@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2018;24(2):132-138

Background
Cancer is the second most common cause of mortality after cardiovascular disease, worldwide and developed countries, and it is the third leading cause of mortality after cardiovascular disease and accidents in developing countries, including Iran [1-3].
Previous Studies
... [4-7]. The incidence of breast cancer in Iran is increasing and people with breast cancer are about 10 years younger than those in western countries [8]. ... [9-11]. Breast self-examination (BSE) is a safe, simple, cost-effective, non-invasive method, without the need for specialized equipment and personnel and also without geographical limitation, which is considered as the easiest self-care screening method for early diagnosis of breast cancer [12, 13]. ... [14-18]. In this research, the theory of planned behavior (TBP), which has been used to teach healthy behaviors, family planning, and breast cancer was employed. According to this theory, attitude towards behavior, the subjective norm about behavior and the control of perceived behavior is the main constituent determining the intention to do the behavior [19].
Aim(s)
The aim of this study was to determine the effect of educational intervention based on TBP in promoting BSE of women in Gonabad, IRAN.
Research type
This research is a clinical field trial study.
Research society, place and time
This research was done on 140 married women aged 20-49 years from Gonabad in 2015.
Sampling method and number
In this field trial study, the minimum sample size obtained 58, according to the sample size formula to test the mean hypothesis in two independent groups, 95% confidence interval, the test power (β-1) of 80% as well as the guideline (21) and also different structures of the theory. 70 subjects were studied as the experimental and control group, due to the 20% possible reduction of the samples and also to increase the accuracy of the data. 140 married women of Gonabad aged 29-40 years were randomly divided into the experimental and control groups.
Used devices&materials
BSE behavior was studied using the constructs of the TBP theory, then, the questionnaire was completed before, immediately and three months after the intervention. The educational program was performed in four 50-minute theoretical sessions and one practical session by lecture, group discussion, slideshow, educational film and educational pamphlet based on the constructs of the TBP theory. Subjects who had breast self-examination during this period their reports were recorded. In the interval between training and three months after the intervention, educational messages were sent to women in the test group. The inclusion criteria included women aged 20-40 years, being literate, married, no breast cancer in participants or their first-degree relatives (such as mother, sister, daughter), and also unwillingness to continue the study, unorganized and ineffective presence in educational sessions (for two sessions and more), no response to the questionnaire, immigration and the confirmed breast cancer were considered as the exclusion criteria. This study is extracted from the Master's thesis in Health Education, which was approved by the Department of Research and Technology of Gonabad University of Medical Sciences (ID: REC 1393 131, GMU). The ethical permission was provided by the Medical Ethics Committee of the Gonabad University of Medical Sciences. To observe ethical standards, the participants were informed about the research and they were assured of voluntary participation as well as confidentiality of data and the right for withdrawal from the study. The questionnaires were coded and recognizable, and the address and telephone number of the individuals were first recorded on the list by the researcher. In the pre-test stage, a pre-test questionnaire was completed by the samples. The questionnaire was read for the subjects by the researcher to resolve the ambiguity. BSE training was carried out by an experienced midwifery expert in communication and with an interest in education at the Fayyaz Bakhsh Health Center of Gonabad. Educational intervention was performed based on the model constructs. Face-to-face training, questions and answers, positive and negative outcomes of behavior, facilitating factors of the behavior and intention, pursuing the influential people, educational pamphlets and also for BSE, visual education, role play and doing exercise by participants were considered, however no intervention was done for the control group. The effect of intervention on the intention and BSE behavior was evaluated immediately and three months after the intervention, so that the questionnaires were returned to the same female participants. ANOVA with repeated measures, t-test, chi-square test and multivariate analysis of variance analysis were used for comparison between two groups.
Findings by Text
The average age of participants in the study was 37.27 years, the majority had a diploma (52.1%) and had 2 to 3 children (32.45%), they were housewives (96.4%), who experienced breastfeeding (91%) and introduced authorities of health centers (62.1%) as the largest source of information (Table 1). Also, Chi-square test did not show any significant difference in terms of demographic characteristics, such as level of education, occupation, etc. between intervention and control groups before intervention. Among the studied variables, perceived behavioral control in the intervention and control group before, immediately after intervention, and 3 months later showed the highest changes 3.23±3.01 and 3.96±3.85 (Table 2). The mean difference of the model constructs after and before the intervention was statistically significant at 95% confidence level. In the intervention group, the mean difference of the constructs was significantly higher than the control group. There was no statistically significant difference in the main variables, including screening, intention, perceived mental norms, perceived behavioral control and attitude toward the behavior between the intervention and control groups, whereas there was a statistically significant difference between the two groups between the mean scores of these variables after intervention (Table 2). Table 4 shows that before the intervention, 51.6% of women in the control group performed BSE, but it increased to 63.8%, 3 months after the intervention.
Main comparison to the similar studies
... [20-21]. The findings are consistent with the results of the Hatafnia study aimed at promoting mammography with educational intervention based on TPB in 2009 on 35 years and older women [22] as well as Fernandez et al. study on the effect of the intervention in promoting screening behaviors of breast and cervical cancers in low-income women aged 50-years and older, in which there was a significant increase in screening behaviors after intervention in the intervention group than before intervention [23]. ... [24-28]. Also, the present study is consistent with Sadeghnezhad et al. study to compare the effects of health education methods in promoting BSE in both intervention and control groups [29].
Suggestions
Educational interventions based on the constructs of TPB model should be provided in order to promote BSE.
Limitations
None declared.
Conclusions
Educational intervention based on the TPB theory is effective in promoting BSE behaviors.
Acknowledgments
The researchers are thankful to all who helped us with this research, including all the women participating in the study, and the authorities and personnel of the health centers, including the Fayyaz Bakhsh Health Center, Gonabad, Iran.
Conflict of interest
None declared.
Ethical Permissions
None declared.
Funding Sources
This research was funded by the Deputy of Research and Technology of Gonabad University of Medical Sciences.