ID Design Press, Skopje, Republic of Macedonia

Open Access Macedonian Journal of Medical Sciences. 2018 May 20; 6(5):949-953.
https://doi.org/10.3889/oamjms.2018.183
eISSN: 1857-9655
Public Health

Can Health Belief Model Predict Breast Cancer Screening

Behaviors?

1, 2 3,4* 3
Azar Darvishpour , Soheila Mazloum Vajari , Sara Noroozi

1
Department of Nursing, School of Nursing, Midwifery and Paramedicine, Guilan University of Medical Sciences, Rasht, Iran;
2
Social Determinants of Health (SDH) Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran;
3 4
Department of Nursing, Lahijan Branch Islamic Azad University, Lahijan, Iran; Department of Health Services
Management, Science and Research Branch, Islamic Azad University, Tehran, Iran

Abstract
Citation: Darvishpour A, Vajari SM, Noroozi S. Can BACKGROUND: Breast cancer is the second cause of cancer-related death among women. Prevention
Health Belief Model Predict Breast Cancer Screening
Behaviors? Open Access Maced J Med Sci. 2018 May 20;
programs insist on the early diagnosis and screening to reduce the mortality rate.
6(5):949-953. https://doi.org/10.3889/oamjms.2018.183
AIM: The study was conducted to determine the predictors of breast cancer screening behaviours based on the
Keywords: Breast cancer; Health belief model; Screening
methods health belief model.
*Correspondence: Soheila Mazloum Vajari. Department
of Nursing, Lahijan Branch Islamic Azad University, MATERIAL AND METHODS: The present cross-sectional study was conducted by involving 304 women ranging
Lahijan, Iran; Department of Health Services from 20 to 65 years of age, living in East Guilan cities, the North of Iran, in 2015 using two-stage cluster sampling.
Management, Science and Research Branch, Islamic
Azad University, Tehran, Iran. E-mail:
The research instrument was Champion's Health Belief Model Scale. The data were analysed based on
[email protected] Regression test by using SPSS software version 18.
Received: 16-Feb-2018; Revised: 19-Mar-2018;
Accepted: 25-Mar-2018; Online first: 19-May-2018 RESULTS: The results showed perceived benefits (ExpB = 1.118, p = 0.009), self-efficacy (ExpB = 1.122, p =
Copyright: © 2018 Azar Darvishpour, Soheila Mazloum 0.001) and the perceived barriers (ExpB = 0.851, p = 0.001) as the predictors of breast self-examination. In
Vajari, Sara Noroozi. This is an open-access article addition, the study revealed that the two components of perceived benefits (ExpB = 1.202), and the perceived
distributed under the terms of the Creative Commons
Attribution-NonCommercial 4.0 International License (CC
barriers were the predictors of mammography (ExpB = 0.864) (p = 0.001). None of the health belief model
BY-NC 4.0) components showed a role to predict clinical breast examination (P > 0.05).
Funding: This research is part of a research project
approved by Lahijan Islamic Azad University with code CONCLUSION: The present study highlights the need for educational programs, which should focus on
number 52021920223002 increasing breast self-exam skills and understanding the benefits of healthy behaviours and eliminating their
Competing Interests: The authors have declared that no barriers.
competing interests exist

Introduction disease and prevent malignancy in the advanced

stages [6].
The proposed breast cancer screening
Breast cancer is one of the most common methods are mammography, clinical breast
types of cancers [1]. This cancer is considered as the examination (CBE) and breast self-examination (BSE)
first common cancer among Iranian women [2] and [7]. Previous studies indicated that the self-
the third cause of cancer leading death in women [3]. examination is the most important step in identifying
In almost 70 percent of cases, the disease is detected cancer in early stages [8]. It also causes women to
at the end stage, and hence the treatment becomes pay more attention to changes in their breasts and to
difficult. Detection of breast cancer in early stage led go faster for clinical examination and mammography
to an almost complete cure, and with timely diagnosis [9]. However, despite its high efficacy in reducing
and effective treatment, the survival rate can be up to mortality, various research findings showed that the
90 percent [4] [5]. Therefore, a detailed screening adoptions of such behaviours by women in different
program can effectively detect the early stages of the populations are low. Several factors may affect the
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performance or non-performance of breast screening to agree = 5 strongly. Higher scores express more
behaviours that are essential to identify them to agreement with health beliefs except for barriers to
reinforce these behaviours. In health education, mammography [12].
various theoretical models used to study the health
The reliability of this scale has been tested in
behaviour such as the Champion Health Belief Model
different populations and calculated between 0.6-0.89
(CHBM) introduced by Champion in the 1980s. This
using Cronbach's Alpha coefficients [13]. Reported
model has been widely used by researchers [8].
Cronbach alpha coefficients for a Farsi version of
According to this model, behavioral beliefs and
HBM ranged from 0.72-0.84 [12].
modifying factors are effective in shaping behavior
and when a woman is susceptible to breast cancer Data were analysed by descriptive statistics
(perceived susceptibility) and aware of the threat of and regression test using SPSS software version 18.
disease on their health (perceived severity) and also
The present study and its protocol were
know the benefits of screening methods (perceived
approved by the Institutional Human Ethics
benefits) than its barriers (perceived barriers), she
Committee of Lahijan Islamic Azad University. The
most likely will follow the screening methods [9].
researcher entered the research setting only after
Considering the risk factors for breast cancer, proper information to the participants about the
the main emphasis of breast cancer prevention purpose of the study. The written consent was
programs is focused on early detection and screening obtained from all the participants by ensuring that the
to reduce mortality [10]. According to the previous questionnaires were anonymous. Each participant
studies, the health behaviours in using clinical was completely free to participate in the study.
examination, self-examination and mammography are
low [11], and there is not sufficient information about
the predictive factors of breast cancer screening
behaviours, especially in northern areas of Iran.
Therefore, in this study, the researchers decided to Results
use CHBM to predict the behaviour of breast cancer
screening among the women of East Guilan cities. It is
hoped that the results of this research could help The results regarding demographic
improve health decisions for designing effective characteristics showed the age distributions were
educational interventions to reduce breast cancer. almost equal in all three age groups (20-30, 31-40 and
41-65 years of age) are shown in Table 1 below. The
majority of women (78%) were married, with higher
education (41.1%), housewives (75%), and with
moderate family’s income (92.4%). The majority of the
Material and Methods participants (67.3%) had not regular checks, were with
no history of breast cancer (95%), and had no family
history of breast cancer (90.8%) (Table 1).
This article is part of a larger cross-sectional
study was conducted on women of East Guilan, the Table 1: Distribution of demographic variables among the
North of Iran, in 2015. women ranging from 20 to 65 years of age, living in East Guilan
cities (N=304)
The sample size estimated 304 by using the Variable N % Variable N %
sample size formula with a confidence level of 95%. Age group 20-30 100 32.9 History of Yes 15 5
(years) 31-40 105 34.5 benign No 289 95
Inclusion criteria were age between 20 to 65 years breast
lumps
living in East Guilan cities (Lahijan, Astaneh, 41-65 99 32.6 The family Yes 28 9.2
Langerud, Roudsar) and exclusion criteria were Education Illiterate 20 7.2 history of No 276 90.8
breast
breastfeeding, pregnancy and having breast cancer. cancer
Primary- 62 20.4 Having Yes 215 70.7
Secondary children
The data were collected through two-stage High 97 31.9 No 89 29.3
cluster sampling. The research instrument was school
diploma
Champion's Health Belief Model Scale (CHBMS). The Academic 125 41.1 Regular Yes 100 32.7
Job status Housewife 228 75 check-up No 204 67.3
questionnaire contains 57 items that were answered Employed 76 25 Menopause Yes 254 83.6
based on the five degrees Likert scale. Each item has Family Less than 23 7.6 No 50 16.4
income average
5 response choices ranging from strong disagreement Average 145 47.7 Lactation Yes 202 66.4
More than 136 44.7 history No 102 33.6
(1 point) to strong agreement (5 points). The HBM average
subscales were included the perceived susceptibility Marital status Single 55 18.1
Married 237 78
(3 items), Seriousness (7 items), BSE Benefits (6 Widow 12 3.9 Health Yes 252 82.9
and insurance No 52 17.1
items), BSE Barrier (9 items), BSE self-efficacy divorced
(confidence) (10 items), health motivation (7 items),
Data expressed as Frequency (n) and Percentage (%).
benefits of mammography (6 items), barriers of
mammography (9 items). All the items had five
response choices ranging from strongly disagree = 1
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 Darvishpour et al. Can Health Belief Model Predict Breast Cancer Screening Behaviors?
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The predictor factors of screening behaviours mammography will be increased to 0.184 times with a
(BSE, CBE and mammography), according to the significant increase (p = 0.001). The findings also
logistic regression are shown in Tables 2, 3 and 4. indicate that by only one point increase in the
perceived barriers score, the possibility of performing
In relation to the predictor factors of breast
mammography is significantly reduced to -0.146 times
self-examination (BSE), Table 2 shows that by
(p = 0.001). In other words, women with more
increasing only one point in the perceived benefits
perceived benefits and less perceived barriers, have
score, the probability of self-examination significantly
more rates to perform mammography. However,
increase to 0.112 times (p = 0.009) and one point
among the other subscales (perceived susceptibility,
increase in the self-efficacy score, increases the
perceived seriousness, self-efficacy and health
probability of self-examination to 0.115 times with a
motivation) there was no difference between the two
significant increase (p = 0.001). The findings also
groups about performing mammography (P > 0.05).
indicate that by increasing in perceived barriers, the
possibility of self-examination will be reduced to - Table 4: Comparison of performance and prediction of
0.161 times with a significant decrease (p = 0.001). mammography based on the HBM among the investigated
On the other hand, women who have more self- women (N=304)
efficacy and perceived benefits and less perceived Components of Mammography B Exp (B) P.value
barriers have more rates of making BSE. However, HBM Yes
Mean ±SD
No
Mean ± SD
among the other subscales (perceived susceptibility, Perceived 7.46±2.87 6.64±2.67 0.123 1.131 0.108
susceptibility
perceived seriousness and health motivation) there Perceived 21.27±5.96 20.56±5.71 0.035 1.036 0.348
was no difference between the two groups regarding seriousness
Perceived benefits 22.54±5.93 21.12±5.01 0.184 1.202 0.001***
performing or not performing the self-examination (P > Perceived barriers 22.10±5.95 26.30±6.26 -0.146 0.864 0.001***
Self-efficacy 28.22±5.18 27.64±6.11 0.018 1.018 0.525
0.05). Health motivation 26.00±6.05 25.53±4.87 -0.037 0.963 0.418

Note: HBM = Health Belief Model; Data expressed as mean ± S.D, B (coefficient) and
Table 2: Comparison of performance and prediction of BSE based on the HBM Exp(B)( the exponentiation of the B coefficient); a Significant difference of values is
among the investigated women (N=304) indicated by ***p ≤ 0.001.
Components of BSE B Exp (B) P.value
HBM Yes No
Mean ± SD Mean ± SD
Perceived 6.88±2.52 6.68±2.82 0.094 1.099 0.102
susceptibility
Perceived 20.40±5.32 20.80±5.99 0.006 1.006 0.838
seriousness
Perceived benefits 23.31±3.30 20.74±4.51 0.112 1.118 0.009**
Perceived barriers 14.30±4.42 18.32±5.48 -0.161 0.851 0.001***
Self-efficacy 30.12±4.44 26.29±6.34 0.115 1.122 0.001*** Discussion
Health motivation 26.67±4.35 24.95±5.31 0.013 1.013 0.696

Note: BSE = breast self-examination; HBM = Health Belief Model; Data expressed as
mean ± S.D, B (coefficient) and Exp(B) ( the exponentiation of the B coefficient, which is
an odds ratio); Significant difference of values is indicated by **p < 0.01 and ***p ≤ 0.001. The present study aimed to predict the factors
affecting the breast cancer screening behaviours in
women from 20 to 65 years of age living in East
As for the predictor factors of clinical breast
Guilan cities.
examination, Table 3 shows that by increasing in HBM
subscales, despite changes as increase or decrease The results demonstrated that self-efficacy
in results, they could not significantly affect the and perceived benefits predict breast self-examination
probability of clinical breast examination. In other (BSE) directly and perceived barriers affect inversely.
words, the results indicated that none of the health However, other components of HBM (perceived
belief model subscales has a role in predicting clinical susceptibility, perceived seriousness, and health
breast examination performance. motivation) could not predict breast self-examination.

Table 3: Comparison of performance and prediction of CBE

Different studies have been reported various
based on the HBM among the investigated women (N=304) results about predictive factors of breast cancer
Components of HBM CBE B Exp (B) P.value
screening behaviours. The results of Hasani’s study
Yes No (2011), who aimed to predict HBM factors among the
Mean ±SD Mean ±SD
Perceived 6.77±2.86 6.74±2.67 0.036 1.036 0.542 women referred to health centres in Bandar Abbas are
susceptibility by the present study. They also observed perceived
Perceived 20.37±5.75 20.74±5.75 -0.006 0.994 0.823
seriousness benefits and self-efficacy were predictors of breast
Perceived benefits 22.71±4.54 21.39±4.19 0.018 1.018 0.675
Perceived barriers 16.11±5.88 17.03±5.32 -0.033 1.033 0.307 self-examination and perceived barriers were inverse
Self-efficacy 28.51±6.45 27.48±5.84 0.018 1.018 0.525 predictors [8].
Health motivation 26.57±6.36 25.30±4.54 0.001 1.001 0.987

Note: CBE = clinical breast examination; HBM=Health Belief Model; Data expressed as This is in contrast to the study carried out by
mean ±S.D, B (coefficient) and Exp(B)( the exponentiation of the B coefficient) ;Significant
level= *p < 0.05.
Sahraee et al. (2013) whose study found that self-
efficacy impact directly and perceived severity had the
opposite effect on breast self-examination [14].
About the predictor factors of mammography, Mahmoudi et al., (2011) showed that perceived
Table 4 shows that by increasing one point in the susceptibility, perceived seriousness, health
perceived benefits score, the probability of motivation, self-efficacy; perceived benefits predicted
directly breast self-examination and perceived barriers
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were its inverse predictor [15]. Nourizade et al., (2010) and the elimination of barriers to health behaviours
observed a significant correlation between perceived through correct training is required. Also, proper
seriousness and mammography [16]. Ghourchaei et planning is recommended for the implementation of
al., (2013) reported an inverse relationship between educational interventions to promote screening
perceived seriousness and BSE. Similarly, we also programs.
showed a correlation between the health belief model
components and clinical breast examination.
However, a significant relationship was observed
between perceived susceptibility and mammography
[17]. Acknowledgements
In the present study, perceived benefits and
self-efficacy were the main predictors of breast self- This article is part of a research project
examination. Perceived benefits mean positive results approved by Lahijan Islamic Azad University with
by avoiding disease exposure. For example, the code number 52021920223002. The researchers
smallest suspicious mass can be detected by monthly would also like to express their gratitude to this
breast self-examination [8]. Self-efficacy is person’s University for their financial support.
confidence in her ability to carry out successful and
accurate BSE and diagnose the suspected tumour.
Therefore, educational programs should be focused
on proper planning and training to increase women’s
self-efficacy about breast self-examination. On the References
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