Study On The Intervention Effects Of Health Education On Breast Cancer Early Detection Among Urban And Rural Women In Tianjin

Breast cancer has globally been the most common malignant tumor in women.There has been rapid increase in breast cancer incidence in China, especially inseveral big cities (Shanghai, Beijing, Tianjin and Guangzhou), with there now beingmore than 100,000 new cases per year. It shows a younger age for highest incidentrate with the peak age at 40-49 which is 10 years younger than western countries. YetChina has no nationally recognized guidelines for screening, so 40% of breast cancerpatients would die in 5 years because of diagnosis at a later stage. Breast cancer hasbecome the significant issue of health care in Chinese women, so it is very importantto implement breast caner early detection. As three effective ways to early detection,breast self-examination(BSE), clinical breast examination(CBE) and mammographyhas been recommended and validated by American Cancer Society. Given theconcrete condition of China, it is reasonable to carry through BSE. Nevertheless,many studies concerning the implementing of breast cancer early detection methodsdemonstrate that these health-promoting programs are regrettably underutilized. Thisstudy therefore evaluated the intervention effects on knowledge, attitude andbehaviors after education on breast cancer early detection, and health belief model(HBM) were introduced to analyse'the factor influencing the practice of BSE, CBEand mammography in order to promote the early detection of breast cancer andincrease the utilizations of breast cancer early detection, in particular the practice ofBSE, in the future breast cancer early detection education model.Purpose:To evaluate the effectiveness of the health educational program of breast cancerearly detection among women ages 40 and older in rural and urban of Tianjin. HBMwas introduced to analyse to identify the factors influencing breast cancer earlydetection behaviors. To explore and provide a productive health education model forChinese women who live in different residential areas in future health-promotingactivities.Methods: During May of 2006 and January of 2007, a quasi-experiment design of fieldepidemiology intervention was conducted among a convenient sample of 400 womenages 40 and older recruited from urban and rural areas of Tianjin, who were dividedinto two groups. 200 Women, 100 from urban and rural respectively, assigned to theintervention group will experience innovative breast cancer early detection educationand promotion,the other 200 Women, 100 from urban and rural respectively, assignedto the control groups will experience health education only. Data were collectedthrough a self-administered questionnaire both at baseline and six months follow-up.T-test,Chi-square test,Mann-Whitney U test and unconditional logistic regressionanalyses were performed throughout the date analyses.Results:1. Significant improvement was observed concerning the knowledge through theinnovative breast cancer education and promotion. However findings showed that theknowledge was not indicative of screening practice, which means mastery of relevantknowledge may not change behavior, on the contrary, behaviors usually precedeknowledge.2. The significantly increase utilizations by intervention was observed in attitudeof BSE and behaviors of BSE and CBE except mammography. Also we can see thestatistically significant difference in BSE and mammography between rural and urbanareas after intervention, those Who lived in rural area has higher compliance rate thanthose in urban, while CBE remains similar in these two areas.3. Guided by HBM as the theoretical framework, the Multi-Logistic regressionwas used to analyze factor influencing compliance of early detection practice:①thestatistically significant predictors of regularly BSE at baseline are occupation, rural orurban (OR3.891,95% confidence interval:1.055～14.354) and perceivedbarrier(OR1.115,95% confidence interval:1.033～1.203).②having a CBE previous1-2 years ago has associated with access to health resource(OR2.779,95% confidenceinterval:1.693～4.560), family and social support (OR2.008,95% confidenceinterval: 1.233～3.272), access to media (OR2.639,95% confidence interval: 1.487～4.683),"perceived susceptibility" (OR1.078,95% confidence interval: 1.000～1.163) and occupation.③rural or urban (OR2.313,95% confidence interval: 1.162～4.602),family and social support (OR3.324,95% confidence interval:1.862～5.936), accessto media (OR2.514,95% confidence interval:1.197～5.283), occupation andperceived health status (OR=2.081,95% confidence interval:1.211～3.577)werestatistically associated with mammography in previous 1-2 years.Conclusions:Breast cancer early detection is underutilized among women, and they are lackof sufficiency knowledge. But an innovative health and promotion intervention canimprove women's knowledge and increase compliance on breast cancer earlydetection. While HBM was be introduced and utilized as a guide for the analysis ofthe factor that influence the adoption of and compliance with early detectionbehaviors, we can develop and carry out education model efficiently to promotedetection performance regularly only through fully understanding the related factorsconcerning health behavior.