Determining the need for a breast cancer awareness educational intervention for women with mild/moderate levels of intellectual disability: A qualitative descriptive study.

OBJECTIVE: Following a review of the existing body of literature, this study aimed to explore the need for a breast cancer awareness intervention specifically targeted at women with mild/moderate levels of intellectual disability (ID) and provide perspectives on the preferred processes and content underpinning an intervention. METHODS: A qualitative, descriptive design using semi-structured, individual (n = 5) and focus group (n = 5) interviews were used to engage with a non-probability, purposive sample of key stakeholders (n = 25) including women with mild/moderate levels of ID, caregivers and healthcare professionals. Data were analysed using qualitative content analysis. RESULTS: Findings highlighted that an educational intervention should focus on breast awareness as opposed to breast cancer awareness. Additionally, findings identified that a combined breast awareness and healthy living intervention could be effective. However, the intervention needs to have a multimodal, hands-on, person-centred approach to learning which is underpinned by theory. Furthermore, integrating the caregivers and healthcare professionals into the intervention is recommended. CONCLUSION: Findings from this study provide a foundation for developing and implementing a theoretically underpinned, multimodal, breast awareness and healthy living educational intervention for women with mild/moderate levels of ID.

Defining breast cancer awareness and identifying barriers to breast cancer awareness for women with an intellectual disability: A review of the literature.

INTRODUCTION: Incidence rates for developing breast cancer are similar for women regardless of intellectual ability. However, women with an intellectual disability present with advanced breast cancers, which often have a poor prognosis. METHOD: A structured narrative review of the literature was performed to explore the concepts of breast awareness and breast cancer awareness and subsequently, identify barriers to breast cancer awareness encountered by women with an intellectual disability. RESULTS: A total of 22 studies involving people with varying levels of intellectual disability informed this review. The barriers to breast cancer awareness encountered by women with an intellectual disability include: lack of their understanding, the role of the carer and literacy issues. CONCLUSION: Identifying the barriers to breast cancer awareness for women with an intellectual disability will help to facilitate breast cancer awareness which has the potential to result in better long-term outcomes through an early diagnosis of breast cancer.

A Theoretical Framework to Underpin Clinical Learning for Undergraduate Nursing Students.

The aim of this is paper is to propose Benner's "Novice to Expert" Framework to underpin learning for students as they progress through the clinical components of an undergraduate nursing educational program. Steinaker and Bell's "Experiential Taxonomy" is presented as a practical medium for itemizing the nursing activities novices are exposed to at the initiation of clinical experience and to the clinical competencies expected of nurses on completion of their educational program. The authors also propose a range of theories of learning applicable to the clinical education of undergraduate nursing students, which can be maximized to enhance clinical learning.

Health Literacy Influences Men's Active and Passive Cancer Information Seeking.

BACKGROUND: For cancer prevention information to be effective, it must be accessible to its target populations. Prevalence of inadequate health literacy (HL) is high, but there is a dearth of information on the impact of HL on men's cancer information seeking. OBJECTIVE: We investigated (1) men's cancer information seeking behaviors, (2) the effect of HL on men's cancer information seeking behavior, and (3) men's preferences for cancer information, considering their HL level. From a national perspective, we investigated men's information seeking behavior from the Irish Cancer Society (ICS), the largest provider of cancer information in Ireland. METHODS: Men from adult literacy classes and men's groups were invited to complete a questionnaire. General and ICS-specific cancer information seeking behavior was investigated. Univariate and multivariate logistic regression models were conducted with "ever" seeking cancer information from any source, and actively seeking and passively acquiring ICS information as dependent variables. KEY RESULTS: Overall, 259 men completed the questionnaire and 44% had inadequate HL. About one-half of responders reported "ever" actively looking for cancer information. In the study group, 19% actively sought and 67% passively acquired ICS-specific information. In multivariate analysis, the odds of actively seeking (2.93; 95% CI [1.05, 8.15]) or passively acquiring (4.7; 95% CI [1.99, 11.05]) ICS-specific cancer information was significantly higher among those with adequate versus inadequate HL, respectively. HL was not significantly associated with odds of "ever" cancer information seeking in multivariate analysis (odds ratio 1.81; 95% CI [0.90, 3.63]). Men want information about cancer prevention. Suggested future cancer information sources differed by HL levels. General practitioners and the Internet were the preferred source for men with inadequate (53.3%) and adequate HL (57%), respectively. CONCLUSIONS: Men both passively acquire and actively seek cancer prevention information. Multimodal dissemination of cancer prevention information is necessary to reach a wide cross-section of men, including those with inadequate HL. This could potentially lower men's cancer burden and reduce gender inequalities in cancer mortality. [HLRP: Health Literacy Research and Practice. 2019;3(3):e147-e160.]. PLAIN LANGUAGE SUMMARY: Most men get cancer prevention information by coming across it passively in their daily lives, instead of actively looking for this information. Men with low health literacy are less likely to obtain cancer information both passively and actively. Men want this information. Organizations need to make this information available in many places and formats (e.g., Internet, doctor, television, sports clubs).

Promoting men's knowledge of cancer risk reduction: A systematic review of interventions.

OBJECTIVE: To critically appraise and discuss evidence from interventions designed to increase men's knowledge about cancer risk reduction. METHODS: A systematic review was conducted. Six electronic databases were searched for interventions published between January 1st 2006 and May 30th 2016 in English. Studies were included if they used an experimental design, included adult males (≥18 years), and had a primary focus on the acquisition and utilisation of information on cancer risk reduction. The methodological quality of the included studies was appraised. RESULTS: A total of 25 studies met the inclusion criteria, 23 of which involved prostate cancer risk reduction. Twenty-one studies reported knowledge gain among the men. Three studies found that knowledge gain was associated with health literacy. CONCLUSIONS: Interventions aiming to improve men's knowledge about cancer risk reduction require a multimodal approach. Findings highlight the need to design and measure the impact of interventions for men on wider cancer risk reduction topics, while accounting for different socio-demographic and ethnic groups, literacy and health literacy levels. PRACTICE IMPLICATIONS: More research is warranted into the development and evaluation of theoretically-driven multimodal community-based approaches to information dissemination for men taking into account their daily information spheres such as workplaces and community environs.

Men's information-seeking behavior regarding cancer risk and screening: A meta-narrative systematic review.

OBJECTIVE: Preventive strategies are known to reduce cancer risk and incidence and improve prognosis. Men seldom seek medical information about cancer prevention and risk reduction. The aim of this meta-narrative systematic review was to critically appraise evidence from qualitative, quantitative, and mixed-methods studies that explored men's information-seeking behaviors in relation to cancer prevention and risk reduction. METHODS: MEDLINE, CINAHL Plus with Full Text, PsycINFO, PsycARTICLES, Psychology and Behavioral Sciences Collection, Education Full Text, and ERIC were systematically searched for studies published in English between January 1, 2006 and May 30, 2016. A total of 4117 titles were identified; of which, 31 studies were included (21 qualitative studies, 9 quantitative studies, and 1 mixed-methods study). The methodological quality of the studies was appraised by using different tools. RESULTS: Most studies focused on screening for prostate (n = 18) and colorectal cancer (n = 7). Most men were passive information-gatherers rather than active information-seekers. Key sources of information included the Internet for active information-seekers and health care professionals for passive information-gatherers. Barriers to information-seeking included information overload, embarrassment, and fear. Low literacy and health literacy levels were addressed in 3 studies and were identified as impediments to active information-seeking. Facilitators to information-seeking included family support, media, celebrity endorsements, and targeted information. CONCLUSIONS: Men's information-seeking behavior regarding cancer risk reduction, prevention, and screening is influenced by several factors. This necessitates targeted interventions aimed at raising awareness of cancer prevention and screening, while accounting for men's informational needs, preferred learning strategies, and literacy levels.

Making Sense of Turmoil: How Women Reconcile Their Emotional Response to Discovery of a Potential Breast Cancer Symptom.

BACKGROUND: Breast cancer continues to be a major public health problem for women. Early detection and treatment are key to improved outcomes. Whereas most women seek help promptly, some postpone seeking help for self-discovered breast symptoms. Investigation of women's help-seeking behavior and the associated influencing factors on self-discovery of a breast symptom were sought. OBJECTIVES: The aim of this article is to report the qualitative data from women who had self-discovered a breast symptom. METHODS: Women (n = 167) with a self-discovered breast symptom (who were part of a large quantitative correlational study) commented in an open-ended question on their overall experience. Comments were analyzed using Discourse Analysis. RESULTS: Four linked discourses were identified: (1) "being and remaining normal," (2) "emotion," (3) "becoming and being abnormal," and (4) "rationality." A sidelined discourse of emotion is drawn on to defer taking action based on rational knowledge. CONCLUSION: The tension between discourses "emotion" and "rationality" further informs our understanding of women's help-seeking behavior following self-discovered symptoms. Findings provide a deeper understanding of the emotional aspects of women's experience around symptom discovery. IMPLICATIONS FOR PRACTICE: Findings will be of benefit to all healthcare professionals involved in assessment and screening of breast changes suggestive of breast cancer. They provide a novel insight into the meaning of breast cancer, its diagnosis and treatment, and how this impacts women's emotions as they await consultation in a breast clinic.

Interventions for raising breast cancer awareness in women.

BACKGROUND: Breast cancer continues to be the most commonly diagnosed cancer in women globally. Early detection, diagnosis and treatment of breast cancer are key to better outcomes. Since many women will discover a breast cancer symptom themselves, it is important that they are breast cancer aware i.e. have the knowledge, skills and confidence to detect breast changes and present promptly to a healthcare professional. OBJECTIVES: To assess the effectiveness of interventions for raising breast cancer awareness in women. SEARCH METHODS: We searched the Cochrane Breast Cancer Group's Specialised Register (searched 25 January 2016), Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 12) in the Cochrane Library (searched 27 January 2016), MEDLINE OvidSP (2008 to 27 January 2016), Embase (Embase.com, 2008 to 27 January 2016), the World Health Organization's International Clinical Trials Registry Platform (ICTRP) search portal and ClinicalTrials.gov (searched 27 Feburary 2016). We also searched the reference lists of identified articles and reviews and the grey literature for conference proceedings and published abstracts. No language restriction was applied. SELECTION CRITERIA: Randomised controlled trials (RCTs) focusing on interventions for raising women's breast cancer awareness i.e. knowledge of potential breast cancer symptoms/changes and the confidence to look at and feel their breasts, using any means of delivery, i.e. one-to-one/group/mass media campaign(s). DATA COLLECTION AND ANALYSIS: Two authors selected studies, independently extracted data and assessed risk of bias. We reported the odds ratio (OR) and 95% confidence intervals (CIs) for dichotomous outcomes and mean difference (MD) and standard deviation (SD) for continuous outcomes. Since it was not possible to combine data from included studies due to their heterogeneity, we present a narrative synthesis. We assessed the quality of evidence using GRADE methods. MAIN RESULTS: We included two RCTs involving 997 women: one RCT (867 women) randomised women to receive either a written booklet and usual care (intervention group 1), a written booklet and usual care plus a verbal interaction with a radiographer or research psychologist (intervention group 2) or usual care (control group); and the second RCT (130 women) randomised women to either an educational programme (three sessions of 60 to 90 minutes) or no intervention (control group). Knowledge of breast cancer symptomsIn the first study, knowledge of non-lump symptoms increased in intervention group 1 compared to the control group at two years postintervention, but not significantly (OR 1.1, 95% CI 0.7 to 1.6; P = 0.66; 449 women; moderate-quality evidence). Similarly, at two years postintervention, knowledge of symptoms increased in the intervention group 2 compared to the control group but not significantly (OR 1.4, 95% CI 0.9 to 2.1; P = 0.11; 434 women; moderate-quality evidence). In the second study, women's awareness of breast cancer symptoms had increased one month post intervention in the educational group (MD 3.45, SD 5.11; 65 women; low-quality evidence) compared to the control group (MD -0.68, SD 5.93; 65 women; P < 0.001), where there was a decrease in awareness. Knowledge of age-related riskIn the first study, women's knowledge of age-related risk of breast cancer increased, but not significantly, in intervention group 1 compared to control at two years postintervention (OR 1.8; 95% CI 0.9 to 3.5; P < 0.08; 447 women; moderate-quality evidence). Women's knowledge of risk increased significantly in intervention group 2 compared to control at two years postintervention (OR 4.8, 95% CI 2.6 to 9.0; P < 0.001; 431 women; moderate-quality evidence). In the second study, women's perceived susceptibility (how at risk they considered themselves) to breast cancer had increased significantly one month post intervention in the educational group (MD 1.31, SD 3.57; 65 women; low-quality evidence) compared to the control group (MD -0.55, SD 3.31; 65 women; P = 0.005), where a decrease in perceived susceptibility was noted. Frequency of Breast CheckingIn the first study, no significant change was noted for intervention group 1 compared to control at two years postintervention (OR 1.1, 95% CI 0.8 to 1.6; P = 0.54; 457 women; moderate-quality evidence). Monthly breast checking increased, but not significantly, in intervention group 2 compared to control at two years postintervention (OR 1.3, 95% CI 0.9 to 1.9; P = 0.14; 445 women; moderate-quality evidence). In the second study, women's breast cancer preventive behaviours increased significantly one month post intervention in the educational group (MD 1.21, SD 2.54; 65 women; low-quality evidence) compared to the control group (MD 0.15, SD 2.94; 65 women; P < 0.045). Breast Cancer AwarenessWomen's overall breast cancer awareness did not change in intervention group 1 compared to control at two years postintervention (OR 1.8, 95% CI 0.6 to 5.30; P = 0.32; 435 women; moderate-quality evidence) while overall awareness increased in the intervention group 2 compared to control at two years postintervention (OR 8.1, 95% CI 2.7 to 25.0; P < 0.001; 420 women; moderate-quality evidence). In the second study, there was a significant increase in scores on the Health Belief Model (that included the constructs of awareness and perceived susceptibility) at one month postintervention in the educational group (mean 1.21, SD 2.54; 65 women) compared to the control group (mean 0.15, SD 2.94; 65 women; P = 0.045).Neither study reported outcomes relating to motivation to check their breasts, confidence to seek help, time from breast symptom discovery to presentation to a healthcare professional, intentions to seek help, quality of life, adverse effects of the interventions, stages of breast cancer, survival estimates or breast cancer mortality rates. AUTHORS' CONCLUSIONS: Based on the results of two RCTs, a brief intervention has the potential to increase women's breast cancer awareness. However, findings of this review should be interpreted with caution, as GRADE assessment identified moderate-quality evidence in only one of the two studies reviewed. In addition, the included trials were heterogeneous in terms of the interventions, population studied and outcomes measured. Therefore, current evidence cannot be generalised to the wider context. Further studies including larger samples, validated outcome measures and longitudinal approaches are warranted.

Shedding light on women's help seeking behaviour for self discovered breast symptoms.

PURPOSE: To describe women's help seeking behaviour (HSB) and the associated influencing factors on self-discovery of a breast symptom. METHODS: A descriptive, correlational survey design was used. Following ethical approval, survey data were collected from women (n = 449) attending the breast clinics of two large urban hospitals within the Republic of Ireland. RESULTS: The majority of women (69.9%; n = 314) sought help (by visiting their General practitioner, GP) within one month, 30.1% (n = 135) delayed help seeking for more than one month following symptom discovery and 16.7% (n = 75) delayed for three months or more. The factors most significantly associated with delayed HSB were knowledge around symptom identity (Odds Ratio (OR) = 4.80, p = 0.005); ignoring the symptom and hoping it would go away (OR = 10.72, p < 0.001) and women's belief that the symptom would persist for a long time (OR = 1.18, p = 0.023). Being afraid on symptom discovery (OR = 0.37, p = 0.005) was associated with reduced risk of delayed HSB. CONCLUSIONS: It is encouraging to see that the majority of women who find a breast symptom seek help promptly. However, a small cohort of women delay seeking help from their GP. HSB is influenced by multiple factors which can impact on patient outcomes. Findings are important for oncology nurses who have a key role to play in promoting breast awareness, prompt help seeking and early detection and treatment of breast cancer, amongst women.

Women's help seeking behaviour for self discovered breast cancer symptoms.

PURPOSE OF THE RESEARCH: The aim of the study was to explore women's Help Seeking Behaviour (HSB) for a self discovered breast symptom, in order to gain understanding of women's experience of finding a breast symptom and how this influenced their HSB. In addition, the study sought to confirm the appropriateness of the "Help Seeking Behaviour & Influencing Factors" framework, for use in phase two of the study. METHODS AND SAMPLE: A qualitative descriptive method was used involving semi-structured interviews with ten women, ranging in age from 25 to 55 years, who had discovered a breast symptom. KEY RESULTS: Women's HSB ranged from up to one month (n = 6), one to three months (n = 2) and over three months (n = 2), following symptom discovery. The key variables linked to delayed help seeking were denial, fear, social factors and knowledge and beliefs. The study verified that the variables within the "Help Seeking Behaviour and Influencing Factors" framework act as both facilitators and barriers to women's HSB. Thus, confirming the appropriateness of this framework for a larger quantitative study of women's help seeking behaviour. CONCLUSIONS: The study highlights that despite continued emphasis on early help seeking for breast cancer symptoms, delay is still prevalent amongst women. This reiterates the need for continued emphasis on the message of early detection for breast cancer symptoms. To this end, nurses have a significant role to play in educating women in both clinical and community settings, about breast cancer and early detection practices.

Help seeking for cancer symptoms: a review of the literature.

PURPOSE/OBJECTIVES: To define help seeking and identify a theoretical framework to explain the help-seeking process of patients with self-discovered cancer symptoms. DATA SOURCES: Literature published in English from 1998-2008. DATA SYNTHESIS: Findings highlighted gender's role in help-seeking behavior. Delayed help seeking for cancer symptoms was common, with many associated influencing factors. To date, research on intentions to seek help has facilitated the development of health-promotion programs that target those who are likely to delay. CONCLUSIONS: Help seeking was defined as a response to health changes as well as a part of the broader process of health-seeking behavior. Reviewed frameworks and models provided knowledge and understanding about help-seeking behavior in various contexts. However, an all-encompassing framework explaining the entire process was not identified. IMPLICATIONS FOR NURSING: Nurses are in a unique position to promote prompt help seeking for patients with self-discovered cancer symptoms. Gaining clarity on the concept and identifying a theoretical framework may help nurses understand the complex nature of help seeking in patients with self-discovered cancer symptoms.

Factors influencing women in seeking help from a health care professional on self discovery of a breast symptom, in an Irish context.

AIM: To identify the extent of delay and the factors influencing women in seeking help from a health care professional on self discovery of a breast symptom, in an Irish context. BACKGROUND: Breast cancer is the most common malignancy among women in the developed world. In Ireland, 2700 women are diagnosed with breast cancer and over 900 die from it annually. A longer delay in presenting with breast symptoms is associated with a lower rate of survival from breast cancer. However, many women wait for longer than three months before presenting to a health care professional on self discovery of a breast symptom. DESIGN: A quantitative correlational design was used. METHODS: Data were collected using the 'Women's help seeking for breast symptoms' questionnaire. Women were recruited in the breast clinic prior to their visit with the consultant. RESULTS: A total of 100 women participated, 99 of whom fully completed the questionnaire. Mean age was 40 years. It was found that 72.7% (n = 73) of women visited their GP within one month, 14.1% (n = 14) within one to three months and 10% (n = 12) after three months. Delay time was significantly related to women's knowledge and beliefs and social issues. Conversely, help seeking also correlated to women's knowledge and beliefs about the symptom and the anxiety surrounding the initial symptom discovery period. CONCLUSION: Despite breast health promotion campaigns, many women delay for one month or more, in seeking help from a health care professional for self discovered breast symptoms. Prolonged delay has potential to impact on survival from breast cancer. This highlights the need for continued education and breast health promotion for women. RELEVANCE TO CLINICAL PRACTICE: Health care professionals need to be aware of possible reasons for delay in seeking help for self discovered breast symptoms and explore new ways to address these barriers.