Document Type

Final Project

Graduation Date

Spring 5-2-2024

Degree Name

Doctor of Nursing Practice

First Advisor

Jennifer Cera DNP, APRN-NP, WHNP-BC


Purpose and Aims

Breast disease, whether benign or malignant, encompasses a wide array of diagnoses. Breast self- examination (BSE) is a simple screening assessment that improves early recognition and diagnosis. With changes in the 2021 ACOG practice guidelines from mandatory to optional provider-performed clinical breast examinations (CBE), it is imperative for patients to possess basic breast health knowledge and accurate BSE techniques. Current standard patient education is provided via brochures or pamphlets. An educational multimedia website was created using ACOG guidelines to impart knowledge and demonstrate proper BSE techniques. Aims were to evaluate changes in participant’s (1) breast health knowledge (2) self-efficacy in performing BSE.

Theoretical Framework

The educational intervention was developed using the Health Belief Model (HBM) which assesses individuals’ behavior and actions regarding health conditions. Model concepts include 1.) health susceptibility, 2.) seriousness, 3.) benefits/barriers to a behavior, 4.) cues to action, and 5.) self-efficacy. This research assessed behavior towards breast health knowledge and self- efficacy of BSE.


A single group, pre/post efficacy design was used. Breast health knowledge was assessed with the Breast Health Assessment (BHA) and consisted of three subscales; (1) breast cancer signs and symptoms (2) breast cancer risk, and (3) BSE knowledge. The Champions Health Belief Model Scale (CHBM) assessed BSE self-efficacy and consisted of five subscales; (1) susceptibility, (2) seriousness, (3) BSE benefits, (4) BSE barriers, (5) BSE efficacy, (6) health motivation, (7) mammography benefits, and (8) mammography barriers. The validated instruments were collected at pre-intervention (Time 1) and 1-month post-intervention (Time 2). Paired t-tests determined change in all outcome measures. Participants were provided the website link at Time 1 and had access throughout the study. To reduce attrition, text and email reminders were sent at Time 2.

Interim Analysis

A convenience sample of 62 participants were enrolled. The BHA and CHBM at Time 2 were completed by 18 and 24 participants, respectively. Statistically significant increases were found in the BHA subscale of “breast cancer signs and symptoms (p=.024, d=.58), and on the CHBM subscale of “mammography barriers” (p= .023, d=.51). A positive trend was demonstrated in the BHA subscale of “BSE knowledge” as was the CHBM subscale of “BSE efficacy.” Mean age was 44 years (SD = 12.7). Most of the sample were Caucasian and college educated. Thirty-six percent were on hormone contraception or replacement therapy. Eighteen percent had a personal history of breast disease and 46% had a family history of breast cancer.


Participants gained the greatest knowledge with the BHA subscale of breast cancer signs and symptoms and the CHBM subscale of mammography benefits. These findings may translate to increased awareness of early detection and diagnosis. Interim analysis demonstrates attrition to be higher than expected. Considerations to improve retention include provision of one-on-one education of content and use of website at Time 1. Weekly “booster videos” may promote retention. Limitations include time between pre- and post-intervention (1 month). This is an interim analysis; final data has not yet been measured.