A web-based tailored educational intervention increases positive perceptions of mammography and intention to obtain mammography compared to standardised mammography brochures among Taiwanese women
- Correspondence to Maggi Banning
School of Health Sciences and Social Care, Mary Seacole Building, Brunel University, Uxbridge UB8 3PH, UK;
Interventions to increase breast health awareness are not new.1 Several approaches have been used including telephone outcall interventions and practice-based interventions.2 The Transtheoretical model (TTM) is a health behavioural tool that has assessed mammographic screening practices among women of differing demography.3 The TTM model proposes that health behaviour can be classified into varying progression phases, for example, in terms of mammographic screening a precontemplator may be an unscreened woman with no intention o commence screening.3 At this stage, a woman can be targeted to hopefully become aware of the benefits of breast cancer screening, particularly the detection of early stage breast cancer when the cancer is not clinically significant.
Breast cancer is a global disease. In Asia, breast cancer rates in women are equivalent or higher than in European countries4 with increasing breast cancer mortalities.5 For this reason, breast cancer screening is important. Kim and Kim5 recently reported that Korean women identified fear of breast cancer and health motivation as barriers to participating in mammography, and such barriers may also be present in Taiwanese women.
This quantitative study used a pretest and post-test design to evaluate the use of a web-based educational intervention and premenopausal women's perceptions and intentions to use mammographic screening. The study was developed using a TTM approach. It is suggested that increasing consciousness is an important aspect of the precontemplation stage of the model. Numerous approaches have previously been used to enhance consciousness awareness, including educational instruction and testimonials. In this study, it was hypothesised that a combination of tailored educational interventions and testimonials would help precontemplators to become contemplators, improving women's breast health awareness and intention to participate in mammography.
Data was collected using three validated questionnaires; Stage of Adoption of Mammography Question, Decisional Balance of Mammography Inventory (DBMI) and Demographics Inventory, which were amended to suit the cultural sensitivities of Taiwanese women. Results for the DBMI questionnaire indicate a significant difference with respect to positive perceptions and intentions. Mean data were 89.88±9.03 in the intervention group and 80.70±9.12 in the standard treatment group, respectively, indicating that women in the education tailored intervention group had a stronger intention to undertake a mammogram compared to women in the standard treatment group. These data concur with those of Prochaska and colleagues6 and Rimer and colleagues7 but not with those of Rakowksi and colleagues.8 The variability in data has been previously reported by Ryan and Lauver.9 The reasons attributed to the difference in findings may relate to increased breast health awareness.
This study included women below 40 years of age from the Eastern part of Taiwan. The selection of women from a specific part of Taiwan and the relatively narrow age range will inevitably limit the generalisability of the study, particularly as the incidence of breast cancer can affect women of all ages. The inclusion of premenopausal and postmenopausal women may have provided an interesting comparison group. Given the significant difference in women's responses to intention to participate in breast cancer, it is a pity that the study did not include any follow-up, as this would have allowed some assessment of the contribution and long-term efficacy of tailored interventions. This is an area of investigation that is under research. What are needed are longitudinal studies of health behaviour related to mammographic screening in a wide age-range of women to establish the efficacy of health education interventions.