It is in the name of Allah that I always start.

1. It is in the name of Allah that I always start. In completing this task, I must acknowledge that there is still a lot to do and to learn.

2. THE INFLUENCE OF DEMOGRAPHIC FACTORS, KNOWLEDGE, AND BELIEFS ON INTENTION FOR MAMMOGRAPHY SCREENING AMONG JORDANIAN WOMEN Areej Othman, R.N., Msn, PhD

3. Breast Cancer in Jordan • Breast cancer was ranked first of all cancers among Jordanians; it accounts for 18.2% of total cancer cases. • It is ranked first among cancers in females; it accounted for 34.8% of all female cancers. • Breast cancer is identified as the second cause of death for all cancers. • Unfortunately, almost 90% of breast cancer cases are diagnosed as an invasive cancers.

4. Breast cancer Screening Recommendations • In USA, screening recommendations are revised recently. • In Jordan, the Jordan Breast Cancer Program (JBCP) recommends mammography every two years for women in their forties, and annually for 50 years and above.

5. BREAST CANCER SCREENING BEHAVIOR AMONG JORDANIAN WOMEN • Jordanian women have a fairly limited Knowledge about breast cancer. • Practicing regular Breast self exam (BSE) is limited. • Women who are older, have increased education and knowledge, and decreased perception of barriers are more prone to practice BSE monthly. • Studies addressing mammography practice are very limited and lack statistical power. • No interventional studies were conducted to promote women screening practices (Othman, 2008)

6. FACTORS CONTRIBUTING TO MAMMOGRAPHY SCREENING BEHAVIOR • Among health beliefs, perception of lower barriers were the most significant predictors of adherence to mammography screening behavior. • The constructs of perceived benefits, susceptibility, seriousness and self efficacy had minimal influence on mammography screening behavior. • Among demographic factors, increased age appeared as the most significant predictor of mammography behavior. • Recommendation from a health care provider, family or friends were potent predictor of women engagement in mammography screening. (Othman, 2009)

7. Predictors of Intention to Perform Mammography Screening among Jordanian Women Modifying Factors Women’s Perceptions Behavioral Intention Health Beliefs Demographic factors Behavioral Intention Subjective Norms Breast Cancer Knowledge Fatalistic Beliefs

8. Purpose of the Study The purpose of this study was to determine the influence of demographic characteristics, breast cancer knowledge, fatalistic beliefs, health beliefs and subjective norms on Jordanian women’s intention to participate in mammography screening.

9. Specific Aims of the Study • Determine knowledge about breast cancer among Jordanian women. • Examine the relationship of demographic characteristics (age, education, family history of breast cancer and health insurance) and structural factor (knowledge) with women health beliefs (perceived susceptibility, seriousness, self efficacy, benefits and barriers) fatalistic beliefs and subjective norms.

10. Specific Aims Continued • Determine the contribution of demographic characteristics, breast cancer knowledge, fatalistic beliefs, health beliefs and subjective norms in predicting Jordanian women intention for mammography screening.

11. METHODOLOGY STUDY DESIGN • This was a descriptive correlational study to determine factors influencing Jordanian women’s intention to engage in mammography screening. • The dependent variable was women’s intention to perform mammography; the independent variables were (1) demographic characteristics (2) breast cancer knowledge (3) health beliefs. (4) Subjective norms and (5) fatalistic beliefs

12. Sample Criteria Sample size & Sampling Procedure • Eligible women were: Jordanian women aged 40 years and above, able to read and write in Arabic, had no personal history of breast cancer. • Sampling design was convenient and snowball sampling designs. • 142 women were recruited from 2 major cities in Jordan. • Women were recruited from different community settings, those settings were: public health care centers and principal investigator’s personal networking.

13. Measurement of variables of

15. Data Collection Procedure • Women at health care centers were invited to participate by the PI and the research assistant. • Women who were identified through the PI’s personal network were met individually and in small groups in their homes. • The time for completing this self report survey was 30-45 minutes. The PI and the research assistant were present during this time.

16. Data analysis • Data were analyzed using SPSS 17.0 for Windows. • Pearson correlation coefficient was used to assess: • Correlation between continuous demographic variables and health beliefs. • The relationship between the independent variables and behavioral intention. • Independent t tests were performed to assess the relationship between categorical demographic variables (family history of breast cancer and health insurance coverage) and women’s beliefs in addition to intention to perform mammography. • Multiple logistic regression was performed to assess the contribution of independent variables on women’s intention to perform mammography.

17. Results

18. Sample Characteristics

19. Sample Characteristics • Only 30 women (21.1%) ever had a mammogram procedure. • Only five women (16.7%) had it within the last year. • Reason for mammography: • 36.7% Obstetrician recommendation. • 33% Self made decision. • 20% General practitioner’s recommendations. • 10% Family/Friends recommendations.

20. Breast Cancer Knowledge

21. Correlation among model constructs • Age had a negative correlation with intention (r = -0.18, p<0.05). • Perception of self efficacy (r = 0.52, p< 0.01) and the influence of subjective norms (r = 0.50, p< 0.01) correlated significantly with women’s intention to perform mammography • Perception of susceptibility to breast cancer (r = 0.27, p<0.01) and the identification of benefits to mammography (r = 0.42, p<0.01) correlated significantly with women’s intention to perform mammography. • The strongest correlations were found between women’s perceptions of self efficacy and the benefits of mammography (r = 0.61, p<0.01). • women who perceive themselves as being more susceptible to developing breast cancer had significantly higher perception of benefits to have mammogram (r = 0.29, p<0.01).

22. Factors related to intention to perform mammography

23. Unique contribution of model blocks on intention for mammography

24. Discussion • Our study found that Jordanian women continue to exhibit limited knowledge about breast cancer. This situation persists through this decade • Jordanian women acknowledged the influence of significant others on their intention to engage in mammography screening. In Jordan, kinship remains the principle unit of social and economic organization.

25. Discussion • Women perception of greater levels of self efficacy contributed significantly to women’s intention to engage in mammography screening behavior. In previous studies self efficacy contributed to women’s intention to have a mammogram; however, it demonstrated minimal influence on the actual behavior. Other factors may intervene on women’s actual behavior.

26. Discussion • The present study found that behavioral barriers were not associated with women intention to have a mammogram. Most of the women in this study were convinced that there is no need to perform screening as long as they are free of symptoms. • The belief in predestination made no significant contribution to women’s intention to perform mammography. Belief in God and predestination neither implies passivity nor impedes seeking health promotion and disease prevention activities.

27. Implications • Nurses in Jordan need to emphasize and educate women regarding the importance of screening and the efficiency of early detection of breast cancer. • Nurses may need to seize opportunities to invite women as well as others who receive nursing services for mammography screening. This may include other parties such as friends or family members who could recommend mammography for their female friends or family members. • Nurses can help women evaluate self potentials and increase their self confidence by providing adequate information and skill to perform the procedure.

28. Future Research • Future research should focus on determinants of women’s actual mammography behaviors. • A closer assessment of women’s barriers to perform mammography is needed. • Future research should include measurement of cultural beliefs.

29. STRENGTHS AND LIMITATIONS • Findings from our study may lead to the development of breast cancer screening campaigns. • Limiting sample recruitment to the cities of Amman and Zarqa potentially limits the generalizability of the study findings to Jordanian women in general. • Although, this study incorporates factors that are believed to influence women behavior according to well respected theories of health behavior and the context of Jordanian society, other factors may have been overlooked. • This study examined the influence of the independent variables on intention to perform mammography in the future; measurement of the actual behavior could have strengthened the results of this study.

30. Thank You