Methods of motivating the practice of breast self-examination: a randomized trial

A randomized trial of 1,733 women compared three methods of motivating the practice of breast self-examination (BSE): (a) cognitive teaching which emphasized factual knowledge; (b) affective teaching which stressed feelings, attitudes, and values; and (c) a mixed approach which combined features of both. Subjects returned for follow-up at 3, 12, and 24 months or at 6 and 12 months, at which times they completed questionnaires and were evaluated by nurses. They demonstrated how they performed BSE and palpated breast models for lumps. No differences were observed among the teaching groups for any of several indicators of BSE practice, such as frequency, knowledge about when to do BSE, technique, or number of lumps detected in the model. However, these measures were associated with women's initial confidence in practicing BSE. Women in all teaching groups improved their BSE technique over time. Women in this study practiced BSE more frequently and detected more lumps than reported in other studies. The better performance of subjects in the present study might be ascribed to the amount of time spent teaching and to reinforcement from repeated follow-ups. The affective and cognitive approaches were equally effective in motivating the practice of BSE.