Document Type : Original Article

Authors

1 Department of Emergency Medicine, Emergency Medicine Specialist, Metabolic Disease Research Center, Qazvin University of Medical Science, Qazvin, Iran

2 Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran

3 Department of Occupational Health, School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences, Tehran, 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.

Keywords

1. Karimi SE, Rafiey H, Sajjadi H, Nosrati Nejad F. Identifying
the social determinants of breast health behavior: A qualitative
content analysis. Asian Pac J Cancer Prev 2018;19:1867‑77.
2. Abdul Hadi M, Hassali MA, Shafie AA, Awaisu A. Knowledge
and perception of breast cancer among women of various ethnic
groups in the state of Penang: A cross‑sectional survey. Med Princ
Pract 2010;19:61‑7.
3. Roh S, Burnette CE, Lee YS, Jun JS, Lee HY, Lee KH. Breast cancer
literacy and health beliefs related to breast cancer screening among
American Indian women. Soc Work Health Care 2018;57:465‑82.
4. Nafissi N, Saghafinia M, Motamedi MH, Akbari ME. A survey of
breast cancer knowledge and attitude in Iranian women. J Cancer
Res Ther 2012;8:46‑9.
5. Banegas MP, Bird Y, Moraros J, King S, Prapsiri S, Thompson B.
Breast cancer knowledge, attitudes, and early detection
practices in United States‑Mexico border Latinas. J Womens
Health (Larchmt) 2012;21:101‑7.
6. Azizi F, Hatami H, Janghorbani M. Epidemiology and Control
of Common Diseases in Iran. Tehran: Khorasavi Publisher; 2011.
p. 542‑57.
7. Mahdavi Z, Ramezankhani A, Ghanbari S, Khodakarim L.
Relationship between Health Literacy and female cancers
preventive behaveiors. Payesh J 2017;17:613‑25. Available from:
http://payeshjournal.ir/article‑1‑84‑en.html. [Last accessed on
2018 Oct 06].
8. Naghibi SA, Jamshidi P, Rostami F. Identification of factors
associated with breast cancer screening based on the PEN‑3 model
among female school teachers in Kermanshah. Iran J Health Educ
Health Promotion 2016;4:58‑64.
9. Tehrani H, Majlessi F, Shojaeizadeh D, Sadeghi R, Hasani
Kabootarkhani M. Applying socioecological model to improve
women’s physical activity: A randomized control trial. Iran Red
Crescent Med J 2016;18:e21072.
10. Rosenberg R, Levy‑Schwartz R. Breast cancer in women younger
than 40 years. Int J Fertil Womens Med 2003;48:200‑5.
11. Didarloo A, Shorkhabi Z, Pourali R. Survey of knowledge, worry
and screening behavior towards breast cancer among female
students of Urumia University of Medical Sciences in 2014. Urmia
Nurs Midwifery Fac 2016;14:201‑12. Available from: http://unmf.
umsu.ac.ir/article‑1‑2715‑en.html. [Last accessed on 2019 Sep 09].
12. Guo S, Davis E, Yu X, Naccarella L, Armstrong R, Abel T, et al.
Measuring functional, interactive and critical health literacy of
Chinese secondary school students: Reliable, valid and feasible?
Glob Health Promot 2018;25:6‑14.
13. Halverson JL, Martinez‑Donate AP, Palta M, Leal T, Lubner S,
Walsh MC, et al. Health literacy and health‑related quality of life
among a population‑based sample of cancer patients. J Health
Commun 2015;20:1320‑9.
14. Panahi R, Ramezankhani A, Tavousi M. Health literacy and
preventive behaviors. J Res Health 2018;8:93‑4.
15. Mantwill S, Schulz PJ. Low health literacy associated with
higher medication costs in patients with type 2 diabetes mellitus:
Evidence from matched survey and health insurance data. Patient
Educ Couns 2015;12:625-1630. DOI: 10.1016/j.pec.2015.07.006.
16. Oldach BR, Katz ML. Health literacy and cancer screening:
A systematic review. Patient Educ Couns 2014;94:149‑57.
17. Sentell TL, Tsoh JY, Davis T, Davis J, Braun KL. Low health literacy
and cancer screening among Chinese Americans in California:
A cross‑sectional analysis. BMJ Open 2015;5:e006104.
18. Davis TC, Williams MV, Marin E, Parker RM, Glass J.
Health literacy and cancer communication. CA Cancer J Clin
2002;52:134‑49.
19. Panahi R, Dehghankar L, Hossei N, Hasannia E. Factors Related to
Adoption of Osteoporosis Preventive Behaviors among Females'
High School Students; a Case Study of Qazvin City. J Educ
Community Health 2020;7:105-12.
20. Farah SM, Saati Asr MH, Kavivani Manesh A, Barati M, Afshari M,
Mohammadi Y. Health literacy level and its related factors among
college students of Hamadan University of Medical Sciences,
Hamadan, Iran. J Epidemiol Community Health 2017;4:11‑7.
21. Panahi R, Ramezankhani A, Tavousi M, Osmani F, Ghazanfari E,
Niknami S. Evaluation of health literacy and its influencing factors
on dormitory students of Shahid Beheshti University of Medical
Sciences in Tehran. J Educ Community Health 2016;3:30‑6.
22. Montazeri A, Tavasousi M, Rakhshani F, Azin SA, Jahangiri K,
Ebadi M, et al. Health literacy for Iranian Adults (HELIA):
Development and psychometric properties. J Payesh
2014;13:589‑99. Available from: http://payeshjournal.ir/
article‑1‑279‑en.html. [Last accessed on 2019 Jul 10].
23. Panahi R, Ramezankhani A, Tavousi M, Haeri Mehrizi A,
Niknami S. The psychometric properties of health literacy for
Iranian adults (HELIA) in medical sciences students. J Res Health
2020;10:53‑8.
24. Farmanfarma KK, Zareban I, Jalili Z, Shahrakipour M, Lotfi B.
The effect of education on condition of knowledge, attitude
and preventive behaviors of breast cancer in female teachers
at guidance schools in Zahedan. J Torbat Heydariyeh Univer
Med Sci 2013;1:65‑73. Available from: http://jms.thums.ac.ir/
article‑1‑49‑en.html. [Last accessed on 2019 May 05].
25. Dafei M, Dehghani A, Momeni Z, Kalan Farmanfarma K,
Koohgardi M, Jalali M, et al. Study of breast cancer knowledge,
attitude, and preventive behaviors among women referring
to health‑treatment centers in Yazd, Iran, 2015. Poultry Sci J
2017;15:46‑53.
26. Akhtari‑Zavare M, Muhamad HJ, Rosliza AM, Salmiah MS.
Knowledge on breast cancer and practice of breast self‑examination
among selected female university students in Malaysia. Med
Health Sci 2011;7:49‑56.
27. Javadzade SH, Sharifirad GR, Radjati F, Mostafavi F, Reisi M,
Hasanzade A. The relationship between health literacy, health
status and healthy behaviors among elderly in Isfahan. J Educ
Health Promot 2012;1:31. [doi: 0.4103/2277-9531.100160].
28. Peyman N, Amani M, Esmaily H. The relationship between
health literacy and the theory of planned behavior on breast
cancer screening programs among rural women in Roshtkhar,
Iran 2015. Iran J Breast Dis 2016;9:60‑9. Available from: http://
ijbd.ir/article‑1‑561‑en.html. [Last accessed on 2020 Feb 15].
29. Fernandez DM, Larson JL, Zikmund‑Fisher BJ. Associations
between health literacy and preventive health behaviors among
older adults: Findings from the health and retirement study. BMC
Public Health 2016;16:596.
30. Izadirad H, Zareban I. The relationship of health literacy with
health status, preventive behaviors and health services utilization
in Baluchistan, Iran. J Educ Community Health 2016;2:43‑50.
31. Sajadi FA, Sajadi HS, Panahi R. Health literacy of university
students and its influential factors: A case study at Isfahan
university. J Educ Community Health 2020;7:23‑8.
32. Vozikis A, Drivas K, Milioris K. Health literacy among
university students in Greece: Determinants and association with
self‑perceived health, health behaviours and health risks. Arch Public Health 2014;72:15.
33. Zhang Q, Cui G, editors. Investigation and analysis of Xi’an
college students’ health literacy. International Conference on 2011.
HHBE; 2011. p. 994‑7. Available from: http://ieeexplore. ee.org/
stamp/stamp.jsp?tp=&arnumber=6028991&isnumber=6027878.
[Last accessed on 2019 Aug 20].
34. Scott TL, Gazmararian JA, Williams MV, Baker DW. Health
literacy and preventive health care use among Medicare enrollees
in a managed care organization. Med Care 2002;40:395‑404.
35. Panahi R, Yekefallah L,Shafaei M, Dehghankar L, Anbari M,
Hosseini N, et al. Effect of health literacy among students on the
adoption of osteoporosis-preventive behaviors in Iran. J Edu
Health Promot 2020;9:191.
36. PanahiR, RamezankhaniA, TavousiM, Niknami S. Health literacy
and smoking. J Res Health 2018;8:1‑2.