Health Promotion/Disease Prevention Design Project: Breast Cancer

Abstract

Prevalent health problems, in communities, will be addressed by providing health promotion programs (Kumar & Preetha, 2012, p. 5). Health promotion programs have the potential to change participants health behaviors and increase their knowledge about health problems (Kumar & Preetha, 2012, p.

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8). Breast cancer is found in women of different ages and ethnicities, including adult women living in Chesterfield County. Health promotion programs can increase knowledge related to breast cancer and increase breast cancer screening rates. Health promotion programs have the potential to improve the community and personal health. Educational sessions, provided to adult women, can increase breast cancer knowledge, awareness, and reduce mortality rates in communities. Providing health education to increase breast cancer knowledge, among adult women, is important for improving community health by lowering incidence and mortality rates.

Keywords: health promotion, breast cancer, community health, mortality

Breast cancer diagnoses account for 229,000 cases, annually, in women (Danforth, 2013). Women are disproportionately affected by breast cancer compared to men and have higher mortality rates from breast cancer compared to any other type of cancer (G. Sharma, Dave, Sanadya, J. Sharma, & K. Sharma, 2010, p. 109). Breast cancer is typically diagnosed within the breast tissue of a woman (G. Sharma et al., 2010, p. 109).

Breast cancer affects women of all ethnicities around the world contributing to 10.4% of all cancer cases (G. Sharma et al., 2010, p. 109). Breast cancer risk factors include age, gland diseases, and history of cancer in first-degree relatives (Kami?ska, Ciszewski, Lopacka-Szatan, Miotla, & Staroslawska, 2015, p. 196). Health promotion programs that incorporate education about risk factors and health behavior change can help to lower incidence rates of breast cancer (Kami?ska et al., 2015, p. 196). The highest risk groups for breast cancer include women carrying the BRCA1 or BRCA2 gene and African American women (Amir, Freedman, Seruga, & Evans, 2010, p. 680). Breast cancer is a
serious concern that needs to be addressed in all communities because it affects women of different ages and ethnicities (Howell et al., 2014). Over the course of a women’s lifetime, they have a 12% chance of developing breast cancer (Centers for Disease Control & Prevention, 2016). Breast cancer incidence and mortality rates are increasing. Addressing lack of awareness about breast cancer in adult women of all ethnicities living in Chesterfield County through a health promotion program is inherent to reducing mortality and
incidence rates.

Population and Community of Interest

Breast cancer is a community and public health concern. Breast cancer affects women of all races, ethnicities, and various ages. The target population for breast cancer, adult women, make up 51.8% of Chesterfield County (United States Census Bureau, 2017). Between the years of 2005-2008, breast cancer incidence rates for 100,000 women increased from 119.9 to 127.8 in Chesterfield County (Virginia Department of Health, 2016). Between the years of 2008-2012, the mortality rate from breast cancer remained stable at 21.7 per 100,000 women because of increased screening (Bon Secours Richmond Health System, 2016). The increasing incidence rate demonstrates the need for community awareness related to breast health.

Factors that Influence Health and Health Behavior

Women who are between the ages of 50-69 should take part in mammograms, which serve as an early intervention for diagnosing breast cancer and reducing mortality rates (Shah, Hernandez, Ng, & Gao, 2014). Low rates of mammography screening result in higher mortality rates (Kratzke, Wilson, & Vilchis, 2013). Increased mammography rates are due to increased education; however, rates remain low for women who are in poverty, have low educational attainment, and are of certain ethnicities (Davis et al., 2012, p. 748). Mammography rates
are often influenced by many reasons including a woman’s race, socioeconomic status, education level, and location (Henry, McDonald, Sherman, Kinney, & Stroup, 2014, p. 664). Women who are not Caucasian often have lower breast cancer screening rates, because of the inability to access care and deficiencies in knowledge related to the importance of mammograms (Patel et
al., 2014, p. 943). Many factors influence whether women choose to participate in mammography screenings versus why they do not participate. Breast cancer screening can improve survival rates among women who are diagnosed resulting in better outcomes.

Access to Health Care Problems

A woman’s health outcome and survival rate, for breast cancer, are dependent upon the stage at diagnosis (Wang, McLafferty, Escamilla, & Luo, 2008, p. 54). Mammograms have the potential for diagnosis of early-stage breast cancer, which will help to reduce the mortality rate. Geographical proximity to health care clinics, culture, and socioeconomic status impact whether women receive health care or
not (Wang et al., 2008, p. 54). Women who live in more rural areas tend to have lower mammography screening rates due to the proximity from medical facilities and the lack of abundance of medical services (Henry et al., 2014, p. 664). Increased travel distance and dwelling in rural areas affect the ability of women receiving mammograms (Henry et al., 2014, p. 664).

Income. Cost of medical care affects the ability to access care and 8% of adults in Chesterfield County reported this as to why they could not see a physician (Bon Secours Richmond Health System, 2016). The percentage of uninsured adults living in Chesterfield County is 16% (Bon Secours Richmond Health System, 2016). Female households had a median income of $37,957 compared to male households which had an income of $49,377 (Chesterfield County Planning Department, 2017). Low income and no health insurance affects the percentage of women who receive mammograms. In Virginia, 51.7% of women who did not have health insurance received a mammogram compared to 80.2% of women with health insurance (The Cancer Action Coalition of Virginia, 2013). Roughly 71.4% of women who made under $50,000 received a mammogram compared to 82.8% of women who made over $50,000 in Virginia (The Cancer Action Coalition of Virginia, 2013). Women of a low-socioeconomic status often do not participate in mammograms, due to being uninsured, which results in higher mortality rates (Park, Buist, Tiro, & Taplin, 2008).

Poverty. Women with low socioeconomic status often lack transportation, which influences access to health care (Patel et al., 2014, p. 943). Chesterfield County faces a major concern with transportation because there are no alternatives (Bon Secours Richmond Health System, 2016). Women who live farther away from medical services in Chesterfield County and lack transportation will have greater difficulty
in accessing health care services. Currently, Chesterfield County does not provide lower-cost options for transportation, such as buses, which affects women with no transportation options to access care.

Ability to Understand Health Information

Education levels are directly correlated to breast cancer risk factors, lower screening rates, and the likelihood of participating in health promotion programs (Hussain, Altieri, & Sundquist, 2007, p. 165). In Chesterfield County, 91.4% of the population who were 25 years and older had a high school diploma (United States Census Bureau, 2017). In Virginia, 88.9% of the population had completed high
school in 2015 (Virginia Performs, 2017). Roughly 37.7% of the population, in Chesterfield County, 25 years and older, had a bachelor’s degree (United States Census Bureau, 2017). In 2015, 36.9% of Virginia’s population held a bachelor’s degree (Virginia Performs, 2017). Having a higher level of education increases the ability to understand health information. Higher levels of education result in higher levels of health literacy, which result in better health outcomes, because of the ability to understand health information.

Problem Description

Adherence to mammograms is influenced by anxiety and apprehension (Harvey, Gallagher, Nolan, & Hughes, 2015, p. 777). Since
1990, breast cancer survival has been on the rise due to increased screening rates (Harvey et al., 2015, p. 777). Chesterfield County ranks number 28 as the highest incidence rate of female breast cancer and ranked number 16 for breast
cancer mortality rates compared to the other counties within Virginia (Virginia Department of Health, 2016). Breast cancer is a community concern in Chesterfield County due to the high incidence and mortality rates. Health promotion programs can be developed and designed to address community health problems. In Chesterfield County, the program will address the problem of breast cancer, which includes education about breast health, mammograms, and free community resources that provide medical services.

Community Diagnoses. The risk of complications or death from breast cancer among adult women of Chesterfield County, indicated in the high rate of mortality in African American women and a 12% chance of developing breast cancer in all women, is caused by lack of early screening and treatment but is mediated by certain risk factors, such as a first-degree relative having breast cancer, obesity, increasing age, having the BRCA1 or BRCA2 gene, as well as socioeconomic factors such as poverty and lack of health insurance, lack of education, and
anxiety, given that education, mammograms, financial assistance, and early intervention moderate the causes and that genetic predisposition, age, and race exist prior to the causes.

Community Assessment and Analysis

Roughly 51.8% of women live in Chesterfield County compared to 50.8% who live in Virginia and the United States (United States Census Bureau, 2017). In Virginia, the incidence rate of breast cancer for females in the years of 2009-2013 was 125.5 per 100,000 cases (Virginia Department of Health, 2016). The mortality rate for those years was 22.4 per 100,000 cases, in women, compared with the national
rate of 21.5 deaths per 100,000 cases. As compared with Virginia, the community of Chesterfield County had an incidence rate of 134.2 per 100,000 cases and a mortality rate of 21.0 per 100,000 cases from breast cancer in women (Virginia Department of Health, 2016).

Community strengths and resources. Chesterfield County provides free preventive services, such as Every Woman’s Life, through its health department along with Bon Secours. This free service allows for qualified low-income women to receive mammograms, which can lead to early detection of breast cancer. Social Services, in Chesterfield County, offers many other free services and assists residents with applying for food benefits as well as financial benefits.

Access to care. Chesterfield County has fewer primary care physicians when compared to Virginia overall (Bon Secours Richmond Health System, 2016). In Chesterfield County, there are 89.9 primary care providers per 100,000 residents (Bon Secours Richmond Health System, 2016). In Virginia, there are 124 primary care providers for every 100,000 residents (Bon Secours Richmond Health System, 2016). The lack of physicians in Chesterfield County creates access to care problems for the residents (Bon Secours Richmond Health System, 2016). Access to care issues affects the ability of women to receive breast cancer screening, diagnosis, and treatment if needed.

Review of Literature on Breast Cancer

Løberg, Lousdal, Bretthauer, and Kalager (2015) conducted a literature review related to benefits versus harm of mammography screening for the early detection of breast cancer. Mammography is now available in most developed countries and is the most accurate screening form of diagnosis. Mammograms serve as early interventions for diagnosing breast cancer and create more favorable outcomes. Mammograms help to diagnose breast cancer at an early stage, which improves the chances of survival. The benefits of mammograms outweigh the potential harm that they can cause.

Colditz and Bohlke (2014) conducted a literature review on priorities for the primary prevention of breast cancer. In 2012, 25% of women, worldwide, were diagnosed with breast cancer. Breast cancer was found in 140 cases per 100,000 women ages 45 to 49 years old. Partaking in lifestyle changes to help prevent breast cancer include exercising, lowering alcohol consumption, and changing diet habits. If women participate in modifying lifestyle risk factors attributed to breast cancer, the incidence rates can decrease. Overall, healthy behaviors can reduce breast cancer diagnosed in half of women.

Kraschnewski and Schmitz (2017) conducted a literature review on exercise in the prevention of breast cancer. In 2016, quarter-million women were diagnosed with invasive breast cancer. Certain lifestyle behaviors can contribute to breast cancer and cause negative health outcomes for women who are diagnosed. Participating in exercise has the potential to mitigate breast cancer, reduce mortality rates
from breast cancer, and alleviate side effects from breast cancer treatment.

The United States Department of Health (2014) provides recommendations for Healthy People 2020 for preventing breast cancer. The chance of getting breast cancer can be reduced by changing lifestyle behaviors. Mammography serves as an early intervention for diagnosis.
Women who have no health insurance often fail to participate in mammograms, which reduces the survival rate, if diagnosed. The recommendations provided by Healthy People 2020 seek to help women engage in preventative screenings and change modifiable lifestyle risk factors to prevent the onset of breast cancer.

The United States Preventative Services Task Force (2016) recommends biennial screening mammography for women aged 50 to 74
years. Women aged 40 to 49 years have an individual choice to engage in mammograms. Women ages 50 to 74 years with an average risk of breast cancer benefit most from biennial screening. Women ages 60 to 69 years are more likely to avoid death from breast cancer by participating in mammography. For women aged 75 years and older, there is inconclusive evidence to examine the benefits versus harms of mammography. Women who follow these recommendations are likely to have increased survival rates and better health outcomes due to mammograms.

Community Medical and Health Services

Chesterfield County offers a variety of physician offices, urgent care centers, and free-standing emergency rooms to choose from.
The major hospital located in Chesterfield County is Bon Secours St. Francis Hospital, which was built in 2005 (Bon Secours Health System, 2018). St. Francis has 130 inpatient beds, 497 practicing physicians, and offers 61 specialties (Bon Secours Health System, 2018). Inpatient services provided include surgery, women’s services, 24-hour onsite neonatology, emergency care, cardiology, and much more (Bon Secours Health System, 2018). Bon Secours provides many community health services including Care-A-Van, St. Joseph’s Outreach Clinic, Every Woman’s Life, Children’s Health Insurance, Community Support Committee, and Free Clinic Consortium (Bon Secours Health System, 2018). Care-A-Van provides free medical services for uninsured adults and children who are in remote areas around the region. This service allows for adults, who would otherwise not be able to receive medical services, to receive some type of health care. Many of the community services provided by this hospital are free of charge and seek to reach the residents living in Chesterfield County who are uninsured.

Every Woman’s Life program, provided by Bon Secours, provides breast and cervical cancer screenings for women ages 40-64 who meet
specific financial criteria (Bon Secours Health System, 2018). This program allows for women to receive breast screenings, who otherwise would not be able to afford it, because of having no health insurance. This program has the potential to diagnose early-stage breast cancer in women who cannot afford the cost of screenings. This is just one of the many health services created to help uninsured women receive health care.

Gaps in Services

Women with higher socioeconomic status tend to participate in mammograms more frequently than women with lower socioeconomic
status (Lundqvist, Andersson, Ahlberg, Nilbert, & Gerdtham, 2016, p. 804). Socioeconomic status influences incidence and mortality rates of breast cancer as well as the ability to access health care services (Lundqvist et al., 2016, p. 804). Socioeconomic factors can impact the choice of treatment for breast cancer (Kuzhan & Adli, 2015, p. 17). Socioeconomic status has the potential to create significant health disparities and gaps in services related to breast cancer for women of different ethnicities.

Health disparities or health inequities are important to health care (Riley, 2012, p. 167). Health disparities create unequal health care treatment for different ethnic groups. African American women are affected more by health disparities, which result in higher mortality rates (Riley, 2012, p. 167). Breast cancer mortality rates in African American women are 30.8 per 100,000 compared to Caucasian women, which are 22.1 per 100,000 (Gathirua-Mwangi et al., 2017, p. 70). Other health disparities that lead to low mammography screening rates include socioeconomic status, ethnicity, education level, and geographic location (Susan G. Komen, 2018). Health disparities impact incidence and mortality rates. In the years of 2010-2014, breast cancer mortality was 42% higher in African American women than Caucasian women (Susan G. Komen Foundation, 2018). African American women have an incidence of 114.7 per 100,000 cases of breast cancer compared to 121.7 per 100,000 cases in Caucasian women (Danforth, 2013). Although African American women have a lower incidence of breast cancer, they still experience health disparities due to higher mortality rates and are typically diagnosed at a later stage than Caucasian women (Danforth, 2013). Mammograms can reduce health disparities among women of different ethnicities (Newman, 2005). Women with low-socioeconomic status and no health insurance often experience more health disparities. African American women are twice as likely to rely on Medicaid compared to Caucasian women, which affects the ability to receive mammograms (Newman, 2005). Women who live in medically underserved areas are less likely to receive mammograms, which contributes to higher mortality and late-stage diagnosis compared to women who live in medically served areas (National Cancer Institute, 2008). African American women, when compared to Caucasian women, in the United States, have worse health outcomes and access to health care (Parish, Swaine,
Son, Luken, & Igdalsky, 2014). African American women often receive less mammograms than Caucasian women due to the inability to afford health insurance (Parish et al., 2014). Health disparities and gaps in services result in unmet needs of the patient, which have the potential to lead to mortality and higher incidences of breast cancer.

Health Belief Model

Hochbaum and Rosenstock (1974) developed the Health Belief Model to explain preventive health behavior. The model’s constructs try to predict why individuals engage in certain health behaviors, which is often influenced by how severe the individual views the consequence of getting the disease to be (Skinner, Tiro, & Champion, 2015, p. 75). The model can be used as a framework for health promotion programs, including for the interventions and evaluations (Wang, Hsu, J.H. Wang, Huang, & W.L. Hsu, 2014, p. 422). The model’s constructs can be
utilized in health promotion programs to determine why women fail to receive mammograms (Wang et al., 2014, p. 422). Women who participate in mammograms may feel more susceptible towards breast cancer and may understand the consequences of the disease (Abolfotouh et al., 2015).

Breast cancer screening rates are lowest among African American women due to many different factors (Wells & Thompson-Robinson, 2016). Breast cancer has a higher incidence rate in Caucasian women, however, African
American women have a higher mortality rate (Gathirua-Mwangi et al., 2017, p. 70).
African American women may have lower screening rates due to lack of health
insurance and knowledge about mammograms (Wells, & Thompson-Robinson, 2016).
In health promotion programs, women’s barriers to accessing care and beliefs
should be addressed as well as incorporated into the program (Wells &
Thompson-Robinson, 2016). The model can help discover why there are lower rates
of mammography screening among different ethnicities.

Constructs

The
model’s constructs can be incorporated into health promotion programs to help
determine why women engage in certain health behaviors (Zare et al., 2016, p. 57).
The Health Belief Model tries to determine why certain women engage in
preventive breast cancer health behaviors compared to others (Zare et al.,
2016, p. 57). There are six major constructs in the model that can be
incorporated into the Chesterfield County breast cancer health promotion
program. Perceived susceptibility can determine why certain women participate
and others do not in mammograms (Skinner et al., 2015, 78). Women’s beliefs about
the severity of breast cancer can be assessed. Women’s beliefs about the
benefits from participating in the breast cancer program can be assessed to
determine the likelihood of engaging in health behavior change to reduce the
risk of breast cancer (Skinner et al., 2015, p. 78). Barriers as to why women
fail to engage in mammograms need to be incorporated into the program to
increase screening rates. Assessing women’s cues to engaging in health behavior
change is important as well as the belief in themselves to change (Skinner et
al., 2015, p. 78). Incorporating all six of the constructs into the program is
important to increase knowledge and screening rates related to breast cancer.

Health
Promotion Program

Mammograms
serve as an early intervention by detecting breast cancer at a curable stage,
which is the most common type of cancer found in women (Torbaghan, Farmanfarma,
Moghaddam, & Zarei, 2014, p. 44). Breast cancer, roughly, represents 23% of
cases in women (Torbaghan et al., 2014, p. 44). Healthy lifestyle changes can
help prevent or reduce the risk of breast cancer. Mammography remains the top
screening recommendation for detecting breast cancer (Torbaghan et al., 2014,
p. 44).

Torbaghan
et al. (2014) conducted a health promotion program using the Health Belief
Model. The aim of the study was to determine the effects of an educational
intervention using this model on breast cancer preventive behaviors. The study
was conducted on 130 female employees, with 65 in the intervention group and 65
in the control group. A questionnaire was developed to assess the participants’
demographics and incorporated the Health Belief Model’s constructs. The
participants in the intervention group received an educational program that
incorporated various methodologies toward delivering the content in the
program. The study found that those in the intervention group had increased
awareness, knowledge, and were willing to engage in health behavior change
related to breast cancer compared to the control group. Perceived barriers were
found to impact screening rates. Developing educational interventions based on
the Health Belief Model have positive effects on knowledge of breast cancer
preventive behaviors among participants. Educational programs, that incorporate
the Health Belief Model, have the potential to positively impact the health of
women living in different communities.

Use of the Health Belief Model in educational programs to
help women engage in mammography and preventive behaviors related to breast cancer
is important. Determining why women, of all ethnicities, do not engage in
mammograms is essential. Many breast cancer programs incorporate the Health
Belief Model (Torbaghan et al., 2014, p. 44). The goal of the breast cancer
health promotion program, in Chesterfield County, is to encourage women to
participate in mammograms as well as other preventive measures to lower
mortality and incidence rates. The model will be utilized in planning,
implementing, and evaluating the breast cancer health promotion program. A
pre-test questionnaire will be given to participants to help with planning the
educational sessions. The questionnaire will assess beliefs, attitudes, and
knowledge related to breast cancer. Based on the results, the content of the
educational sessions will be developed. The educational sessions will implement
the model’s constructs by addressing beliefs and attitudes related to breast
cancer. Content will also include general breast cancer knowledge. At the end
of each session, a post-test questionnaire will be given to assess the beliefs,
attitudes, and knowledge of the participants. The data will be utilized to
determine if the session was effective in changing health behaviors and
increasing knowledge of breast cancer. The model will be used to increase
breast cancer knowledge in women of all ethnicities in Chesterfield
County.

Critical Analysis

The Health Belief Model’s constructs can be used to determine why women of
different ethnicities have lower screening rates (Pasick & Burke, 2008, p. 352).
The Health Belief Model has been prominently used in research across ethnic
groups since the late 1980s (Pasick & Burke, 2008, p. 353). Women’s health
beliefs and behaviors toward breast cancer may be impacted by cultural views,
awareness of the disease, socioeconomic status, and education level (Skinner et
al., 2015, p. 79). A woman’s age will also impact breast screening behaviors
because breast cancer is more likely to be diagnosed in older women compared to
younger women (Skinner et al., 2015, p. 79). Young women may be less likely to
perceive breast cancer as a threat or engage in breast health or preventive
behaviors because breast cancer is more likely to occur in older women. Gender
can impact how breast cancer is viewed by men and women. The model does not specify
how health behaviors are related to certain variables, such as the possibility
of using alternative methods to examine the health behaviors of women towards
mammograms (Skinner et al., 2015, p. 80).

The Health Belief Model’s constructs have been
scrutinized to determine if they do predict health behavior and if the model is
applicable in changing health behavior (Skinner et al., 2015, p. 80). Perceived
barriers are the most important construct regarding behavior change and
perceived benefits are the second most important construct (Skinner et al.,
2015, p. 81). The model examines why individuals engage in certain health
behaviors but it fails to recognize the emotional component of engaging in
those behaviors (Skinner et al., 2015, p. 89). The Health Belief Model has been
used in a variety of research studies, including cancer screenings, but more
research is needed to determine the effect of the variables on behavior.

Addressing Limitations

The Health Belief Model helps to predict health behavior but fails to consider
alternative reasons as to why women fail to participate in mammograms (Taymoori,
Molina, & Roshani, 2015, p. 288). Acknowledging the possibility of all
reasons as to why women fail to engage in mammograms is important for health
promotion programs (Taymoori et al., 2015, p. 288). Addressing social factors
include looking at religion, family, and lifestyle factors that affect why
women fail to receive mammograms or participate in preventive behaviors is
important. Interpersonal factors concerning the relationship between women and
their physicians may determine why women fail to receive mammograms. Contextual
factors may consist of how the community views mammography and breast cancer,
which may impact women’s health behaviors related to breast cancer screening. More
research is needed to determine how the constructs affect behavior change (Skinner
et al., 2015, p. 89). To address this limitation in health promotion/disease
prevention projects related to breast cancer, questionnaires can be given to
the women involved. The questionnaires will ask questions that reflect the
constructs of the model and individual beliefs related to breast cancer. Careful
consideration will need to be taken to address limitations of the Health Belief
Model in health promotion/disease prevention projects related to breast cancer.

Review of Literature for Health Promotion Program

Asuquo and Olajide (2015) conducted research about the role of health education on breast
cancer awareness. Providing health education about breast cancer can increase
both knowledge and awareness about the disease. Health education about breast
cancer can reduce misconceptions and anxieties related to mammograms as well as
the disease. Incorporating mammograms into health education is important for
reducing incidence and mortality rates among women of all ethnicities.
Providing breast cancer health promotion programs to communities is inherent
for health behavior change in women. Surveys were used in this research to
collect baseline data about the participants, including both their personal
information and knowledge of breast cancer. Health education about breast
cancer has the potential to positively impact the health of women in
communities.

Kisuya et al. (2015) conducted research on the impact of an educational intervention
on breast cancer knowledge. Mammograms have been widely advertised to reduce
mortality from breast cancer. Barriers to mammograms include anxiety,
low-socioeconomic status, insufficient knowledge, and lack of health insurance.
Educating women, in all communities, about breast cancer is vital to reducing
mortality and incidence rates. A survey was used to assess women’s baseline
knowledge about breast cancer. Questionnaires were used after each educational
session to determine the effect of increasing the knowledge of the
participants. Pre and post-test questionnaires were used to monitor the
participants’ knowledge of breast cancer after each session. The study
concluded that the participants’ knowledge about breast cancer increased
significantly after being provided the educational sessions. Providing breast
cancer education through community health promotion programs will help to
increase the knowledge, awareness, and screening rates of women living in that
community.

Agide, Sadeghi, Garmaroudi, and Tigabu (2018) conducted a systematic review of health
promotion interventions to increase breast cancer screening. Health outcomes of
women depend on the stage of breast cancer when they were diagnosed.
Interventions in health promotion programs can increase screening rates due to
increased knowledge and awareness about breast cancer. North America has a high
survival rate of breast cancer compared to other developed countries. The study
found that women who participated in community educational interventions had
improved awareness and knowledge about breast cancer. Providing community
breast cancer health promotion programs is important to improving community
health and screening rates.

Lee and Wu (2011) conducted a study
on the impact of breast cancer educational workshops on knowledge and breast
self-examination practice. Women who are diagnosed with cancer are most
commonly diagnosed with breast cancer. Mammograms serve as an early
intervention in diagnosing and treating breast cancer. The more women who are
educated about breast cancer, the more mortality rates will decrease. Many
different educational strategies, such as health promotion programs tailored to
breast cancer, will help to improve women’s knowledge and awareness. The
researchers used pre and post-test questionnaires to determine how effective
the educational workshops were on improving women’s knowledge of breast cancer.
The Health Belief Model’s constructs were incorporated to determine why women fail
to engage in mammograms.

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