Type of Document	Thesis
Author	Registe, Marlaine F.
Author's Email Address	mfr05@fsu.edu
URN	etd-04112008-121959
Title	The Relationship between Health Beliefs, Knowledge, Attitudes and the Performance of Breast Self Examination among African American Women.
Degree	Master of Arts
Department	Nursing, School of
Advisory Committee	Advisor Name Title Susan Porterfield Committee Chair
Keywords	Breast Cancer Breast Self Examination Health Beliefs African American Women Knowledge Attitudes
Date of Defense	2008-03-20
Availability	unrestricted
Abstract ABSTRACT Breast cancer is the second leading cause of cancer deaths of North American women. In the last thirty years, great strides have been made in the diagnosis and treatment of breast cancer, which have led to a reduction in breast cancer deaths. Research studies have shown, however, that the drop in the mortality rate observed in Caucasian women has not been replicated in African American women. African American women are more likely to die at a higher rate than Caucasian women. The racial difference in survival rates have been attributed to early detection practices such as those recommended by the American Cancer Society (ACS) and the National Cancer Institute (NCI); annual mammography, CBE, and monthly BSE, to be readily adopted by Caucasian women but underutilized by African American women. According to some well documented researches, a very small percentage (30%) of African American women, especially those at increased risks for hereditary diseases, adhere to the ACS recommendation guidelines. The purpose of this study was to investigate the relationship between African American women’s health beliefs in regard to breast cancer and screening behaviors, knowledge and attitudes that may serve as incentives or barriers to their adherence to routine BSE practices. For the purpose of this research study, reference to African American women encompassed all women whose ancestors were brought from the continent of Africa to the Americas, Europe, and the Caribbean, involuntarily. The Health Belief Model (HBM), one of the most widely recognized conceptual frameworks of health behavior, served as the theoretical framework. The Breast Cancer Screening Beliefs Instrument Scale (HBMS) was the instrument used in this study. This instrument explores ethnic differences in attitudes toward health practices, health beliefs, risk estimates, and knowledge about breast cancer and breast cancer screenings. A convenience sample of 131 African American women, between the ages of 20-65, was recruited from different sites in north and south Florida. Forty six (36.2%) women were between the ages of 20-29, 23 (18.1%) women were between 30-39 years old, and 28 (22.0%) women were 40-49. Fifty six (43.1%) women were single women, 40 (30.8%) were married, 13 (9.9%) were divorced, and 6 (4.6%) were widowed. Twenty seven (20.6%) earned a Bachelor degree, 18 (13.7%) earned a Master’s or higher degree, 57 (43.5%) an Associate’s, 19 (14.5%) a high school diploma, 10 (7.6) had not graduated high school. Most participants were employed; 40.3% were in the 10,000-30,000 range, 21.7% made 30,000-50,000, and 13.2% were in the 50,000-60,000 annual income range. Most had insurance coverage for yearly physical and mammogram, 48.9 % had health insurance, 99.2% had no personal history of breast cancer, 61.8% had no family history of breast cancer. The number of women who reported compliance to BSE was surprisingly high. The majority of the participants 109 (83.8%) reported practicing BSE within the past 12 months. However, 21 (16.2%) women had never practiced BSE. The majority of the women, 105 (80.2%) reported that their primary health care providers recommended BSE and screening mammograms. The analyzed data, using the HBMS scale, revealed that increased perceived susceptibility to breast cancer, perceived benefits of BSE, and confidence were related to increased frequency of BSE. The study participants had poor knowledge of breast cancer and breast cancer treatments, did not feel susceptible to breast cancer, but were aware of the benefits of BSE. Data analysis showed significant correlation between susceptibility, benefits, health motivation and BSE frequency. No significant correlation existed between perceived seriousness, barriers, confidence and BSE frequency. There were also no significant correlations between socio-demographic characteristics: age, marital status, education, family history of breast cancer, and health insurance coverage. The analyzed data showed a negative correlation between income and BSE frequency, as income increases, BSE frequency decreases. Negative correlations were found between religion, health insurance coverage, personal history of breast disease and BSE performance. Recommendation by health care provider was positively related to increase BSE performance. Decrease BSE frequency was associated with young adults, nineteen or younger, 60 or older, and widowed women. In summary, the analyzed data showed that women who adhere to the American Cancer Society recommendations and practice BSE had better knowledge of breast cancer, were well aware of its benefits, had lower perceived barriers to BSE, and were confident in their ability to perform BSE properly. The results not only emphasized the complexity and strength of cultural beliefs in regard to African American women’s health care practices, but have also highlighted the significant role that health care providers play in the lives of these women.
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