Aim: The current study was conducted to assess female workers’ beliefs regarding breast cancer and its preventive measures according to their health belief model. Subjects and Methods: Design: A descriptive design was utilized. Sample and Settings: 323 working women at Beni-Suef University. Tools: Tool I: A Structured Interviewing Questionnaire Sheet: It contains women's personal and socio-demographic data a sage, education, age of marriage, marital status, residence, and family income. Tool II: Health Belief Model Questionnaire. Results: It revealed that most of women have negative beliefs regarding perceived susceptibility (68.1%), benefits (51.4%), barriers (53.3%), cues to action (66.3%), and self-efficacy (62.2%). However, most of them have natural beliefs regarding perceived seriousness (55.7%). Also, 52.3% of the studied female workers have negative beliefs pre-HBM implementation regarding breast cancer, breast self-examination, and breast cancer preventive measures, compared to 47.1% & 0.6% who had natural and positive beliefs, respectively. For family history of breast cancer, mammogram and breast problems history; 0.0% had positive beliefs. Conclusion: Based on the findings of the present study, it can be concluded that there is a highly statistically significant relation between the studied female workers total health belief model level score with their age, age of marriage, history of breast problems, and marital status. Moreover, a statistically significant relation with their family history of breast cancer, monthly income of family but there was no statistically significant relation with their educational level, place of residence, and history of mammogram. Recommendations: Implement an educational program to enhance women’s beliefs regarding breast cancer and preventive measures according to their health belief model

The illness known as breast cancer is caused by aberrant breast cells that proliferate and develop into tumors. Tumors have the potential to grow throughout the body and become lethal if ignored. The milk ducts and/or the breast's milk-producing lobules are where breast cancer cells first proliferate [1-10]. There is no risk to life from the early form (in situ). Cancer cells can invade neighboring breast tissue. Tumors produced by this result in thickening or lumps [11-16]. Metastasis is the process by which invasive tumors move to neighboring lymph nodes or other organs. One can die from metastasis [17- 22].

The Health Belief Model is a cognitive paradigm that explains poor participation in disease prevention initiatives by examining factors promoting or hindering participation. It focuses on the belief that a specific behavior can improve or prevent health and the desire to avoid illness [23-28].

The updated Champion's HBM Scale (CHBMS) consists of six elements: perceived susceptibility to illness, risk perception, perceived severity of illness, perceived benefits of behavior modification, and perceived barriers to action. Perceived susceptibility refers to an individual's vulnerability to a health issue, while perceived threat is the result of combining perceived severity and susceptibility. Perceived severity includes opinions about the illness itself, potential medical ramifications, and social ramifications [29-33].

Perceived benefits are an individual's evaluation of the value or utility of adopting a health-promoting action to reduce the likelihood of becoming unwell. These benefits have a significant impact on screenings and other secondary prevention measures, such as early identification of breast cancer. Perceived obstacles to action involve an individual's evaluation of the impediments to altering their behavior. Obstacles may keep someone from engaging in a health-promoting behavior, even if they think that doing so will significantly lessen the threat that their health condition poses [34-35].

Perceived impediments can be tangible, mental, or emotional elements, such as lack of access to care, the expense of treating the illness, the effect on social networks and support systems, the effect on family life, and one's line of work. Individual traits, such as demographic, psychosocial, and structural factors, can influence how health-related actions are evaluated, including their perceived seriousness, susceptibility, advantages, and barriers [36-41].

Internal cues to action include physiological cues like pain or illness, events or information from close friends and family, media messages, social interactions, and the influence of significant others. Cues to action are situations that arise from within or without and start a decision-making process about the best way to pursue health. If a woman does not think her advanced-stage breast cancer is severe, strong and persuasive cues to action may cause her to change her mind and seek treatment [42-47]. 

The current study was conducted to assess female workers’ beliefs regarding breast cancer and its preventive measures according to their health belief model.

Research design:

To accomplish its goals, the study used a descriptive research design.

Subjects and Settings:

It consists of 323 working women at Beni-Suef University.

Tools of data collection:

Tool I: A Structured Interviewing Questionnaire Sheet

It contains women's personal and socio-demographic data a sage, education, age of marriage, marital status, residence, and family income (6`Items).

Tool II: Health Belief Model Questionnaire:

This self-reported questionnaire, which was modified to assess perceived susceptibility, perceived seriousness, perceived rewards, perceived barriers, cues to action, and self-efficacy, was used to measure women's attitudes regarding breast cancer screening using a Likert scale that included statements with five responses. It has six subscales for health belief: strongly disagree, disagree, neutral, agree, and strongly agree. Six groups of questions make up the attitude scale: ten questions about susceptibility, twelve questions about seriousness, seven questions about benefits, thirteen questions about the barrier, ten questions about cues to action, ten questions about self-efficacy, and six questions about benefits. On a five-point Likert scale, the replies were scored as follows: strongly disagree (1), disagree (2), neutral (3), agree (4), and extremely agree (5). Three hundred degrees was the sum of the scores. The estimated total attitude score was divided into three categories: positive belief is indicated by a score of ≥75% (≥225 degrees); neutral belief is indicated by a score of 50% to 74% (150-225 degrees); and negative belief is indicated by a score of <50>

Tools Validity:

In order to ensure comprehensiveness, accuracy, and clarity, a jury panel at Beni-Suef University assessed the content validity of study tools and made the required adjustments.

Tools Reliability:

The study tools' reliability was assessed using Cronbach's Alpha test, revealing Total knowledge, Health Belief Model, and Breast Cancer Preventive Measures as reliable; Total knowledge (0.897), Health Belief Model (0.910), and Breast Cancer Preventive Measures (0.886).

Administrative Design and Ethical Consideration:

The study received approval from the dean of the nursing faculty at Beni-Suef University and ethical approval from the Faculty of Medicine's Research Ethics Committee.

Statistical Design:

The data was analyzed using SPSS version 20 to compare women's understanding and use of preventive behaviors, using mean, standard deviation, number, and percentage distribution.

Figure 1: presents female worker’s beliefs regarding breast cancer and its preventive measures as measured by the health belief, it reveals that most of women have negative beliefs regarding perceived susceptibility (68.1%), benefits (51.4%), barriers (53.3%), cues to action (66.3%), and self-efficacy (62.2%). However, most of them have natural beliefs regarding perceived seriousness (55.7%).

Figure 2: illustrates that more than half (52.3%) of the studied female workers have a negative belief pre-HBM implementation regarding breast cancer, breast self-examination, and breast cancer preventive measures, compared to 47.1% & 0.6% who had natural and positive beliefs, respectively.

Figure 3:  proves that there was a highly statistically significant relation between the studied female workers total health belief model level score with their age, age of marriage, and marital status, as P-value = 0.000 & 0.001, respectively. Moreover, a statistically significant relation with their monthly income of family as P-value = 0.026, but there was no statistically significant relation with their educational level and place of residence as P-value = 0.381 & 0.130& 0.131, respectively.

Figure 4: presents the relation between history of mammogram and breast problems for the studied female workers and their total beliefs about breast cancer, breast self-examination, and breast cancer preventive measures as measured by the health belief model. In which no one (0.0%) of females who have a mammogram or breast problem history had positive beliefs. It reveals that there was a statistically significant relation between history of breast problems of the studied female workers and their total health belief model level as p-value 0.019.

Figure 5: presents the relation between family history of breast cancer of the studied female workers and their total beliefs about breast cancer, breast self-examination, and breast cancer preventive measures as measured by the health belief model. In which no one (0.0%) of females who have a family history of breast cancer had positive beliefs. It presents that there was a statistically significant relation between family history of breast cancer of the studied female workers and their total health belief model level as p-value = 0.013.

Figure 1: Studied female workers’ beliefs regarding breast cancer and its preventive measures as measured by the health belief model

Figure 2:  Studied female workers’ total beliefs regarding breast cancer and its preventive measures as measured by the health belief model

Figure 3: Relation between socio-demographic data of the studied female workers and their total health belief model level about breast cancer, breast self –examination and breast cancer preventive measures (n=323).   

Figure 4: Relation between female workers’ history and their total health belief model level about breast cancer, breast self –examination and breast cancer preventive measures

Figure 5:  Relation between family history of breast cancer of the studied female workers and their total beliefs about breast cancer, breast self-examination and breast cancer preventive measures as measured by health belief model (n= 323, X2 = 8.702, p value = 0.013*)

The aim of the study was assessing female workers’ beliefs regarding breast cancer and its preventive measures according to their health belief model. Regarding the overall perceived beliefs of female employees regarding breast cancer and its prevention strategies, as determined by HBM, the current study found that over half of them held negative beliefs, over one-third held natural beliefs, and a minority held positive beliefs about breast cancer, breast self-examination, and breast cancer prevention strategies. This result is similar to that of Khorsandi et al. (2020) [48].

The study found that female workers' socio-demographic characteristics significantly influence their beliefs about breast cancer, self-examination, and preventive measures, with a minority aged 30-40 years having positive beliefs. This finding is accepted with Mohamed et al. (2023), who stated that there was a highly statistically significant relationship between the studied patients’ total HBM score and their age [49]. This finding is also supported by Kalliguddi et al. (2019), who studied “knowledge, attitude, and practice of breast self-examination amongst female information technology professionals in Silicon Valley of India” and showed that a significant relationship was found between the beliefs and age of the health workers [50].

In relation to educational level, there was no relationship between the studied female workers total beliefs score and their educational level. In which the minority of females who had intermediate education had positive beliefs. Conversely, Yılmaz et al. (2018) found a significant relationship between women's education level and knowledge and beliefs about breast cancer and early diagnosis methods in Turkey [51]. Also, this finding is in contrast with George et al. (2019), who studied “knowledge and attitudes about breast cancer among women: a wake-up call in Nigeria” and proved that there was a significant relationship between level of education and beliefs toward breast cancer [52].

Regarding marital status, there was a highly statistically significant relationship between the studied female workers total beliefs as measured by the health belief model level (pretest) score with their marital status pretest but no statistically significant relationship posttest. In which the minority of married women had positive beliefs before the program, which increased to almost one-half after the program. Also, this finding is supported by George et al. (2019), who studied “knowledge and attitudes about breast cancer among women: a wake-up call in Nigeria” and proved that there was a significant relationship between marital status and beliefs toward breast cancer [52].

Additionally, there was no statistically significant relationship between the studied female workers total beliefs score with their place of residence pre- & posttest. In which the minority of females who lived in urban areas had positive beliefs before the program, which improved to less than one-half after program implementation.  Also, there was a statistically significant relationship with their monthly income of family from their point of view pretest but no statistically significant relationship posttest. In which the minority of females who had enough monthly income had positive beliefs before the program, which increases to more than one-half after the educational program. 

Based on the findings of the present study, it can be concluded that there is a highly statistically significant relation between the studied female workers total health belief model level score with their age, age of marriage, history of breast problems, and marital status. Moreover, a statistically significant relation with their family history of breast cancer, monthly income of family but there was no statistically significant relation with their educational level, place of residence, and history of mammogram.

Recommendations

• Implement an educational program to enhance women’s beliefs regarding breast cancer and preventive measures according to their health belief model

Improve maternity nurses’ beliefs about health belief models via educational programs as they have a golden role with women in society.

Ethics approval: 

Ethical approval for the study was obtained from the Research Ethics Committee at the Faculty of Medicine, Beni-Suef University.