Breast self-examination as a pathway for early detection in a lower-middle-income country: assessment of psychosocial determinants among women in Surabaya, Indonesia | BMC Women’s Health


The present study aimed to investigate relevant and changing psychosocial determinants that contribute to BSE intention and behavior in the past year. Study included RAA variables [14] and HBM [15] as well as variables informed by the results of previous qualitative studies [16, 18]. The knowledge gained in this study can inform interventions aimed at promoting the regular practice of BSE by targeting the main explanatory factors of the (non)performance of this preventive behavior. The results indicate that regular BSE on a monthly basis over the past year was not prevalent among respondents, which is consistent with the previous study. [17]. Additionally, the likelihood of having engaged in BSE-related behavior in the past year was associated with adequate knowledge of breast cancer and positive attitudes toward BSE. Together, the two variables explained approximately 33.3% of the variance in BSE behavior.

In agreement with previous findings [16, 18], current data have demonstrated that knowledge of breast cancer is a correlate of BSE behaviour. Thus, the greater the respondents’ understanding of the nature of breast cancer in terms of definition, symptoms, risk factors and screening methods, the greater the likelihood that they had practiced BSE in the last year is high. Similarly, previous studies of female populations in Iran, Ghana, and Nigeria have confirmed that adequate knowledge of breast cancer significantly improves the likelihood of women having BSE. [22,23,24]. Taken together, the findings that (a) knowledge about breast cancer serves as a unique predictor of BSE performance and (b) low rates of regular BSE practice in the current sample, imply that the Low performance of BSE may be due to lack of knowledge of breast cancer. This conclusion agrees with that of Didarloo et al. [22], who conducted a study of college students in Iran and found that respondents with high levels of knowledge about breast cancer performed 5.51 times higher than those with low levels of knowledge. This finding highlights the need to improve knowledge about breast cancer among Indonesian women and the need to support education on breast cancer screening.

As noted by Bartholomew Eldredge et al. [25], knowledge does not lead directly to behavior change; women’s understanding of breast cancer alone is insufficient to manage BSE-related behaviour. Ajzen et al. [26] suggested that a more positive attitude toward health-related behavior plays a major role in facilitating such behavior. Consistent with these suggestions, the present study finds that women with positive attitudes towards BSE were 2.08 times more likely to engage in this behavior than women with negative attitudes. This finding supports previous research with Indo-Australian women, which indicated that respondents with positive attitudes towards general examinations regularly practiced breast screening as recommended. [27]. Conversely, women with a negative perception of BSE felt embarrassed performing it or had difficulty performing it were less likely to practice BSE. This result is consistent with that of Al-Dubai et al., [28]who proposed that a negative attitude towards BSE would hinder BSE behavior.

Intention to perform BSE regularly among respondents was relatively high. However, only 7.8% and 2.9% of respondents indicated that they practiced BSE regularly (monthly and weekly, respectively). Moreover, although intention was positively correlated with BSE behavior, the intention measure could not explain any unique variance in BSE behavior. This finding supported intention-behaviour gap hypothesisthat is, participants with positive intentions failed to perform the behavior [29]. Moreover, current data indicate that the 32.2% variance in intention to practice BSE was predicted by positive attitudes towards BSE and high CBP. Thus, the study concluded that women who perceived BSE as an important process and were able to perform it were more likely to report an increased intention to perform it. This result agrees with those of Wang et al. [30], who conducted a study in China and found that behavioral attitude was one of the only correlates of intention to screen for breast cancer. Moreover, the current finding that women who felt confident in their autonomy and ability to perform BSE indicated high levels of intention to do so is consistent with that of Roncancio et al. [31] on Latinas. The authors documented that PBC was a strong predictor of intention to get screened for cervical cancer.

Several variable psychosocial variables, i.e., perceived benefits, perceived barriers, and subjective norms failed to explain the unique variances in BSE intention and behavior. However, in the bivariate correlation analysis, these variables were significantly associated with intention to practice BSE and BSE behavior. Similarly, previous studies have reported evidence that if women perceived BSE as highly beneficial, they would be more likely to form positive intentions and/or practice BSE. [17, 22, 30]. Conversely, ESB intention and/or behavior would be less likely to occur when women perceived certain barriers to ESB performance. [17, 32, 33]. Additionally, a strong family support system characterized the Indonesian population. [34]. Thus, the idea that women’s breast cancer screening behavior is influenced by the support they (perceive) receive from their close social circles is not surprising. Indeed, a previous study highlighted the importance of subjective norms, such as encouraging girls or relatives to participate in breast cancer screening. [35]. Also, Cho and Lee [36] found that in general, individuals from collectivistic cultures (i.e. Indonesia) score higher on subjective norms compared to those from the individualistic culture. Therefore, the study suggests that program or intervention designers should focus on the role of subjective norms in conveying information about the benefits of practicing BSE. Additionally, developers should formulate strategies to overcome barriers to BSE performance when educating about breast cancer awareness, for example, involving women’s close friends or family in outreach activities. health education.

The study was interested in exploring the distribution of demographic and psychosocial determinants among women who practiced BSE in the past year (compared to non-performers). The results indicated that women who practiced BSE in the past year reported higher levels of intention to practice BSE, positive attitudes toward BSE and breast cancer (c’ that is, they feel that breast cancer is not related to moral misconduct or a taboo subject), subjective norms, and PBC compared to those of non-performers. Additionally, BSE performers were found to possess a better understanding of breast cancer and were more likely to perceive that performing BSE was beneficial to them. Interestingly, the study also found that women who practiced BSE saw more barriers to BSE performance than those who did not practice BSE. The study inferred that ESB performers gained a more realistic view of ESB performance but nonetheless found it important, which contributed to their decision to perform. Additionally, consistent with previous research, younger women were less likely to have BSE than older women, possibly because they perceived a lower risk or susceptibility to breast cancer. [27].


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