The Effectiveness of Educational Interventions on Breast Cancer Screening Uptake, Knowledge, and Beliefs among Women: A Systematic Review

Patient and caregiver perceptions of oxygen therapy in facility-based settings for acute hypoxemic conditions: a scoping review

Background

Access to oxygen therapy is essential for ensuring a functioning health care system. Despite its widespread application across multiple patient groups and all ages, there is a lack of understanding about community perceptions and experiences while receiving oxygen therapy for acute conditions. We aimed to understand patient and caregiver perceptions of oxygen therapy in facility-based settings for acute hypoxemic conditions.

Methods

We conducted a scoping review. We searched Medline, Embase, and Web of Science (26 February 2024) for original studies published since 2000 relating to patient or caregiver perceptions and experiences of oxygen for an acute medical need in health facility settings. We used an adapted theoretical framework of acceptability to extract and structure the findings.

Results

Searches returned 10 425 unique records, and 25 articles were included. 20 were from high-income countries, and 18 were qualitative studies. The results showed that patient and caregiver attitudes and feelings about oxygen therapy are strongly influenced by perceived effectiveness, which was almost universally positive. Patients and their caregivers suffer different types of burdens, and these are greater for more advanced respiratory therapies than for simple oxygen therapy. Patient and caregiver understanding of oxygen therapy was low, presenting an opportunity for improved communication. Opportunity costs were highest in caregivers of neonates, who were often separated from their infants for long periods, and out-of-pocket costs were a major consideration in low- and middle-income countries.

Conclusions

In this scoping review, we found distinctions in caregiver and patient burden, and their perspectives of oxygen varied between country income. Intervention coherence - the extent to which the patient and their caregivers understand the treatment - was singled out as the key policy area for improvement. Educational campaigns, like those implemented for previous public health emergencies, could lead to increased public knowledge, and thus acceptability, of oxygen therapy.

DOST: A consolidated health behavior model that maps factors influencing cancer screening uptake

BACKGROUND

Cancer is a leading cause of death worldwide, particularly in low- and middle-income countries (LMICs), where preventive interventions like screening and vaccination face challenges due to limited resources. Despite the availability of user-friendly screening methods, uptake remains poor. Psychological theories are recommended to identify and address determinants of screening participation; however, existing models often focus on a limited range of domains and overlook critical belief-related factors needed to encourage screening uptake. A comprehensive, integrated model addressing these gaps could significantly improve the identification of barriers to screening.

METHODS

This conceptual paper proposes a model that maps potential barriers to cancer screening uptake through the lens of beneficiaries. The 'Determinants Of Screening upTake' (DOST) model was systematically developed through a series of steps integrating three existing health behavior theories that have been successfully used previously to improve screening uptake: the Health Belief Model (HBM), the Theory of Planned Behavior (TPB), and the Theory of Care-Seeking Behavior (TCSB).

RESULTS

The DOST model integrates dimensions represented in existing health behavior models, presenting a detailed map of potential barriers in real world, faced by beneficiaries of screening. These barriers are categorized systematically to enhance understanding and facilitate its use among non-experts in empirical research.

CONCLUSION

By integrating multiple models, the DOST model offers a comprehensive framework that combines theoretical robustness with practical guidelines. It highlights psychosocial barriers that influence screening attitudes, intentions, and uptake. The model can guide the assessment of screening determinants in populations and support the design of educational messages or interventions aimed at increasing screening uptake.

Multilevel analysis of undergoing clinical breast examination and its associated factors among mothers of reproductive age in Kenya: Kenyan Demographic and Health Survey 2022

INTRODUCTION

Breast cancer is one of the most common public health concerns among women around the world. The incidence of breast cancer is increasing in all areas of the world. It is the first cause of death from malignant tumors. Breast cancer in Sub-Saharan African countries is the number one cancer and the leading cause of cancer mortality among women. In low-income countries like Kenya, early screening programs, including clinical breast examination by health professionals, can identify women's health status and risk of breast cancer. Therefore, this study was conducted to assess the uptake of clinical breast examination for cancer and to determine the associated factors among mothers of reproductive age.

METHODS

A total weighted sample of 10,267 mothers of reproductive age was included in this study. The data were taken from the recent Kenyan Demographic and Health Survey 2022. A multilevel multivariable logistic regression model was used to identify the associated factors associated with the uptake of clinical breast examination. In the multivariable multilevel analysis, the adjusted odds ratio (AOR) with a 95% CI was used to declare statistically significant associations with uptake among mothers of reproductive age in Kenya.

RESULTS

In Kenya, the overall prevalence of clinical breast examination uptake among mothers of reproductive age was 11.39%. In multilevel analysis, the significant factors associated with the uptake of clinical breast examination were the age of the mothers; age was significantly associated with the uptake of clinical breast examination; when compared with mothers aged 15-24 years, examination increased in those aged 25-34 years (AOR =  1.45; 95% CI (1.15-1.83)) and 34-49 years (AOR =  2.4; 95% CI (1.88-3.29)), when compared to no education, odds of examination increased in those with primary education (AOR =  2.0; 95% CI (1.19-3.37)) and secondary and higher (AOR =  2.67; 95% CI (1.56-4.57)), when compared to mothers who are unemployed, the odds of examination were higher among those who are employed (AOR =  1.42; 95% CI (1.16-1.74)), place of delivery; when compared to mothers who delivered at home, the odds of examination were higher among those who delivered at a health institution (AOR =  1.5; 95% CI (1.0-2.19)), when compared to those who are not exposed to television, odds of examination increased in those who were exposed to this form of media (AOR =  1.34; 95% CI (1.0-1.72)), when compared to those who travel on foot, odds of examination increased in those who used vehicles for transportation (AOR =  1.34; 95% CI (1.12-1.62)), and when compared to communities with a high level of literacy, the odds of examination increased in communities with a low level of literacy (AOR =  1.7; 95% CI (1.14-2.54)).

CONCLUSION

In Kenya, the uptake of clinical breast examinations among mothers of reproductive age remains low. To address this, policymakers and stakeholders need to prioritize breast cancer screening programs to reduce mortality rates. The factors identified in this study are crucial for developing strategies to enhance clinical breast examination services, facilitating early detection and treatment of breast cancer.

Effects of a sexual health enhancement program for women with breast cancer: A quasi-experimental study

OBJECTIVE

This study evaluated the effectiveness of a culturally adapted Sexual Health Enhancement (SHE) program, grounded in the Permission, Limited Information, Specific Suggestions, Intensive Therapy (PLISSIT) model, in addressing sexual health challenges in women with breast cancer. It examined the program's impacts on sexual function, distress, body image, marital intimacy, and sexual knowledge.

METHODS

A quasi-experimental pretest-posttest design included 50 married women diagnosed with breast cancer within five years post-mastectomy without reconstruction. Participants were divided into intervention (n = 24) and control (n = 26) groups. The intervention consisted of four weekly group sessions and phone consultations. Outcomes were assessed at baseline, one week, and five weeks posttest using validated tools.

RESULTS

The intervention group showed significant improvements in sexual distress (F = 24.852, p < 0.001), body image (F = 25.887, p < 0.001), and sexual knowledge (F = 60.876, p < 0.001). Marital intimacy improved over time (F = 7.050, p = 0.011), but no significant group-by-time interaction was found (F = 0.478, p = 0.493). Sexual function showed no significant differences (F = 0.748, p = 0.391).

CONCLUSIONS

The SHE program effectively improved sexual distress, body image, and knowledge in breast cancer survivors. Tailored interventions for body image and marital intimacy remain essential, and future research should explore digital solutions and spousal involvement to enhance outcomes.

Current and future burden of breast cancer in Asia: A GLOBOCAN data analysis for 2022 and 2050

BACKGROUND

Breast cancer remains a significant health concern in Asia. This study seeks to analyze the burden of breast cancer in Asia based on the most recent GLOBOCAN 2022 estimates.

METHODS

Data were obtained from GLOBOCAN 2022. Age-standardized rates for incidence and mortality per 100,000 person-years were calculated using direct age standardization with the Segi-Doll World standard population. Pearson's correlation coefficient was utilized to evaluate the relationship between human development index and incidence or mortality rate. The future number of breast cancer cases and deaths by 2050 was estimated based on global demographic projections.

RESULTS

In 2022, breast cancer accounted for 2296.8 thousand new cases and 666.1 thousand deaths worldwide. In Asia, an estimated 985.4 thousand new cases and 315.1 thousand deaths were reported, corresponding to age-standardized incidence and mortality rates of 34.3 and 10.5 per 100,000, respectively. Both incidence and mortality rates were notably higher among older individuals, especially in countries with high human development index. A positive correlation between human development index and incidence rates was observed, while mortality rates were highest in countries with low human development index. China and India are the leading contributors to both new cases and deaths, with projections indicating that by 2050, around 1.4 million new breast cancer cases and 0.5 million deaths are expected to occur in Asia.

CONCLUSION

Breast cancer is the most common cancer among women in Asia. Global collaboration is essential to reduce its growing burden, especially in low-HDI countries facing rising incidence and high mortality rates.

The impact of educational intervention based on the theory of planned behavior on preventive behaviors for gastric cancer in obese and smoking individuals

BACKGROUND

Gastric cancer remains a significant global health issue due to its aggressive nature and high heterogeneity, making early detection and prevention critical. Obesity and smoking are established risk factors that significantly contribute to the development of gastric cancer. Despite the clear links between these risk factors and the disease, there is a lack of targeted educational interventions that address these behaviors. This study aims to fill this gap by investigating the impact of an educational intervention based on the Theory of Planned Behavior (TPB) on promoting preventive behaviors for gastric cancer among obese and smoking individuals.

METHODS

This quasi-experimental study was conducted in 2021-2022 on 150 obese or overweight individuals, more than 25 years old who smoked (cigarettes and hookah) in Fasa city, Iran. From six urban health centers, two centers were randomly selected (one as the experimental group and the other as the control group). Data collection tools included a demographic characteristics questionnaire based on the TPB model (a researcher-made questionnaire). Based on pre-test results, the educational intervention for the experimental group included 12 educational sessions for 50 min, following the TPB model, through lectures, Question and Answers, group discussions, practical demonstrations, video clips, and PowerPoint presentations. The questionnaires were completed by both groups before and six months after the intervention. Data were analyzed using SPSS 22 and descriptive and analytical statistical methods (paired t- test, McNemar test, Chi-square test, and independent t-test) (p < 0.05).

RESULTS

The results showed no significant difference between the two groups before the educational intervention. However, six months after the intervention, the experimental group showed a significant increase in TPB model cues (awareness, attitude, subjective norms, perceived behavioral control, behavioral intention, and behavior) (P < 0.001).

CONCLUSION

The findings of the present study indicate that the educational intervention based on the TPB model is useful in improving gastric cancer screening and preventive behaviors. It can also be used in planning and implementing appropriate programs to prevent and treat this disease.

Knowledge and beliefs on breast cancer screening and uptake among Yemeni female school teachers in Malaysia

Limited breast cancer screening uptake among women may lead to late-stage diagnosis and reduce the survival rate. Hence, this study was conducted to determine breast cancer screening (BCS) uptake and its association with knowledge, beliefs, and socio-demographic factors among female Yemeni school teachers in Malaysia. A cross-sectional study was conducted as part of a large cluster-randomized controlled trial (CRT) among 180 Yemeni female teachers aged 20 years and above. The sample was selected using cluster sampling from 12 Arabic schools in the Klang Valley area, Malaysia. Data was collected using a validated Arabic questionnaire. Data analysis was performed using the SPSS 22.0 software. Both descriptive and logistic regression analyses were employed. The logit model with a p-value less than 0.05 was conducted to determine the predictors of BCS uptake. The screening uptake by the study participants was 23.3% (n = 42), 21.1% (n = 38), and 5.6% (n = 10) for breast self-examination (BSE), clinical breast examination (CBE) and mammogram (MMG), respectively. Additionally, the total mean knowledge score was 18.02 (SD = 5.82). Regarding the participants' beliefs, the mean benefits and mean barriers of BSE were 23.29 (SD = 3.77), and 12.97 (SD = 3.80), respectively. In addition, mean confidence in doing BSE and mean health motivation were 31.85 (SD = 7.17) and 27.95 (SD = 4.22), respectively. Besides, the mean benefits of MMG were 21.26 (SD = 4.07), and the mean barriers to MMG were 14.81 (SD = 2.14). The logit model showed that higher knowledge among study participants increased the probability of performing BSE, CBE, and MMG with (OR = 1.09, 95% CI 1.01-1.17, p = 0.021), (OR = 1.08, 95% CI 1.00-1.16, p = 0.036), and (OR = 1.47, 95% CI: 1.14-1.91, p = 0.003), respectively. In addition, the higher confidence level increased the probability of performing BSE (OR = 1.090, 95% CI 1.017-1.168, p = 0.014). However, more barriers to CBE were associated with a decrease in the probability of performing CBE (OR = 0.892, 95% CI 0.802-0.992, p = 0.034). Moreover, as the participants got older, the MMG uptake increased (OR = 1.418, 95% CI 1.116-1.801, p = 0.004). Breast cancer screening uptake and knowledge, as well as beliefs concerning BCS are low among Yemeni school teachers in Malaysia. Conducting educational interventions on BCS is needed to improve awareness and encourage early detection of BC among women.

Factors associated with the uptake and utilisation of diabetic retinopathy screening services in sub-Saharan Africa: A scoping review

INTRODUCTION

Diabetic Retinopathy (DR) is a microvascular complication of chronic Diabetes that can lead to visual impairment if left untreated. While concerted efforts have been made to develop screening modalities to facilitate the early detection of Diabetic Retinopathy in sub-Saharan Africa, little is known about the factors impacting the optimal use of these screening services. This paper aims to identify and highlight factors associated with the access of Diabetic Retinopathy screening services from patient and service provider perspectives.

METHODOLOGY

This scoping review was conducted using the Arksey and O'Malley (2005) framework. A comprehensive search of peer-reviewed articles and grey literature was conducted from May 2023 to June 2023. Electronic databases searched include Medline, Embase, PubMed, CINAHL Complete, APA PsycINFO, Web of Science, and African Journal Online (AJOL). Two reviewers independently screened the retrieved records for eligibility, and relevant data was extracted from the included studies. A descriptive overview of key findings was provided, and the 5As conceptual framework of access to healthcare was used to map the identified factors.

RESULTS

The search strategy yielded 873 records. Of those, 19 studies met the criteria for inclusion. Health literacy and duration of Diabetes were reported in 12 and 9 studies as the most common factors associated with DR screening services access. Similarly, age at onset and inadequate referral by healthcare providers were cited as significant determinants of DR screening access in 7 studies, respectively.

CONCLUSION

The 5As framework of access to healthcare aids our understanding of factors associated with the access of DR screening from patient and service provider standpoints. To address these issues, there is a need for more research on this topic to design effective DR screening services in the region.

Centering intersectional breast cancer screening experiences among black, Latina, and white women: a qualitative analysis

Objective

Mammography screening guidelines in the United States highlight the importance of informing and involving women when making their breast cancer screening decisions. However, the complexity of interpreting and applying these population-level guidelines can contribute to patient burden. Patient-centered communication strategies can alleviate patient burden, but few consider perspectives from racially and ethnically marginalized populations. We examine diverse women's perspectives on screening to characterize patient-centered experiences.

Methods

We conducted 28 focus groups with 134 non-Latina Black (n = 51), non-Latina White (n = 39), and Latina (n = 44) participants. We coded participants' discussion of their screening influences. We used deductive and inductive qualitative methods to identify common themes.

Results

We identified three themes: (1) personal relationships with primary care providers, (2) potential impacts of cancer on families, and (3) interactions with medical systems. Most White participants described trusting physician relationships in contrast to perfunctory, surface-level relationships experienced by many Black participants; high costs of care prevented many Latina participants from accessing care (Theme 1). Diagnosis was a concern for most Black participants as it could burden family and most Latina participants as it could prevent them from maintaining family well-being (Theme 2). While many White participants had general ease in accessing and navigating healthcare, Latina participants were often held back by embarrassment-and Black participants frequently described disrespectful providers, false negatives, and unnecessary pain (Theme 3).

Conclusion

Cultural and structural factors appeared to influence participants' approaches to breast cancer screening. Structural barriers may counteract culturally salient beliefs, especially among Black and Latina participants. We suggest patient-centered communication interventions be culturally adjusted and paired with structural changes (e.g., policy, insurance coverage, material resources) to reflect women's nuanced values and intersectional social contexts.

A systematic review of educational interventions to enhance cancer awareness and screening in individuals with intellectual disabilities: A mixed-methods approach

BACKGROUND

Cancer awareness and screening among individuals with intellectual disabilities face unique challenges. To bridge this gap, educational interventions have been developed.

AIMS

This review comprehensively analyzes educational interventions aimed at enhancing cancer awareness among individuals with intellectual disabilities (IDs). It addresses key questions regarding intervention types and effectiveness, influencing factors, and recommendations for impactful programs.

METHODS AND PROCEDURES

A robust search strategy was deployed across reputable databases yielding 2512 articles. After meticulous screening and eligibility assessments, eight studies met the inclusion criteria, encompassing qualitative research, a feasibility study, and randomized control trials.

OUTCOMES AND RESULTS

The studies employed diverse interventions and assessment methods, leading to varying outcomes. Interventions included educational materials, communication packs, health education DVDs, and healthcare professional support, typically delivered over a short period with limited follow-up. Assessment methods comprised surveys, interviews, and knowledge surveys. However, a comprehensive evaluation of knowledge gains and screening uptake was often absent. While some studies reported modest increases in knowledge, none measured actual screening uptake and long-term effects. The strengths and limitations of these studies underscore the need for more comprehensive research in this area, considering factors such as sample size, study design, and long-term impact.

CONCLUSION AND IMPLICATIONS

In conclusion, this review provides valuable insights into educational interventions for cancer awareness among individuals with intellectual disabilities. Its comprehensive methodology and findings underscore the significance of tailoring interventions, extending their duration, and involving caregivers to optimize outcomes for this vulnerable population.

The Effect of a Tailored Educational Flyer on Colorectal Cancer Screening Among Rural Residents: Lessons Learned from a Pilot Randomized Trial

Background/Objectives: Stool-based tests, such as the fecal immunochemical test (FIT), have been widely used for increasing colorectal cancer (CRC) screening. Small media, such as printed materials or flyers, are known to be an effective intervention to increase CRC screening by fecal tests. However, more evidence is needed to determine whether such small media are effective in improving screening uptake of a mailed FIT intervention targeted at rural populations in the USA. Methods: In this randomized study, 1230 FIT kits were mailed from July to December 2022 to rural Nebraskans aged 45-74 who were not up to date on CRC screening. Half of the participants (n = 608) also received a tailored, one-page, gender-specific educational flyer created based on focus groups with rural residents. Logistic regression was used to determine predictors of returning the FIT. Results: Study participants were predominantly female (76%), non-Hispanic White (83%), and within the age group of 55-64 (43%). Overall, 192 (15.6%) kits were returned (16.1% from the flyer group; 15.1% from the no-flyer group). However, we found no significant differences between the flyer and no-flyer groups (Adjusted Odds Ratio [AOR]: 1.21; 95% CI: 0.88-1.66). Females (AOR: 1.78; 95% CI: 1.19-6.14) and the oldest (65-74) age group (AOR: 5.03; 95% CI: 2.78-8.47) were more likely to return FIT kits than males and the youngest (45-54) age group. Conclusions: A tailored educational flyer was not effective in improving the CRC-screening-rate-by-mailed-FIT approach for rural populations. Future research should explore the content, timing, and mode of delivery of educational interventions as well as other multi-component strategies to improve screening rates. Public health officials might also consider developing strategies targeted at males and younger (45-54) age groups.

Narratives of resilience: Understanding Iranian breast cancer survivors through health belief model and stress-coping theory for enhanced interventions

Breast cancer poses a significant global health challenge, with Iran experiencing particularly high incidence and mortality rates. Understanding the adaptation process of Iranian breast cancer survivors' post-treatment is crucial. This study explores the health perceptions, barriers, and coping mechanisms of Iranian survivors by integrating Stress-Coping Theory (SCT) and the Health Belief Model (HBM). Semi-structured interviews were conducted with 17 survivors, and a grounded theory approach guided the deductive content analysis of the data. The findings reveal key themes, including perceived susceptibility, benefits, barriers to care, cues to action, self-efficacy, and appraisal of action. Perceived susceptibility highlights diagnostic challenges stemming from practitioner errors and symptom misconceptions. Perceived benefits underscore the importance of early detection and support from healthcare providers and families. Barriers include cultural and financial obstacles, while cues to action reflect the influence of media, family, and personal experiences on healthcare-seeking behavior. The study also examines coping strategies, such as problem-focused and emotion-focused approaches, along with family support and external stressors. To address these barriers and enhance support systems, the study suggests specific strategies for healthcare providers, including targeted training to improve diagnostic accuracy and patient communication. Culturally sensitive awareness campaigns can correct symptom misconceptions, while financial counseling can mitigate economic barriers. Establishing community-based support groups and involving family members in care plans can enhance emotional and psychological support. These strategies aim to overcome the identified barriers and improve support systems for Iranian breast cancer survivors, ultimately fostering better recovery outcomes.

Barriers and enablers to breast cancer screening in rural South Africa

BACKGROUND

 The breast cancer burden on the South African healthcare system is severe, with rural South African women often diagnosed at an advanced stage of the disease. South Africa's rural areas are classified as low-resource settings with limited medical services and infrastructure. The impact of breast cancer on rural communities in South Africa requires ongoing research to better understand the severity of this disease among one of the most vulnerable populations.

OBJECTIVES

 This study aimed to explore the barriers and enablers of breast cancer screening among rural South African women.

METHOD

 An exploratory qualitative study was utilised. A semi-structured interview was conducted with 22 rural South African women. Data were analysed using thematic analysis. This study utilised the care-seeking behaviour theory as its theoretical framework.

RESULTS

 Participants identified many barriers to breast cancer screening, including individual affordability, transportation, rural services, infrastructure, health professional behaviour, and the lack of educational materials. Several factors are suggested to enable the screening of breast cancer in rural South Africa, including breast cancer campaigns, health education, the involvement of key stakeholders, and promotional materials.

CONCLUSION

 Despite the many barriers to breast cancer screening among rural South African women, there is still hope in implementing the various promotional tools outlined in this study and ensuring that breast self-examination is an alternative, affordable screening method.Contribution: The purpose of this article is to contribute to the attainment of the Sustainable Development Goal (SDG) 3, which focusses reducing premature mortality from non-communicable diseases, including cancer.

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.

Effects of Hormonal Replacement Therapy and Mindfulness-Based Stress Reduction on Climacteric Symptoms Following Risk-Reducing Salpingo-Oophorectomy

Breast Cancer Associated Susceptibility Proteins Type 1/2 (BRCA1/2) promote cellular functioning by modulating NRF2-mediated antioxidant signaling. Redox failure in women with BRCA1/2 insufficiency increases the risk for breast/ovarian/uterine cancers. Risk-reducing salpingo-oophorectomy (RRSO) is a prophylactic surgery of the reproductive organs, which is frequently conducted by the age of 40 to lower the occurrence of cancer in women with BRCA1/2 mutations. However, abrupt estrogen decline following RRSO causes ovarian failure, which implicates various cellular physiological processes, resulting in the increased release of free radicals and subsequent severe onset of menopausal symptoms. Comfort measures (e.g., hormonal replacement therapy (HRT) and mindfulness-based stress reduction (MBSR)) may improve chronological menopause-related quality of life, but their specific effects are not clear in women with gene mutations. Aiming to fill the gap, this study used path analysis to examine the effects of HRT and MBSR on menopausal symptoms among RRSO patients (N = 199, mean age = 50.5 ± 6.7 years). HRT directly alleviated the levels of urogenital symptoms (β = -0.195, p = 0.005), which mediated its indirect significant effects on the somatic-vegetative and psychological symptoms of menopause (β = -0.046, -0.067; both p values = 0.004, respectively), especially in BRCA2 carriers and in women who were currently physically active, premenopausal at the time of RRSO, had a high BMI, and had no history of breast cancer. It increased the severity of urogenital symptoms in women with a history of cancer. MBSR, on the other hand, was associated with indirect increases in the intensity of the somatic-vegetative and psychological symptoms of menopause (β = 0.108, 0.029; p = 0.003, 0.033, respectively). It exerted positive direct effects on different menopausal symptoms in multigroup analysis. The results suggest that young women undergoing recent RRSO may benefit from HRT at an individual level, while their need for extensive measures to optimize their psychological wellbeing is ongoing. The adverse effects of MBSR, which are captured in the present study, imply that MBSR may interfere with redox sensitivity associated with estradiol fluctuations in BRCA1/2 carriers. Investigations are needed to test this hypothesis and elaborate on the underlying mechanisms in these women.

Knowledge, attitude, and practice toward ultrasound screening for breast cancer among women

Background

Several obstacles can hinder breast cancer screening. This study aimed to investigate the knowledge, attitude, and practice (KAP) toward ultrasound screening for breast cancer in women.

Methods

This cross-sectional study recruited women who visited the breast specialist clinic of Zhongshan City People's Hospital (a tertiary hospital) between August 2022 and April 2023 through convenience sampling. KAP scores ≥70% were considered adequate.

Results

This study enrolled 501 participants. The mean knowledge, attitude, and practice levels were 8.56 ± 1.81/12 (possible range 0-12, 71.33%), 29.80 ± 2.71 (possible range 8-40, 74.50%), and 32.04 ± 3.09 (possible range 8-40, 80.10%). Senior high school education (vs. junior high school and below, coefficient = 1.531, 95%CI: 1.013-2.312, p = 0.044), bachelor's education and above (vs. junior high school and below, coefficient = 5.315, 95%CI: 3.546-7.966, p < 0.001), housewife or unemployed (vs. employed, coefficient = 0.671, 95%CI: 0.466-0.966, p = 0.032), and a history of breast ultrasound (vs. no, coefficient = 1.466, 95%CI: 1.121-1.917, p = 0.005) were independently and positively associated with knowledge. Knowledge (coefficient = 1.303, 95%CI: 1.100-1.544, p = 0.002) and monthly income >10,000 (vs. <5,000, coefficient = 4.364, 95%CI: 1.738-10.956, p = 0.002) were independently and positively associated with attitude. Only attitude (coefficient = 1.212, 95%CI: 1.096-1.340, p < 0.001) was independently and positively associated with the practice. A structural equation modeling (SEM) analysis was used to estimate causality among KAP dimensions, showing that knowledge directly influenced attitude (β = -1.090, p = 0.015), knowledge did not directly influence practice (β = -0.117, p = 0.681) but had an indirect influence (β = 0.826, p = 0.028), and attitude directly influenced practice (β = -0.757, p = 0.016).

Conclusion

Women in Zhongshan City had good knowledge, favorable attitudes, and active practice toward breast ultrasound screening for breast cancer. Women's characteristics associated with a poorer KAP were identified, allowing for more targeted interventions.

Health Literacy among Korean American Immigrant Women in the USA: Role of Social Support

Health literacy is associated with health behaviors and outcomes. Using Andersen's Behavioral Model of Health Services Use, this study examined the role of limited English proficiency (LEP) and social support for the health literacy of Korean American immigrant women, one of the most affected groups by LEP. Researchers surveyed 232 Korean American immigrant women in a metro area in a Southeastern state, U.S. Health literacy was measured by the CDC Behavioral Risk Factor Surveillance System Questionnaire and the California Health Interview Survey. Participants with better English proficiency and larger social support had higher health literacy. LEP and social support interaction was significantly associated with health literacy, illustrating social support as a buffer that mitigates the negative impact of LEP on health literacy. Community programs that enhance social support through community health advocates or peer educators may increase health literacy and reduce health disparities among Korean American immigrant women with LEP.

Implementing supplementary breast cancer screening in women with dense breasts: Insights from European radiographers and radiologists

INTRODUCTION

In response to the critical need for enhancing breast cancer screening for women with dense breasts, this study explored the understanding of challenges and requirements for implementing supplementary breast cancer screening for such women among clinical radiographers and radiologists in Europe.

METHOD

Fourteen (14) semi-structured online interviews were conducted with European clinical radiologists (n = 5) and radiographers (n = 9) specializing in breast cancer screening from 8 different countries: Denmark, Finland, Greece, Italy, Malta, the Netherlands, Switzerland, United Kingdom. The interview schedule comprised questions regarding professional background and demographics and 13 key questions divided into six subgroups, namely Supplementary Imaging, Training, Resources and Guidelines, Challenges, Implementing supplementary screening and Women's Perspective. Data analysis followed the six phases of reflexive thematic analysis.

RESULTS

Six significant themes emerged from the data analysis: Understanding and experiences of supplementary imaging for women with dense breasts; Challenges and requirements related to training among clinical radiographers and radiologists; Awareness among radiographers and radiologists of guidelines on imaging women with dense breasts; Challenges to implement supplementary screening; Predictors of Implementing Supplementary screening; Views of radiologists and radiographers on women's perception towards supplementary screening.

CONCLUSION

The interviews with radiographers and radiologists provided valuable insights into the challenges and potential strategies for implementing supplementary breast cancer screening. These challenges included patient and staff related challenges. Implementing multifaceted solutions such as Artificial Intelligence integration, specialized training and resource investment can address these challenges and promote the successful implementation of supplementary screening. Further research and collaboration are needed to refine and implement these strategies effectively.

IMPLICATIONS FOR PRACTICE

This study highlights the urgent need for specialized training programs and dedicated resources to enhance supplementary breast cancer screening for women with dense breasts in Europe. These resources include advanced imaging technologies, such as MRI or ultrasound, and specialized software for image analysis. Moreover, further research is imperative to refine screening protocols and evaluate their efficacy and cost-effectiveness, based on the findings of this study.

Evaluation of Breast Health Promotion Intervention Among Catholic Nuns in Lake Zone 'Tanzania

Objective

Despite facing unique barriers, Catholic nuns in Tanzania require accessible breast health promotion. This study explores interventions to empower nuns through knowledge, improved attitudes, and positive practices, ultimately promoting well-being and early detection for better breast cancer outcomes.

Materials and Methods

A quasi-experimental design study guided by the Health Belief Model was conducted to monitor the implementation of a breast health intervention program aimed at increasing breast cancer screening knowledge among 385 Catholic nuns aged 20 to over 60 years old within Lake Zone, Tanzania. Data were collected at two-time points: pre-intervention (baseline) and implementation phase intervention (after three months). The intervention consisted of a 2-hour educational session. Participants had opportunities to ask questions and provide feedback.

Results

The breast health promotion intervention was well-received by Catholic nuns, with 339 (88%) expressing strong motivation to learn and promote awareness. The training effectively increased knowledge and positive attitudes towards breast cancer screening. Researcher assistants successfully delivered the program, and 354 (92%) of participants expressed interest in continued education and support. The intervention addressed cultural barriers and empowered nuns to take charge of their health, though some challenges remain meanwhile 158 (41%) had limited prior knowledge, 81 (21%) hesitated to discuss breast health due to religious beliefs, and some faced difficulty applying the learnings.

Conclusion

Overall, the breast health promotion intervention had a positive outcome on the Catholic nuns' awareness and knowledge of breast health. However, addressing the identified barriers and challenges is crucial to further enhance the intervention's effectiveness and sustainability.

The Effect of an Educational Intervention on Breast Cancer Screening of Rural Women: Application of the Theory of Planned Behavior

BACKGROUND

Early diagnosis of breast cancer is a key factor affecting patient survival, so screening can reduce the burden of this disease. The present study aimed to investigate the effect of education based on the theory of planned behavior (TPB) on breast cancer screening in rural women.

METHODS

In this quasi-experimental study, 480 women referring to the health care centers in the cities of Fasa and Shiraz were divided into two groups, intervention (n = 240) and control (n = 240), using cluster random sampling method, in 2021-2022. We randomly selected two health care centers in Shiraz and Fasa and invited them to participate in the study. The demographic information questionnaire and a researcher-made questionnaire based on the TPB were used to collect the data. The intervention included 50-minute sessions on topics such as breast cancer basics, screening methods, barriers to mammography, and the role of peer groups. Data were collected before and 4 months after the intervention.

RESULTS

The results showed no difference between the two groups in awareness, attitude, perceived behavioral control, subjective norms, behavioral intention, and breast cancer screening performance before the intervention. Four months after the intervention, a significant increase was found in the intervention group in awareness (7.46 ± 1.50 to 18.54 ± 1.20), attitude (28.55 ± 4.62 to 58.69 ± 4.35), perceived behavioral control (22.52 ± 3.32 to 40.88 ± 3.84), and subjective norms (20.37 ± 3.34 to 21.99 ± 3.38). Instead, no significant difference in the mentioned constructs (P < 0.05) was observed in the control group.

CONCLUSION

This study demonstrated that TPB-based education enhanced awareness, attitude, perceived behavioral control, subjective norms, and behavioral intention towards breast cancer screening. The TPB empowers women in rural communities to prioritize their health and seek timely breast cancer screening. Continued efforts and improved access to screening services are crucial for improved outcomes.

A Novel Provider Education Module to Enhance Detection of Alpha-1 Antitrypsin Deficiency

Background

Alpha-1 antitrypsin deficiency (AATD) is the most common genetic risk factor for early-onset emphysema. However, AATD continues to be underrecognized and underdiagnosed. Provider awareness about AATD, concerns with testing costs, and limited understanding about therapeutic options contribute to its underdiagnosis. We hypothesized that provider education would improve awareness of AATD and improve screening.

Objective

To evaluate the impact of a targeted provider education module on AATD screening.

Methods

We developed a web-based education module to address barriers to screening for AATD, deployed the education module using the Medscape Education platform, assessed perceived healthcare provider confidence in AATD screening, and conducted a prospective pre and postintervention study of AATD testing practices at a high-volume academic outpatient subspecialty pulmonary clinic.

Results

A total of 11,385 healthcare providers, including eight pulmonologists at our institution, completed the web-based education module. Confidence in identifying patients at high risk for AATD improved after completing the module ("not confident" in AATD screening was 7.7% postintervention compared with 19.4% preintervention). The rate of screening patients at high risk for AATD improved more than twofold (AATD screening rate 9.7% preintervention vs. 20.4% postintervention; P = 0.004). Among patients screened for AATD in our cohort, 27.2% had a genotype/phenotype or low alpha-1 antitrypsin concentration consistent with AATD.

Conclusion

Targeted healthcare provider education can improve the confidence in testing for AATD. Improvements in provider confidence corresponded to improvements in AATD screening in a subspecialty pulmonary clinic. More than one-fourth of screening tests suggested AATD, underpinning the value of testing in high-risk individuals.

The Sociocultural Influences on Breast Cancer Screening among Rural African Women in South Africa

The incidence of breast cancer in South Africa is increasing, with rural South African women presenting with advanced stages of the disease. A woman's breasts are a symbol of her womanhood; they also constitute a social definition of her femininity. Women with breast cancer in rural South Africa are heavily stigmatized and suffer from various sociocultural interpretations of the disease. Breast cancer is frequently interpreted in rural South Africa as a symbol of witchcraft, sin, and punishment, and traditionally, it is treated by offering animal sacrifices, consumption of herbs, and prayer to ancestors. Using care-seeking behaviour theory as the theoretical framework, we intend to explore the sociocultural factors influencing breast cancer screening practices among rural South African women. A qualitative exploratory study was conducted using semi-structured interviews with 22 rural South African women selected by purposive sampling. Thematic analysis was used to analyse the data. The study identified four sociocultural factors influencing women's practices of breast cancer screening in rural South Africa, including psychological factors, habits, beliefs, and perceptions of healthcare. Women in rural South African communities have deep-rooted traditional beliefs and practices regarding breast cancer. Consequently, this influences women's preventative health behaviours regarding breast cancer screening. The development of culturally appropriate health education programs involving traditional healers and influential community leaders is essential to increasing the number of women being screened for breast cancer in rural South Africa.

Health perceptions and attitudes on mobile health apps in China

Since the COVID-19 pandemic, the use of mobile health apps has been increasing significantly. Many have started using mobile health apps to manage their health and well-being. People need to develop healthy habits that will increase their job productivity, life expectancy and improve their social relationships. This study tests the Health Belief Model with adults in China in influencing health motivation and in turn improving their health behavior. A mobile and online survey was developed, and 120 usable responses were collected. A structural equation modeling was used to test the relationships between perceived benefits, perceived susceptibility, perceived barriers, health motivation, and health behavior. We found perceived self-efficacy, perceived benefits, and perceived susceptibility predicts health motivation, and health motivation predicts health behavior. We did not find that perceived barrier is a predictor for health motivation. We conclude that to encourage behavioral change, it is important to enhance self-efficacy and address the benefits; in the meantime, educating people on susceptibility is also important.

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.

Killing Two Birds with One Stone: Is the COVID-19 Vaccination Campaign an Opportunity to Improve Adherence to Cancer Screening Programmes? The Challenge of a Pilot Project in a Large Local Health Authority in Rome

The COVID-19 pandemic has affected health services worldwide. The suspension of cancer screening programs during the lockdown period, coupled with the other measures taken to limit the SARS-CoV-2 spread, contributed to the idea that cancer preventive interventions are deferrable. In this opinion paper, we present some data on cancer screening coverage in one of the largest Local Health Authorities in Italy in recent years. Within this context, we introduce the benefits of a pilot project in which we took advantage of the great attention on the COVID-19 vaccination campaign to improve screening uptake. In this project, we offered men and women eligible for cancer screening the opportunity to book appointments while waiting to be vaccinated. In addition, trained healthcare personnel were available on-site to discuss any barriers to participation with the attendees. Despite the project having only just started, preliminary results are encouraging, with positive feedback from the attendees. In conclusion, we advocate for the need to adopt a comprehensive approach when it comes to population health, and we use this project as an example to discuss how it is possible to contribute to minimizing the long-term impact of the COVID-19 pandemic with resources already in place.

Interventions to increase mammography screening uptake among women living in low-income and middle-income countries: a systematic review

OBJECTIVE

To systematically identify interventions that increase the use of mammography screening in women living in low-income and middle-income countries (LMICs).

DESIGN

Systematic review.

DATA SOURCES

MEDLINE, Embase, Global Health, CINAHL, PsycINFO, Web of Science, Cochrane Central Register of Controlled Trials, Google Scholar and African regional databases.

ELIGIBILITY CRITERIA

Studies conducted in LMICs, published between 1 January 1990 and 30 June 2021, in the English language. Studies whose population included asymptomatic women eligible for mammography screening. Studies with a reported outcome of using mammography by either self-report or medical records. No restrictions were set on the study design.

DATA EXTRACTION AND SYNTHESIS

Screening, data extraction and risk-of-bias assessment were conducted by two independent reviewers. A narrative synthesis of the included studies was conducted.

RESULTS

Five studies met the inclusion criteria consisting of two randomised controlled trials, one quasi-experiment and two cross-sectional studies. All included studies employed client-oriented intervention strategies including one-on-one education, group education, mass and small media, reducing client out-of-pocket costs, reducing structural barriers, client reminders and engagement of community health workers (CHWs). Most studies used multicomponent interventions, resulting in increases in the rate of use of mammography than those that employed a single strategy.

CONCLUSION

Mass and small media, group education, reduction of economic and structural barriers, client reminders and engagement of CHWs can increase use of mammography among women in LMICs. Promoting the adoption of these interventions should be considered, especially the multicomponent interventions, which were significantly effective relative to a single strategy in increasing use of mammography.

PROSPERO REGISTRATION NUMBER

CRD42021269556.

A Health Inequity: Associations Between Cigarette Smoking Status and Mammogram Screening Among Women of Color

INTRODUCTION

We evaluated differences in yearly mammogram screening by smoking status in a sample of US women. We also examined differences in mammogram screening by race/ethnicity, age, and health care coverage.

METHODS

Data were from 1884 women participants in the 2018 Health of Houston Survey study. Binary logistic regression was used to assess the association between smoking status (current/former/non-smokers) and mammograms within 12 months. Moderators included race/ethnicity (Hispanic, Black, Asian, Other, White), age, and health care coverage.

RESULTS

In comparison to women who were non-smokers, current and former smokers showed lower odds to get a yearly mammogram (OR = 0.720; 95% CI = 0.709, .730 and OR = 0.702; 95% CI = 0.693, 0.710, respectively). Current smokers who identified as Hispanic or Black women and former smokers who identified as Hispanic, Asian, and other women showed lower odds of getting a mammogram (OR = 0.635, 95% CI = 0.611, 0.659; OR = 0.951, 95% CI = 0.919, 0.985) and (OR = 0.663, 95% CI = 0.642, 0.684; OR = 0.282, 95% CI = 0.263, 0.302; OR = 0.548, 95% CI = 0.496, 0.606) compared to White women. There were significant interactions by age and health care coverage.

CONCLUSIONS

Women of color who are current and former smokers showed lower odds to engage in mammogram screening, thus increasing their risk of undiagnosed breast cancer when compared to non-smokers. Ethnically diverse women already experience increased health disparities and smoking puts them at exacerbated risk of health complications and death.

IMPLICATIONS

Our findings suggest that smoking status is a modifiable behavioral risk factor that requires further attention in the prevention of breast cancer in ethnic minority women. Health care institutions and policymakers need to increase their awareness of and outreach efforts to women of color who smoke. These outreach efforts should focus on increasing access to smoking interventions and cancer screenings.

Breast cancer knowledge & information seeking among African American women below screening age

OBJECTIVES

African American women below screening age disproportionately face greater mortality from breast cancer relative to peers of other races and African American women of screening age. The current study examines breast cancer knowledge and health information seeking of African American women below screening age.

METHODS

We collected survey data from 99 African American women below screening age on their breast cancer knowledge and health information seeking behaviors. As secondary analysis, we harmonized data from a previous study to compare breast cancer knowledge between African American women below and of (N = 209) screening age.

RESULTS

The average woman below screening age correctly answered 2.84 (SD=1.08) of six breast cancer knowledge items, 2.67 (SD=1.01) of five mammogram items, 1.44 (SD=0.86) of three treatment items, and had lower knowledge (p < .001) in each area relative to screening age women. Women below screening age sought information primarily from medical providers and the internet.

CONCLUSIONS

A strategy for eliminating early-onset breast cancer disparities impacting African American women is addressing the limited breast cancer knowledge in this age group. Practice Implications In addition to age-appropriate information for this group, guidance for medical providers would be beneficial, as providers are this group's most common source of health information.

Silently Proliferating: Cancer

Cancer is a health problem that has existed for years and frequently affects tissues and organs. Although some standards have been set for its treatment, different treatments and approaches are used for each type of cancer. The treatment process and having to live with cancer drag the individual to a difficult process that affects the individual negatively. Problems such as the severe course of the disease, taking longer than expected treatment, and having many side effects reduce the individual's physical performance and activities of daily living. Therefore, this situation reduces the quality of life and causes the general well-being of the individual to be negatively affected at the psycho-social level. In order to cope with the problems that cancer patients experience, it is important to support them physically, mentally, emotionally, socio-culturally, and spiritually. The decrease in the quality of life of the caregiver also affects the quality of care and therefore the quality of life of the patient. For this reason, it is necessary to determine how patients and caregivers perceive the disease, reduce their psychological anxiety and pain, as well as the factors affecting this perception, and ensure their compliance with treatment.

Availability of Financial and Medical Resources for Screening Providers and Its Impact on Cancer Screening Uptake and Intervention Programs

Interventions for residents and medical/financial resources available to screening providers can improve cancer screening rates. Yet the mechanisms by which the interactions of these factors affect the screening rates remain unknown. This study employed structural equation modeling to analyze the mechanisms underlying these factors. Data for Japanese municipalities' medical/financial status, their implementation of screening interventions, and the number of municipality-based cancer screening appointments from April 2016 to March 2017 were obtained from an open database. Five cancer screenings were included: gastric, lung, colorectal, breast, and cervical cancer screening; all are nationally recommended for population screening in Japan. We defined two latent variables, namely, intervention for residents and medical/financial resources, and then analyzed the relationships between these variables and screening rates using structural equation modeling. Models were constructed for gastric, lung, and breast cancer screening, and similar relationships were observed. With these cancer types, medical/financial resources affected the intervention for residents, directly affecting screening rates. One limitation of this study is that it only included screening by municipalities, which may cause selection bias. In conclusion, financial pressures and lack of medical resources may cause a reduction in screening intervention programs, leading to stagnant screening rates. Ensuring consistent implementation of interventions for residents may improve local and regional cancer screening rates.

Improving intervention design to promote cervical cancer screening among hard-to-reach women: assessing beliefs and predicting individual attendance probabilities in Bogotá, Colombia

Background

Despite being a preventable disease, cervical cancer continues to be a public health concern, affecting mainly lower and middle-income countries. Therefore, in Bogotá a home-visit based program was instituted to increase screening uptake. However, around 40% of the visited women fail to attend their Pap smear test appointments. Using this program as a case study, this paper presents a methodology that combines machine learning methods, using routinely collected administrative data, with Champion’s Health Belief Model to assess women’s beliefs about cervical cancer screening. The aim is to improve the cost-effectiveness of behavioural interventions aiming to increase attendance for screening. The results presented here relate specifically to the case study, but the methodology is generic and can be applied in all low-income settings.

Methods

This is a cross-sectional study using two different datasets from the same population and a sequential modelling approach. To assess beliefs, we used a 37-item questionnaire to measure the constructs of the CHBM towards cervical cancer screening. Data were collected through a face-to-face survey (N = 1699). We examined instrument reliability using Cronbach’s coefficient and performed a principal component analysis to assess construct validity. Then, Kruskal–Wallis and Dunn tests were conducted to analyse differences on the HBM scores, among patients with different poverty levels. Next, we used data retrieved from administrative health records (N = 23,370) to fit a LASSO regression model to predict individual no-show probabilities. Finally, we used the results of the CHBM in the LASSO model to improve its accuracy.

Results

Nine components were identified accounting for 57.7% of the variability of our data. Lower income patients were found to have a lower Health motivation score (p-value < 0.001), a higher Severity score (p-value < 0.001) and a higher Barriers score (p-value < 0.001). Additionally, patients between 25 and 30 years old and with higher poverty levels are less likely to attend their appointments (O.R 0.93 (CI: 0.83–0.98) and 0.74 (CI: 0.66–0.85), respectively). We also found a relationship between the CHBM scores and the patient attendance probability. Average AUROC score for our prediction model is 0.9.

Conclusion

In the case of Bogotá, our results highlight the need to develop education campaigns to address misconceptions about the disease mortality and treatment (aiming at decreasing perceived severity), particularly among younger patients living in extreme poverty. Additionally, it is important to conduct an economic evaluation of screening options to strengthen the cervical cancer screening program (to reduce perceived barriers). More widely, our prediction approach has the potential to improve the cost-effectiveness of behavioural interventions to increase attendance for screening in developing countries where funding is limited.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01800-3.

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.

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.

The effect of multimedia health education on pain and anxiety in women undergoing mammography in Taiwan

OBJECTIVE

Breast cancer is the most common cancer among women in Taiwan. However, the discomfort of receiving mammograms reduces the willingness to screen.

MATERIALS AND METHODS

This study using a quasi-experimental design and recruited 150 participants in a medical center, Taiwan. In the control group, only provided traditional health education sheets, the experimental group has joined the intervention of multimedia health education. State-Trait Anxiety Inventory and Visual Analogue Scale, respectively, were used to compare the differences in anxiety and pain between the two groups before and after receiving mammography.

RESULTS

After the intervention, the experimental group's state anxiety score was significantly lower than that of the control group (30.63 ± 8.43 vs. 33.77 ± 10.74, p < .05). However, there was no significant difference in pain scores (4.13 ± 2.37 vs. 4.57 ± 2.31; p = .25).

CONCLUSIONS

Younger, prior experience with mammography, and high trait anxiety affect pain and state anxiety of women undergoing mammography. The multimedia health education intervention could reduce anxiety effectively, but it does not significantly relieve the pain undergoing mammography.

Determinants of Intention to Participate in Breast Cancer Screening among Urban Chinese Women: An Application of the Protection Motivation Theory

Despite the significance of early detection of breast cancer through screening, the screening uptake in China remains relatively low. Protection motivation theory (PMT) suggested by Rogers is one of the theories concerning threat appeal. This study aimed to apply the protection motivation theory (PMT) in predicting breast cancer screening intention. In this cross-sectional study, a sample of Chinese urban women was recruited using the convenient sampling method from five communities in Wuhan. Data were collected using a self-report questionnaire that included demographic variables, knowledge about breast cancer, six PMT subconstructs, and screening intention. We used the structural equation modeling (SEM) to identify the predictor factors associated with screening intention. Of the total sample (n = 412), 86.65% had intention to participate in screening. Our data fit the hypothesized SEM model well (Goodness of fit index (GFI) = 0.91, adjusted GFI (AGFI) = 0.89, comparative fit index (CFI) = 0.91, root mean square error of approximation (RMSEA) = 0.05, standardized root mean residual (SRMR) = 0.06, and Chi-square/df = 2.01). Three PMT subconstructs (perceived severity, response cost, and self-efficacy) were significantly associated with screening intention. Knowledge, social status, and medical history had significantly indirect associations with screening intention through the mediating effect of PMT subconstructs. Considering the utility of PMT, intervention programs might be more effective based on the subconstructs of PMT, especially to improve self-efficacy, perceived severity, and knowledge, reduce response cost, as well as targeting specific demographic groups.

The effect of a smartphone application on women's performance and health beliefs about breast self-examination: a quasi-experimental study

BACKGROUND

Breast Self-Examination (BSE) is a simple and inexpensive method for early diagnosis of breast cancer. This study aimed to determine the effect of a smartphone application on women's performance and health beliefs regarding BSE.

METHODS

In this quasi-experimental study, 150 women referring to therapeutic clinics in Jahrom, Iran from December 2019 to May 2020 were randomly assigned to an intervention or a control group. The intervention group participants had access to a smartphone application including BSE reminder, training, alarm, and feedback to the therapist. The application also contained educational movies and self-assessment. The study data were collected using Champion's Health Belief Model Scale and BSE information record form before and six months after the intervention. Then, the data were entered into the SPSS 21 software and were analyzed using descriptive statistics, paired t-test, independent t-test, Chi-square, ANCOVA, Mann-Whitney, and Wilcoxon tests.

RESULTS

After the intervention, the largest number of BSEs was four times among 60% of the participants in the intervention group and once among 24% of the participants in the control group during four months (p = 0.001). After the intervention, the mean differences of the scores of perceived susceptibility (1.03 ± 2.65 vs. 0.01 ± 0.42, p = 0.001), BSE barriers (2.80 ± 5.32 vs.  0.04 ± 1.43, p = 0.001), self-efficacy (10.75 ± 7.63 vs. - 2.75 ± 2.44, p = 0.001), and health motivation (2.77 ± 3.70 vs. - 0.29 ± 0.63, p = 0.001) were significantly higher in the intervention group compared to the control group. However, no significant difference was observed between the two groups with regard to perceived severity and BSE benefits after the intervention.

CONCLUSIONS

Access to the smartphone application enhanced the participants' performance and health beliefs regarding BSE in the areas of perceived susceptibility, self-efficacy, and health motivation. Therefore, we recommend using the same smartphone application to improve women's performance and health beliefs regarding BSE.

A Qualitative Focus Group Study for the Exploration of Knowledge and Attitudes of Informal Caregivers Toward Breast Cancer: Perceptions of Informal Caregivers and Healthcare Professionals in Three European Countries

Breast cancer (BC) early screening and detection is a main component for the outcome of the treatment and overall survival. Informal caregivers (ICGs) are less likely to initiate early BC screening methods and utilize health services. The purpose of this study was to explore ICGs’ knowledge and perceptions, including educational and training opportunities or barriers, in promoting early detection practices for BC, as well as healthcare professionals’ (HCP) respective perceptions concerning ICGs in order to identify the need of selected health literacy interventions. A qualitative focus group study was implemented in 3 European countries, using a purposive sampling technique. In total, 26 ICGs and 18 HCPs were involved. The themes that emerged from the focus groups interviews included knowledge, perceptions, attitudes, and beliefs concerning BC; motivational factors and barriers that influence early screening practices and personal involvement. Motivators and barriers concerning BC screening adherence were linked to knowledge, beliefs and perceptions. Health promotion strategies and user-friendly tools should be developed, targeting on the implementation of BC early detection practices among informal caregivers.