Content and context in health education: persuading women to perform breast self-examination

Content in a breast self-examination (BSE) education program was tested according to three motivational approaches with 923 women in Vermont women's clubs. The program was a slide-tape presentation using one of the three approaches and a BSE demonstration followed by a group discussion led by a nurse. A post-test of 374 women 6 months later showed a significant increase in monthly BSE performance from 40 to 71% regardless of motivational approach and an increase in breast cancer knowledge that was somewhat varied by approach, but was significant across all three approaches. Women who did not adopt monthly BSE after the program had an increase in knowledge similar to those who had adopted it. After the program, older women had somewhat less knowledge but performed BSE as often as younger women. Women with a family history of breast cancer were somewhat less likely to perform monthly BSE than other women, and women admitting to inhibitions about BSE were significantly less likely to adopt the practice than other women, yet their monthly BSE also increased as a result of the program. The significant positive change in BSE and knowledge across all groups appeared to be more a result of the supportive women's club context than of variations in program content. Thus, to achieve desired changes in prevention-oriented health behavior, it is suggested that health educators emphasize structuring a favorable context for the presentation of recommended actions such as BSE.