Journal List > Korean J Women Health Nurs > v.16(2) > 1037223

Park and Kim: The Effects of Breast Self-examination Program Enriched Environmentally among Healthy Women



The purpose of this study was to determine the effects of an environmental enrichment program on barrier, benefit, confidence, and compliance of breast self-examination in women at 3 months after instruction.


Nonequivalent control group pretest-posttest design was conducted among 62 healthy women. Data were collected through the self-reported questionnaires from December 2008 to March 2009. Women were assigned to one of two treatment groups: (a) no-support of environmental enrichment with the instruction control group; (b) the support of environmental enrichment with the instruction experimental group. All women received the same instruction on breast self-examination once a week for two weeks. Data were analyzed with paired t-test, McNemar test and ANCOVAs of controlling for age run using SPSS/WIN 17.0.


The experimental group was significantly lower than control group on perceived barrier (F=5.91, p=.02) and higher than control group on compliance of breast self-examination (F=4.57, p=.04) after environmental enrichment program. However the environmental enrichment program did not make significant differences on benefit (F=0.01, p=.91) and confidence (F=0.77, p=.38).


Findings suggest that the environmental enrichment should be needed to support women's breast self-examination and expanded for compliance of breast self-examination to promote the secondary prevention of women breast cancer.

Figures and Tables

Figure 1
Research design.
Exp.=experimental group; Cont.=control group; O1=participants' characteristics, barrier, benefit, confidence, and compliance of breast selfexamination; O2=barrier, benefit, confidence, and compliance of breast self-examination; E1, E2=education on breast self-examination, once a week for 2 weeks; X1=environmental enrichment program.
Table 1
Test of Homogeneity of the Participants' Characteristics

Fisher's exact test; have complianced regularly BSE once a month; Exp.=experimental group; Cont.=control group; BSE=Breast self-examination; FHx=Family history.

Table 2
Test of Homogeneity of Perceived Barriers, Perceived Benefits and Confidence of the Participants
Table 3
Effects of Environmental Enrichment Program on Perceived Barriers, Perceived Benefits, Confidence and Compliance of BSE

Paired t-test; McNemar test; §Dummy coded: 1=Have complianced regularly BSE once a month; BSE=breast self-examination.

Table 4
Group Differences of Environmental Enrichment Program on Perceived Barriers, Perceived Benefits, Confidence and Compliance of BSE

ANCOVAs after controlling for age were used to identify group differences in mean change scores between pretest and posttest; Dummy coded: 1= have complianced regularly BSE once a month; BSE=breast self-examination.


This research was supported by Basic Science Research Program through the National Research Foundation of KOREA(NRF) funded by the Ministry of Education, Science and Technology (KRF-2008-313-E00676).


1. Bener A., Honein G., Anne O. The determinants of breast cancer screening behavior: A focus group study of women in the United Arab Emirates. Oncology Nursing Forum. 2002. 29(9):E91–E98.
2. Champion V.L., Menon U. Predicting mammography and breast self-examination in African American women. Cancer Nursing. 1997. 20(5):315–322.
3. Choe M.A., Hah Y.S., Kim K.S., Yi M.S., Choi J.A. A study on exercise behavior, exercise environment and social support of middle-aged women. Journal of Korean Academy of Nursing. 2008. 38(1):101–110.
4. Choi K.O. Effectiveness of teaching in accordance with the teaching program types for the breast self-examination. 1996. Seoul: Kyung Hee University;Unpublished doctoral dissertation.
5. Clark V.A., Savage S.A. Breast self-examination training: A brief review. Cancer Nursing. 1999. 22(4):320–326.
6. Cohen M. Breast cancer early detection, health beliefs, and cancer worries in randomly selected women with and without a family history of breast cancer. Psychooncology. 2006. 15(10):873–883.
7. Dundar P.E., Ozmen D., Oxturk B., Hasploat G., Akyildiz F., Coban S, et al. The knowledge and attitudes of breast self-examination and mammography in a group of women in a rural area in western Turkey. BioMed Central Cancer. 2006. 24:6–43.
8. Elmore J.G., Armstrong K., Lehman C.D., Fletcher S.W. Screening for breast cancer. Journal of the American Medical Association. 2005. 293(10):1245–1256.
9. Hur H.K., Park S.M., Kim G.Y. Factors related to the stage of mammography screening in married Korean women. Journal of Korean Academy of Adult Nursing. 2004. 16(1):72–81.
10. Janda M., Stanek C., Newman B., Obermair A., Trimmel M. Impact of videotaped information on frequency and confidence of breast self-examination. Breast Cancer Research Treatment. 2002. 73(1):37–43.
11. Jirojwong S., MacLennan R. Health beliefs, perceived self-efficacy, and breast self-examination among Thai migrantsin Brisbane. Journal of Advanced Nursing. 2003. 41(3):241–249.
12. Common knowledge for breast cancer. Korean Breast Cancer Society. 2009. Retrieved July 17, 2009. from
13. Lee E.H., Kim J.S., Song M.S. Translation and validation of Champion's health belief model scale with Korean women. Cancer Nursing. 2002. 25(5):391–395.
14. Lee E.O., Lim N.Y., Park H.A. Nursing·medical research & statistical analysis. 1998. Seoul: Soomoonsa.
15. Lee Y.W., Lee E.H. Predicting factors of breast self-examination among middle-aged women. Journal of Korean Academy of Adult Nursing. 2001. 13(4):551–559.
16. Lierman L.M., Young H.M., Powell-Cope G., Georgiadou F., Benoliel J.Q. Effects of education and support on breast self-examination in older women. Nursing Research. 1994. 43(3):158–163.
17. Ludwick R., Gaczowski T. Breast self exams by teenagers: Outcome of a teaching program. Cancer Nursing. 2001. 24(4):315–319.
18. Malotte C.K., Jarvis B., Fishbein M., Kamb M., Iatesta M., Hoxworth T, et al. Assessing breast self-examination compliance in the natural environment. Journal of Behavioral Medicine. 1986. 9(4):363–371.
19. The analysis of patient with cancer on National Health Insurance (2007). Ministry for Health, Welfare and Family Affairs. 2009. Retrieved March 15, 2009. from
20. Nahcivan N.O., Secginli S. Health beliefs related to breast self-examination in a sample of Turkish women. Oncology Nursing Forum. 2007. 34(2):425–432.
21. Nekhlyudov L., Fletcher S. Is it time to stop teaching breast self-examination? Canadian Medical Association Journal. 2001. 164(13):1851–1854.
22. Park S.M., Hur H.K., Kim G.Y., Song H.Y. A descriptive study for developing a program to promote compliance with regular breast self-examination (BSE). Korean Journal of Women Health Nursing. 2007. 13(2):88–97.
23. Pender N.J. M.A. Choi I.S Lee . Health promotion in health practice. 1997. Seoul: Hyunmoonsa;(Original work published 1996).
24. Rosenstock I.M., Strecher V.J., Becker M.H. Social learning theory and the health belief model. Health Education Quartely. 1988. 15(2):175–183.
25. Salazar M.K., Carter W.B. Evaluation of breast self examination beliefs using a decision model. Western Journal Nursing Research. 1993. 15:403–421.
26. Seo Y.O. The difference of women's knowledge, attitudes and practice education after education for breast self-examination. Journal of Korean Academy of Adult Nursing. 2003. 15(1):5–13.
27. Stamler L.L., Thomas B., Lafreniere K. Working women identify influences and obstacles to breast health practices. Oncology Nursing Forum. 2000. 27(5):835–842.
28. Tennessen C., Cimprich B. Views to nature: Effectson attention. Journal of Environmental Psychology. 1995. 15:77–85.
29. Thomas B., Stamler L.L., Lafreniere K.D., Delahunt T.D. Breast health educational interventions: Changes in beliefs and practice of working women. Journal of the American Association of the Occupational Health Nurses. 2002. 50(10):460–467.
30. van Praag H., Kempermann G., Gage F.H. Neural consequences of environmental enrichment. Nature Reviews Neuroscience. 2000. 1(3):191–198.
31. Yang Y.H. The effect of BSE education with practice on knowledge, self-efficacy and performance in middle-aged women. Journal of Korean Academy of Fundamentals Nursing. 2007. 14(2):189–197.
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