Effect of the Breast Health Program Based on Health Belief Model on Breast Health Perception and Screening Behaviors

To the Editor: Breast self examination (BSE) is known as one of the early diagnosis screening methods of breast cancer (1–3). Health belief model (HBM) is used to explain protective health actions and the cause of insufficient participation to screening programs (2–4). The main purpose of this study was to determine the attitudes, beliefs, and behaviors of the mothers who accompany their children in the hospital for breast health (BH) problems. Another purpose of this study was to determine the effects of breast health program based on HBM on BH perceptions and screening behaviors. This study is one group pretest–post-test comparative experimental type. Study sample (n = 51) includes all the voluntary women accompanying their children in the hospital. The mean age of the mothers was 34.2 years. All mothers attended BH program based on HBM that lasted 30–35 minutes. Data were collected before, during, and 3 months after BH program and obtained using five different forms including information form, breast health behavior form, breast cancer HBM scale developed by Champion (3), BSE control lists, and lastly, the observation form developed by Seçginli (5). Breast cancer HBM scale is composed of eight subscales (susceptibility, seriousness, health motivation, confidence, benefits-BSE, barriers-BSE, benefitsmammography, and barriers mammography). These subscales measure personal decision related to breast cancer and general health conditions. Each subscale is separately evaluated and not merged into a single total score. Scoring of the scale, a five-point likert type scale (strongly disagree, disagree, neutral, agree, and strongly agree) was used (2–4). Before the application of HBM-based BH program, less than half of the mothers (39.2%) made BSE; however, 3 months after the BH program, this rate increased to 78.4%, which was statistically significant (p = 0.00). BSE ability scores of mothers were measured according to BSE control list immediately and 3 months after BH program based on HBM. The mean scores of both periods were found as 93.5 ± 9.5 and 88 ± 14.9, respectively, and the difference was statistically significant (Z = )2.069, p = 0.039). The mean number of the mass correctly detected by mothers on breast pattern containing eight masses was higher immediately after the program (7.56 ± 0.80) than after 3 months (7.54 ± 0.83). When BH perception of mothers was investigated, susceptibility perception was found higher after 3 months when compared with before BH program. The difference was statistically insignificant (t = )0.902, p = 0.371). Seriousness perception was found to be lower 3 months after BH program than before. The difference was statistically insignificant (Z = )2.645, p = 0.08). The mean score of benefits of BSE perception was found to be higher (t = 5.922, p = 0.00) 3 months after BH program, and the mean score of barriers-BSE perception was found to be lower (t = 3.685, p = 0.01), both of which were statistically significant. The mean scores of confidence and health motivation perceptions were found to be higher 3 months after BH program than before. The difference was statistically significant in confidence perception (t = )10.192, p = 0.00), but not significant in health motivation (t = )2.523, p = 0.15). The mean score of benefits-mammography perception was found to be statistically significantly higher, 3 months after BH program, based on HBM than before (Z = )3.907, p = 0.00), and the mean score of barriers-mammography perception was found significantly lower (t = 3.432, p = 0.01). In this study, mothers accompanying their children in the hospital for a long time were included in HBMbased BH program, and then the effect of the BH program on screening behaviors were observed. Health Address correspondence and reprint requests to: Nevin Hotun Şahin, PhD, Istanbul University Nursing Faculty, Sisli, Istanbul, Turkey, or e-mail: nevinsahin34@yahoo.com