Cue enhancement and the long-term practice of breast self-examination

This study investigates the stimulus control of breast self-examination (BSE) using two methods of cue enhancement: self-managed use of calendars with sticker reminders and monthly reminder postcards. One hundred eighty-nine women patient volunteers with or without menstrual cycles ("cyclic" or "non-cyclic") were randomly assigned to experimental conditions after an initial interview and teaching session. Their monthly BSE records, returned by mail during the 6-month experimental period, constituted the major dependent measure of the study. Results indicate an overall positive effect of postcard reminders and a positive effect for self-management for the cyclic women only. In addition, noncyclic women practiced BSE at a higher rate than cyclic women. A subsequent analysis clarified these results substantially by showing that timing of the postcard and use of self-management account for these group differences. Thus, the interventions seem to be extraordinarily effective in obtaining high rates of BSE over 6 months provided only that they can be appropriately instituted. During the postexperimental period, the rate of BSE practice declined, especially in the postcard conditions. Results are discussed in terms of the applicability of behavioral analysis to intractable problems of patient compliance.