Motivations and purposes for women attending BSE training program: A qualitative study

1. Motivations and purposes for women attending BSE training program: A qualitative study Rea-Jeng Yang, RN, PhD, Associate Professor, National Taipei University of Nursing and Health Science; rea@ntunhs.edu.tw Published in BMC Women’s Health, 10(23), 2010

2. Background • Breast cancer is a major threat to women’s health • BSE has shown that cancer may be discovered anytime • BSE is still advocated by some health departments • Less understanding about the motivation of learning BSE for women 。

4. To explore why women want to learn BSE skills and how women make decision to learn this technique AIMS

5. Method • A descriptive study • Sixty-six women aged 27-50 were recruited • Individual and focused group in-depthinterviews • Thematic analysis and constant comparison techniques for data analysis

6. Findings Participation of BSE training was a purposive action Satisfaction of self-preservation emerged as the central theme Common entering motivation was related to the risk perception A ladder motivation model was constructed to explain these participants’ motivations 6

7. Illness monitoring Having breasts lesions Concerning of the breast lesion Multiple monitor strategy Health maintaining Conscious of risk Limitation of medical Benefit of BSE Confusion clarifying Breast mass Resources utilizing Lower risk perception Passive attending Suspicious to efficacy Uncertainty of risk Consciousness of risk Satisfaction of self-preservation Figure 1. Ladder of motivation

8. Satisfaction of self-preservation “I wanted to learn it and take self-care.” (AC) “I want to more understand my body.” (DC) “I hope I can get some correct information at this program.” (BA) “I think, if I learn the skills I can do it often by myself and feel peace in my mind.” (CA) to control by self

9. Health maintaining Conscious of risk Limitation of medicine Benefit of BSE 9

10. Conscious of risk “I am a high-risk person, because that my mother and my older sister had breast cancers.” (CB) “To my surprise, a colleague who younger than me (less than 28 years) was diagnosed a breast cancer. (CH) “The first, I attended this training due to my large breasts. I have heard that the enormous breast will increase the risk of breast cancer.” (CF) “the reports by media with Mrs. Kao…” (CS,CL)

11. Limitation of medicine “I felt that is necessary to have a mammography. But I also have heard that the mammography has its limitation, and the correctness is not enough.” (CC) “I had a breast examination by doctor, but he only took less than 3 minutes.” (CK) “I felt that the doctor did a breast examination for me without concern, he did without standards. In general, the doctor depended on the sonogram as a principal screening equipment. However, Mrs. Kao had died of breast cancer, although she had regular mammography and sonogram.” (CJ) “I felt discomfort able that I had ever done a breast examination by the doctor. Because of his facial expressions let me felling disgusting. I do not want to see the rotten doctor anymore.” (CF)

12. Benefit of BSE “My friend discovered the breast cancer by herself touching...” (CC) “The Vietnamese maiden who found the lump in my mother’s breast, as she assisted a bathing for my mother. She did a favor for my mother. BSE, it is good chance for me to learning the skills. I think that I can do it often by myself with my own feelings that might be peace of my mind.” (CA) “I want to say, that I did BSE just for health but did not intend for augmenting my breasts. The incentive of health still is strong (laugh). By the way, I have suggested the skills to my friends, for example, I talked to my boy-friend I can teach his sister, since us all of are women, we have to protect ourselves…” (CG)

13. Discussion The four motivation patterns had interwoven with personal and social factors 1. Personal factors influencing entering into BSE training 2. Social factors influencing the practice of BSE

14. 1.Personal factors influencing entering into BSE training 1-1 With valuable to BSE 1-2 Having risk perception 1-3 Desire to have self-controlled

15. Social factorsinfluencing BSE entering Legitimacy of strip off Social history 15

16. Conclusions • Understanding the different risk assessments women rely on in their decision making • It would aid researchers and health professionals to better understand alternative ways of dealing with breast health

17. Practical Implications Programs should focus on training women to perform proficient BSE and thereby improve their sense of self-efficacy of BSE Understanding the psychological processes of women’s perception and judgments should aide health professionals are better placed to provide meaningful services 17

18. Put Yourself in Trained Hands Your Own! THANK YOU

19. Legitimacy of strip off be struggling with social norms in graphic stories of embarrassment, sexual connotations and vulnerability * felt embarrassment, because her breast is a small and plat one * felt exposure to strangers enables them to gain some power over her in the form of criticism They convinced self that breast examination is a proper issue, and a female professional will conduct this educational training

20. Social history women described their decision of entering BSE training was aroused by media with special events for breast cancer. For example, as a case suffer from breast cancer, the news typically constitutes a persuasive message called a fear appeal—a line of argument that to be must acknowledge the severity of the threat.