@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2014;1(1):11-18

Background
Breast cancer is considered as the most common cancer in women [1]… [2-9].Health education is effective and essential with using the theories and instructional models to raise awareness, to change attitude and to adopt healthy behaviors [10].
Previous Studies
Health Belief Model is a one of the proposed educational models in health education. This model is a comprehensive model that plays a more role in disease prevention and the pattern of this model is based on people's motivation for action. This model emphasizes that the person's perception makes motivation and momentum and it causes behavior on her. In general, this model focuses on changes in beliefs, and changes in beliefs will lead to changes in behavior [11].
Aim(s)
This study aimed to investigate the effect of training on adopting preventive behaviors of breast cancer with using the Health Belief Model on junior school teachers in Zahedan city.
Research type
This study is a quasi-experimental study of pre and post controlled group.
Research society, place and time
This study was conducted on female teachers in schools of Zahedan city.
Sampling method and number
240 persons (110 persons in the intervention group and 110 persons in the control group) of female teachers in schools in Zahedan were selected by multistage sampling. To achieve the required samples, first, a list of secondary schools for girls from education zones 1 and 2 was prepared in Zahedan city. An area was selected randomly as intervention group and an area was selected randomly as the control group. Then, 6 schools were randomly selected from each area. In total, 12 schools were selected from both areas and all teachers of these schools were enrolled in the study. Inclusion criteria included educated teachers at all levels (associate, bachelor, master) and people without a history of benign or malignant breast disease. Also, criteria of deselecting or exit included those people who had the experience of getting breast cancer.
Used devices&materials
Data collection tool was a researcher made two-part questionnaire. The first part included demographic questions such as age, education, marital status and the second part included questions of awareness (16 question) with questions such as “which one of items caused increase in risk of breast cancer”, questions of perceived susceptibility (6 question) with questions such as “I’m too young for getting breast cancer so I do not need to do breast self-examination”, perceived severity (5 question) with questions such as “If I am diagnosed with breast cancer, life will be hard for me”, perceived benefits (5 question) with questions such as“I do breast self-examination because it is convenient and simple action”, perceived barriers (5 question) with questions such as ”I do not do breast self-examination, because I'm afraid of having cancer”, self-efficacy questions (5 questions) with questions such as “I can do BSE Without the help of other people”, cues to action (6 questions) with questions such as “which is the greatest source of your information in relation to diagnostic tests for breast cancer?” and behavior (5 questions) with questions such as “Have you ever had a mammogram?”. For determining the validity of the questionnaire, content validity method was used. For this purpose, ten health education specialists, oncologists, women and epidemiologists were consulted and the content validity and content validity index were calculated. Items that their ratio content validity score was, more than 0.62 and their content validity index was, higher than 0.79, were accepted. Also, the reliability of all constructs of the Health Belief Model in a pilot study on 30 persons of subjects were evaluated by Cronbach’s alpha. Reliability coefficient of all constructs was calculated more than 0.70. Five one-hours training sessions, were implemented for experimental group. The methods used for training were including: lectures and film screenings, PowerPoint presentations, question and answer, discussion group and sending SMS messages via the mobile phone. During these meetings, in connection with increase in awareness of the target group of diseases and complications of breast cancer, familiarity with methods of screening like the right time for mammography examination by a doctor or true way for self-examination and having a healthy way of life based on the Health Belief Model were presented with educational content based on model constructs. 2 months after the intervention, again the participants completed the same questionnaire. Statistical analysis: Collected information was analyzed using SPSS 15 software and independent T statistical tests and Chi-square test. The significance level for all tests was considered less than 0.05.
Findings by Text
The age range of participants in study was between 21 and 65 years with a mean of 39.4±7.4. Most people (53.2%) were in the age range of 35 to 40 years.40.8% of teachers had an associate degree, 55.8% of them had a bachelor's degree and 3.3% of them had a master's degree.90% of participants were married and the rest were single, divorced or widowed.Table 1 has examined the demographic characteristics of the study's participants. Based on Chi-square test results, statistically significant difference was not observed between the two groups before the study in terms of education level and marital status form. Also, the comparison of scores of Health Belief Model constructs by using independent t-test showed that there wasn’t significant difference between intervention and control groups before educational intervention (p>0.05). The changes in mean scores of Health Belief Model constructs in both groups after the intervention is presented in Table2. Changes before and after the study had significant difference in the mean score of awareness, perceived susceptibility, perceived severity, benefits, perceived barriers, self-efficacy and behavior in both intervention and control groups (p<0.001). Chi-square test results showed that there was a significant difference between the two groups of intervention and control before educational intervention in terms of age.Considering the significant difference before intervention, to determine the significant difference after the intervention, multivariate linear regression analysis was used, and after the intervention, still, significant difference was existed between the two groups in terms of Health Belief Model constructs (P˂ 0.001). The most important cues to action about preventive behaviors of breast cancer in the participants, after the intervention, were physicians and health staff (86.2%), radio and television (79.3%), books (71.5%), friends and acquaintances (70.7%), newspapers (63.8%) and Journals (60.4%) respectively (Figure 1).In Table 3 in the question of (Do you do breast self-examination?), changes after the intervention was much more than other questions that the prevalence of lack of breast self-examination in the participants of the intervention group was decreased from 50% to 5.2%.
Main comparison to the similar studies
… [12, 13].The results of study by Moodi et al., with title of comparison of three methods of educational intervention based on Health Belief Model on breast cancer screening behaviors in women over 40 years in Isfahan showed that awareness scores and most Health Belief Model constructs in each of the studied groups had significant difference before and three months after intervention[14].Also, In a study by Judkins et al. with title of the effect of improving nursing skills in the breast investigation and diagnosis of tumors in them, was reported similar gains with this study[15]….[16].Also, in Rigi et al. study,investigation of research units in terms of attitude showed that changes in both groups who were trained by simulation and speech was significant [17]. …[18]. Also, in a study done by Crombie indicated increase in the positive attitude of women to the ways of early diagnosis, three months after educational intervention[19]. …[20-23].In this study, increase of self-efficacy scores increased significantly after the educational intervention. In line with the findings in this research, in Heidari study, self-efficacy was significantly increased in adolescents with diabetes after intervention [24].Also, in Karimy et al. study, after training, the self-efficacy in rural women was increased in prevention of brucellosis[25].In various studies, significant positive relationship has been proved between self-efficacy and adopting of preventive behavior[25, 26]. … [27, 28].
Suggestions
In various studies, significant positive relationship has been shown between self-efficacy and adopting of preventive behavior. So, in designing training programs, the role of this construct in the empowerment of women should be noted.
Limitations
In limitations of this study, lack of coordination in some schools in the allocation of time and place to provide training can be noted.
Conclusions
By using Health Belief Model, appropriate training to promote preventive behaviors among working women should be provided.
Acknowledgments
Respected management education organizations, all participating teachers, Department of Health Faculty and honorable advisers are appreciated.
Conflict of interest
Non-declared
Ethical Permissions
This research is research project number 2502.
Funding Sources
This study is part of MA thesis of the first author at the Zahedan University of Medical Sciences and Health Services.

TABLES and CHARTS

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