Original Research Article

SAGE Open Nursing

Volume 8: 1–8
Breast Self-Examination: Knowledge, © The Author(s) 2022
Article reuse guidelines:
Practice, and Beliefs Among Females sagepub.com/journals-permissions
DOI: 10.1177/23779608221124517
in Jordan journals.sagepub.com/home/son

Suhad Ahmad, MSc1, Aladeen Alloubani, PhD2 ,

Ruba Abu-Sa’da, MSc3 and Yasar Qutaiba, MD4

Abstract
Introduction: Worldwide, breast cancer is one of the most common types of cancer. It is the leading cause of cancer-related
deaths among females in Jordan.
Objective(s): The current study aimed to evaluate breast cancer knowledge levels and practice and assess health beliefs
regarding the model supporting self-breast examination (BSE) in a group of females aged between 20 and 60 in Jordan.
Methods: Descriptive, cross-sectional, correlational design was used; Two hundred females participated in the study, employ-
ing convenient sampling. The adjusted version of the Champion’s Health Belief Model Scale (CHBMS) was utilized to collect
the data.
Results: Most participants were married (F = 128, 64%), and the mean of the participants’ age was (36.18, SD = 10.87). About
73 participants (36.5%) don’t practice BSE; however, 53 participants (26.5%) plan to practice BSE in the future monthly. The
logistic regression model showed that the impact of confidence as positive predictive value on practicing BSE in the last year
(B = 0.141, p < .001) and this year (B = 0.130, p < .001) was statistically significant.
Conclusion: Implications for practice include identifying culturally specific barriers and improving health education programs
to trigger breast self-examination utilization.

Keywords
breast self-examination, breast cancer, knowledge, beliefs, practice
Received 6 April 2022; Revised received 9 August 2022; accepted 21 August 2022

Introduction/Background deaths (International Agency for Research on Cancer,

2021). The top three cancer types are lung, colorectal, and
Breast cancer is a critical illness in developing and developed
female breast cancers in terms of incidence. They are
countries. It is the primary type of cancer among females, among the top five (first, second, and fifth, respectively) in
and the risk rises with age (Francies et al., 2020). Specific terms of mortality. Together, these three cancer types are
hereditary genetic mutations, a personal and family history responsible for one-third of all cancer incidence and mortal-
of breast cancer, and biopsy-confirmed hyperplasia are the ity worldwide. (World Health Organization, 2018). In
main reasons that raise the risk of breast cancer in females Jordan, breast cancer is estimated for 19.7% of total cancer
(Feng et al., 2018). Other reasons that would contribute to
breast cancer are menstrual history (menstrual cycles begin
early or stopped late in life), obesity next to menopause,
1
current use of oral contraceptives, postmenopausal hormone Breast Clinics/Nursing, King Hussein Cancer Center, Amman, Jordan
2
treatment, having the first baby after the age of 30 years, or 3
King Hussein Cancer Center, Amman, Jordan
King Hussein Cancer Center, Amman, Jordan
never had babies, ethnicity features, exposure to radiation, or 4
Early Detection Program, King Hussein Cancer Center, Amman, Jordan
drinking of alcoholic drinks daily (Olsson & Olsson, 2020). Corresponding Author:
In 2020, it was estimated that the worldwide cancer rate Aladeen Alloubani, King Hussein Cancer Center, Amman, Jordan.
has increased to 19.3 million new cases and 10 million Email: [email protected]

Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-
NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution
of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-
us/nam/open-access-at-sage).
2 SAGE Open Nursing

cases diagnosed in 2018 (The Global Cancer Observatory, Health beliefs strongly impact compliance with screening
2020). methods for breast cancer. The HBM is accepted internation-
Globally, breast cancer prevalence rates in women sig- ally as a psychological model capable of predicting and opti-
nificantly outweigh those for other cancers. Moreover, the mizing prevention and health screening actions (Ogden,
most frequently diagnosed cancer in women is breast 2012). This model also offers a valuable context for inter-
cancer (24.2%), and in 154 of the 185 countries, breast preting health actions and has been widely used for breast
cancer is the most prevalent. The leading cause of screening (Champion, 1993). Several studies have assessed
cancer mortality in females (15%) is still breast cancer the awareness, attitudes, and knowledge level of the effect
(World Health Organization, 2018). An early breast of health beliefs on BSE (Abolfotouh et al., 2015;
cancer diagnosis will guide to a better prognosis, and Akhtari-Zavare et al., 2015; Yilmaz & Durmus, 2016).
early discovery of breast cancer aims to enhance the treat- The HBM was used in a study conducted in Saudi Arabia
ment’s outcome. to evaluate BSE practice’s knowledge level and attitudes.
The knowledge level about breast cancer was marginal,
with pessimistic views towards BSE and less than a quarter
Review of Literature of Saudi Arabia women practicing BSE daily (Abolfotouh
Breast self-examination (BSE) is considered the corner- et al., 2015). Another research was carried out in Turkey to
stone testing method for breast cancer screening and early assess health beliefs on BSE practice of a group of health
detection (O’Donovan et al., 2020; World Health care professional women. More than 93% of females don’t
Organization, 2016). The Health Belief Model (HBM) is perform CBE and mammography annually, and less than
one of the frameworks for investigating health-related 43% practice BSE (Yilmaz & Durmus, 2016).
issues to accommodate behavioral health ideas. In the The current study aimed to evaluate the level of knowl-
1950s, a team of psychologists proposed this model to edge and practice about breast cancer and assess the effect
support the reasoning for whether women would or would of health-related behaviors on BSE in a group of females
not utilize preventive health care, such as cancer screening aged 20–60 in Jordan. Moreover, to identify the relation-
and influenza immunizations (Janz & Becker, 1984; ship between health beliefs (Perceived susceptibility,
Rosenstock, 1974). The HBM has been used as an analyti- barriers, seriousness, confidence, benefits, and health
cal tool to study breast cancer screening practices such as motivation) with the frequency of BSE among Jordanian
BSE or mammography screening and attitudes relevant to women.
cancer screening procedures (Dewi et al., 2019; Kirag &
Klzllkaya, 2019).
While several organizations such as the American Cancer Methods
Society (American Cancer Society, 2019) and World Health
Design
Organization (Khatib & Modjtabai, 2006) do not endorse
BSE as an effective screening measure for breast cancer Quantitative, cross-sectional, and correlational designs were
diagnosis, it can raise awareness of breast cancer and utilized. A correlational study is an efficient and effective
warn females and doctors of the need to conduct more approach for obtaining large quantities of data about special
effective screening measures, particularly females with a phenomena (Polit & Beck, 2016).
family history of breast cancer. Screening preventive pro-
cedures for breast cancer, including BSE, clinical breast
examination (CBE), and mammography are the primary
Sample
measures for discovering breast cancer (Shah & Guraya, The data were collected between June 2019 and December
2017). Despite the worldwide guideline for conducting 2020 in Amman, Jordan. A convenience sample of 200
breast cancer screening measures, routine practice is still females aged between 20 and 60 living in Jordan participated
low (Hajian-Tilaki & Auladi, 2014). It was also found in the study. The sample size was calculated with a 95% con-
that adherence to BSE, mammography, and CBE is com- fidence level, 0.5 prevalence, and 0.05 margin of error using
paratively poor in Turkey (Yilmaz & Durmus, 2016). the Epi-info 2000 statistical software.
Another study in Saudi Arabia showed that 7.8% only prac-
ticed BSE regularly. Moreover, health beliefs may impact
women’s behavior in practicing BSE (Gonzales et al.,
Instrument
2018). Other studies were conducted among female stu- The health beliefs model scale (HBMS) was developed by
dents in Jordan; these studies showed that the awareness Champion, which has Cronbach’s alpha ranges from
of breast cancer and practice of BSE are inadequate, and 0.73–0.93 (Champion, 1993). The Arabic revised version
they must be encouraged to practice BSE regularly of the BMS was developed by Mikhail and Petro-Nustas
(Al-Mousa et al., 2020; Al Odwan et al., 2016; Alsaraireh (2001). The questionnaire includes sociodemographics,
& Darawad, 2018; Suleiman, 2014). measuring breast cancer’s health beliefs, signs of breast
Ahmad et al. 3

cancer, and risk factors, as well as Sociodemographic charac- Statistical Analysis

teristics such as the participants’ age, income level, marital
The Statistical Package for the Social Sciences (SPSS)
status, family type, health insurance, and education level,
version 22 was used to analyze the data. Descriptive statistics
were assessed. The perceived income level was evaluated to
included (frequency, percentage, mean, and standard devia-
recognize the family’s income level. The participants were
tion) were used to analyze the demographic data. Binomial
asked about breast cancer knowledge and family history of
logistic regression was used to predict the probability of
breast cancer.
the practice of BSE in the last year, now, and in the future
HBMS comprises 42 items to assess six domains, includ-
based on knowledge and demographic variables.
ing susceptibility (five items), seriousness (seven items), ben-
efits (six items), barriers (six items), health motivation (item
questions), and confidence (11 items). A 5-level Likert scale Results
was applied for scoring ranging from strongly disagree (1
point) to strongly agree (5 points), with the total score Sample Characteristics
ranging between 42 and 220.
Most participants were married (F = 128, 64%), and around
half of them had a bachelor’s degree (F = 95, 47.5%). The
Inclusion/Exclusion Criteria mean age of the participants was 36.18 (SD = 10.87).
The inclusion criteria include females able to read, write, and Regarding the history of breast cancer, most of them didn’t
understand because the data collection technique is a form of have a personal history (F = 174, 87%), and more than half
a self-report questionnaire. Additionally, BSE has suggested of them had a family history of breast cancer (F = 114,
being adopted by 20–60 years females as a potential age 57%). Finally, 95 participants have private medical insur-
group for an early detection practice for breast cancer ance. (Detailed information about demographics is presented
(American Cancer Society, 2019). in Table 1).

Data Collection Procedure Knowledge and Practice on BSE

Participant recruitment was conducted face to face by the two Table 2 presents the Knowledge and Practice of BSE.
female nurses for those who met the inclusion criteria. Around 35 participants heard about breast cancer from
Informed consent was obtained from all subjects before the par- doctors or nurses, 18 participants from the media, and 14 par-
ticipation. Participants who met the inclusion criteria were ticipants from their families. At the same time, about 29.5%
invited to participate voluntarily in the study. They were of participants heard about breast self-examination from
assured that there were no consequences for their refusal; the doctors or nurses, followed by the media (11.5%) and 7%
participants were completely anonymous; hence at any time, from newspapers.
participants had the option to withdraw from the study. About 73 participants don’t practice BSE; furthermore,
HBMS was numerically coded and provided with a 30% of the participants didn’t practice the BSE in the past,
closed envelope for each participant to assure confidentiality. and 14% of the participants don’t have a plan to practice
Furthermore, the investigators were postings a flyer that calls BSE in the future. In contrast, 16.5% of the participants prac-
for visitors interested in participating in opening contact with ticed BSE on monthly basis. However, 26.5% have a plan to
the data collector. In addition, the primary investigator has pro- practice BSE monthly in the future. (Detailed information on
tected the confidentiality of the research participants’ personal BSE practice is presented in Table 2).
information. Lastly, the data collector gave the participants
adequate possibility to consider whether or not to enroll in
Health Belief
the study.
Table 3 showed the Participants’ Responses to HBM
Subscale; the mean score for confidence to perform BSE
Ethical Consideration was 23.52 (SD = 7.52). Moreover, the mean of the benefits
Ethical approval to conduct the study was obtained from the of BSE is = 17.02 (SD = 4.15). Also, the mean of the barriers
Institutional Review Board (IRB). All methods were per- to performing BSE was ( 6.3, SD = 3.85). (Detailed informa-
formed in accordance with the relevant guidelines and regula- tion about HBMS is presented in Table 3).
tions. The aim of the study was clearly described to the
participants. Confidentiality was guaranteed, and the partici- Prediction of BSE Practice by age and HBM
pants were assured about the anonymity of their data. Each
participant was assigned an identification number on the Subscale
tool. For more confidentiality, the collected data for this Binomial logistic regression was executed to determine the
study were stored in a locked file cabinet. effects of age and HBMS on the likelihood that participants
4 SAGE Open Nursing

Table 1. Participants’ Demographic Characteristics.

Frequency Percentage

Education High school 40 20%

Diploma 27 13.5%
Part of Bachelor 10 5%
Bachelor degree 95 47.5%
Higher education 28 14%
Marital Status Single 64 32%
Married 128 64%
Divorce or Widow 7 3.5%
Family History about Breast Cancer No 114 57%
Mother 31 15.5%
Sister 21 10.5%
Second degree relatives 34 17%
Personal History of breast cancer Yes 26 13%
No 174 87%
Medical Insurance No 45 22.5%
Private 95 47.5%
Governmental 23 11.5%
Military 12 6%
Other 25 12.5%
Mean Std. Deviation Min. – Max.
Age 36.18 10.877 20 - 60

practice BSE in the last year, now, and in the future. The 2015; Alomair et al., 2020). Another study by Ewaid et al.
logistic regression model showed that the impact of confi- in Iraq showed that most respondents had information
dence on practicing BSE in the previous year was statistically about breast cancer risk factors. In addition, the internet
significant (B = 0.141, odds ratio = 1.151, p < .001). and television were the primary sources of information
Regarding practicing BSE this year, the regression model about breast cancer (Ewaid et al., 2018). Furthermore,
showed only two predictors were statistically significant as similar to the current study results, Ibnawadh et al.
presented in Table 4: barriers as negative predictive value reported that social media was the main source of BSE
(B = −0.110, odds ratio = 0.896, p = .042) and confidence knowledge (Ibnawadh et al., 2017). Other studies reported
as positive predictive value (B = 0.130, odds ratio = 1.193, inconsistent results with the present study’s findings;
p < .001). Concerning the participants’ plan to practice Dundar et al. conducted a study in western Turkey that
BSE in the future, BSE benefits were statistically significant stated that the primary source of information about
as positive predictive value for practice BSE in the future breast cancer is health care professionals (Dündar et al.,
(B = 0.165, odds ratio = 1.179, p = .011). 2006).
Most participants in the current study assumed that they
had heard about BSE; however, around one-third of the par-
Discussion ticipants did not practice it. Ewaid et al. stated that the BSE
The current study aimed to evaluate the level of knowledge practice of females in Iraq was poor because they have insuf-
and practice about breast cancer and assess the effect of ficient knowledge about breast cancer, and around a quarter
health related-behaviors on BSE in a group of females aged of the students practiced BSE (Ewaid et al., 2018). Another
20–60 in Jordan. Moreover, to identify the relationship study conducted in Iraq stated that less than half of the par-
between health beliefs (Perceived susceptibility, barriers, ticipants practiced BSE. A lack of understanding of how to
seriousness, confidence, benefits, and health motivation and correctly perform the BSE technique was the most
BSE frequency among Jordanian women. common explanation for not doing so. Nearly 84% of the par-
In the current study, most participants were aware of ticipants were able to teach others in the BSE methodology
breast cancer and agreed that social media was the main (Alwan et al., 2012).
source of information for their knowledge. Other studies A study conducted in Iran stated that participants’
conducted in Saudi Arabia in 2015 and 2020 stated that knowledge regarding breast cancer and BSE is insuffi-
most participants displayed a moderate knowledge level cient, and knowledge level of breast cancer was signifi-
concerning breast cancer, and the primary source of infor- cantly linked with BSE performance (Akhtari-Zavare
mation about breast cancer is social media (Al-Haji et al., et al., 2014). Another study conducted in Jordan indicated
Ahmad et al. 5

Table 2. Knowledge and Practice on Breast Self-Examination. Table 3. Participants’ Responses to Health Belief Model Subscale.

Frequency Percentage Minimum Maximum Mean Std. Deviation

Susceptibility 0 20 9.68 3.49
Have you heard about No 13 6.5% Seriousness 0 28 13.65 5.57
breast cancer & Family 14 7% Benefits 0 24 17.02 4.15
Source of Information Doctor or 35 17.5% Barriers 0 22 6.30 3.85
Nurse Confidence 0 42 23.52 7.52
Friends 6 3% Motivation 0 28 18.95 4.30
Media 18 9%
Newspaper 10 5%
Other 104 52% Table 4. Prediction of BSE practice by age and Health Belief Model
Have you heard about No 10 5% Subscale Using binomial logistic regression.
breast self-exam & Family 10 5%
Source of Information member 95% C.I.
Odds
Doctor or 59 29.5%
B S.E. P value Ratio Lower Upper
Nurse
Friends 3 1.5% Did you practice BSE in the last year
Media 23 11.5% Susceptibility −.016 .057 .779 .984 .880 1.100
Newspaper 14 7% Seriousness .019 .035 .580 1.020 .952 1.093
Other 81 40.5% Benefits −.012 .052 .818 .988 .893 1.093
Did you practice BSE in No 60 30% Barriers −.063 .052 .228 .939 .848 1.040
the last year Monthly 33 16.5% Confidence .141 .030 < .001 1.151 1.086 1.220
Once per 2-3 22 11% Motivation .006 .047 .906 1.006 .917 1.103
months Age .030 .018 .102 1.030 .994 1.067
Once every 6 29 14.5% Are you practicing BSE
months Susceptibility −.048 .054 .378 .953 .858 1.060
Once per 40 20% Seriousness .050 .035 .145 1.052 .983 1.126
year Benefits .004 .051 .940 1.004 .908 1.109
Others 16 8% Barriers −.110 .054 .042 .896 .807 .996
Are you practicing BSE Yes 66 33% Confidence .130 .028 < .001 1.139 1.078 1.204
No 73 36.5% Motivation .033 .048 .486 1.034 .942 1.135
Sometimes 61 30.5% Age −.001 .015 .945 .999 .969 1.030
Do you have a plan to No 28 14% Do you have a plan to practice BSE in the future
practice BSE in the Monthly 53 26.5% Susceptibility .060 .069 .386 1.062 .927 1.217
future Once per 2-3 31 15.5% Seriousness −.084 .046 .069 .920 .840 1.007
months Benefits .165 .065 .011 1.179 1.039 1.338
Once every 6 45 22.5% Barriers −.064 .059 .277 .938 .836 1.053
months Confidence .068 .037 .067 1.070 .995 1.151
Once per 43 21.5% Motivation −.008 .059 .887 .992 .883 1.114
year Age .003 .023 .896 1.003 .959 1.049

that 34.9% were aware of BSE, but it was carried out by BSE (Koc et al., 2019). Moreover, El Bcheraoui et al. reported
only 11%. So, the breast cancer awareness among a higher incidence of non-compliance with breast cancer
female students in Jordan and BSE performance are insuf- screening measures in Saudi Arabia (89%) (El Bcheraoui
ficient (Suleiman, 2014). Furthermore, Jahan et al. et al., 2015).
reported that 69.7% of the women had never heard about In developing nations, females seek medical care when
BSE, and about 18.7% said that they practiced it (Jahan cancer has already entered an advanced phase. There may
et al., 2006). Ahmed et al. stated that although about be several explanations for this delayed practice: Lack of
71.4% of the females in Pakistan knew what BSE was, awareness and knowledge of the importance of cancer
only 33.1% had performed it (Ahmed et al., 2018). screening measures are the frequently described reasons for
Dadzi and Adam stated that about 64.9% of the females paying no attention to screening measures (Elkum et al.,
in Ghana had good knowledge of breast cancer and that 2007). So, developing an early detection program for breast
only 37.6% of them practice BSE (Dadzi & Adam, cancer could be the most viable technique in a population
2019). Moreover, Koc et al. reported that around 73.3% where most cancers eligible for early detection are detected
of female university students in Turkey had heard about in the late stages. From its late stages (III and IV) to its
BSE, and only about half of them stated that they practice early stages (0, I, and II), where the condition is more
6 SAGE Open Nursing

curable, survival rates are highest, and care costs are lowest, Ethical Approval
the early detection program can downgrade the present status Ethical approval to conduct this study was received from the
of a breast cancer diagnosis. Institutional Review Board (IRB) at the King Hussein Cancer
Center. All methods were performed in accordance with the relevant
Strengths and Limitations guidelines and regulations.

The current study includes some limitations concerning the Informed Consent
study design; cross-sectional or descriptive designs can
Informed consent was obtained from all subjects prior to the
limit inferences of causality (Brady Germain & Cummings,
participation.
2010). Another limitation of this study’s findings is not
intended to be generalized but rather to be used to understand
ORCID iD
the experiences of BSE practices and attitudes among
females in Jordan. Aladeen Alloubani https://orcid.org/0000-0002-5073-3152

References
Implications for Practice
Abolfotouh, M. A., Banimustafa, A. A., Mahfouz, A. A., Al-Assiri,
The Health beliefs model can promote early detection of M. H., Al-Juhani, A. F., & Alaskar, A. S. (2015). Using the
breast cancer by enhancing knowledge and awareness of health belief model to predict breast self examination among
BSE. As a result, women should be advised to self-monitor Saudi women health behavior, health promotion and society.
their breasts in order to recognize abnormalities. Effective BMC Public Health, 15(1), 1–12. https://doi.org/10.1186/
educational strategies are needed to enable women to partic- s12889-015-2510-y
ipate in daily BSE. Ahmed, A., Zahid, I., Ladiwala, Z. F., Sheikh, R., & Memon, A.
(2018). Breast self-examination awareness and practices in
young women in developing countries: A survey of female stu-
Conclusion dents in karachi, Pakistan. Journal of Education and Health
To summarize, breast cancer is the most prevalent cancer in Promotion, 7(1), 90. https://doi.org/10.4103/JEHP.JEHP_147_17
females and can be fatal if not detected early. Advance detec- Akhtari-Zavare, M., Ghanbari Baghestan, A., Latiff, L. A.,
Matinnia, N., & Hoseini, M. (2014). Knowledge of breast
tion can help people live longer and have a better quality of
cancer and breast self-examination practice among Iranian
life. Various diagnostic tools have been developed to assist in
women in Hamedan, Iran. Asian Pacific Journal of Cancer
the early detection of cancer. CBE and mammography are Prevention, 15, 6531–6534. https://papers.ssrn.com/sol3/
recommended as primary diagnostic methods by the World papers.cfm?abstract_id = 3203905
Health Organization, with BSE as a secondary method in Akhtari-Zavare, M., Juni, M. H., Ismail, I. Z., Said, S. M., & Latiff, L.
the absence of CBE and mammography, even though BSE A. (2015). Barriers to breast self examination practice among
is still useful for increasing awareness and discovering any Malaysian female students: A cross sectional study. SpringerPlus,
abnormal changes in the breast. 4(1), 1–6. https://doi.org/10.1186/s40064-015-1491-8
Al Odwan, M. I., Khreisat, I. F., & Khreisat, A. F. (2016).
Authors’ Contributions Knowledge attitude and practice of breast self examination
Suhad Alsater contributed for the conceptualization of the article. among female graduates in princess Muna college of nursing
Yasar Qutaiba contributed for the validation and editing of the and royal medical services college of allied health professions.
article. Ruba Abu-Sa’da contributed for the data curation and meth- Journal of the Royal Medical Services, 23(4), 41–53. https://
odology of the article. Aladeen Alloubani contributed for the doi.org/10.12816/0032200
writing-original draft and formal analysis of the article. Al-Haji, K. M., Amoawed, S., & Mal-Haji, K. (2012). Breast
Cancer, Breast Self-Examination Knowledge Among Female
Availability of Data and Material High School Students In Riyadh City. Middle East Journal Of
Nursing, 9, 25–33. https://doi.org/10.12816/0032200
The data is available upon request. Al-Mousa, D. S., Alakhras, M., Hossain, S. Z., Al-Sa’di, A. G., Al
Hasan, M., Al-Hayek, Y., & Brennan, P. C. (2020). Knowledge,
Code Availability attitude and practice around breast cancer and mammography
SPSS version 21 was used to analyze the data. screening among Jordanian women. Breast Cancer: Targets
and Therapy, 12, 231–242. https://doi.org/10.2147/BCTT.
Declaration of Conflicting Interests S275445
Alomair, A., Felemban, D., Felemban, M., Awadain, J., Altowairqi,
The authors declared no potential conflicts of interest with respect to
A., Alfawzan, N., Almazayen, F., Korkoman, A., & Alrusayyis,
the research, authorship, and/or publication of this article.
N. (2020). Knowledge, attitude, and practice of breast self-
examination toward breast cancer among female students at
Funding King Saud University in Riyadh, Saudi Arabia. International
The authors received no financial support for the research, author- Journal of Medicine in Developing Countries, 4(2), 429–434.
ship, and/or publication of this article. https://doi.org/10.24911/ijmdc.51-1576668182
Ahmad et al. 7

Alsaraireh, A., & Darawad, M. W. (2018). Breast cancer awareness, Francies, F. Z., Hull, R., Khanyile, R., & Dlamini, Z. (2020). Breast
attitude and practices among female university students: A cancer in low-middle income countries: Abnormality in splicing
descriptive study from Jordan. Health Care for Women and lack of targeted treatment options. American Journal of
International, 39(5), 571–583. https://doi.org/10.1080/07399332. Cancer Research, 10(5), 1568–1591. http://www.ncbi.nlm.nih.
2017.1368516 gov/pubmed/32509398
Alwan, N. A. S., Al Attar, W. M., Eliessa, R. A., Madfaic, Z. A., The Global Cancer Observatory (2020). Jordan: Globocan 2018.
& Awfeeq, F. N. (2012). Knowledge, attitude and practice World Health Organization. https://gco.iarc.fr/today/data/
regarding breast cancer and breast self-examination among a factsheets/populations/400-jordan-fact-sheets.pdf.
sample of the educated population in Iraq. EMHJ-Eastern Gonzales, A., Alzaatreh, M., Mari, M., Saleh, A., & Alloubani, A.
Mediterranean Health Journal, 18(4), 337–345. https://www. (2018). Beliefs and behavior of Saudi women in the university
sciencedirect.com/science/article/pii/S2305050013600986. of tabuk toward breast self examination practice. Asian Pacific
doi:10.26719/2012.18.4.337 Journal of Cancer Prevention (APJCP, 19(1), 121–126.
American Cancer Society (2019). Breast Cancer Early Detection https://doi.org/10.22034/APJCP.2018.19.1.121
and Diagnosis. https://www.cancer.org/content/dam/CRC/PDF/ Hajian-Tilaki, K., & Auladi, S. (2014). Health belief model and
Public/8579.00.pdf. practice of breast self-examination and breast cancer screening
Brady Germain, P., & Cummings, G. G. (2010). The influence of in Iranian women. Breast Cancer (Tokyo, Japan), 21(4), 429–
nursing leadership on nurse performance: A systematic literature 434. https://doi.org/10.1007/s12282-012-0409-3
review. Journal of Nursing Management, 18(4), 425–439. Ibnawadh, S. K., Alawad, M. A., Alharbi, S. S., Alduawihi, N.,
https://doi.org/10.1111/j.1365-2834.2010.01100.x Alkowiter, F. S., Alsalhy, A. E., Alzahrani, A. A., & Alenizy,
Champion, V. L. (1993). Instrument refinement for breast cancer L. A. (2017). Knowledge, attitude and practice of breast self-
screening behaviors. Nursing Research, 42(3), 139–143. examination among females in medical and non-medical col-
https://doi.org/10.1097/00006199-199305000-00003 leges in qassim university. Journal of Health Specialties, 5(4),
Dadzi, R., & Adam, A. (2019). Assessment of knowledge and prac- 219. https://www.thejhs.org/article.asp?issn = 2468-6360;year =
tice of breast self-examination among reproductive age women 2017;volume = 5;issue = 4;spage = 219;epage = 224;aulast = .
in akatsi south district of volta region of Ghana. PloS One, doi:10.4103/jhs.JHS_137_16
14(12), e0226925. https://doi.org/10.1371/JOURNAL.PONE. International Agency for Research on Cancer. (2021). GLOBOCAN
0226925 2020: New Global Cancer Data. https://www.uicc.org/news/
Dewi, T. K., Massar, K., Ruiter, R. A. C., & Leonardi, T. (2019). globocan-2020-new-global-cancer-data.
Determinants of breast self-examination practice among Jahan, S., Al-Saigul, A. M., & Abdelgadir, M. H. (2006). Breast cancer.
women in surabaya, Indonesia: An application of the health Knowledge, attitudes and practices of breast self examination
belief model. BMC Public Health, 19(1), 1581. https://doi.org/ among women in qassim region of Saudi Arabia. Saudi Medical
10.1186/s12889-019-7951-2 Journal, 27(11), 1737–1741. https://pubmed.ncbi.nlm.nih.gov/
Dündar, P. E., Özmen, D., Öztürk, B., Haspolat, G., Akyildiz, F., 17106553/
Çoban, S., & Çakiroǧ lu, G. (2006). The knowledge and attitudes Janz, N. K., & Becker, M. H. (1984). The health belief model: A
of breast self-examination and mammography in a group of decade later. Health Education & Behavior, 11(1), 1–47.
women in a rural area in western Turkey. BMC Cancer, 6(1), https://doi.org/10.1177/109019818401100101
1–9. https://doi.org/10.1186/1471-2407-6-43 Khatib, O., & Modjtabai, A. (2006). Guidelines for the early detection
El Bcheraoui, C., Basulaiman, M., Wilson, S., Daoud, F., Tuffaha, and screening of breast cancer. EMRO Technical Publications
M., AlMazroa, M. A., Memish, Z. A., Saeedi, M. A., & Mokdad, Series, 30. World Health Organization.
A. H. (2015). Breast cancer screening in Saudi Arabia: free but Kirag, N., & Klzllkaya, M. (2019). Application of the Champion
almost no takers. Plos one, 10(3), e0119051. https://doi.org/10. Health Belief Model to determine beliefs and behaviors of
1371/journal.pone.0119051 Turkish women academicians regarding breast cancer screening:
Elkum, N., Dermime, S., Ajarim, D., Al-Zahrani, A., Alsayed, A., A cross sectional descriptive study. BMC Women’s Health,
Tulbah, A., Al Malik, O., Alshabanah, M., Ezzat, A., & 19(1), 1–10. https://doi.org/10.1186/s12905-019-0828-9
Al-Tweigeri, T. (2007). Being 40 or younger is an independent Koc, G., Gulen-Savas, H., Ergol, S., Yildirim-Cetinkaya, M., &
risk factor for relapse in operable breast cancer patients: The Aydin, N. (2019). Female university students’ knowledge and
Saudi Arabia experience. BMC Cancer, 7(1), 1–8. https://doi. practice of breast self-examination in Turkey. Nigerian
org/10.1186/1471-2407-7-222 Journal of Clinical Practice, 22(3), 410. https://doi.org/10.
Ewaid, S. H., Shanjar, A. M., & Mahdi, R. H. (2018). Knowledge 4103/NJCP.NJCP_341_18
and practice of breast self-examination among sample of Mikhail, B. I., & Petro-Nustas, W. I. (2001). Transcultural adapta-
women in shatra/dhi-qar/Iraq. Alexandria Journal of tion of champion’s health belief model scales. Journal of
Medicine, 54(4), 315–317. https://doi.org/10.1016/j.ajme. Nursing Scholarship, 33(2), 159–165. https://doi.org/10.1111/j.
2017.12.002 1547-5069.2001.00159.x
Feng, Y., Spezia, M., Huang, S., Yuan, C., Zeng, Z., Zhang, L., Ji, O’Donovan, J., Newcomb, A., Macrae, M. C., Vieira, D., Onyilofor,
X., Liu, W., Huang, B., Luo, W., Liu, B., Lei, Y., Du, S., C., & Ginsburg, O. (2020). Community health workers and early
Vuppalapati, A., Luu, H. H., Haydon, R. C., He, T. C., & detection of breast cancer in low-income and middle-income coun-
Ren, G. (2018). Breast cancer development and progression: tries: A systematic scoping review of the literature. BMJ Global
Risk factors, cancer stem cells, signaling pathways, genomics, Health, 5(5), e002466. https://doi.org/10.1136/bmjgh-2020-002466
and molecular pathogenesis. In Genes and Diseases, 5(2), 77– Ogden, J. (2012). Health Psychology: A Textbook: A textbook (5th
106. https://doi.org/10.1016/j.gendis.2018.05.001 Edition). McGraw-Hill. https://books.google.jo/books?hl = en&lr
8 SAGE Open Nursing

= &id = MYzFQWZ6GxQC&oi = fnd&pg = PR1&dq = (Ogden, Suleiman, A. (2014). Awareness and attitudes regarding breast
+ 2012). + &ots = ICFV5C3Qcz&sig = 0BS5IveRNairTaPkLqp cancer and breast self-examination among female Jordanian stu-
7v83J2S8&redir_esc = y#v = onepage&q = (Ogden%2C 2012).&f dents. Journal of Basic and Clinical Pharmacy, 5(3), 74. https://
= false. doi.org/10.4103/0976-0105.139730
Olsson, H. L., & Olsson, M. L. (2020). The Menstrual Cycle and World Health Organization (2016). Breast cancer: prevention and
Risk of Breast Cancer: A Review. Frontiers in Oncology, 10, control. WHO. http://www.who.int/cancer/detection/breastcancer/
21, https://doi.org/10.3389/fonc.2020.00021 en/index2.html.
Polit, D. F., & Beck, C. T. (2016). Nursing research : generating World Health Organization (2018). Latest global cancer data:
and assessing evidence for nursing practice. Cancer burden rises to 18.1 million new cases and 9.6
Rosenstock, I. M. (1974). Historical origins of the health belief million cancer deaths in 2018. International Agency for
model. Health Education & Behavior, 2(4), 328–335. https:// Research on Cancer. World Health Organization. http://gco.
doi.org/10.1177/109019817400200403 iarc.fr/.
Shah, T., & Guraya, S. (2017). Breast cancer screening programs: Yilmaz, M., & Durmus, T. (2016). Health beliefs and breast cancer
Review of merits, demerits, and recent recommendations practiced screening behavior among a group of female health professionals
across the world. Journal of Microscopy and Ultrastructure, 5(2), in Turkey. Journal of Breast Health, 12(1), 18–24. https://doi.
59. https://doi.org/10.1016/j.jmau.2016.10.002 org/10.5152/tjbh.2015.2715