title: Mixed method systematic review: the relationship between breast cancer risk perception and health-protective behaviour in women with family history of breast cancer.
abstract: OBJECTIVE
  The aim of this study was to determine and explore the relationship between risk perception and health-protective behaviour in individuals with family history of breast cancer.
  
  
  BACKGROUND
  Women with increased risk of breast cancer due to inherited predisposition can use health-protective behaviours to facilitate prevention or early detection of cancer.
  
  
  METHODS
  Four scientific literature databases (CINAHL, Medline, AMED, PsychInfo) and three systematic review databases were searched.
  
  
  METHODS
  Mixed method systematic review.
  
  
  METHODS
  The systematic review of peer-reviewed literature was conducted following the method described by the Centre of Reviews and Dissemination. Research studies published in English between January 2004-December 2014 focussing on individuals with family history of breast cancer were included. Of 210 papers identified, 10 studies were eligible for inclusion. Studies were assessed for their quality. Due to the diversity of the studies, a three-step analysis was undertaken involving narrative summary of the quantitative data, thematic analysis and presentation of integrated results in narrative form.
  
  
  RESULTS
  A clear link between breast cancer risk perception and some health-protective behaviour was identified. Screening administered by health professionals (mammogram screening, chemoprevention) were appropriately adopted. However, behaviours requiring high individual input (breast self-examination, lifestyle changes) were not as appropriately adopted and the decision process was not as clearly linked to risk perception.
  
  
  CONCLUSIONS
  There is limited understanding about the complex relationship between risk perception and health-protective behaviour. Risk communication and health promotion need to be further developed to assist individuals to better engage with their actual risk and risk-appropriate behaviours, particularly those that require regular personal effort.
authors.affiliation: Clinical Genetics Department, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Kati
authors.identifier: http://orcid.org/0000-0002-6102-0609
authors.initials: K
authors.lastname: Paalosalo-Harris
authors.affiliation: School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Skirton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000235:genetics / Q000517:prevention & control* / Q000523:psychology*; D055088:Early Detection of Cancer / Q000523:psychology*; D005260:Female; D020022:Genetic Predisposition to Disease / Q000517:prevention & control / Q000523:psychology*; D015438:Health Behavior; D006293:Health Promotion; D006801:Humans; D008875:Middle Aged; D018570:Risk Assessment; D012309:Risk-Taking
keywords: Health Belief Model; breast cancer; family history; health-protective behaviour; literature review; nursing; risk perception; systematic review