INDICACIONES PARA CONTESTAR EL CUESTIONARIO

The Health Belief Model (HBM) is a psychosocial model that accounts for health beliefs by identifying factors associated with individual’s belief which influence their behaviour.^82,83 This model has been widely used to examine beliefs related to BCS behaviours. It is used to develop educational interventions to promote BCS practices. Health beliefs play a role in a person’s interest inhealth protective behaviours which leads to action.²⁴ Practicing BSE and having CBE and MM are more likely if a woman feels susceptible to BC, perceives more benefits than barriers to the behaviours such as BSE, CBE and MM. Socio-demographic background and knowledge are related with an increase in the chances of performing certain behaviours. HBM appears to be the most frequently cited in the literature with regard to breast cancer screening. The model suggests that changes in preventive behaviour are based on six factors namely: Susceptibility, Seriousness, Benefits, Barriers, confidence and Health Motivation.⁸³

The model posits that variables such as age, sex, geography, economic status, educational attainment, social status, knowledge of breast cancer and family factors will affect a woman’s perceived threat of breast cancer. This in turn is affected by anxiety in the case of a woman with family history of breast cancer, higher educational level, awareness levels and a recommendation from a physician. The variables also affect the perceived susceptibility to and the seriousness of breast cancer. If a death from breast cancer has occurred among

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relatives and friends, there may be greater awareness, information and this should increase the woman’s perceived threat of breast cancer.⁸³

Women religious have been identified as being a high-risk population for developing and dying from BC.^{32-3, 37} A study carried out in America sought to see the relationship between health beliefs and breast cancer screening. Significant predictions of BSE were the variables of susceptibility, barriers, and confidence. Significant predictions for MM were Susceptibility, Barriers and Health Motivation.³³

Health belief and its effect on practices as related to breast cancer screening were studied among three ethnic Asian sub-groups in the U.S. There was a strong influence of ethnicity on the perception of susceptibility and seriousness subscales while Asian-Indian women had the highest mean score for the perceived benefits and the perceived barriers subscales. Ninety-one percent of all women had heard of BSE but their perceptions of the recommended frequency of BSE varied. Less than 60% of the Asian-Indian and Chinese women above 40 years reported that they had up-to-date CBE and mammograms. Those who reported having regular mammograms were more likely to have resided in the U.S for at least ten years. No effect was found for BSE and CBE. Barriers were common for all groups and these were, being examined by a male practitioner, having their breasts touched by a stranger and the risk of being exposed to radiation.⁸⁴

A similar observation was made among Nigerians in Texas who were surveyed with regards to the influence of religious and spiritual beliefs on their breast health choices. The mammography rates among women who had lived in the USA for 10 years or more was 85%

while those who had stayed for less than 10 years had a 50% mammography rate. This finding was statistically significant with a p value of 0.004.⁸⁵

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A group of Turkish women’s breast cancer screening behaviours and the relationships with health beliefs were investigated. They had rates of 34% for mammography, CBE 14.12% and 59.4% for BSE. Reasons proffered for not using screening methods were, not having any symptoms, neglect, not seeing the need and not knowing how BSE is done. Statistically significant relationships were determined between the following subscales mean scores:

benefits-BSE, Barriers-BSE, Confidence-health motivation, Benefits-mammography and barriers-mammography subscale score means. Women with high levels of self-esteem, high levels of hope for the future and with a positive body perception were found to have more positive health beliefs on breast cancer screening.⁸⁶

Personal characteristics are known to have an effect on health and cultural beliefs. These also have an effect on the uptake of BC screening. A cross-sectional study was carried out among 344 women who had not had a mammogram in the preceding 18 months. Their level of education significantly affected 6 of the 12 beliefs and knowledge scales. Higher educated women felt less susceptible to breast cancer, had higher self efficacy, less fear and lower fatalism scores. They were also less likely to be present-time oriented and were more knowledgeable about breast cancer.⁸⁷

Two hundred and twenty-four Turkish female academicians in a university were evaluated with regards to their health beliefs and its effect on their BSE practices. Twenty seven point seven percent of these women regularly practiced BSE. The constructs of benefits and health motivation as relates to BSE practice were the highest as was their confidence in carrying out BSE. The lowest mean score was for the perceived barriers to BSE. The participants’ family history of cancer affected their health belief subscale, with the single academicians having higher rates of perceived susceptibility and seriousness than that of their married

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counterparts. BSE performance was more likely in those who exhibited higher confidence and those who perceived fewer barriers as related to BSE performance.²⁴

Another group of Turkish women in a rural area in Western Turkey were surveyed to find out their levels of knowledge and attitudes towards BSE. Those who were BSE performers among the study group were more likely to be women who exhibited higher confidence and perceived greater benefits from BSE practice. They also perceived fewer barriers to BSE performance and possessed knowledge of breast cancer.⁸⁸