Effects of an Education Program using a Narrative Approach for Women with Breast Cancer

Myungsun Yi; Young Mi Ryu; Jieun Cha

doi:10.16952/pns.2014.11.1.39

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Yi, Ryu, and Cha: Effects of an Education Program using a Narrative Approach for Women with Breast Cancer

Original Article

Perspectives in Nursing Science 2014;11(1):39-48.

Published online: 20 April 2014

DOI: https://doi.org/10.16952/pns.2014.11.1.39

Effects of an Education Program using a Narrative Approach for Women with Breast Cancer

Myungsun Yi¹, Young Mi Ryu², Jieun Cha²

¹Professor, College of Nursing ․ the Research Institute of Nursing Science, Seoul National University, Seoul, Korea

²Doctoral Student, College of Nursing, Seoul National University, Seoul, Korea

Corresponding author: Ryu, Young Mi College of Nursing, Seoul National University, 28 Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea. Tel: +82-10-2038-3674, Fax: +82-2-747-3948, E-mail: youngmiryu@gmail.com

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study investigated the effects of an educationprogram integrating self-efficacy theory and narratives on self-efficacy, knowledge, and resilience inwomen with breast cancer.

Methods

This study employed a nonequivalent control group posttest only design. A 3-day program consisting of sessions in which participants shared their experiences of breast cancer, lectures on breast cancer, and breast self-examinations was implemented. Datawere collected usingself-reported questionnairesin 2013.

Results

Themean age of participants was 50.8±5.3; approximatelyhalf (52.8%) had Stage II breast cancer at thetime of diagnosis. Theresults showed that the levels of self-efficacy, knowledge, and resilience were significantly higher in the experimental group than in the control group (p<.05).

Conclusion

The results of the study suggest that programs integrating self-efficacytheoryandnarratives wouldbeeffectiveinpromotingresilienceaswellasself-efficacyandknowledge in women with breast cancer. Further studies are needed to identify the effects of such education programs for people with other types of cancer or chronic illnesses.

Keywords: Breast neoplasms, Self-efficacy, Personal narratives, Health education, Psychological resilience

References

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Table 1.

Three-day Education Program using Narrative Approach

Day	Time	Contents	Education methods	Lecturers and goals	Sources of self efficacy/narrative
1st day	09:00∼10:00	Opening announcement	․ Introduction to program and self introduction	․ Nursing professor
	10:00∼12:00	Risk factors and prevention strategies of breast cancer	․ Lecture ․ Question & answer	․ Nursing professor ․ Improve knowledge about breast cancer	․ Vicarious experience
	13:00∼15:00	The structure and function of breast and breast self-examination	․ Lecture and demonstration	․ Nursing professor ․ Improve knowledge about breast ․ Identify the difference between normal and abnormal breast	․ Verbal persuasion ․ Vicarious experience
	15:00∼17:00	The diagnosis and treatment of breast cancer	․ Lecture ․ Question & answer	․ Medical doctor ․ Improve knowledge about breast cancer	․ Vicarious experience
2nd day	09:00∼10:00	Interpersonal communication	․ Lecture ․ Question & answer	․ Nursing professor ․ Improve communication skills	․ Vicarious experience
	10:00∼12:00	Breast self-examination (BSE)	․ Lecture & video watching ․ Question and answer ․ Practice of BSE using silicone breast model and mirror	․ Nursing professor ․ Identify between normal and abnormal breast ․ Improve skills of breast self-examination	․ Vicarious experience ․ Enactive attainment
	13:00∼15:00	Life with breast cancer: Body image and sexual life	․ Lecture & narratives ․ Question & answer	․ Nursing professor ․ Improve quality of life	․ Narrative ․ Vicarious experience
	15:00∼18:00	Narratives: Sharing one's breast cancer experience	․ Listening and talking about breast cancer experiences	․ All participants ․ Increase resilience by telling their own illness experiences	․ Narrative ․ Vicarious experience
3rd day	10:00∼11:00	Written exam
	11:00∼13:00	Practical exam for BSE
	14:00∼17:00	Plan for the future	․ Listening and talking about how to live in the future as women with breast cancer	․ All participants ․ Increase self-efficacy and resilience	․ Narrative
	17:00∼18:00	Closing remarks & program evaluation	․ Discussion ․ Question & answer	․ Program evaluation

Table 2.

Characteristics of the Participants and Homogeneity Test (N=36

Characteristics	Categories	Exp. (n=13)	Cont. (n=23)	Total (N=36)	x² or t	p
Characteristics	Categories	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	x² or t	p
Age (year)		50.5±4.5	50.9±5.7	50.8±5.3	–0.18	.859
Marital status	Single	1 (7.7)	0 (0.0)	1 (2.8)	1.82	.361∗
Marital status	Married	12 (92.3)	23 (100.0)	35 (97.2)
Religion	Yes	11 (84.6)	21 (91.3)	32 (88.9)	0.38	.609∗
Religion	No	2 (15.4)	2 (8.7)	4 (11.1)
Education	Middle schhool	1 (7.7)	3 (13.0)	4 (11.1)	0.70	.784^†
	High school	7 (53.8)	14 (60.9)	21 (58.3)
	College and above	5 (38.5)	6 (26.1)	11 (30.6)
Employment	Yes	5 (38.5)	4 (17.4)	9 (25.0)	1.97	.235∗
Employment	No	8 (61.5)	19 (82.6)	27 (75.0)
Economic status	Upper	12 (92.3)	2 (8.7)	2 (5.6)	1.54	.527^†
Economic status	Middle	1 (7.7)	17 (73.9)	29 (80.6)
Lower	0 (0.0)	4 (17.4)	5 (13.9)
Months since diagnosis		51.8 (60.2)	60.0 (26.0)	58.3 (41.1)	–0.59	.567
Stage	0	1 (7.7)	0 (0.0)	1 (2.8)	7.59	.066^†
	I	3 (23.1)	5 (21.7)	8 (22.2)
	II	4 (30.8)	15 (65.2)	19 (52.8)
	III	5 (38.5)	2 (8.7)	7 (19.4)
	IV	0 (0.0)	1 (4.3)	1 (2.8)
Received treatment^‡	Chemo-therapy	10 (76.9)	21 (91.3)	31 (86.1)	1.44	.328∗
	Radiation-therapy	10 (76.9)	17 (73.9)	27 (75.0)	0.04	1.000∗
	Hormone therapy	8 (61.5)	11 (47.8)	19 (52.8)	0.63	.502∗
Surgery type	Mastectomy	8 (61.5)	13 (56.5)	21 (58.3)	1.90	.393
	Lumpectomy	3 (23.1)	9 (39.1)	12 (33.3)
	Mastectomy + Breast reconstruction	2 (15.4)	1 (4.3)	3 (8.3)
Recurred or metastastic cancer (N=35)	Yes	1 (8.3)	4 (17.4)	5 (14.3)	0.65	.634∗
Recurred or metastastic cancer (N=35)	No	11 (91.7)	19 (82.6)	30 (85.7)
BSE education experience Yes	6 (46.2)	14 (60.9)	20 (55.6)	0.73	.393
BSE education experience Yes	No	7 (53.8)	9 (39.1)	16 (44.4)
BSE performance	1/1 month	0 (0.0)	2 (8.7)	2 (5.6)	8.78	.072^†
	1/2∼3 mon	nths 1 (7.7)	4 (17.4)	5 (13.9)
	1/4∼5 mon	nths 0 (0.0)	1 (4.3)	1 (2.8)
	1/6 month	s 0 (0.0)	6 (26.1)	6 (16.7)
	1/12 mont	hs 4 (30.8)	5 (21.7)	9 (25.0)
	Never	8 (61.5)	5 (21.7)	13 (36.1)

Exp.=experimental group; Cont.=control group;.BSE=breast self-examination.

∗Fisher's exact test; ^†Fisher-Freeman-Halton test; ^‡More than one choice can be checked.

Table 3.

Scores of Self Efficacy, Knowledge, and Resilience in Two Groups (N=36)

Dependent variables	Exp. (n=13)	Cont. (n=23)	t or Mann-Whitney U	p
Dependent variables	M±SD	M±SD	t or Mann-Whitney U	p
Self efficacy	28.4	12.9	21.50	.001 ＜
Knowledge	14.2±0.9	10.8±1.7	6.73	.001 ＜
Resilience	83.5±6.8	75.2±11.9	2.32	.027

Exp.=experimental group; Connt.=control group.

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