Breast
Self-Examination Class
in Pregnant Women
Anna Lee, Carol Wuollet, Kris
Pederson, Liz Garrison
Problem Identification
●
Approximately 1 in 8 women in the U.S. will develop breast cancer in their
lifetime
It is the leading cause of cancer deaths in women age 20-59 and second
leading cause of cancer deaths in all women
Early detection increases survival rate
Many women report that they discovered changes in their breast prior to
diagnosis by performing breast self-examinations (BSE)
More women are delaying pregnancy to later in life
1 in 3,000 women develop breast cancer during pregnancy
Hormonal changes in pregnancy can alter breast tissue, but breast awareness
and BSE are still important
(Breastcancer.org, 2024)
●
(American Cancer Society, 2023)
●
●
(Nationalbreastcancer.org, 2024)
(Nationalbreastcancer.org, 2024)
●
●
●
(BCRF, 2018)
(BCRF, 2023)
(BCRF, 2023)
Nursing Intervention - Breast Self-Exam Class
●
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Educational classes on proper BSE
technique by health professionals
Educating them about the importance
of early detection
Gaining skills to empower women to
perform BSE with confidence
(OHSU, 2004), (Strickland,
et al., 1997)
●
Informing them that there are safe,
effective, and specialized treatment
options for breast cancer during
pregnancy
(BCRF, 2023)
Self-Efficacy Theory Description
● Self-efficacy: individual’s belief in their own ability to accomplish
goals.
● Healthcare goals: individuals’ objectives in achieving outcomes
● Developed by Albert Bandura in the 1970s under his social cognitive
theory
● Initial research based on exposure to conditions resulting in
behavioral change by increasing strength of self-efficacy
● First study conducted on subjects with snake phobias.
● Utilized in various fields: psychology, education, sports, business,
and healthcare to guide self-motivation and achieve goals.
Bandura (1977)
Self-Efficacy Concept Definitions
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Self-Efficacy Expectations:
○ Judgment about one’s own personal ability to
complete a task
Outcome Expectations:
○ Judgements made about what will occur if
the task is successfully completed
Informational Sources:
○ Enactive Attainment: individual’s
performance
○ Vicarious Experience: role modeling
○ Verbal persuasion: encouragement
○ Physiological feedback: information from the
body used to judge performance abilities
Behavior
Resnick (2023)
Self-Efficacy Theory Selection Rationale
●
Overwhelming evidence that perceived self-efficacy is associated with
behavioral intentions and health behavior changes
○
●
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Self-efficacy is a determinant of current health behavior, future health behavior, and
health behavior change.
Increased self-efficacy → Increased behavior action and compliance
Theory framework regarding BSE is supported by prior research
○
○
Perceived capabilities carry more weight than expected outcomes
Self-efficacy is an important factor in performing breast cancer screening behaviors
(Holloway & Watson, 2002; Lu, 1995;
Healthcare Equity
●
Lower levels of perceived health self-efficacy
are seen in:
○
○
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BSE interventions have the potential to
improve existing health inequities
○
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Individuals affected by racial and socioeconomic
disparities
Individuals with lower levels of health literacy
BSE interventions → Increased self-efficacy →
Increased behavior action and compliance
Potential unintended consequences include:
○
○
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Increased benign lesion identification
Unnecessary imaging/ biopsies
Anxiety provoked by a perceived potential cancer
diagnosis
Theory Evaluation
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Substantive Foundations
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Within discipline of nursing
Self-efficacy explained and at middle range level
Origin based on Bandura’s initial snake phobia research and studies
○
○
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Key concepts and inter-relationships clearly defined
All concepts present are necessary to understanding of theory
Model presents causal pathways and interactions between concepts
○
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Self-efficacy can be applied across environments and populations
Several measures of self-efficacy have developed
Research on the theory has been conducted and the use of it in practice has been
published
Structural Integrity
Functional Adequacy
(Smith, 2023)
Conceptual Model
Adapted from Resnick (2023)
Conceptual Model: Narrative Summary
In the Effect of Breast Self-Examination (BSE) on Adherence in
Pregnant Women study the intervention tested is a BSE class. The
BSE class will serve as multiple informational sources for the
participant to use. These informational sources can include verbal
persuasion, role modeling, performance, and physiological
feedback. The information gathered from these sources will have
an impact on the self-efficacy expectations held by the participant.
These include BSE self-efficacy expectations, barriers to BSE, and
BSE outcome expectations. These will expectations and barriers
will then influence the intended behavior of BSE adherence.
Operational Model
Operational Model Narrative Summary
In this operational diagram for Effect of Breast Self-Examination (BSE) Class on Adherence in
Pregnant Women, the theoretical framework used to guide the study is the Theory of
Self-Efficacy. The first main concept of this framework is informational sources. The study
concepts used under this are BSE class, performance, role modeling, verbal persuasion, and
physiological feedback. The intervention used to assess BSE class is a BSE class evaluation
form. The other informational sources are measured using a BSE knowledge assessment form
both before the class and after the class. The second theoretical framework concept is
self-efficacy expectations. The concepts under this used in the study were BSE self-efficacy
expectations - measured by the Self-Rated Abilities for BSE scale, BSE outcome expectations –
measured by the Self-Rated BSE Outcome Expectation Scale, and Barriers to BSE – measured
by the Barriers to BSE Scale. The third theoretical framework concept is behavior. The study
concept used under this was recommended BSE adherence, broken down into frequency and
accuracy. Frequency is measured using the BSE frequency form and Accuracy is measured
using demonstration and an accuracy questionnaire.
References
American Cancer Society. (2024). American cancer society recommendations for the early detection of breast cancer.
https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html
Bandura, A., & Adams, N. E. (1977). Analysis of self-efficacy theory of behavioral change. Cognitive Therapy and Research, 1(4), 287–310.
Breastcancer.org. (2024). Breast cancer facts and statistics. https://www.breastcancer.org/facts-statistics?gad_source=1&gclid=Cj0KCQjwlN6wBhCcARIsAKZvD5jLTO5bjzxQdU0BV4tJl0CF0zscvd8GUjXJkg43j3K42BzcdsOYBpkaAvoeEALw_wcB
Breast Cancer Research Foundation (BCRF). (2023). AACR 2023: Special symposium on pregnancy and breast cancer.
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