Attitude sustains longer than subjective norm and perceived behavioral control: Results of breast cancer screening educational intervention

Rojana Dhakal; Chiranjivi Adhikari; Prabha Karki; Nirmala Neupane; Pooja Bhandari; Aditi Gurung; Nisha Shrestha; Nandaram Gahatraj; Niranjan Shrestha; Niranjan Koirala; Govind Subedi

doi:10.1371/journal.pone.0281184

Attitude sustains longer than subjective norm and perceived behavioral control: Results of breast cancer screening educational intervention

PLoS One. 2023 Feb 10;18(2):e0281184. doi: 10.1371/journal.pone.0281184. eCollection 2023.

Authors

Affiliations

¹ Department of Nursing, School of Health and Allied Sciences, Pokhara University, Pokhara, Gandaki Province, Nepal.
² Department of Public Health, School of Health and Allied Sciences, Pokhara University, Pokhara, Gandaki Province, Nepal.
³ Department of Public Health, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, Gujarat, India.
⁴ Department of Nursing, Pokhara Nursing Campus, Institute of Medicine, Tribhuvan University, Pokhara, Gandaki Province, Nepal.
⁵ Department of Natural Products Research, Gandaki Province Academy of Science and Technology, Pokhara, Nepal.
⁶ Central Department of Population Studies, Tribhuvan University, Kritipur, Bagmati Province, Nepal.

Abstract

Breast malignancy is the most frequent carcinoma among females across the world and third-most in Nepal. Early diagnosis of breast cancer through breast health awareness and self-examination, in addition to mammography screening, is a highly feasible and useful technique in poorly resourced settings. However, their intentions, whether to modify behaviors or actions, remain debatable and less explained in the literature. So, we aimed to assess how long an educational intervention affects women's intention to do a breast self-examination (BSE) and mammography screening. After assessing feasibility, one ward was assigned to the intervention (IG; ward number 30) and control group (CG; ward number 33), and then with inclusion criteria, a total of 360 females (180 each in IG and CG) aged 40-75 years enrolled in the study. After the baseline assessment, participants in the IG were delivered an hour-long breast cancer screening-related lecture-discussion- demonstration session that included BSE and mammography, aided with a silicone dummy. The session was carried out by the female trained nurses. Outcome data were obtained at the baseline, 4, 8, and 12 months following the intervention. Attitudes, perceived behavioral controls (PBCs) and behavioral intents (BIs) of both mammography and BSE at baseline were similar in both IG and CG except in case of subjective norms (SNs). Intents of BSE remained effective for 4 months, whereas for mammography, it was effective only at 4 and 12 months. Moreover, attitudes toward both tests remained intact for 4, 8, and 12 months (p = < .05) consistently. With regards to PBCs, women having good control remained only for 4 months in both screening tests. Further, regarding SN, significant mean changes were observed at 4 and 12 months in BSE, and only at 4 months in mammography screening. The session was effective in sustaining BSE and mammography intentions for at least 4 months. To retain the effects longer (up to 12 months), additional educational strategies focusing on subjective norms and perceived behavioral controls of both tests are highly warranted.

Copyright: © 2023 Dhakal et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Breast Neoplasms* / diagnosis
Breast Neoplasms* / prevention & control
Breast Self-Examination
Early Detection of Cancer
Female
Health Knowledge, Attitudes, Practice
Humans
Mammography
Mass Screening
Surveys and Questionnaires

Grants and funding

We received financial support (FRG number: 73/74-HS-15) from the University Grants Commission, Nepal to carry out the study. Pokhara University's School of Health and Allied Sciences disbursed the funds directly to the principal investigator's official account, which was given by the University Grants Commission directly to the school. The silicone breast model was purchased with funds provided by the University Grants Commission. The funding and other institutions had no role in the study design, data collection and analysis, the decision to publish, or the preparation of the manuscript."