Journal of Education and Health Promotion

Abstract BACKGROUND: Breast cancer is the most common type of cancer and the second leading cause
of death among women. Religion and spiritual behaviors are effective strategies for maintaining
human health. The aim of this study was to determine the relationship between religious orientation
and spiritual intelligence with general health dimensions in women with breast cancer.
MATERIALS AND METHODS: The present study is a correlational study that was performed on
50 women with breast cancer referred to medical centers affiliated to Isfahan University of Medical
Sciences in 2020. Data were collected through questionnaires of religious orientation, spiritual
intelligence, and general health. Data were analyzed by Spearman and regression tests.
RESULTS: The results showed that religious orientation had a significant positive relationship with
the overall score of general health, but the components of religious orientation had a significant
negative relationship with the number of components of public health (p < 0.05). Spiritual intelligence
also had a significant positive relationship with general health. However, the number of components
of spiritual intelligence has a significant negative relationship with the number of components of
general health (p < 0.05).
CONCLUSION: Considering the relationship between religious orientation and spiritual intelligence
with public health and considering educational programs based on spiritual intelligence and religious
orientation in this group of people can be an important step in promoting their general health.

Abstract BACKGROUND: Breast cancer (BC) is the most common cause of cancer‑related deaths in women
globally. Currently, many machine learning (ML)‑based predictive models have been established to
assist clinicians in decision making for the prediction of BC. However, preventing risk factor formation
even with having healthy lifestyle behaviors or preventing disease at early stages can significantly
lead to optimal population‑wide BC health. Thus, we aimed to develop a prediction model by using a
genetic algorithm (GA) incorporating several ML algorithms for the prediction and early warning of BC.
MATERIAL AND METHODS: The data of 3168 healthy individuals and 1742 patient case records
in the BC Registry Database in Ayatollah Taleghani hospital, Abadan, Iran were analyzed. First, a
modified hybrid GA was used to perform feature selection and optimization of selected features.
Then, with the use of selected features, several ML algorithms were trained to predict BC. Afterward,
the performance of each model was measured in terms of accuracy, precision, sensitivity, specificity,
and receiver operating characteristic (ROC) curve metrics. Finally, a clinical decision support system
based on the best model was developed.
RESULTS: After performing feature selection, age, consumption of dairy products, BC family history,
breast biopsy, chest X‑ray, hormone therapy, alcohol consumption, being overweight, having children,
and education statuses were selected as the most important features for prediction of BC. The
experimental results showed that the decision tree yielded a superior performance than other ML
models, with values of 99.3%, 99.5%, 98.26% for accuracy, specificity, and sensitivity, respectively.
CONCLUSION: The developed predictive system can accurately identify persons who are at elevated
risk for BC and can be used as an essential clinical screening tool for the early prevention of BC and
serve as an important tool for developing preventive health strategies.

Abstract BACKGROUND: Women undergoing breast cancer treatment, especially those of reproductive age,
experience sexual health challenges. The aim of this study is to design an interventional program
for promoting the sexual health of women undergoing breast cancer treatment.
MATERIALS AND METHODS: This is a mixed qualitative‑quantitative exploratory study consisting
of four phases. In the first phase, the needs and strategies for promoting sexual health of Iranian
women with breast cancer in Isfahan city will be identified through a qualitative study. The patients will
be selected using purposive sampling method and the data will be collected through semi‑structured
interviews. In the second phase of the study, the relevant literature will be reviewed. In the third phase,
the initial version of the program will be designed based on the results of qualitative study and review
of literature, the appropriate strategies are prioritized by the members of the panel of experts, and
then, the final interventional program is prepared. In the fourth phase, the designed interventional
program will be conducted as a quasi‑experimental study in two groups of intervention and control
and the effectiveness of the program on sexual quality of life, sexual satisfaction, and sexual function
of women undergoing breast cancer treatment will be evaluated. The type of the intervention will be
selected based on the results of the previous phases and the opinion of the expert panel.
CONCLUSIONS: The results of this study are expected to contribute to the design of an interventional
program based on the needs of women undergoing breast cancer treatment and promote health and
meet the sexual health needs of breast cancer patients.

Abstract INTRODUCTION: It is universally acknowledged that strengthen the participation rate in breast
cancer (BC) screening can find cancer in its earlier stages. The aim of this study was to determine the
effect of regular visits to the health centers on women’s knowledge and attitude about BC screening.
MATERIALS AND METHODS: In a cross‑sectional study, data were collected from 380 women
identified with Kurdish background, who were registered in health care centers of Islamabad‑e Gharb
during January and February 2017. The subjects were divided into two regular and irregular groups
based on the quantity of presence in health centers. Data on women’s awareness and attitude about
BC screening were collected by a trained interviewer using a structured questionnaire. Bivariate
analysis, analysis of variance, and independent sample t‑test were used to see the mean differences
within the groups. The level of confidence was set at 0.05 significant.
RESULTS: Women were representative of four health‑care centers of the city, mainly ≤39 years
old  (73.9%), married  (96.3%), with high school education  (44.2%) characteristics. The total
mean  ±  standard deviation of awareness score about BC was 6.03  ±  3.90. In total, 19.2% of
participants had poor  (<2.13), 64.2% had an average  (2.13–9.93), and 16.6% had good  (˃9.93)
awareness about BC. The results showed that the level of knowledge and attitude about BC screening
was significantly different between regular and irregular groups (P < 0.05).
CONCLUSION: An important message from this study is the need for improved and coordinated
BC education for all social classes of women. It is necessary to discover ways to encourage women
with academic education to visit health centers regularly during interventional studies.

Abstract BACKGROUND: Breast cancer is the most common type of cancer among women and it is the
second leading cause of mortality among cancers in women and a major health issue in developed
countries. Although there are simple and effective screening methods, just minority of women use
them. Given the high prevalence of breast cancer in Isfahan women and the low prevalence of
screening behavior, the present study aimed to determine the impact of theory‑based educational
intervention on breast self‑examination (BSE) behavior and mammography.
MATERIALS AND METHODS: The present experimental study was conducted on 93 women referred
to comprehensive health centers in Isfahan through convenience sampling, and by this way 46 women
were included in the control group and 47 in the intervention group. Data collection was done by
a valid and reliable questionnaire. Furthermore, educational interventions were performed for the
intervention group in three sessions. Furthermore, the data were completed in the intervention group
before, immediately after, and 3 months after intervention and before and 3 months after intervention
in the control group. The data were analyzed by SPSS (16); and paired t‑test and repeated measure
test were used for analysis in the intervention group and also independent t‑test and paired t‑test
were employed to analyze data of the control group.
RESULTS: The results showed significant changes in perceived benefit constructs (P = 0.023),
knowledge (P < 0.001), self‑efficacy (P < 0.001), and behavioral intention regarding BSE (P = 0.035)
in the intervention group over time, but changes were not significant in both perceived susceptibility
and severity in the intervention group. As far as mammography behavior is concerned, only the
perceived benefit construct in the intervention group had significant changes. In terms of the screening
behavior, only BSE behavior significantly changed before and after intervention.
CONCLUSION: The study showed that theory‑based education by applying of constructs such
as perceived benefits and self‑efficacy and intention for BSE model could promote breast cancer
screening behavior such as BSE. Therefore, it is suggested that health educators utilize educational
texts based on these constructs to increase their influence on individuals via screening behavior
for breast cancer.

Abstract BACKGROUND: Breast cancer is the most common type of cancer among women. Mammography
is the most sensitive and important method for screening and early diagnosis of breast cancer.
Considering the importance of using mammography in breast cancer screening, this study was
performed to evaluate mammographic determinants.
MATERIALS AND METHODS: In the cross‑sectional study, we surveyed 985 women over 40 years in
Tehran concerning demographic characteristics: age, socioeconomic status, a problem in the breast,
alcohol use, drug use, and health belief model. Logistic regression was used to identify determinant
factors associated with mammography performance.
RESULTS: The results of this study showed that 42.1% (95% confidence interval [CI]: 38, 45)
participant performed mammography at least once during their lifetime. Age (odds ratio [OR] = 4.252;
95% CI = 2.041–8.857); housing situation (OR = 1.706; 95% CI = 1.178–2.469); having breast
problems (OR = 5.224; 95% CI = 3.501–7.795); socioeconomic status (OR = 1.855; 95%
CI = 1.035–3.325); family income level (OR = 1.998; 95% CI = 1.028–3.884); alcohol
consumption (OR = 2.676; 95% CI = 1.344–5.328); smoking (OR = 2.824; 95% CI = 1.418–5.623);
self‑efficacy (OR = 1.935; 95% CI = 1.242–3.015); perceived barriers (OR = 2.017; 95%
CI = 1.348–3.019); self‑care (OR = 4.901; 95% CI = 3.152–7.620); perceived susceptibility (OR = 1.971;
95% CI = 1.271–3.057) and perceived severity (OR = 1.830; 95% CI = 1.170–2.860) were
mammography behaviors determinants.
CONCLUSION: The findings indicated that the rate of mammography screening among Tehranian
women is low and highlights the need for developing a comprehensive national breast cancer control
program, which should be considered as the priority for health‑care providers. Furthermore, the
identification of these factors can help to design an appropriate educational intervention that focuses
on the benefits of mammography screening.

Abstract BACKGROUND: Breast cancer is a preventable disease, using three secondary preventive methods
of mammography, clinical breast examination (CBE), and breast self‑examination (BSE) that can
lead to early detection of breast cancer. This study was designed to assess breast cancer screening
behavior and its associated factors in females employed in South Khorasan.
MATERIALS AND METHODS: In this analytic‑descriptive study, 2256 female personnel of
governmental organizations were investigated in Birjand city in 2016–2017. The data collection tool
was a three‑part questionnaire: sociodemographic characteristics, knowledge about breast cancer
screening methods plus women’s performance, and stage of change regarding screening behaviors
of mammography, CBE, and BSE. The data were analyzed by SPSS 16 and one‑way analysis
variance, Tukey’s post hoc, and multiple logistic regression model statistical tests.
RESULTS: The mean ± standard deviation score of knowledge of the women was 3.45 ± 1.5. There
was a significant difference of the mean score of knowledge between the single and married (P = 0.03)
and age group (P = 0.04). The stage action of mammography, CBE, and BSE was 6.8%, 12.3%,
and 16.8%, respectively. Logistic regression model showed that variables such as age and family
history of breast cancer were highly significant related to mammography and also CBE. Knowledge
was also highly significant in mammography, CBE, and BSE. Education level in CBE, marital status
in BSE and mammography, and job in BSE were also significant (P < 0.001).
CONCLUSIONS: This study reveals insufficient knowledge of female workers about breast cancer
and the negative influence of low knowledge on the practice of breast cancer screening behavior.
Therefore, the establishment and maintenance of regular educational courses for female employees
is essential.

Abstract BACKGROUND: Breast cancer is the most common cancer in Iranian women. The number of people
with this disease is increasing across the world. Positive family history is one of the risk factors for
developing breast cancer. However, early detection is the main method to fight this disease. This
study was conducted to examine the effect of education based on the health belief model (HBM) on
self‑care behaviors among first‑degree relatives of patients with breast cancer.
METHODS: This clinical trial was conducted in 2016 on 80 women in Tehran city, Iran. Data were
collected using a three‑part questionnaire regarding demographic data, the HBM, and self‑care
behaviors. The educational program based on the HBM was held in 4 ninety‑minute training sessions
through lectures, group discussions, question and answer, image presentations, and PowerPoint
presentations. The questionnaires were completed before and 2 months following the intervention
by intervention and control groups. Data were analyzed using descriptive and inferential statistics
through the SPSS16 software.
RESULTS: The mean score of the HBM constructs before the intervention in the groups had no
statistically significant differences (P > 0.05). Eight weeks after the intervention, the mean score of the
constructs of the HBM in the intervention group significantly increased and a statistically significant
increase in the mean score of self‑care in the intervention group compared to the preintervention
was found, so that the self‑care behavior score in the intervention group was 0.69 ± 0.09 before the
intervention and was changed to 0.74 ± 0.09 after the intervention (P < 0.0001).
CONCLUSION: Our results suggest that education based on the HBM was effective in promoting
self‑care behaviors among first‑degree relatives of breast cancer patients. Therefore, education
based on HBM may have an important implication for breast cancer prevention in Iran.

Abstract BACKGROUND: Health literacy plays an important role in adopting preventive behaviors. Considering
the relatively high prevalence of breast cancer in women, this study aimed to assess the association
between health literacy and adopting the preventive behavior of breast cancer in Iran.
METHODS: This was a descriptive, cross‑sectional study, in which 375 female students at Imam
Khomeini International University in Qazvin in the academic year of 2018–2019 were selected through
a stratified random sampling method. Demographic and background questionnaire, the standard
questionnaire of Health Literacy for Iranian Adults in addition to another questionnaire for measuring
breast cancer preventive behaviors, were used for collecting data. Data were analyzed using SPSS
22 using descriptive statistics and logistic regression.
RESULTS: The mean of the breast cancer preventive behaviors and health literacy were 8.92 ±
1.82 out of 16 and 70.80 ± 12.49 out of 100. Regression results showed that there was a statistically
significant association between the adoption of breast cancer preventive behaviors and physical
activity (P < 0.001) and health literacy (P < 0.018). Accordingly, the chance for adopting the preventive
behaviors in good level among students with rare and without physical activity was 0.105 and
0.100 times, respectively, more than students who had been doing physical activity on a daily basis.
Moreover, the same chance among students with adequate and very adequate health literacy was
1.802 and 2.169 times more than students with inadequate health literacy.
CONCLUSION: The results indicated that students with lower levels of health literacy and less
physical activity had shown less tendency to adopt preventive behaviors of breast cancer. Therefore,
special attention should be paid to health literacy (HL), particularly physical activity, application of
health information, and assessment in students when designing educational programs to prevent
breast cancer.

Abstract BACKGROUND: Breast cancer is an increasing health problem in India. Screening for early detection
should lead to a reduction in mortality from the disease. Majority of the population, especially in rural
areas, contact health‑care system through primary health‑care workers.
AIM: To know the knowledge of breast cancer risk factors and methods for its early detection among
the primary health‑care workers in Shimla district, Himachal Pradesh.
MATERIALS AND METHODS: A descriptive cross‑sectional study questionnaire study was
conducted among primary health‑care workers (both males and females) in Shimla district,
Himachal Pradesh. The data were analyzed using SPSS software version 16. The statistical
tests used were t‑test, ANOVA, and Fisher’s exact test. P = 0.05 was considered statistically
significant.
RESULTS: Out of a total of 120 patients, there were 46 males (38.3%) and 74 females (61.7%).
The mean age of the population was 48.5 ± 5.3 years, with a range of 25 and 57 years. The mean
knowledge score percent of the present population was 71.04 ± 18.3. The mean knowledge score
was higher among males (73.9 ± 19.8) as compared to females (69.2 ± 17.2). Approximately 43.3%
of the participants had very good knowledge about risk factors followed by 31.7% having excellent
knowledge, 20% having good knowledge, and 5% having poor knowledge.
CONCLUSION: The overall mean knowledge percent about breast cancers among primary
health‑care workers in this study was very good, slightly higher among males and postgraduates,
but to make it universal, reinforcement of educational programs can be planned for them.

Abstract BACKGROUND: Health beliefs play an important role in people’s willingness to participate in
health‑promoting behaviors. Given the role of beliefs in women’s function and the importance of
the benefits of mammogram, and because the predictors of a behavior are a major prerequisite to
codification of an effective prevention program, the present study was conducted with the aim of
predicting mammography based on Health Belief Model (HBM) in women in Khorramabad.
Materials and Methods: In this cross‑sectional study, 262 women referring to health centers in
Khorramabad, Lorestan province, in 2018, were selected by randomly sampling. The data collection
tool was a four‑part questionnaire including demographic information, knowledge on breast cancer
and mammography, Champion’s Health Belief Model, and Champion’s Self‑Efficacy Questionnaire
for Mammography. Validity and reliability of the tool were investigated and confirmed. Data were
analyzed by version 16 of SPSS software using descriptive statistics, Chi‑squared test, and multiple
logistic regression.
RESULTS: The mean (standard deviation) age of the participants was 49.26 (±7.79) years.
Seventy‑nine (30.85%) of the 262 participants reported mammography. Constructs’ sensitivity,
benefits, barriers, and perceived self‑efficacy were significantly different in terms of performing
mammography (P < 0.05). Participants with a history of breast cancer (odds ratio [OR] = 11.18, 95%
confidence interval [CI] = [3.73–33.46]) had lower perceived barriers (OR = 3.54, 95% CI= [1.77–7.09]),
were more likely to undergo mammography than women with no family history of breast cancer, and
had moderate‑to‑high perceived barriers (P < 0.001).
CONCLUSION: The results of this study indicate that health managers are required to pay more
attention to training and promoting screening methods. Understanding the barriers to mammography in
women by managers can help design and implement effective programs that enhance mammography
in women.

Abstract BACKGROUND: With an estimation of every two women newly diagnosed with breast cancer,
one dies. It is accounted that 1 in 28 women is likely to develop breast cancer during her lifetime.
Developing a risk prediction tool by assessing the prevalence of known risk factors in the community
will help public health intervention.
METHODOLOGY: A cross‑sectional study was conducted among 18–64‑year‑old women to gather
the prevalence of known breast cancer risk factors, through a community survey (sample survey). In
this multistage random number‑based cluster sampling study, the results were compiled, collated, and
analyzed in rates and proportions. Statistical conclusions were made using spreadsheets (Microsoft)
and the values were converted into ordinal values using modified Likert scale and median was used
to estimate central values. The estimated prevalence of these known risk factors was re‑assorted for
analysis and these re‑assorted data were categorized into range of values across the communities.
The internal validity of the survey questionnaire was measured using Cronbach’s alpha (α).
RESULTS: The analysis of 558 participants was performed for the known risk factors for breast cancer
including participant’s age, age at menarche, marriage, first childbirth, menopause, family history of
breast cancer and benign breast disease, history of abortion, and body mass index. Based on the
estimated prevalence of these risk factors, a community‑based risk prediction tool was developed
with Cronbach’s α score of medium internal validity.
CONCLUSIONS: The risk assessment tool has collated most of the risk factors of breast cancer
that are capable of being measured at community level. The survey findings concluded that the
community under survey was bearing moderate risk for breast cancer for women.

Abstract BACKGROUND: Awareness of sources of information of mastectomy patients has an important role
in accessibility of reliable health information sources, thus, when they get information, they can be
effective in the treatment and self‑care. The present study aimed to identify the sources of information
used by women underwent mastectomy.
MATERIALS AND METHODS: The current practical research methodology was qualitative, and
research method was conventional qualitative content analysis was performed on 17 patients with
breast cancer undergone mastectomy. The sample targeted two hospitals were selected based on
criteria of Shaeid Mohammadi and the Persian Gulf and Omid Central chemotherapy in Babdar
Abbas. Data were collected by face‑to‑face semi‑structured interviews were conducted in winter
2015. Qualitative content analysis of data was performed at the same time of data collection.
RESULTS: Three themes were seemed (medical, interpersonal, and media) sources for explaining
the sources of information searching. Subcategories derived from the content of medical (physicians,
surgeons, and health workers of health facility centers), interpersonal sources (Family and friends,
peers), and media sources (printed, electronic, and Internet).
CONCLUSION: Given the importance of information on women underwent mastectomy, and their
priority in the use of medical sources, necessitates more attention of health system managers and
planners in providing essential information and their accessibility.

Abstract BACKGROUND: Breast cancer is the most frequently diagnosed cancer and the leading cause
of cancer death in females’ worldwide. Pakistan has higher incidence of the disease than the
neighboring countries and one in every nine Pakistani women suffers from breast cancer which is
one of the highest incidence rate in Asia. Numerous risk factors such as nulliparity, family history,
genetic mutations, increasing age, early menarche, and late menopause are associated with the
development of breast cancer. Lack of awareness and the preexisting myths regarding this disease
have led to the detection of breast cancer at a later stage.
OBJECTIVE: The main objective of this study is to determine the frequency of adequate breast
cancer knowledge and its level among nonmedical women of Karachi coming to attend general
surgery outpatient clinics.
METHODS: A cross‑sectional Study was conducted in Outpatient Clinics, Department of General
Surgery, Civil Hospital, Karachi. The sample of 250 females with nonmedical background was gathered
from December 27, 2016 to June 26, 2017. Adequate breast cancer knowledge was divided into
three criteria such as poor, fair, and good knowledge. Chi‑square test was applied. P ≤ 0.05 was
considered as statistically significant.
RESULTS: The mean age was 35.63 ± 9.56 years. Mean knowledge score was 5.24 ± 2.92.
Overall, 42% of participants were found with adequate breast cancer knowledge whereas 58% of the
participants had inadequate knowledge. Based on the study questionnaire, 38% had poor knowledge,
40.4% had fair knowledge, and 21.6% had good knowledge. Significant association was observed
with age, monthly family income, education status, and occupation.
CONCLUSION: The results showed lack of adequate knowledge. A high proportion (58%) of
nonmedical females had inadequate knowledge about breast cancer.

Abstract BACKGROUND AND AIM: One of the methods for involving breast cancer patients in their own
treatment is to provide them with credible and simple information. To provide this information, it is
first necessary to investigate health information‑seeking behaviors of these patients including their
information needs, sources, barriers, and attitudes regarding health information.
METHODS: This is an applied type study using survey method. The statistical population included
female breast cancer patients referring to Seyed‑Al‑Shohada Hospital of Isfahan (60 patients). Data
gathered through questionnaire.
RESULTS: “Self‑care,” “emotional‑psychological support information,” and “treatment length
and chance of relapse” were the most sought‑after health information by patients. “Brochure and
catalog provided by hospital,” “other cancer patients,” and “physicians and nurses” were the most
important information sources. “High cost of information sources,” “Lack of response from treatment
personal (physicians and nurses),” and “lack or trust in website information” were the most important
information‑seeking barriers. Regarding attitude, participants stated that health information can help
them in areas such as “controlling their conditions,” “adapting to their conditions,” “stress and anxiety
control,” and “preforming their social roles” and “hopefulness.”
CONCLUSION: Credible and relevant information can help patients to seek their treatment with
renewed motivation and energy. This information should be provided for the patients from various
sources such as brochures and websites according to their information‑seeking abilities and health
literacy with low cost. The knowledge of library and medical information experts can be used for
evaluation and creation of easy‑to‑understand information sources.

Abstract BACKGROUND: Breast cancer is a leading cause of deaths worldwide. In Pakistan, one in every
nine women develops breast cancer some time in her life. This high incidence of breast cancer and
the poor socioeconomic conditions of Pakistan make breast self‑examination (BSE) the best tool for
the prevention and early diagnosis of breast cancer. Therefore, the aim of the study was to assess
the knowledge, attitude, and practice of BSE among female college students of Karachi, Pakistan.
METHODS: A cross‑sectional study was conducted on 1000 students from June to December 2016.
Data were collected using a pre-piloted questionnaire, and SPSS (version 20) was used for data
analysis. Chi‑square test was used to determine the significance of the difference in knowledge
and attitude among participants who had performed BSE and those who had not. A P < 0.05 was
considered statistically significant.
RESULTS: The overall response rate was 90.9%. Although 71.4% of the women knew what BSE
was, only 33.1% had performed it. Majority of the participants considered that BSE is important in
the early detection of breast cancer. With 59.7% of the population having an adequate amount of
knowledge, 87.2% had a positive attitude toward BSE. A medical background was found to be a
significant predictor for adequate knowledge and a positive attitude toward BSE.
CONCLUSION: Despite a positive attitude found among the population toward BSE, its knowledge
and practice were inadequate. Educational interventions are required in Pakistan to encourage
young women to perform BSE regularly so that breast abnormalities can be detected early on and
mortalities can be minimized.

Abstract Context: Breast cancer is the most common cancer among Iranian women. Although survival
rate of breast cancer patients has been increased some distresses affect the patients’ quality
of life negatively. the effectiveness of self‑care education, particularly in the sociocultural
context of Iran, has not been adequately investigated. Aims: This study aims at evaluating
the effectiveness of nurse‑led self‑care education program on quality of life in this patients.
Settings and Design: A controlled trial as pretest and posttest design was conducted in
Sayyed‑Al‑Shohada Hospital in Isfahan in 2012. Materials and Methods: Sixty patients with
breast cancer were assigned to either the nurse‑led self‑care education program (n = 30),
or to routine care (n = 30). Quality of life was measured at the time of recruitment and also
3 months after the intervention by the instrument of the National Medical Center and Beckman
Research Institute. Statistical Analysis Used: Data were analyzed by SPSS (version 16)
software using T‑independent, T‑paired and 2
, and Fisher’s exact tests. Results: The
intervention group had significantly greater improvements in quality of life status (P < 0.05).
Furthermore, self‑care education caused a significant increase in the quality of life score related
to physical (P = 0.00), psychological (P = 0.00), social (P = 0.00), and emotional (P = 0.00)
dimensions. Conclusions: Quality of life in patients with breast cancer can be improved by
participating in a nurse‑led self‑care education program. It is suggested that self‑care education
to be added to the routine nursing care delivered to these patients.

Abstract Introduction: Nausea is the worst and most prevalent chemotherapy‑induced complication
experienced by 70–80% of patients despite mediation therapy. Reduction of nausea is one of
the most important roles of oncologist nurses. Today, complementary therapies in addition
to classic medicine, because of their lower costs, receive much attention. Nonetheless, their
safety and effectiveness are not yet proven. The purpose of this research was to investigate the
effect of therapeutic touch plan as a complementary therapy on acute nausea in women with
breast cancer in 2012–2013 in Isfahan, Iran. Materials and Methods: A quasi‑experimental,
single‑blind, randomized control trial with three groups (control, placebo and intervention) was
performed at the Isfahan Seyedolshohada (AS) Teaching Hospital, Isfahan, in 2012–2013. The
intervention was therapeutic touch plan on women with breast cancer, with the three groups
receiving the same medicine regimen. Information was recorded by a checklist after infusion of
chemotherapy drugs. Data analysis was performed by SPSS, ANOVA and Kruskal–Wallis tests.
Results: The ANOVA test showed that the therapeutic touch plan was significantly effective in
reducing the duration of nausea compared with the control and placebo groups (P < 0.001).
The Kruskal–Wallis test showed that the frequency of occurrence of nausea was also reduced
in the intervention and placebo groups compared with the control group (P < 0.001). The
therapeutic touch plan was significantly effective in delaying the onset of nausea compared
with the control and placebo groups (P < 0.001). Conclusion: This research showed that the
therapeutic touch plan is effective in reducing acute chemotherapy‑induced nausea; thus,
education and implementation of the therapeutic touch plan is proposed for clinical nurses.

Abstract Introduction: Traumatic events such as breast cancer along with negative effects on patients
also have positive effects. These cases have been studied less in Iran. Therefore, this study
was conducted with the aim of explanation of positive changes after breast cancer by using a
qualitative approach. Materials and Methods: This qualitative study was conducted in 2012 in
one of the specialized centers for cancer affiliated to Isfahan University of Medical Sciences.
In this study, it was interviewed with 19 women with breast cancer about positive changes
after cancer by using individual, open and deep methods. The interviews were analyzed
with conventional content analysis method. Results: The titles of the three major categories
were included as behavioral changes to maintain and promote health (acquisition of health
information and adopting promoting health behaviors), spiritual development (attention to the
God and sense of meaning in life, revising the values and priorities, strengthening moral and
behavioral traits) and personal growth and flourish (feeling empowerment, confidence and
efforts to achieve the goals and desires). These three categories have led to emerge themes
in this study as the “Awakening after cancer.” Conclusions: The results of this study indicated
positive changes after breast cancer. Considering such changes while providing care and
consulting to patients with breast cancer in addition to facilitate and accelerate positive changes
will be prompted to provide care and proper and influential consulting to promote patient health.

Abstract Background and Objectives: Breast cancer is a major threat to women’s health. Evaluation
of the changes in trend of the incidence rate provides valuable information for the assessment
and planning of development indicators of each country. The aim of the present study was to
apply the JoinPoint regression model for determining changes in the trend of the breast cancer
incidence rate in Isfahan. Materials and Methods: In this cross‑sectional study, 3640 women
with breast cancer referring to oncology and radiotherapy departments of Seyed‑al‑Shohada
and Milad cancer treatment centers of Isfahan during 2001–2010 were studied and sampling
was not done. Joinpoint regression model was used to investigate the pattern of breast
cancer incidence rate. Response and independent variables were the natural logarithm of the
age‑standardized incidence rates and year of diagnosis of breast cancer, respectively, in which
various levels of cancer tumor characteristics (P < 0.05) were analyzed. Results: The incidence
rates increased annually in the age groups of 40–44 years (6.2%), 45–49 years (5.3%), and
55–59 years (5.3%). The trend of incidence rates in women with tumor size ≤2 cm (18.2%),
well (moderately) differentiated tumor grade [8% (10.2%)], positive estrogen (progesterone)
hormone receptor status [10.5% (6.9%)], and the proportion of positive lymph node to surgery
node ≤25% (nonsignificant) was upward. Conclusion: The trend of incidence rates with tumor
size ≤2 cm, well‑differentiated tumor grade, moderately differentiated tumor grade, and positive
estrogen and progesterone hormone receptors was upward. The pattern of breast cancer can
help in cancer prevention and prognosis, and in selecting the best type of surgery.

Abstract Background: Breast cancer is one of the most common cancers in females. Methods of
screening are the best among early detection methods. The goal of this study is effect of
education on preventive behaviors of breast cancer in female teachers of guidance schools
of Zahedan city based on health belief model Materials and Methods: This study was a
semi‑experimental, a kind of case‑control research. This study was carried on 240 female
teachers in guidance schools, Zahedan city, in 2011‑2012 academic years with multi‑stage
sampling. Data collection tool was a questionnaire that was used after confirmation of validity
and reliability. Data were collected with questionnaire after analysis, educational intervention
with lecture, view video, group discussion, question and answer performed. Two month after
intervention, secondary evaluation was performed. Collected data with SPSS software and
appropriate statistical tests like: Paired t‑test, independent t‑test, regression analysis, Chi‑square
were analyzed. Results: Persons mean age in this study was 39.40(±7.4) years. In awareness
item and health belief model constructs (awareness, perceived susceptibility, perceived
seriousness, perceived benefits, perceived barriers, self‑efficiency, behavior) and also practice,
paired t‑test showed significant difference among before and after education (P > 0.0001).In two
groups based on Chi‑square in level of education and married status, there were no significant
differences. Also, regression analysis outcomes showed that perceived barriers had the most
effect on behavior, and this construct could be predictor of preventive behaviors from breast
cancer. Conclusions: The findings of this study could conclude that educational programs
designed based on the health belief model have significant impact on improving preventive
treatment of breast cancer. Given the fact that Iran has a very high incidence of breast cancer,
since Iranian women’s awareness level and performance specially research samples according
to educational level (associate degree and
higher) and employment conditions as
model for today girls and future mothers in
breast cancer screening before educational
intervention was very low. So, due to need,
increasing women’s awareness in health
belief model framework to promote preventive
behaviors is recommended.

Abstract Background: Breast cancer is the most prevalent type of cancer among Iranian females;
it is noteworthy that the condition of this type of cancer among Iranian women does not
significantly differ from what has been reported from other countries. Considering the
importance of this issue, identification of the backgrounds factors and risk factors of the
breast cancer risk are highly needed. Therefore, the present study is aimed to compare
the risk factors of resident patients of Isfahan province, Iran, with accredited risk factors by
other countries and also identify the importance of each factor in the incidence of cancer.
Materials and Methods: The present work is a case-control study, which was conducted
in 2011. In order to conduct the study, 216 women who had been clinically identified with
breast cancer were selected from Seiedo-Shohada Hospital, Isfahan, Iran, as the case group.
Moreover, 41 healthy women who were the relatives of the selected patients (i.e., sisters and
aunts) were selected as the control group. The data and information of the patients from
1999 to 2010 were collected from either assessing the database system of the center for breast
cancer research or interviewing the patients through phone. To analyze the data, multiple
logistic regression method was applied. Results: The range of age among selected individuals
in this study was from 20-75 years old. The determinant factors for odds of breast cancer
included in the applied multiple logistic regression model were the use of oral contraceptive
pills (OCPs) (odds ratio [OR] =0.18, 95% confidence interval [CI] = 0.04-0.75) as the protective
factor, hormone replacement therapy (OR = 10.2, 95% CI = 1.18-88.89) and menopause at
old age (OR = 1.26, 95% CI = 1.11-2.12) as the risk factors. Furthermore, there was not seen
any significant relationship between age, vocation, and marital status with odds of breast
cancer in multiple model. Conclusion: Based
on the results, use of OCPs as protective
factor, hormone replacement therapy, and
menopause at old age are identified as the
risk factors in developing breast cancer
among women. Influencing and modifiable
factors should be considered very important
in society based interventions and preventive
interventions planning.

Abstract Introduction: Breast cancer is an international health problem in the world over.
Mammography screening behavior has critical role in early detection and decreasing of
its mortality. Educational programs play an important role in promoting breast cancer
screening behaviors and women health. Health belief models (HBM) is the most common
models that have been applied in Mammography screening behaviors. The aim of this
study was to determine the effect of breast cancer screening education using HBM on
knowledge and health beliefs in 40 years women and older. Materials and Methods: In this
Population‑based controlled trial, 290 women of 40 years and older were divided randomly
into experimental and control groups. Health beliefs determined using the Persian version
of Champion’s health belief model scale (CHBMS). Questionnaires were completed before
and 4 weeks after intervention. Four educational sessions were conducted each session
lasting 90 min by lecturing, group discussion, showing slide and educational film based
on HBM constructs. The obtained data were analyzed by SPSS (version 18) and statistical
test at the significant level of a = 0.05. Results: Mean scores of perceived susceptibility,
perceived severity, perceived benefits, barriers and self‑efficacy of mammography and
health motivation in the experimental group had significant differences in comparison
with the control group after educational intervention (P ≤ 0.001). Conclusion: The results
of this study have confirmed the efficiency of educational intervention based on HBM
in increasing of knowledge and health beliefs about breast cancer and mammography
screening behavior. Hence, implementing appropriate educational programs with focus
on benefits of Mammography in early detection of breast cancer and creating positive
motivation for health among women, can increase their practice of having mammography
screening.

Abstract Background: Breast cancer is the most common cause of death in women in the age range
of 35‑55 years. Each year, one or two cases of breast cancer per 1000 women are diagnosed
as new cases. Despite the serious prognosis and high rate of morbidity, mortality, and
pathogenicity, in the case of early diagnoses, the prognosis will be better. The aim of this
study was to investigate the age trends in breast cancer patients with different sizes of tumors
in Breast Cancer Research Center of Isfahan University of Medical Sciences in 2001‑2010.
Materials and Methods: The information in radiotherapy and oncology of Isfahan University of
Medical Sciences and Milad Hospital from 2001 to 2010 were coded and analyzed. Frequency
of patients’ age groups, tumor sizes and the year of cancer diagnosis were calculated.
Correlation test was used for data analysis in statistical analysis in social science (SPSS)
software version 18. Findings: Among the 3722 patients with breast cancer, the highest
relative frequency distribution, respectively was observed in the age of 40‑49 years (34.4%),
50‑59 years (26.6%), 30‑39 years (17.7%), 60‑69 years (13.2%), 20‑29 years (2.5%), 70 years
and older (5.2%) and less than 20 years. Relative frequency distribution of tumor sizes in a
variety of 5 cm (T2) was with the frequency of 59.8%, and then 26% at 5 cm (T3), 10.5% at
2 cm (T1), 3.1% at T4 and 0.6 at In‑situ, respectively. Conclusion: The investigation of age
trends showed that diagnosis rate of breast cancer increased from 2001 to 2004. It reached its
highest value in 2006 at the age range of 30‑39 years. Then, the trend has been downward, and
it has continued to decline until 2010, which
could be the result of the equipping screening
system and recording the malignant cases.
85.8% of the examined tumors in T2 and T3
group were visible and may be disturbing.
Comparing the frequency distribution of the
infected population showed that the highest
incidence of breast cancer diagnosis were in
the age range of 40‑49 years. It seems that as
long as the mass has not reached an obvious
palpable state, it has not been diagnosed.

Abstract Introduction: The prevalence of breast cancer among women in compare to other types of
cancers in all over the world and in Iran is high. Mastectomy surgery is one of the common
treatments for these patients. Another method, which is less invasive, is Lumpectomy. This
study comprised the satisfaction of patients under two types of surgery; Mastectomy and
Lumpectomy. Materials and Methods: In this cross-sectional study, two types of patients which
had either, Mastectomy or Lumpectomy, were studied. Results: From 119 patients which studied
here, 80 patients (66.7%) were treated by mastectomy and 39 patients (32.5%) were treated
under lumpectomy. Two groups had not significant differences in duration between diagnostic
and surgery, the number of lymph nodes involved and the number of lymph nodes removed.
Lumpectomy patients had higher pain and numbness in 24 h, 1 week after surgery and at the time
of study than the other group. The observed difference was significant (P = 0.043). Discussion:
It is implied in previous studies that patients under lumpectomy had more satisfaction than
patients under mastectomy. However, no differences were observed in quality-of-life between
the two groups in some other studies. The differences between various studies might be for the
sake of cultural variety and time interval between surgery and filling questionnaire.