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Fulltext Validity and Reliability of Health Belief Model Questionnaire for Promoting Breast Self-examination and Screening Mammogram for Early Cancer Detection

Che Mohamed N, Moey SF, Lim BC

Asian Pac J Cancer Prev, 2019 09 01;20(9):2865-2873.
PMID: 31554389 DOI: 10.31557/APJCP.2019.20.9.2865

Background: Early detection of breast cancer is essential in improving overall women’s health. The researchers
sought to develop a comprehensive measure that combined the basic components of the health belief model (HBM)
with a focus on breast self-examination (BSE) and screening mammogram amongst women. Methods: Questionnaire
items were developed following a review of relevant literature of HBM on BSE and screening mammogram. The
sampling frame for the study was Malaysian women aged 35 to 70 years old, living in Kuantan, Pahang and able to
read or write in Bahasa Malaysia or English. As such, 103 women were randomly selected to participate in the study.
Tests of validity using exploratory factor analysis (EFA) and reliability were subsequently performed to determine the
psychometric properties of the questionnaire. Results: The EFA revealed nine factors (self-efficacy of mammogram,
perceived barriers of BSE and mammogram, perceived susceptibility of breast cancer, perceived severity of breast
cancer, cues to action for mammogram screening, perceived benefits of BSE, health motivation, perceived benefits
of mammogram and self-efficacy of BSE) containing 54 items that jointly accounted for 74.2% of the observed
variance. All nine factors have good internal consistency with Cronbach’s alpha ≥ 0.8. Fifty-four items remained in
the final questionnaire after deleting 13 problematic items. The scale also showed good convergent and discriminant
validity. Conclusion: The findings showed that the designed questionnaire was a valid and reliable instrument for the
study involving women in Kuantan, Pahang. The instrument can help to assess women’s beliefs on BSE adoption and
mammogram screening in health care practice and research.
Fulltext A path analytic model of health beliefs on the behavioral adoption of breast self-examination

Moey SF, Mohamed NC, Lim BC

AIMS Public Health, 2021;8(1):15-31.
PMID: 33575404 DOI: 10.3934/publichealth.2021002

BACKGROUND: In Malaysia, breast cancer accounted for 34.1% of all female cancer cases with women presenting breast cancer at late stages. Breast cancer has a higher five-year survival rate if detected early. An increase of approximately 30% in the five-year survival rate is indicated if breast cancer is detected at stage III compared to stage IV. Thus, survival rate of breast cancer can be increased by creating awareness and encouraging breast cancer screening amongst women. Breast self-examination (BSE) is highly recommended for breast cancer screening due to its simplicity with no incurred cost. The Health Belief Model is used in this study to explain and predict the adoptive behavior of BSE amongst women in Kuantan, Pahang.
MATERIALS AND METHODS: This study employed a multi-stage sampling method using a simple proportion formula at 5% type 1 error, p < 0.05 and absolute error at 2% which resulted in a sample of 520 participants. The data for the study was obtained using a validated bilingual self-constructed questionnaire and the model constructed using Mplus software.
RESULTS: Perceived severity, benefits and barriers were found to significantly influence the behavioral adoption of BSE. Married women aged from 45 to 55 years and knowledge were found to significantly moderate the relationship between perceived benefits and behavioral adoption of BSE. Further, self-efficacy was found as the core construct that mediates the relationship between married women aged 45 to 55 years and the behavioral adoption of BSE.
CONCLUSION: Self-efficacy is found in the study to influence the behavioral adoption of BSE. This is undeniable as self-efficacy can promote confidence in initiating and maintenance of behavioral change if the perceived change is beneficial at an acceptable cost.
Fulltext The relationship of socio-demographic characteristics and knowledge of breast cancer on stage of behavioral adoption of breast self-examination

Moey SF, Mutalib AMA, Mohamed NC, Saidin N

AIMS Public Health, 2020;7(3):620-633.
PMID: 32968682 DOI: 10.3934/publichealth.2020049

Background/aim: In Malaysia, breast cancer is the most common cancer among women. As such, early diagnosis and screening practices are important to increase the survival rate. Breast self-examination (BSE) is one of the main screening methods for breast cancer. Socio-demographic characteristics and knowledge of breast cancer are amongst the crucial roles in determining women's behavioral adoption in performing BSE. This study aims to assess the relationship of socio-demographic factors and knowledge of breast cancer on the stage of behavioral adoption of BSE among Malaysian women in Kuantan, Pahang.
Materials and methods: A cross-sectional study was conducted on 520 women from three different government health clinics in Kuantan and IIUM Family Health Clinic from February to April 2018. Data were collected using a self-administered questionnaire on socio-demographic factors and knowledge of breast cancer and its effect on the behavioral adoption of BSE.
Results: Significant difference was found between socio-demographic characteristics and behavioral adoption of BSE. However, only breast screening and the best time for screening were found to be significant with the behavioral adoption of BSE and knowledge of breast cancer.
Conclusion: It is found that most women in Kuantan, Pahang perform BSE but were still unaware of the importance of performing BSE for early breast cancer detection. This study was expected to enhance women's awareness of the benefits of performing BSE.
Fulltext The Relationship of Health Beliefs on the Stage of Mammography Behavior Adoption amongst Women in Kuantan, Pahang

Ramli HA, Moey SF, Abdul Mutalib AM

Asian Pac J Cancer Prev, 2019 06 01;20(6):1913-1920.
PMID: 31244318 DOI: 10.31557/APJCP.2019.20.6.1913

Background: Breast cancer (BC) awareness is relatively poor among Malaysian women indicated by the presence of BC at a late stage and the low rate of mammography screening. Only a few theoretically based studies have been conducted on Malaysian women’s participation in mammography. Therefore, the objective of this study is to use health belief model (HBM) and stage of change model (SCM) to determine the relationship between health beliefs on the behavioral adoption of mammography amongst women in Kuantan, Pahang. Methods: Five hundred and twenty women were randomly selected to complete the survey. Data were analyzed using multinomial logistic regression (MLR) to ascertain the multivariate relationships between health beliefs and stage of mammography behavioral adoption. Results:
The MLR test indicates that there is no significant difference in perceived severity, benefits, motivator factors and cues to action between participants in the action stage and the maintenance stage. However, significant differences existed in perceived severity, susceptibility, motivator factors and self-efficacy between the pre-contemplation, relapse and contemplation stage to that of the referenced (maintenance) stage of mammography adoption. Conclusion: Women in the action stage are more likely to progress towards maintenance stage as they perceived breast cancer as a disease that leads to death and that mammogram screening is beneficial in detecting the disease at an early stage. However, women in the pre-contemplation, relapse and contemplation stage are found unlikely to move towards the maintenance stage as they perceived their risk of getting breast cancer is low.
Fulltext Cultural, Religious and Socio-Ethical Misconceptions among Muslim Women towards Breast Cancer Screening: A Systematic Review

Moey SF, Sowtali SN, Mohamad Ismail MF, Hashi AA, Mohd Azharuddin NS, Che Mohamed N

Asian Pac J Cancer Prev, 2022 Dec 01;23(12):3971-3982.
PMID: 36579977 DOI: 10.31557/APJCP.2022.23.12.3971

INTRODUCTION: Breast cancer is the most diagnosed cancer worldwide. With an estimated 685,000 deaths, female breast cancer was the fifth leading cause of cancer mortality worldwide, accounting for 6.9% of all cancer deaths. Previous studies have shown that late detection and delayed diagnosis are associated with advanced-stage breast cancer and poor survival. Factors contributing to non-adherence to breast cancer screening among women were elicited from previous studies. However, few studies have focused on the Muslim community, particularly Muslim women. As such, this systematic review aims to fill this gap by collecting information from studies conducted globally over the past ten years that examined cultural, religious and socio-ethical misconceptions about breast cancer screening among Muslim women.
METHODS: Following the PRISMA guidelines, literature searches were conducted systematically through various databases including PubMed, Science Direct, Scopus, Cochrane Library and Oxford Academic Journals. Article identification, screening steps and eligibility measures were meticulously performed throughout the review.
RESULTS: A total of 22 papers were appraised and included in this review. Five main themes were generated which were socio-ethical misconceptions, cultural and religious beliefs, cultural and religious barriers, stigmatization and fear of breast cancer impact. Eight sub-themes and 14 sub sub-themes were further elicited from the main themes.
CONCLUSION: Muslim women have socio-ethical, cultural and religious misconceptions on what constitutes health and practices as well as on the nature and etiology of BC. Cultural barriers and religious values of Muslim women were indicated to influence their health behaviors such as upholding their modesty when choosing health interventions. BC stigma and fear were also found to be key sources of psychological distress that discouraged Muslim women from undergoing BC screening. The study suggests the implementation of holistic effort in educating Muslim women to increase BC screening rate.