Study design and sampling
This cross-sectional descriptive study was carried out from March to July 2018 with female academicians in Aydın (Aydın Adnan Menderes University), Turkey. The study population was determined to be 156 with the G-power program using an impact size of 0.40, α = 0.05 and power (1-β) = 0.80 at a confidence level of 95%. Their schools were divided into two groups: health care schools and other schools. The number of female academicians from each school was determined using stratified sampling followed by simple random sampling. The following formula was used to determine the sample size.
n: Sample size,
N: Number of units in the population,
Nh: number of units in layer h,
Sh2: variance of layer h,D2 = (d2 / z2),
d: The maximum error amount that can be accepted by the investigator or the difference between the sample mean and the population mean,
z: This is the z value in the standard normal distribution table according to the margin of error.
$$ \frac{\mathrm{N}.\sum \left(\mathrm{Nh}.{\mathrm{Sh}}^2\right)\;\mathrm{n}=}{{\mathrm{N}}^2\kern0.5em .{\mathrm{D}}^2+\sum \left(\mathrm{Nh}.{\mathrm{Sh}}^2\right)\;} $$
A total of 200 female academicians were included in the study. Of them, 135 were in the health care field, and 65 were in other fields.
The inclusion criteria were: Women academician, working in Aydın Adnan Menderes University, agreed to participate in the study.
Data collection and ethics
This study was approved by the Aydın Adnan Menderes University Faculty of Health Sciences Ethics Committee [code number:2018/08]. Permission to carry out the study was obtained from the Rectorate of Adnan Menderes University before the data collection. A validated and reliable self-administered, structured questionnaire was prepared according to the Health Belief Model Scale for BC Screening, developed by Champion 1984 and the validity and reliability of Turkish version as tested by Gozum and Aydin, together with an extensive review of the literature on sociodemographic forms [15, 16]. After obtaining the participants’ written and verbal consent to participate, the study’s purpose and its benefits for women’s health were briefly explained. Academicians included in the study were visited in their schools and all the participants filled out the forms by their own in approximately 15 min.
Socio-demographic characteristics questionnaire
The questionnaire was developed for this study. And the questionnaire hasn’t been published elsewhere. This questionnaire included 20 questions about the participants’ age, marital status, school field, title, family type, income level, smoking, drinking alcohol, exercise level, chronic disease, mental illness, giving birth, BC screening in the last 6 months, regular BSE, BC history of close relatives, body type, stress control levels, health assessment, eating habits and sleep habits. In addition, the questions “Have you ever done any BSE?” and “Can you perform a regular BSE?” were asked to determine the practice of BSE, with the response options of “yes” or “no”, “Can you mark your sleep habits” was asked to select one of the given expressions to “I would lay out at the same time as the regular time and be careful to sleep at the same time as the previous day”, “Some nights I only sleep for a few hours, except that I regularly sleep”, “My sleep order does not change every day”, “Do you have a chronic disease?”, with the response options of “yes”, “no”.
The Champion health belief model scale for breast Cancer screening
This scale has been developed by Champion in 1984 and revised in 1993,1997 and lastly in 1999 for the health beliefs concerning BSE and mammography screening of BC, and it was translated into Turkish by a number of researchers and culturally adapted for use with the Turkish population [15, 16]. This study used the Turkish version of CHBMS developed by Gözüm and Aydın (2004). This particular version includes 52 Likert-type items in six subscales: perceived sensitivity, perceived severity, and benefits of BSE, BSE barriers, self-efficacy and health motivation. The participants were asked to rate each item on a five-point scale: 1, I strongly disagree; 2, I disagree; 3, I am undecided; 4, I agree, and 5, I strongly agree. The highest scores on each subscale are: 3–15 for perceived sensitivity, 6–30 for perceived severity, 4–20 for benefits of BSE, 8–40 for BSE barriers, 10–50 for self-efficacy and 5–25 for health motivation. High scores indicate more positive opinions and attitudes towards health for all the subscales except the subscale of BSE barriers, where higher scores indicate more barriers [16]. The Cronbach’s alpha values were: 0.89 for sensitivity, 0.85 for severity, 0.80 for health motivation, 0.86 for BSE benefits, 0.81 for BSE barriers, 0.91 for BSE self-efficacy, 0.73 for mammography benefits and 0.88 for mammography barriers. Permission to use this scale was obtained.
Data analysis
Data were analyzed using t-test, One-way ANOVA, and Chi-square tests using Statistical Package for Social Sciences (SPSS) version 20.The threshold for statistical significance was p < 0.05. This study used percentages, means and standard deviation values as descriptive statistics. In order to determine the preliminary indicators of BSE, CBE and mammography logistic regression was performed with the factors that were found to be statistically significant in bivariate analysis. This analysis used performing and not performing BSE as dependent variables, and age, title, birth, academic field, BSE training, chronic disease and income level as independent variables. Its results determined relative risk (odds ratio, OR) at a 95% confidence interval (CI). The retraction method (Wald) was used as the regression model.