The Effects of Peer Education on University Students' Knowledge of Breast Self-Examination and Health Beliefs

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The Effects of Peer Education on University Students' Knowledge of Breast Self-Examination and Health Beliefs
   PLEASE SCROLL DOWN FOR ARTICLE This article was downloaded by: [TÜBTAK EKUAL]  On: 20 October 2009  Access details: Access Details: [subscription number 772815468]  Publisher Routledge  Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House,37-41 Mortimer Street, London W1T 3JH, UK Journal of Cancer Education Publication details, including instructions for authors and subscription information: The Effects of Peer Education on University Students Knowledge of BreastSelf-Examination and Health Beliefs Ayla Akka Gürsoy a ; Çala Ytba a ; Fatma Yilmaz a ; Hacer Erdöl a ; Hacer Kobya Bulut a ; Havva KaradenzMumcu a ; Kiymet Yelççek Çalik a ; lknur Kahrman a ; Sevlay Hntstan a ; Nesrn Nural aa  Karadeniz Technical University Trabzon School of Health, Trabon, TurkeyOnline Publication Date: 01 October 2009 To cite this Article  Gürsoy, Ayla Akka, Ytba, Çala, Yilmaz, Fatma, Erdöl, Hacer, Bulut, Hacer Kobya, Mumcu, Havva Karadenz, Çalik,Kiymet Yelççek, Kahrman, lknur, Hntstan, Sevlay and Nural, Nesrn(2009)'The Effects of Peer Education on University Students'Knowledge of Breast Self-Examination and Health Beliefs',Journal of Cancer Education,24:4,331 — 333 To link to this Article: DOI: 10.1080/08858190902997449 URL: Full terms and conditions of use: article may be used for research, teaching and private study purposes. Any substantial orsystematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply ordistribution in any form to anyone is expressly forbidden.The publisher does not give any warranty express or implied or make any representation that the contentswill be complete or accurate or up to date. The accuracy of any instructions, formulae and drug dosesshould be independently verified with primary sources. The publisher shall not be liable for any loss,actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directlyor indirectly in connection with or arising out of the use of this material.  331  Journal of Cancer Education , 24:331–333, 2009Copyright © AACE and EACEISSN: 0885-8195 print / 1543-0154 onlineDOI: 10.1080/08858190902997449 HJCE The Effects of Peer Education on University Students’ Knowledge of Breast Self-Examination and Health Beliefs Peer Educationand UniveristyStudents’ Knowledge ofBSE AYLA AKKA S  GÜRSOY, PHD, ÇA G LA Y IGI TBA S , MSC, FATMA YILMAZ, MSC, HACER ERDÖL, MSC, HACER KOBYA BULUT, MSC, HAVVA KARADEN I Z MUMCU, MSC, KIYMET YE SI LÇ I ÇEK ÇALIK, MSC, I LKNUR KAHR I MAN, MSC, SEV I LAY H I  NT I STAN, PHD, NESR I  N NURAL, PHD Abstract— This study was carried out to determine the effects of peer education on breast self-examination (BSE) knowledge and health beliefs. 180 female university students were trained inBSE by the nursing students. Students instructed in groups by their peers showed a much higherdegree of BSE knowledge. It was also found that perceived confidence of the students educatedboth individually and in groups increased afterward. Study results further revealed that the meth-ods used for peer instruction do not affect students’ sub-dimensions of health beliefs differentlyafter the education.imilar to the cancer types and rates for womenthroughout the world, breast cancer is the most com-mon cancer in Turkey and accounts for the secondhighest cause of cancer deaths. 1,2  It is currently not possi-ble to prevent breast cancer; however, early diagnosis isvitally important to improve outcomes. The most effec-tive ways to make a diagnosis are by breast self-examina-tion (BSE), mammography, which is the “gold standard”for early diagnosis, and clinical breast examination(CBE). Studies on BSE in Turkey show that the rate of women having adequate knowledge and who do BSE regu-larly is extremely low. 3-6  Educating young women aboutearly diagnostic methods of breast cancer is criticallyimportant to increasing their awareness. Acquiring thebehavior and practice of BSE at an early age will alsolikely increase the probability of continuing it later. 7,8 The purpose of this study was to determine the effects of peer education on breast self-examination (BSE) knowl-edge and health beliefs. METHODS One-hundred eighty students (180), excluding HealthDepartments, were chosen at random to take part in thisquasiexperimental study. The data of the study are col-lected by questionnaire forms and the Champion HealthBelief Scale.At first, 11 volunteer fourth-level students from theSchool of Health were trained in order to be able to dem-onstrate and teach peer education. Peer training in thatstudy was conducted individually and in group sessions andthe instructor gave a brochure to the student at the end.According to this plan, 32 university students took part inthe individual instruction group and 148 students took partin the group education. The data were collected in 2 phases,a pre-education phase and 1 month after the education. RESULTS The pre-education BSE mean score was 15.4 ±  10.7 andpost-education mean score was 38.0 ±  8.7, and the differ-ence between their knowledge before and after the trainingsessions was exceptionally significant ( P  = .000).Of the students, 82.2% was instructed in groups bytheir peers and 17.8% received training individually. Theeffects of using different methods in peer education on BSEknowledge were studied by using the t  test in dependent Received from Karadeniz Technical University Trabzon School of Health, Trabon, Turkey.Address correspondence and reprint requests to: Ayla Akka s  Gürsoy,PhD, Assistant Professor, Trabzon Saglik Yuksekokulu Emniyet Karsisi,61040 Trabzon, Turkey; phone: +90 462 2300476; fax: +90 462 2300475;e-mail:<>. S  D o w nl o ad ed  B y : [ TÜ B T A K  E K U A L]  A t : 07 :55 20  O c t ob e r 2009  332 GÜRSOY et al.  ■ Peer Education and Univeristy Students’ Knowledge of BSE groups (Table 1). Results showed that the students taughtboth individually and in groups showed a significantincrease in BSE knowledge when compared with theirprevious knowledge ( P  = .000). Again the t  test in inde-pendent groups was used to find out whether the instruc-tion method used would lead to any difference betweenthe groups’ BSE knowledge. The results showed that a sig-nificant difference existed between the groups both before( P  = .012) and after ( P  = .009) the education. The differ-ence between pre- and post-training BSE knowledge lev-els was higher for students who received group educationthan for those who received individual training.Test results also indicated that perceived confidenceafter the training increased significantly for studentsinstructed both individually ( P  = .001) and in the groups ( P = .000). The difference between the students’ (both theones individually taught and the ones educated in groups)health belief scale subdimensions after the education wasnot significant.The significant variables that affect students’ BSEknowledge after the education (Table 2) were also analyzedby using stepwise multiple regression analysis. The type of instruction used for educating students accounted for atotal of 6.6% variance in BSE knowledge after training wascompleted.The correlation between Champion Health Belief Model Scale subdimensions and BSE knowledge wasanalyzed using bivariate correlation analysis. A positiveand highly significant correlation ( r  = .364, P  = .000)between perceived confidence and BSE knowledgebefore the education was found. After the instruction, apositive and significant correlation between BSE knowl-edge and perceived confidence ( r =.028, P  = .002) andhealth motivation ( r  = 0.199, P = .007) was noted.There was also a negative and significant correlationwith perceived barrier ( r  = − .164, P  = .028). DISCUSSION Educating and informing youth about this serious diseaseis both a challenge and important investment in the healthof future generations of women. Peer education consists of discussing the nature of concepts being learned or one per-son teaching another the subject he/she has mastered. Jobanputra and colleagues educated adolescent medicalschool students by using peer education methods to presentinformation about sexual issues. 9  There are sources that rec-ommend using peers for health education so as to reachlarger groups of society. 10  Consequently, there are studiesdemonstrating the success of peer education in differentbranches of health. 11-14  Regarding breast cancer education,peer education has been used for educating adult women,nurses, and midwives. 15,16 The study showed that the students’ knowledge aboutBSE increased significantly after the training. Other studieswhich used peer education to educate about BSE also pre-sented similar results. 17-19 Another question of the study was whether using differ-ent education methods in peer training have any differenteffects on BSE knowledge or not. The surprising result wasthat students instructed in groups had increased their BSEknowledge compared with those instructed individually.Other studies, using both individual and group methods,proved that education increases BSE knowledge. 17,18  Butthe effects of these education methods were not comparedin these studies.This study also investigated the effects of peer educationon health beliefs of the participating students. According tothe results, peer instruction enhances perceived confidencein a positive way. Furthermore, the type of educationmethod does not affect health beliefs.With the aim of finding out the significant variables thataffect students’ BSE knowledge, it was discovered thatregarding the type of peer education method, the study con-firmed that it has a very low effect on BSE knowledge afterthe education (6.6%). The results confirmed that perceivedconfidence and health motivation increase in accordancewith BSE knowledge, and perceived barrier decreases. Asalso stated in the model, increased perceived confidencewould affect BSE performance positively. Rachel andT ABLE  1.Pre- and Post-BSE Knowledge Scores According to Education Methods BSE Knowledge ScorePre-EducationPost-EducationEducation MethodMeanSDMeanSDDifference P Group education14.510.337.28.922.7.000*Individual education19.711.241.66.921.9.000* P .012+.009+*The difference between the group’s pre- and post-educationknowledge levels.+Difference between the groups in pre- and post-education. T ABLE  2.Regression Analysis on BSE Knowledge After Education BetaSimple Correlation tP Education Method.257.2572.724.008Cancer experience of friends  − .100  − .103  − 1.055.294Ever heard/read about BSE  − .070  − .072  − 0.735.464Breast cancer experience of the family − .052  − .053  − 0.545.587The state of BSE Application − .027  − .028  − 0.286.775Cancer experience in the family − .004.004  − 0.037.971  Note. R 2  = .066; F  = 7.420; significant F  = <.01.  D o w nl o ad ed  B y : [ TÜ B T A K  E K U A L]  A t : 07 :55 20  O c t ob e r 2009   Journal of Cancer Education 2009 , Volume 24, Number 4  333 Dunn’s studies 20  and Gerçek and colleagues’ studies 10 showed that people having BSE knowledge and doingBSE have higher perceived confidence.The first step to increasing the number of women usingearly diagnostic methods for breast cancer can be accom-plished by creating awareness and disseminating informa-tion about breast cancer. Motivated by this gap in theresearch, the results of our study supply data about theeffects of peer education on late adolescent students’ BSEknowledge. References 1.Beyda g  KT, Karao g lan H. Effect of Breast Self Examination Educationto the knowledge and Attitudes of Female Students [Kendi KendineMeme Muyenesi E g itiminin Ö g rencilerin Bilgi ve Tutumlar i na Etkisi],TSK Prevetive Medicine Bulletin [TSK Koruyucu Hekimlik Bülteni].2007;6:106.2.Aslan A, Temiz M, Y i lmaz Y, ve ark. The Knowledge, Attitudes andBehaviours of Nursing Students about Breast Cancer [Hem s irelikYüksek Okulu Ö g rencilerinin Meme Kanseri Hakk i ndaki Bilgi, TutumVe Davran is lar i] . TSK Prevetive Medicine Bulletin [TSK KoruyucuHekimlik Bülteni]. 2007;6:193.3.Nahcivan NO, Secginl I  S. Health beliefs related to breast self-examination in a sample of Turkish women. Oncol Nurs Forum.2007;34:4125-432.4.Dundar PE. Ozmen D. Ozturk B, et al. The knowledge and attitudesof breast self-examination and mammography in a group of women ina rural area in western Turkey. BMC Cancer. 2006;6:43.5.Karayurt O. Dramali A. Adaptation of Champion’s Health Belief Model Scale for Turkish women and evaluation of the selected variablesassociated with breast self-examination. Cancer Nurs. 2007;30:69-77.6.Balkaya N, Memi s  S, Demirk i ran. The effects of breast self-examinationon the performance of nursing and midwifery students: a 6-monthfollow-up study. J Cancer Educ. 2007;22:77-79.7.Daley C. College students knowledge of risk and screening recommen-dations for breast and testicular cancers. J Cancer Educ. 2007;22:86.8.Maurer F. A peer education model for teaching breast self-examinationto undergraduate college women. Cancer Nurs. 1997;20:49-61.9.Jobanputra J, Alice R, Giles J, et al. A feasibility study of adolescentsex education: medical students as peer educators in EdinburgSchools. Br J Obstet Gyneaecol. 1999;106:887-891.10.Gerçek S, Duran Ö, Y i d i r i m G, ve ark. To Determine Health Benefitsabout Breast Cancer and Breast Self-examination of Female Studentsstaying Hostels and Factors that affect them [Kredi Yurtlar Kuru-munda Kalan K i z Ö g rencilerin Meme Kanseri ve kendi kendine memeMuayenesi Konusu Sa g l i k I nançlar i  ve Bunu Etkileyen FaktörlerinBelirlenmesi], 11 th  National Public Health Congress, Congress Book[11. Ulusal Halk Sa g l igi  Kongresi. Kongre Kitapç  igi ]. 2007.11.Garcia AC, Henry CJ, Zok A. Peer educat i on i n nutr i t i on for students:part 1.Program development and process evaluat i on. Foodservice ResInt. 2000;12:163-174.12.Roberta J. Ogletree. BH, Judy C, et al. Knowledge and i ntentions of ninth-grade girls after a breast self-examinations program. J SchoolHealth. 2004;74:9.13.Field M, Burke JM, McAlister D, Lloyd DM. Peer-assisted learning: anovel approach to clinical skills learning for medical students. Med.Educ. 2007;41:411-418.14.Gill D, Parker C, Spooner M, Thomas M, Ambrose K, Richardson J.Tomorrow’s doctors and nurses: peer assisted learning. Clin Teacher.2006;3:13-18.15.Çiçeklio g lu M. Ege EC, Soyer MT, ve ark. Using Peer Educater on theTraining of Primary Health Center Nurses and Midwives Training[Birinci Basamaktaki Hem s ire ve EbelerinE g itiminde Akran E g iticilerinKullan i lmas i ; Meme Kanseri Erken Tan i s i  E g itim Pro g ram i  Geli s tirmeDeneyimi]. The Journal of Sted [Sted Dergisi]. 2005;14:249-255.16.Engels Y, Verheijen N, Fleuren M, Mokkink H, Grol R. The effectof a small peer group continuous quality improvement on the clini-cal practice of midwives in the Netherlands. Midwifery. 2003;19:250-258.17.Özkahraman S, ve ark. Improving the breast self-examination skills of women attending public education. In: Concress Programme Book.The First Regional Meeting of The Asian Pasific Organization ForCancer Prevention; 2003:14–16, 48.18.Sevil Ü, Ünsal S, Kiriz H, ve ark. Evaluation the knowledge andbehaviors of female undergraduates related to –from students to stu-dent training method- (peer training) and self- i nspection of breast.Presented at The First Regional Meeting of the Asian Pasific Organi-zation for Cancer Prevention; 2003.19.Chatterje P. A study to asses the effectiveness of planned teachingprogramme on the knowledge of G.N.M. students regarding braestcancer and breast self examination (BSE) and the ability to performBSE in a selected school of nursing in West Benagal. Nurs J India.2002;93:93-94.20.Rachel BF, Dunn P. Effect of a psychosocial intervention on breast-self examination attitudes and behaviours. Health Educ Res.2005;21:287-295.  D o w nl o ad ed  B y : [ TÜ B T A K  E K U A L]  A t : 07 :55 20  O c t ob e r 2009
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