The role of psychosocial variables in breast self-examination practice: Results from focus group discussions in Surabaya, Indonesia.

INTRODUCTION: Breast cancer is a global life-threatening disease. Breast self-examination (BSE) followed by timely diagnosis and treatment is a viable screening method for populations with limited health care access such as Indonesia. Knowledge of the beliefs underlying BSE could benefit the development of future health education efforts to promote BSE and breast cancer awareness among Indonesian women, with the ultimate aim to achieve early detection and promote long-term survivals. The purpose of this study was to explore the underlying beliefs of BSE among women in Surabaya, Indonesia in accordance with the reasoned action approach (RAA) framework. Moreover, we investigated what these women considered an effective approach to improve breast awareness and promote BSE in their social networks. METHOD: The participants included 62 women aged 18-55 (M = 32,9) in Surabaya, Indonesia who were divided into nine focus groups. Directed content analysis was employed to analyze the data. RESULTS: Six psychosocial determinants of performing BSE emerged from the analysis: knowledge, attitude and beliefs, risk perception, norms, perceived behavior control, and intention. Furthermore, the participants identified face-to-face meetings with visual media and healthcare professionals as effective channels to enhance breast awareness. CONCLUSION: This study sheds light on the application of the RAA for BSE, and reveals the importance of face-to-face meetings involving healthcare professionals and women's social networks for breast education.

Breast self-examination as a route to early detection in a lower-middle-income country: assessing psychosocial determinants among women in Surabaya, Indonesia.

BACKGROUND: Breast cancer has become a public health concern in Indonesia. Regular breast self-examination (BSE) is considered an important first step for its early detection, especially in countries with limited healthcare access, as it is the case in Indonesia. This study aimed to confirm and assess the psychosocial determinants of intention to perform BSE and BSE performance. METHODS: The cross-sectional study was conducted on 204 women aged 18-65 years in Surabaya, Indonesia. A 64-item survey was conducted, included variables from the Reasoned Action Approach, and the Health Belief Model, presented questions about demographics, breast cancer knowledge, and behavior related to BSE. RESULTS: Most women (72.5%) expressed intention to perform BSE; however, only 7.8% and 2.9% performed BSE per week and per month, respectively, in the past year. Breast cancer knowledge and attitudes towards BSE were uniquely associated with BSE performance. Perceived behavioral control (PBC) and BSE attitudes were unique correlates of intention. Perceived benefits and barriers and subjective norms were significantly associated with intention and BSE behavior in bivariate analyses. CONCLUSIONS: Breast screening education should incorporate strategies for improving attitudes towards BSE, PBC, and breast cancer knowledge with perceived benefits and barriers and subjective norms as relevant targets.

Determinants of breast self-examination practice among women in Surabaya, Indonesia: an application of the health belief model.

BACKGROUND: Breast cancer has become one of the most common causes of mortality among Indonesian women. Many women in Indonesia present with late-stage breast cancer, negatively affecting prognosis and treatment outcomes. Better prognosis of breast cancer will be achieved if it is diagnosed in an earlier stage, thus efforts to detect breast cancer earlier are important. Breast Self-Examination (BSE) is considered as an important first step to encourage women to actively be responsible for their own health, especially for women in low-and middle-income countries with limited resources and access to other forms of preventive healthcare (e.g., screening programs). The present study aimed to predict BSE practice among women in Surabaya, Indonesia using the Health Belief Model (HBM). METHODS: This investigation was a cross-sectional survey which was distributed among 1967 women aged 20-60 years. The Indonesian version of Champion's Health Belief Model Scale (I-CHBMS) was used to explain self-reported BSE practice. Logistic regression analysis was used to examine the association of HBM variables with BSE practice. RESULTS: 44.4% of the respondents indicated they had performed BSE. Further, the results indicated that the HBM variables were significantly associated with BSE practice. Specifically, higher perceived benefits and self-efficacy, lower perceived barriers and less cues to action were unique correlates of BSE practice. The result also showed that perceived severity and susceptibility were not associated with BSE practice. CONCLUSION: This study indicated that several HBM constructs significantly associated with BSE practice among Indonesian women, suggesting that BSE health education programs should emphasize the perceived benefits of BSE, focus on increasing women's self-efficacy to address and overcome perceived barriers in performing BSE, and help them in identifying personally relevant cues to action.

Survey data of determinants related to Covid-19 preventive behaviors during the second waves in Indonesia using the reasoned action approach.

The dataset presented in this article examines preventive behaviors related to Covid-19 among Indonesians, i.e., wearing a mask, hand washing, and distancing, and its related determinants. Data collection was carried out when Indonesia was facing the second waves due to the rapid transmission of the Delta variant virus. The data assessing socio-demographic information, beliefs related to Covid-19 preventive behaviors based on the reasoned action approach, general beliefs about Covid-19, and Covid-19 preventive behaviors, from 18th June to 18th August 2021, gathering a total of 863 completed responses. The sampling technique in this online survey used a combination of purposive and snowball sampling methods to gather the participants via social media such as Instagram, Twitter, Facebook, and WhatsApp throughout Indonesia. The survey data were analyzed using frequency distributions and bivariate correlation analysis. The data will help to understand the psychosocial determinants of Covid-19 preventive behaviors and provide insight for the development of behavior change intervention to limit the spread of Covid-19 among Indonesians.

Determinants of early breast cancer presentation: a qualitative exploration among female survivors in Indonesia.

OBJECTIVE: Early presentation with breast cancer symptoms is crucial to the effectiveness of treatment and the affected women's long-term survival. However, in Indonesia, 60-70% of breast cancer patients first present themselves to the hospital in an advanced stage. Knowledge about the determinants of breast cancer early presentation could inform efforts to promote healthcare seeking at earlier symptomatic stages. In the current study, we explored the psychosocial determinants of early presentation among female breast cancer survivors. METHODS: Face-to-face semi-structured interviews were conducted with 23 female breast cancer survivors in Surabaya, Indonesia (mean age = 49.8 years). Directed content analysis approach was used to analyse the data. RESULTS: Half of the respondents underwent breast cancer screening prior to onset of symptoms. Nine determinants of breast cancer early presentation were reflected in the women's responses: (lack of) knowledge, perceived behavioural control, previous health related experiences and risk perceptions, attitudes and beliefs, norms, competing priorities, financial issues, instrumental factors, and health provider factors. CONCLUSION: Health promotion efforts should focus on both internal and external psychosocial determinants related to the breast cancer early presentation, and on involving women's social environment as target for education. Additionally, providing accessible and affordable healthcare is important for early presentation.

Validation of the Indonesian version of Champion's Health Belief Model Scale for breast self-examination.

PURPOSE: The present study aimed to adapt and determine the psychometric properties of the Indonesian version of the Champion's Health Belief Model Scale (I-CHBMS) of breast self-examination in the measurement of belief toward breast cancer screening. SUBJECTS AND METHODS: A convenience sample of 406 Indonesian women aged 19-60 years was recruited. This study was conducted in Surabaya from December 2016 to January 2017. The I-CHBMS applied a "forward-backward" translation procedure to translate from the English version into Indonesian. Validity of the I-CHBMS was assessed using content, face, and construct validity. Confirmatory factor analysis was used to assess the construct validity. Reliability was measured using Cronbach's alpha coefficient. RESULTS: The result of confirmatory factor analysis indicated 42 items of I-CHBMS with six-factor solution (susceptibility, severity, benefits, barriers, cues to action and self efficacy) were acceptable as a new instrument. Cronbach's alpha of the subscale ranged from 0.669 to 0.866, indicating a good range of reliability. CONCLUSION: The finding of the study suggested that I-CHBMS of breast self-examination practice has good psychometric properties and could be an appropriate measure for health beliefs related to breast cancer screening.

Predicting Intention Perform Breast Self-Examination: Application of the Theory of Reasoned Action

Objective: The present study aimed to examine the applicability of the theory of reasoned action to explain intention to perform breast self-examination (BSE). Methods: A questionnaire was constructed to collect data. The hypothesis was tested in two steps. First, to assess the strength of the correlation among the constructs of theory of reasoned action (TRA), Pearson's product moment correlations were applied. Second, multivariate relationships among the constructs were examined by performing hierarchical multiple linear regression analysis. Result: The findings supported the TRA model, explaining 45.8% of the variance in the students' BSE intention, which was significantly correlated with attitude (r = 0.609, p = 0.000) and subjective norms (r = 0.420, p =0 .000). Conclusion: TRA could be a suitable model to predict BSE intentions . Participants who believed that doing BSE regularly is beneficial for early diagnosis of breast cancer and also believed that their significant referents think that doing BSE would significantly detect breast cancer earlier, were more likely to intend to perform BSE regularly. Therefore, the research findings supported the conclusion that promoting the importance of BSE at the community/social level would enhance individuals to perform BSE routinely.

Improving urban environment through public commitment toward the implementation of clean and healthy living behaviors.

BACKGROUND: Some parts of northern Surabaya are slum areas with dense populations, and the majority of the inhabitants are from low-income families. The condition of these areas is seemingly different from the fact that Surabaya city has won awards for its cleanliness, healthy environment preservation, and maintenance. AIM: This study aimed at turning the researched site into a clean and healthy environment. METHODS: The research was conducted using a quasi-experiment technique with a non-randomized design and pretest-posttest procedures. The research subjects were 121 inhabitants who actively participated in the public commitment and psychoeducation program initiated by the researchers to learn and practice clean and healthy living behaviors. RESULTS: The statistical data showed that there was a substantial increase in the aspects of public commitment (t-value = 4.008, p = 0.001) and psychoeducation (t-value = 4.038, p = 0.001) to begin and maintain a clean and healthy living behaviors. CONCLUSION: A public commitment in the form of a collective declaration to keep learning and practicing a clean and healthy living behaviors were achieved. This commitment followed by psychoeducation aimed at introducing and exercising such behaviors was found to have effectively increased the research subjects' awareness to actively participate in preserving environmental hygiene. Developing communal behaviors toward clean and healthy living in inhabitants residing in an unhealthy slum area was a difficult task. Therefore, public commitment and psychoeducation must be aligned with the formulation of continuous habits demonstrating a clean and healthy living behaviors. These habits include the cessation of littering while putting trash in its place, optimizing the usage of public toilets, planting and maintaining vegetation around the area, joining and contributing to the "garbage bank" program, and participating in the Green and Clean Surabaya competition.