Sosyoekonomik Düzeyi Düşük Kadınlara Uygulanan Yapılandırılmış Girişimlerin Meme Kanseri Tarama Davranışlarına ve Sağlık Algılarına Etkisi

Yıl 2025, Cilt: 19 Sayı: 1, 60 - 71

Aysun Perim Ketenciler , Selda Seçginli

https://doi.org/10.21763/tjfmpc.1546273

Öz

Giriş: Meme kanseri, hem dünyada hem de ülkemizde kadınlar arasında yaygın ve önemli bir sağlık sorunudur. Bu araştırmanın amacı, sosyoekonomik düzeyi düşük kadınlara yönelik yapılandırılmış müdahalelerin, özellikle grup eğitimi ve telefon danışmanlığı gibi stratejilerin, meme kanseri tarama davranışları ve sağlık algıları üzerindeki etkilerini sistematik bir şekilde incelemektir. Çalışma, bu müdahalelerin kadınların sağlık farkındalığı, tarama davranışlarını benimseme düzeyleri ve sağlık hizmetlerine erişimlerinde nasıl bir rol oynadığını değerlendirmeyi hedeflemektedir.
Yöntem: Bu çalışma bir aile sağlığı merkezinde gerçekleştirilen randomize kontrollü bir çalışmadır. Çalışmanın örneklemini 123 kadın oluşturdu. Meme Kanseri Taramalarında Yapılandırılmış Girişimler (METYAG) grup eğitimi ve telefon danışmanlığından oluşmuştur. Yapılandırılmış girişimler Sağlık İnanç Modeline temellendirilmiştir. Çalışma grubu yapılandırılmış grup eğitimi alan (N:41), yapılandırılmış telefon danışmanlığı alanları (N:41) kapsayan iki deney grubundan ve standart bakım alan (N:41) bir kontrol grubundan oluşmuştur. Araştırmada, ön test-son test kontrol gruplu tasarım kullanılmış, girişim öncesi ve girişim sonrası 3. ve 6. ayda sonuç değişkenleri değerlendirilmiştir. Çalışmada veriler, Sosyo- Ekonomik Durum Skalası, Tanılama Formu, Meme Kanseri Sağlık İnanç Modeli Ölçeği, Mamografi Yeterlik Ölçeği, Meme Kanseri Korku Ölçeği ve Meme Kanseri Kadercilik Ölçeği ile toplanmıştır. İstatistiksel analizler için NCSS (Number Cruncher Statistical System) programı kullanılmış olup çalışmanın verileri tanımlayıcı istatistiksel yöntemler ile değerlendirilmiştir.
Bulgular: Çalışmada METYAG’ın düzenli kendi kendine meme muayenesi yapma, klinik meme muayenesi yaptırma ve mamografi çektirme oranlarını arttığı belirlenmiştir (p<0,05). Çalışmada METYAG deney gruplarında kendi kendine meme muayenesi yarar, mamografi yarar, güven, sağlık motivasyonu algılarını arttırdığı, kendi kendine meme muayenesi ve mamografi engel algılarını azalttığı (p <0,05), yatkınlık algısını ise değiştirmediği (p>0,05) belirlenmiştir. Benzer şekilde, her iki deney grubundaki kadınların, mamografi yeterlilik algıları yükselir iken, korku ve kadercilik algılarında anlamlı azalma belirlenmiştir (p<0,05).
Sonuç: Sosyoekonomik düzeyi düşük kadınlarda uygulanan METYAG’ın meme kanseri tarama davranışlarının sergilenme oranını ve sağlık algılarını artırmada etkilidir. Bu nedenle, konu ile ilgili yapılacak çalışmalarda yapılandırılmış girişimlerin faydalı olacağı düşünülmektedir.

Anahtar Kelimeler

kendi kendine meme muayenesi, klinik meme muayenesi, mamografi, sağlık algıları, yapılandırılmış girişim

Etik Beyan

Approval for the study was obtained from the Ethics Committee of Istanbul Arel University (Approval date: May 31, 2018/number:69396709-050.01.01) and the Istanbul Provincial Health Directorate (Approval date: May 25, 2018/number:16867222-799). The purpose and process of the study were explained to the doctors and nurses working at the FHC. Women who agreed to participate in the study were asked to complete an informed consent form.

Destekleyen Kurum

The authors received no financial support nor any sponsorship for research, authoeship or publication.

Teşekkür

We thank all the nurses, doctors, and other staff at the family health center for their contributions and support.

The Effect of Tailored Interventions on Breast Cancer Screening Behaviors and Health Perceptions in Women with Low Socioeconomic Levels

Öz

Introduction: Breast cancer is a prevalent and significant health issue among women both globally and in our country. The aim of this study is to systematically examine the effects of tailored interventions, such as group education and telephone counseling, on breast cancer screening behaviors and health perceptions among women with low socioeconomic status. The study seeks to evaluate how these interventions influence women's health awareness, their adoption of screening behaviors, and their access to healthcare services.
Method: This study is a randomized controlled trial conducted at a family health center. Data were collected by using the Diagnostic Form, Breast Cancer Health Belief Model Scale, Mammography Self-efficacy Scale, and Breast Cancer Fear Scale. The study sample consisted of 123 women. The Tailored Interventions in Breast Cancer Screenings (TIBCS) included group education and telephone counseling. These tailored interventions were based on the health belief model. The study consisted of two experimental groups those receiving tailored group education (N=41) and those receiving tailored telephone counseling (N=41) and one control group receiving standard care (N=41). A pre-test and post-test control group design was used in the study, and the outcome variables were evaluated before the intervention and at the 3rd and 6th months after the intervention. Data were collected by using the Socioeconomic Status Scale, Diagnostic Form, Breast Cancer Health Belief Model Scale, Mammography Self-Efficacy Scale, Breast Cancer Fear Scale, and Breast Cancer Fatalism Scale. The NCSS (Number Cruncher Statistical System) program was used for statistical analysis. Data were evaluated by using descriptive statistical methods.
Results: The study found that TIBCS increased the rates of regular self-breast examinations, clinical breast examinations, and mammography screenings (p<0.05). In the experimental groups of the TIBCS, it was observed that self-breast examination benefits, mammography benefits, confidence, and health motivation perceptions increased, while perceived barriers to self-breast examination and mammography decreased (p<0.05), with no change in susceptibility perception (p>0.05). Similarly, in both experimental groups, women's perceptions of mammography self-efficacy increased, while fear and fatalism perceptions showed a significant decrease (p<0.05).
Conclusion: TIBCS applied to women with low socioeconomic status is effective in increasing the rate of breast cancer screening behaviors and improving health perceptions. Therefore, tailored interventions are considered to be beneficial in future studies.

Anahtar Kelimeler

breast self-examination, clinical breast examination, mammography, health perception, tailored intervetion

Etik Beyan

Approval for the study was obtained from the Ethics Committee of Istanbul Arel University (Approval date: May 31, 2018/number:69396709-050.01.01) and the Istanbul Provincial Health Directorate (Approval date: May 25, 2018/number:16867222-799). The purpose and process of the study were explained to the doctors and nurses working at the FHC. Women who agreed to participate in the study were asked to complete an informed consent form.

Destekleyen Kurum

The authors received no financial support nor any sponsorship for research, authoeship or publication.

Teşekkür

We thank all the nurses, doctors, and other staff at the family health center for their contributions and support.

Kaynakça

• 1. Ministry of Health, Republic of Turkey, General Directorate of Public Health. (2022). Breast Cancer. https://hsgm.saglik.gov.tr/tr/kanser-turleri/kanser-turleri/meme-kanseri.html (Accessed: 25.09.2024)
• 2. World Health Organization. Current and Future Burden of Breast Cancer: Global Statistics for 2020 and 2040. (2022) https://www.iarc.who.int/fr/news-events/current-and-future-burden-of-breast-cancer-global-statistics-for-2020-and-2040/ (Accessed: 25.09.2024)
• 3. World Health Organization.. Turkey Source: Globocan 2020. (2022) https://gco.iarc.fr/today/data/factsheets/populations/792-turkey-fact-sheets.pdf (Accessed: 15.06.2023)
• 4. American Cancer Society.. American Cancer Society Recommendations for the Early Detection of Breast Cancer. (2022) https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html (Accessed: 15.10.2023)
• 5. Ministry of Health, Republic of Turkey, General Directorate of Public Health. Cancer Screenings. https://hsgm.saglik.gov.tr/tr/kanser-taramalari (Accessed: 25.09.2024)
• 6. Centers for Disease Control and Prevention. Screening for Breast Cancer. https://www.cdc.gov/breast-cancer/screening/index.html (Accessed: 25.09.2024)
• 7. Secginli, S., Nahcivan, N. O., Gunes, G., & Fernandez, R.. Interventions promoting breast cancer screening among Turkish women with global implications: A systematic review. Worldviews on Evidence-Based Nursing, 2017, 14(4), 316-323.
• 8. Ceyhan, B., Atakır, K., & Özevci, G.. Examination of Awareness of Breast Cancer Screening Methods among Women in Turkey. Journal of World Health and Natural Sciences, 2022,5(2), 123-133.
• 9. Secginli, S., & Nahcivan, N. O.. The effectiveness of a nurse-delivered breast health promotion program on breast cancer screening behaviours in non-adherent Turkish women: A randomized controlled trial. International Journal of Nursing Studies, 2011, 48(1), 24-36.
• 10. Ministry of Health, Republic of Turkey.. Health Statistics Yearbook 2020. https://www.saglik.gov.tr/TR,89801/saglik-istatistikleri-yilligi-2020-yayinlanmistir.html, 2020. (Accessed: 25.09.2024)
• 11. Alpaslan, N.. Deep Feature-Based Decision Support System for Breast Cancer Diagnosis. Selçuk University Journal of Engineering, Science and Technology, 2019, 7(1), 213-227. https://doi.org/10.15317/Scitech.2019.193
• 12. Ishikawa, Y., Hirai, K., Saito, H., Fukuyoshi, J., Yonekura, A., & Honade, K., et al.. Cost-effectiveness of a tailored intervention designed to increase breast cancer screening among a non-adherent population: A randomized controlled trial. BMC Public Health, 2012, 12, 760-768.
• 13. Skinner, C. S., Buchanan, A., Champion, V., Monahan, P., Rawl, S., Springston, J., ... & Bourff, S.. Process outcomes from a randomized controlled trial comparing tailored mammography interventions delivered via telephone versus DVD. Patient Education and Counseling, 2011, 85(2), 308-312.
• 14. Champion, V. L., Rawl, S. M., Bourff, S. A., Champion, K. M., Smith, L. G., Buchanan, A. H., et al.. Randomized trial of DVD, telephone, and usual care for increasing mammography adherence. Journal of Health Psychology, 2016, 21(6), 916-926.
• 15. Wang, J. H., Schwartz, M. D., Luta, G., Maxwell, A. E., & Mandelblatt, J. S.. Intervention tailoring for Chinese American women: Comparing the effects of two videos on knowledge, attitudes and intentions to obtain a mammogram. Health Education Research, 2012, 27(3), 523-536.
• 16. Taşçı Küçükşen, D., Yengil Taci, D., Arslan, İ., Çelik, M., & Fidancı, İ. . Evaluation of the use of breast cancer screening methods among female patients through the Champion Health Belief Model Scale. Journal of Contemporary Medicine, 2022, 12(2), 206-210. https://doi.org/10.16899/jcm.1033932
• 17. Rosenstock, I. M. . Why people use health services. Milbank Quarterly, 165, 44, 94-127.
• 18. Mikhail, B.. The health belief model: A review and critical evaluation of the model, research, and practice. In P. L. Chinn (Ed.), Developing Substance Mid-Range Theory in Nursing: Advances in Nursing Science Series 1994(pp. 74-92). Aspen Publications.
• 19. Singh, T., Sharma, S., & Nagesh, S.. Socio-economic status scales updated for 2017. International Journal of Research in Medical Sciences, 2017,5(7), 3264–3267. https://doi.org/10.18203/2320-6012.ijrms20173029
• 20. Kumar N., Shekhar C., Kumar P., Kundu AS. . Kuppuswamy's Socioeconomic Status Scale-Updating for 2007. The Indian Journal of Pediatrics 2007, 74(12):1131-2
• 21. Avşar, H.. The relationship between socioeconomic status, economic environment, and obesity in adults (Master's thesis). Ankara: Başkent University, Institute of Health Sciences, Nutrition and Dietetics Program.2010.
• 22. Secginli, S., & Nahcivan, N. . Reliability and validity of the breast cancer screening belief scale among Turkish women. Cancer Nursing, 2004, 27(4), 287-294
• 23. Gözüm, S., Karayurt, Ö., & Aydın, İ. . Results of the Turkish adaptations of Champion's Health Belief Model Scale in breast cancer screenings. Journal of Research and Development in Nursing, 2004, 6(1), 71-85.
• 24. Ersin, F., Çapık, C., Kıssal, A., Aydoğdu, N. G. ve Beşer, A. . Breast cancer fatalism scale: A validity and reliability study in Turkey, International Journal of Caring Sciences, 2018,11(2), ss. 783-90
• 25. Secginli, S. . Mammography Self-Efficacy Scale and Breast Cancer Fear Scale: psychometric testing of the Turkish versions. Cancer nursing, 2012, 35(5), 365-373. DOI: 10.1097/NCC.0b013e3182331a9a
• 26. Gathirua-Mwangi, W. G., Monahan, P. O., Stump, T., Rawl, S. M., Skinner, C. S., & Champion, V. L. . Mammography adherence in African American women: Results of a randomized controlled trial. Annals of Behavioral Medicine, 2016, 50(1), 70-78.
• 27. Legler, J., Meissner, H. I., Coyne, C., Breen, N., Chollette, V., & Rimer, B. K. . The effectiveness of interventions to promote mammography among women with historically lower rates of screening. Cancer Epidemiology, Biomarkers & Prevention, 2002, 11, 59-71.
• 28. Stoddard, A. M., Fox, S. A., Costanza, M. E., Lane, D. S., Andersen, M. R., & Urban, N., et al. . Effectiveness of telephone counseling for mammography: Results from five randomized trials. Preventive Medicine, 2002, 34, 90-99.
• 29. Akkaş Gürsoy, A., Yiğitbaş, Ç., Yılmaz, F., Erdöl, H., Kobya Bulut, H., Karadeniz Mumcu, H., Yeşilçiçek K., Kahriman, İ., Hindistan, S., & Nural, N. . The effect of peer education on university students’ knowledge of breast self-examination and health beliefs. The Journal of Breast Health, 2009, 5(3), 135-140.
• 30. Tuzcu, A., Bahar, Z., & Gözüm, S. . Effects of interventions based on health behavior models on breast cancer screening behaviors of migrant women in Turkey. Cancer Nursing, 2016, 39(2), E40-50.
• 31. Anakwenze, C. P., Coronado-Interis, E., Aung, M., & Jolly, P. E. . A theory-based intervention to improve breast cancer awareness and screening in Jamaica. Prevention Science, 2015, 16(4), 578-585.
• 32. Farhadifar, F., Molina, Y., Taymoori, P., & Akhavan, S. . Mediators of repeat mammography in two tailored interventions for Iranian women. BMC Public Health, 2016, 16, 1-13.
• 33. Ahmadian, M., Abu Samah, A., Emby, Z., & Redzuan, M.. Instrument development for understanding factors influencing mammography compliance among Iranian women in metropolitan Tehran, Iran. Asian Social Science, 2010, 6(10), 88-96.
• 34. Hashemian, M., Hidarnia, A., Aminshokravi, F., Lamyian, M., Hassanpour, K., & Akaberi, A., et al. . Farsi version of the mammography self-efficacy scale for Iranian women. Cancer Nursing, 2015, 38(6), 484-489.
• 35. Çidem, F., & Ersin, F. . The impact of women's social support and self-efficacy perceptions on early breast cancer detection behaviors. Koç University Journal of Nursing Education and Research, 2019, 16(3), 183-190.
• 36. Nahcivan, N. Ö., & Seçginli, S.. Attitudes and behaviors toward early diagnosis of breast cancer: The use of the Health Belief Model as a guide. C.U. Journal of Nursing School, 2003, 7(1), 33-38.
• 37. Akhigbe, A., & Akhigbe, K. . Effects of health belief and cancer fatalism on the practice of breast cancer screening among Nigerian women. In Mammography: Recent Advances 2012, (pp. 88-96). DOI: 10.5772/31176
• 38. Altıntaş, H. K., & Aslan-Korkmaz, G. . The effect of breast cancer fatalism perception on breast cancer health beliefs of midwives and nurses. Journal of Hacettepe University Faculty of Nursing (e-journal), 2019, 10-19.
• 39. Kulakci, H., Kuzlu Ayyildiz, T., Yildirim, N., Özturk, Ö., Kose Topan, A., Veren, F., et al. . Effects of breast cancer fatalism on breast cancer awareness among nursing students in Turkey. Asian Pacific Journal of Cancer Prevention, 2015, 16(8), 3565-3572.
• 40. Seçginli, S. . Mammography Self-Efficacy Scale and Breast Cancer Fear Scale: Psychometric testing of the Turkish versions. Cancer Nursing, 2012,35(5), 365-373.
• 41. Polat, P., & Ersin, F. . The effect of breast cancer fear levels of female seasonal agricultural laborers on early-diagnosis behaviors and perceptions of breast cancer. Social Work in Public Health, 2017, 32(3), 166-175. DOI: 10.1080/19371918.2015.1137525
• 42. Ersin, F., Gözükara, F., Polat, P., Erçetin, G., & Bozkurt, M. E. . Determining the health beliefs and breast cancer fear levels of women regarding mammography. Turkish Journal of Medical Sciences, 2015, 45, 775-781.
• 43. Donnelly, T. T., Al Khater, A. H., Al-Bader, S. B., Al Kuwari, M. G., Al-Meer, N., Malik, M., et al. . Arab women’s breast cancer screening practices: A literature review. Asian Pacific Journal of Cancer Prevention, 2013, 14(8), 4519-4528.
• 44. Olçar Ece, Z., Koçak, H. S., & Güngörmüş, Z.. The impact of fear levels of first-degree relatives of women with breast cancer on early detection behaviors. Journal of Nursing Science, 2022, 5(1), 22-29. DOI: https://doi.org/10.54189/hbd.1049877