ethnically sensitive self-instructional breast health kits were found to be effective in increasing knowledge about breast cancer risk and BSE proficiency in older women. Future research is needed to explore how other strategies combined with kit use can assure mammography compliance in this population.

Breast Cancer Detection in Asymptomatic Women: Health Beliefs Implicated in Secondary Prevention

This study assessed the usefulness of health belief model (HBM) constructs in predicting the frequency and proficiency of breast self‐examination among Greek women. Both additive and multiplicative functions were tested. Cross‐sectional data from 195 women were analyzed. Health beliefs explained 16.5% and 19.7% of the variance in frequency and proficiency, respectively. Frequent and proficient breast examination was associated with fewer perceived barriers. Moreover, elevated confidence and susceptibility estimates predicted greater frequency and proficiency, respectively. One moderator interaction emerged, but this was attenuated after accounting for other health beliefs. These findings provide qualified support for the HBM and present a useful template for developing interventions to promote secondary prevention.

Mujeres felices por ser saludables: a breast cancer risk reduction program for Latino women

Background Breast cancer is the most commonly diagnosed cancer and the most common cause of cancer mortality among Latino women. Several behavioral factors such as early detection and dietary practices could help decrease morbidity and mortality associated with breast cancer in this population. Unfortunately, there are few data regarding the efficacy of health-related interventions for young Latino women. Methods Mujeres Felices por ser Saludables is a randomized intervention project designed to assess breast cancer risk reduction behavior among Latino women ages 20–40 years. The primary objectives of the project were to determine whether an 8-month integrated dietary/breast health intervention could lead to a greater reduction in dietary fat, increase in dietary fiber, increase in the frequency and proficiency of breast self examination (BSE), and reduction in anxiety related to BSE compared to controls. Herein we describe the overall design of the project and present baseline characteristics of the 256 randomized women. Results Our results suggest that the average daily intake of dietary fat (percentage of total energy) was slightly below 30% (percentage of total energy) among the women randomized. While over half of these women reported that they practice BSE, and few reported anxiety related to BSE, less than 27% of women were proficient in the recommended BSE technique. Conclusions There are few data on the dietary and breast health behaviors of young low-acculturated Latino women. This study documents the feasibility of recruiting, randomizing, and obtaining both baseline dietary and breast health data on this unique and underserved population.

The effect of an educational intervention on promoting breast self-examination in older African American and Caucasian women.

To test the efficacy of innovative, age- and race-sensitive, self-monitored, video breast health kits in increasing knowledge about breast cancer risk and screening and breast self-examination (BSE) proficiency. Quasi-experimental pretest and post-test design. Dual-site study in community-based settings in the Northeast and Southeast United States. 328 women (206 in the intervention group, 122 in the control group) aged 60 or older; predominantly African American (77%); mean education of 10.8 years; annual income below $10,000 (50%). Individual pretest and post-test interviews conducted by nurses at two-week intervals assessed knowledge about breast cancer risk and screening and BSE proficiency as demonstrated on vested breast models. Intervention subjects used video breast health kits in ethnic editions designed for the study. Control subjects received educational pamphlets. Dependent variables were knowledge about breast health and BSE proficiency measured by demonstration of inspection and palpation skills and detection of lumps in a simulation model. Three multiple analyses of covariance revealed statistically significant differences in outcome variables between the intervention and control groups. The intervention was effective in increasing knowledge about breast cancer risk and screening and BSE proficiency in this sample of older women. These and other educational interventions designed specifically for age and race sensitivity may enhance cancer screening with vulnerable populations. Future studies with more diverse multicultural groups are needed to improve understanding of how to best influence breast health behaviors of older women.

Ethnic differences in breast self-examination practice and health beliefs.

Thirty-two African American nurses (AAN) and 78 Caucasian nurses (CN) were compared on breast self-examination (BSE) practice and health beliefs. Relationships between these variables were also examined. The Health Belief Model provided the framework for the study. The sample is a subset of 269 women from a larger study. AANs were recruited from a professional nurses' group. CNs were recruited from a list of female employees of a university medical centre. The results of t-tests revealed no significant group differences on BSE frequency (P = 0.06) or BSE proficiency (P = 0.10). Noted was that 42% of AANs compared to 20% of CNs examined their breasts 12 or more times during the year. AANs were more likely to consider BSE beneficial (P = 0.002) and to feel confident (P = 0.006) about doing BSE; CNs perceived more barriers (P = 0.001) to BSE. For AANs, BSE frequency and proficiency were positively related to confidence and inversely related to barriers; BSE frequency was also related to health motivation. For CNs, BSE frequency and proficiency were inversely related to seriousness. Implications include additional research to validate findings and to increase the knowledge base of all nurses regarding BSE.

Predicting mammography and breast self-examination in African American women

Breast cancer mortality is significantly greater in African American women than in their Caucasian counterparts. The purpose of this study was to identify variables associated with the breast cancer screening behaviors of mammography utilization and breast self-examination (BSE) in a convenience sample of low income African American women. A total of 328 African American women, living in a large midwestern metropolitan area, who were at < or = 150% of poverty level, and between the ages of 45 and 64 years were included in this study. Data were collected over a period of 18 months. Predisposing, enabling, and need variables from Anderson's theoretical framework included perceived susceptibility, benefits, barriers, confidence, knowledge, physician recommendation, demographic characteristics, and past experiences, as well as health-care and insurance information. Variables that significantly predicted mammography utilization included perceived barriers, mammography suggested by health-care professionals, recent thoughts about mammography, and a regular medical doctor. Variables that significantly predicted either frequency or proficiency of BSE included susceptibility, benefits, confidence, knowledge, barriers, and a regular physician. Implications for clinical practice include (a) recognizing predictors of screening among low-income African American women; (b) addressing culturally specific barriers, e.g., cancer fatalism, in order to increase compliance with screening; (c) establishing consistency in primary care providers; and (d) increasing confidence and knowledge through education.

Breast self-examination proficiency in older women: measuring the efficacy of video self-instruction kits.

Older women represent the highest risk group for breast cancer but do not use screening at recommended frequencies. Age-sensitive screening programs addressing the developmental issues, unique value systems, and problems of access for all older women are critically needed. Television is an ideal medium for reaching isolated older women with health information and educational programs. This research explored the efficacy of using video self-instruction kits to increase breast self-examination (BSE) proficiency and knowledge about breast cancer among a sample of 62 women > 60 years of age. Participants were given breast health kits containing an instructional video, printed educational materials, a miniature lump model, and BSE skill checks. Before using the kits and 30 days later they were tested on measures of BSE proficiency and knowledge about breast cancer. Results indicate that the self-instruction programs had significant and positive impacts on the two BSE proficiency measures: skill demonstrations (t = 7.32, p < 0.0001) and lump detection using a simulation model (t = 4.23, p < 0.0001). Knowledge about breast cancer scores also improved from pretest to posttest. Implications for cancer nurses and direct outcomes from the research including newly designed instructional media materials are discussed.

Assessing Breast Self-Examination

Background. Women practice breast self-examination (BSE) according to their own schedule and skill. This variation in how BSE is performed has complicated the interpretation of studies of BSE efficacy and utilization. Methods. We compared two methods commonly used to assess BSE competency, self-report of practice and ability to detect lumps in a model, among 81 women participating in a controlled toxicity trial of tamoxifen. Subjects were postmenopausal, were under 65 years of age, and had a history of breast cancer within the past 10 years but were currently free of disease. Women were asked to describe their usual BSE practice and were assigned a score (0-10) based on the number of recommended techniques and positions mentioned. Subjects were then instructed to examine a silicone breast model embedded with lumps (HealthEdCo) and to report any abnormalities. Results. Overall proficiency was low by both measures. No significant correlation (r = 0.16, P = 0.15) was found between the two measures of proficiency. Higher correlations were observed among older women and among those practicing BSE monthly. Conclusions. This study suggests that the two techniques are not comparably evaluating BSE proficiency. Further, both of these methods are likely to be poor measures of true BSE practice.

Breast self-examination: Knowledge and practices of Hispanic women in two southwestern metropolitan areas

The breast self-examination (BSE) practices of 1,453 Hispanic women in Phoenix, Arizona and San Diego, California were the focus of this study. Variables proposed as factors that influence the frequency and proficiency of BSE were demographic variables, particularly language and level of acculturation, having been taught BSE by a health professional, and experience with the disease. Results indicate that even though the majority of the women at both the Phoenix (78.1%) and San Diego (83.7%) sites had been taught BSE by a professional and most women in Phoenix (62.5%) and San Diego (63.4%) reported performing BSE within the past month, only 0.7% of the women at both sites were found to be proficient in the technique of BSE. Further, results indicate that language and acculturation were correlated with whether or not a woman performed BSE. These findings suggest that BSE education classes must provide information and techniques that promote proficiency in BSE, and must be designed to meet the unique needs of Hispanic women, particularly those of low acculturation levels.

Reliability and Validity of A Breast Self-Examination Proficiency Rating Instrument

A college laboratory was used as the setting to test the reliability and validity of a newly designed Breast Self-Examination Proficiency Rating Instrument (BSEPRI). The instrument was tested on two groups of nursing students, one instructed prior to testing and one not. BSE proficiency was scored individually for each subject as she demonstrated the procedure on a breast simulation model. Independent sample t tests were used to compare the groups. Mean scores of the instructed group were significantly higher than mean scores of the uninstructed group on the total test and on subscales of palpation and inspection. Criterion-referenced concurrent validity was assessed by correlating palpation scores with lump detection in a silicone model. Interrater reliability using percentage agreement between raters was high on 19 out of 23 criteria. Kuder-Richardson internal reliability coefficients ranged from .67 to .74.

Breast Self-Examination Proficiency: Attitudinal, Demographic, and Behavioral Characteristics

Despite public efforts to promote breast self-examination (BSE), few data exist that identify the skill level that women possess after formal BSE training. This investigation assessed BSE skill deterioration and identified critical factors that may contribute to BSE proficiency level. Data were collected on 57 women who voluntarily participated in a free BSE training program. The subjects completed a 68-item questionnaire and returned for a 30-min reevaluation of self-modeling BSE and examination of a breast model. Proficiency scores were obtained as they related to a woman's weeks posttraining, psychosocial, attitudinal, and behavior profile, and knowledge of breast cancer and BSE. A woman's BSE proficiency level deteriorates after initial training (r = −0.353, p = 0.004). Educational level (r = 0.253, p = 0.029) and age (r = −0.4094, p = 0.001) were significantly related to level of BSE proficiency. Approximately 17 weeks was determined as a critical time period posttraining for skill deterioration. Self-reported data collected from the questionnaire that had been used in previous studies to determine BSE proficiency were inaccurate in predicting observed BSE proficiency. Women should be taught proficiency of BSE by self-modeling and one-on-one training, and they should be reevaluated at 3-4 months. Special emphasis should be directed at offering BSE training to older women, women less educated, and those women at higher risk for developing breast cancer. Self-reported data appear to be unreliable in predicting a women's BSE proficiency. To address the true effect of BSE on cancer morbidity and mortality, an observed evaluation of a women's BSE proficiency should be defined and reevaluated at critical time periods posttraining.

An evaluation of comparative strategies for teaching breast self‐examination

This study compared the effects of three alternative methods of breast self-examination (BSE) instruction (booklet, film and group discussion, individual teaching) on nurses' personal BSE practice. A pre-test and follow-up questionnaire were administered to a convenience sample of 166 nurses from Western Australian hospitals. The results demonstrated that each method of BSE instruction produced a significant improvement in the technique of BSE (P < 0.0001). However, the nurses involved in the film and discussion had the greatest improvement in BSE proficiency. Findings were analysed in terms of the Health Belief Model. The variables 'barriers to action' and 'perceived susceptibility' (in this case, to breast cancer) were found to be predictive of BSE practice; 'perceived barriers' at pre-test and 'perceived susceptibility' at follow-up. The incidence of BSE was significantly higher in the older nurses. A reminder to practise BSE was significantly associated with an effective BSE technique. Implications for nursing practice are discussed.

The role of breast self-examination in breast cancer screening.

The efficacy of breast self-examination (BSE) behavior cannot be adequately evaluated until BSE proficiency is considered. Previous research supports the role of attitudinal and teaching interventions in increasing skills and frequency for BSE behavior, but more research using age-appropriate women and adequate outcome measures is needed. A preliminary analysis of data from 301 randomly selected women who were followed for 1 year after an initial teaching and/or attitudinal intervention is reported. Significant differences were obtained for attitudes toward breast cancer screening between scores before and after intervention using paired t test. Significant changes in proficiency and frequency also occurred after intervention, as well as percentage increases in nine individual BSE steps. Return demonstration scores and nodule detection are reported. Perceived barriers and confidence were significantly related to both frequency and proficiency 1 year postintervention using regression analysis. Knowledge was related to proficiency measures. Preliminary data suggest that BSE practice can be significantly improved through individually tailored attitudinal and teaching interventions.

Measuring breast self-examination proficiency

A continuous scoring strategy yielding a proficiency score on breast self-examination (BSE) performance was developed and validated. The method of paired comparisons was used to provide a rank ordering on an interval scale of the eight components of the evaluation tool. Twenty-one experts in teaching the MammaCare method of breast self-examination participated in the survey to help in developing the composite measure of proficiency in BSE performance. Data on each component of BSE were collected quantitatively, and performance scores were computed using a formula incorporating the weighting schema derived from the paired comparisons procedure. A comparison of preteaching versus postteaching mean performance scores on BSE indicated that the scoring system worked even when the teaching method varied. The scoring system presented here is a start on the development of a tool that can be useful to researchers using relative performance as a measure in BSE studies. The components of the scoring system can be used by nurses in the practice setting as a checklist for evaluating BSE performance.

Measuring breast self-examination proficiency

A continuous scoring strategy yielding a proficiency score on breast self-examination (BSE) performance was developed and validated. The method of paired comparisons was used to provide a rank ordering on an interval scale of the eight components of the evaluation tool. Twenty-one experts in teaching the MammaCare method of breast self-examination participated in the survey to help in developing the composite measure of proficiency in BSE performance. Data on each component of BSE were collected quantitatively, and performance scores were computed using a formula incorporating the weighting schema derived from the paired comparisons procedure. A comparison of preteaching versus postteaching mean performance scores on BSE indicated that the scoring system worked even when the teaching method varied. The scoring system presented here is a start on the development of a tool that can be useful to researchers using relative performance as a measure in BSE studies. The components of the scoring system can be used by nurses in the practice setting as a checklist for evaluating BSE performance.

Breast Self-Examination, Cancer Knowledge and Breast Disease in a Sample of Hunter Valley Women

Fifty women with a history of breast lumps, and fifty control women matched for age and educational level, were administered a self-report questionnaire to determine knowledge of breast cancer, frequency and proficiency of breast self-examination (BSE), and health beliefs relating to BSE. Although women with previous breast lumps were more knowledgeable about breast cancer than those without, the two groups did not differ in attitudes or preventive behaviours. Overall knowledge of cancer and of BSE practice was low. This suggests a need for educational campaigns to increase knowledge and awareness, as a first step towards behaviour change, and a need for research to identify more effective predictors of BSE practice.

Breast Self-Examination Proficiency: Pilot Evaluation of an Instructional Audiotape

The present study evaluated the effects of a refresher instructional audiotape on breast self-examination (BSE) proficiency after proficiency was trained to criteria. Subjects ( N = 46) were trained individually in an initial session to perform BSE competently. Following this session, subjects were randomly assigned to one of two testing conditions: tape or no tape; the test session occurred one week after the initial session. Tape subjects were tested using the tape. Results indicated that subjects in both conditions were practicing BSE at high proficiency levels one week post-training. The use of the tape in no way compromised proficiency, and in fact it resulted in improved (though statistically nonsignificant) levels of specific proficiency variables (i.e., search duration and proper use of fingers). The tape may be a valuable tool in maintaining BSE proficiency during home-practice once BSE is trained.

Effect of knowledge, teaching method, confidence and social influence on breast self-examination behavior.

A descriptive study was conducted to identify the relationship of knowledge, teaching methods, confidence and social influence to intent, frequency and proficiency of breast self-examination. A probability sample of 380 women aged 35 years and over served as subjects for in-home interviews conducted by trained graduate assistants. Knowledge correlated significantly with intent and proficiency of breast self-examination but not with frequency. Confidence correlated significantly with all three dependent variables, while social influence correlated only with intent. Being taught individually with a return demonstration increased proficiency and frequency. Implications for clinical application and future research are suggested.