Effects of Breast Cancer and Breast Self-Examination Education using Breast Models on Nursing Students Knowledge, Health Beliefs, and Compliance

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1 Vol.128 (Healthcare and Nursing 2016), pp Effects of Breast Cancer and Breast Self-Examination Education using Breast Models on Nursing Students Knowledge, Health Beliefs, and Compliance Hye Sook You Dept. of Nursing, Honam University 417 Eodeungdairo Gwangsan-gu Gwangju Korea Abstract. This study aimed to determine the effects of Breast Self-Examination (BSE) education and practice on knowledge, health beliefs, and compliance in nursing students. Participants were 172 students from 2 nursing colleges. They responded to questionnaires assessing knowledge, health beliefs and compliance within a 3-month interval. The experimental group participated in a 120-minute educational session. They were significant differences between groups in knowledge about BSE(t=21.18, p=<.001), health beliefs(t=3.69, p=<.001), and compliance(t=5.59, p=<.001) which indicates that education in breast cancer and BSE improves health beliefs and BSE compliance. Taking into consideration various clinical circumstances of based cancer and the characteristics of university students aged in their early 20s, follow-up studies need to focus on developing customized BSE educational programs thorough teaching methods using diverse media including You Tube, videos, and QR codes and verify their effectiveness. Keywords: Nursing students, Breast self-examination, Knowledge, Health beliefs, Compliance 1 Introduction 1.1. Background The most accurate breast examination methods are breast imaging, ultrasound, and clinical breast examination by experts [1]. Many women rarely visit a hospital for breast examination unless they find a breast abnormality. The most common breast abnormality that leads young women to a hospital is the presence of a lump in the breast [2]. Breast self-examination (BSE) is a safe and convenient method of breast examination for early detection of breast cancer, and is also highly recommended in the west [3]. In Korea in recent years, women in their twenties and thirties are increasingly more exposed to breast cancer risk factors with increasingly delayed first marriage and first birth as well as increased smoking and drinking in women [4]. ISSN: ASTL Copyright 2016 SERSC

2 Therefore, regular and accurate BSEs are required to detect breast cancer early, which is significant in the prevention and management of breast cancer. Because nursing students are prospective professionals who will be handling health education and management for the prevention of diseases and improvement of health in the future, it is important to implement education incorporating behavior-focused strategies to impart appropriate knowledge and convey the significance of BSE, as well as to induce behavioral changes in patients and in themselves. Behavioral change typically occurs after a change of health beliefs has occurred and a trigger for change is given. Health beliefs is a concept that directly affects disease prevention or management [5]. Many studies have reported that such health beliefs facilitate health behaviors, such as BSE, and thus is a key variable influencing compliance with BSE [6][7]. Therefore, to prevent breast cancer, it is important to provide comprehensive education about breast cancer and BSE for nursing students, who are mostly in their early twenties, to impart accurate knowledge and positive health beliefs, which would in turn promote regular compliance with BSE. Against this backdrop, the present study sought to provide such comprehensive education using their own bodies and breast models, which were designed for users to experience various cases of breast cancer, and verify the effects of this education Objective The objective of this study is to verify the impact of breast cancer and breast self examination education using breast models on nursing students knowledge, health beliefs, and compliance. 2. Method 2.1. Sample and setting Participants were second-year nursing students at two four-year universities located in G city. To prevent diffusion effects, students of one school were assigned to the experimental group and students of the other school were assigned to the control group. From a total of 88 participants in the experimental group and 90 participants in the control group, we excluded 3 individuals from each group who desired to opt out of the experiment, resulting in a total of 172 participants (85 and 87 students in the experimental and control groups, respectively). Copyright 2016 SERSC 29

3 2.2. Breast Cancer and BSE(Breast Self-Examination) Educational Program Pre-test & Post test We explained the purpose and method of this study to students of both the experimental and control groups in the first week of the second semester of 2014 and obtained consent. A questionnaire was used to survey the participants demographic characteristics, knowledge about breast cancer and BSE, and health beliefs about and compliance with BSE. After the preliminary survey, we immediately provided BSE education and training for the experimental group. Based on Suh s [8] study, the effectiveness of BSE education was measured three months after the preliminary survey (December 2014; second semester of second year) via a questionnaire containing items regarding knowledge about breast cancer and BSE, and health beliefs about and compliance with BSE. We provided a small gift for the control group BSE (Breast Self-Examination) Educational Program Intervention We based the program on a prior study that reported on education provided to teach accurate knowledge about breast cancer risk factors and methods of inducing specific health behaviors for the early detection of breast cancer [9]. The program was designed to comprise three stages, and the duration was about two hours. The validity of the contents of the program was verified by one nursing professor who has lecture and research experience on breast cancer and BSE, and one breast and endocrine surgeon. Stage 1: To impart accurate knowledge, we undertook a literature review based on the provisions of the Korean Breast Cancer Society [1] and used Power point to provide information about recent breast cancer statistics, risk factors, breast cancer symptoms, types and significance of breast examination, prognosis depending on the stage of detection, treatment modalities, and BSE methods. In addition, we included various photographs and videos of actual cases to provide a sense of reality. After the program, we administered a quiz to help the students remember the contents learned, and gave out a small gift for correctly answering a question to spark interest and motivation. Stage 2: The author of this study and a trained assistant provided training for palpation of breast lumps. The BSE method taught in stage 1 was demonstrated stage by stage by the author using a breast model for instructors. Then the students were divided into small groups (first divided into 4 groups of students, then subdivided into groups of 4-5 students) to help the students experience the palpation of normal and abnormal breasts by locating the position and size of abnormal nodules in the breast model (L50, 3B Scientific GmbH, Germany). Members of the small group and the author observed their fellow members performing BSE to provide immediate feedback about the accuracy of the BSE. Stage 3: Self-palpation training was conducted after instructing the students to remove underwear and change into a gown and stand or sit in front of a full-length 30 Copyright 2016 SERSC

4 mirror. With reference to the PowerPoint slide about the BSE method, the students were instructed to use three fingers to carefully palpate the breast starting from the outside and working toward the inside, so as to allow them to gain hands-on practice for what they had learned Ethical considerations The present study proceeded upon obtaining IRB approval at the author s affiliated university in order to provide ethical protection for the participants (IRB ). The participants were notified that participation could be withdrawn at any time. Furthermore, the participants were also notified that their anonymity was ensured and research outcomes would only be used for research-related purposes. The researchrelated data will be stored with coded personal information for three years following the conclusion of the study and then destroyed as per school regulations Statistical analysis The collected data were analyzed using the SPSS/WIN 20 program. Demographic characteristics and homogeneity of variables were analyzed via χ2-test and t-test. A t- test was used to analyze differences in knowledge, health beliefs, and compliance after receiving education. 3 Results Table 1. Homogeneity Test on General Characteristics of Subjects(n=172) Variables Catrgories Exp.(n=85) Con.(n=87) n(%) or M±SD n(%) or M±SD x 2 /t p Age(years) 21.14± ± Menarche age(years) 13.81± ± Yes 78(91.8) 82(94.3) Health concern No 7( 8.2) 5( 5.7) Regular 28(32.9) 38(43.7) Regularity of menstruation Irregular 57(67.1) 49(56.3) Yes 8( 9.4) 8( 9.2) Family history of breast cancer No 77(90.6) 79(90.8) Yes 20(23.5) 19(21.8) Past history of breast disease No 65(76.5) 68(78.2) Yes 60(70.6) 68(78.2) BSE performance No 25(29.4) 19(21.8) Knowledge 11.06± ± Health belief 3.14± ± Compliance 1.98± ± Exp. : experimental group, Con. : control group BSE : Breast Self-Examination Copyright 2016 SERSC 31

5 Table 2. Effect of Knowledge, Health belief, and compliance between Experimental and Control group(n=172) Variables Groups Pre test Post test Difference t* p Mean±SD Mean±SD Mean±SD Knowledge Exp.(n=85) 11.06± ± ± <.001 Cont.(n=87) 10.21± ± ±2.67 Health belief Exp.(n=85) 3.14± ± ± <.001 Cont.(n=87) 3.01± ± ±0.39 Compliance Exp.(n=85) 1.98± ± ± <.001 Cont.(n=87) 1.65± ± ±0.92 Exp. : experimental group, Con.: control group *independent t-test, t** : paired t-test t** p < < Conclusion The present study was able to confirm that breast cancer and BSE education programs using various audio-visual aids and breast models are effective in improving nursing students knowledge and health beliefs about breast cancer and BSE as well as compliance with BSE. Thus, we propose that future studies develop and confirm the effectiveness of standardized education programs using case-based simulations by developing various scenarios based on numerous clinical situations pertaining to breast cancer and BSE. Reference 1. Korean Breast Cancer Society Common knowledge for breast cancer [Internet]. Seoul: Korean Breast Cancer Society; 2009 [cited 2014 July 17]. Available from: 2. Kim EK, Lee HJ, Ahn SH, Chung ES. Factor influencing on the compliance of breast selfexamination of nurses in a local area. Journal of Korean Academy of Nursing, 2003;33(7): Funke L, Krause-Bergmann B, Pabst R, Nave H. Prospective analysis of the long-term effect of teaching breast self-examination and breast awareness. European Journal of Cancer Care. 2008;17(5): National Cancer Information Center National cancer statistics. [Internet]. Seoul: National Cancer Information Center; 2012 [cited 2014 August 10]. Available from: 5. Champion VL. Use of the health belief model in determining frequency of breast self exami nation. Research in Nursing and Health. 1985;8(4): / /nur Park KY. Differences in Health Belief by Compliance Level with Breast Self-Examination and Predictors of BSE among Women. Journal of Korean Academy of Fundamentals of Nursing. 2009;16(4): Champion VL, Skinner, CS. Difference in perceptions of risk, benefits, and barriers by stage of mammography adoption. Journal of Women s Health. 2003;12(3): Suh YO. The difference of women s knowledge, attitudes and practice education after education for breast self-examination. Korean Journal of Adult Nursing. 2003;15(1): Agars J, McMurray A. An evaluation of comparative strategies for teaching breast self examination. Journal of Advanced Nursing. 1993;18(1): Copyright 2016 SERSC