title: Effects of education based on the health belief model on screening behavior in high risk women for breast cancer, Tehran, Iran.
abstract: BACKGROUND
  Breast cancer is the most common malignancy in women. Early diagnosis allows efficient treatment and increases survival, but the efficacy of breast self examination (BSE) is not sufficiently well established. The American Cancer Society aims to give women the opportunity to recognize the utility, limitations and adverse effects of breast cancer screening through education models based on psychological theories. With the Health Belief Model, people's health perceptions and attitudes influence their practices, for example with screening.
  
  
  OBJECTIVE
  The purpose of this randomized controlled clinical trial was to determine the effect of education based on this model on breast cancer screening in high risk Iranian women.
  
  
  METHODS
  Participants were women with a family history of breast cancer (mother, sister, and daughter). After explanation of the study objectives to participants, they were recruited on obtaining oral consent and each filled out the study questionnaire based on the Health Belief Model. Allocation was into two groups by computerized randomization, control and intervention, receiving education on breast cancer screening. Perceived susceptibility to and seriousness of breast cancer, perceived usefulness of and barriers to BSE, clinical breast examination, and mammography, and self-efficacy in the ability to perform these, were assessed, with comparison of scores for BSE practice before and after education and doing mammography and clinical examination by a physician in intervention and control group.
  
  
  RESULTS
  The mean age was 37.8 ± 11.7 (range 19-60). The mean rank in the intervention group significantly differed before and after the education, but except for " perceived threat" and "perceived usefulness of breast self examination", we did not find any significant differences from the control group. After educational sessions, breast self examination and clinical examination practice rates were elevated.
  
  
  CONCLUSIONS
  Health education based on well known psychological theories for breast cancer screening should be extended to the entire populations in developing countries. In addition, we should pay attention to barriers to women undergoing mammography, such as costs, shame and accessibility, and increase the target population awareness and positive attitudes towards benefits of early breast cancer screening.
authors.affiliation: Shahroud University of Medical Science, Shahroud, Iran.
authors.forename: Sepideh
authors.initials: S
authors.lastname: Hajian
authors.forename: Katayon
authors.initials: K
authors.lastname: Vakilian
authors.forename: Khadijeh Mirzaii
authors.initials: KM
authors.lastname: Najabadi
authors.forename: Jalil
authors.initials: J
authors.lastname: Hosseini
authors.forename: Hamid Reza
authors.initials: HR
authors.lastname: Mirzaei
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D016504:Breast Self-Examination / Q000523:psychology*; D003906:Developing Countries; D055088:Early Detection of Cancer / Q000523:psychology*; D004522:Educational Status; D005260:Female; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007492:Iran; D008327:Mammography / Q000523:psychology; D008875:Middle Aged; D010808:Physical Examination / Q000009:adverse effects; D012306:Risk; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D014930:Women / Q000193:education* / Q000523:psychology*; D055815:Young Adult