THE EFFECT OF EDUCATIONAL INTERVENTION ON THE ACCURACY OF BREAST CANCER RISK SELF-ASSESSMENT AND KNOWLEDGE ABOUT CHEMOPREVENTION

Cilj istraživanja: Ispitan je učinak edukacijske intervencije na točnost samoprocjene rizika obolijevanja od raka dojke, te na znanje i stav o kemoprevenciji raka dojke. Uz to, ispitan je utjecaj zdravstvene pismenosti, općenitog vjerovanja o lijekovima i kvalitete zdravlja na viđenje vlastitog rizika obolijevanja, te na znanje i stav prema kemoprevenciji. Stav o kemoprevenciji je ispitivan u hipotetskoj situaciji. Nacrt studije: Nerandomizirana klinička studija. Ispitanici i metode: Uključeno je 249 zdravih žena koje su posjetile Zavod za dijagnostiku dojke Doma zdravlja Osijek radi probirne (eng. screening) mamografije ili dijagnostičke mamografije ili ultrazvuka dojke. U istraživanju su korišteni standardizirani upitnici: Europski upitnik o zdravstvenoj pismenosti s 47 pitanja, Vjerovanja o lijekovima – Općenito i Zdravstveni upitnik. Za potrebe istraživanja napisan je i validiran upitnik kojim smo ispitali samoprocjenu rizika obolijevanja od raka dojke, znanje o raku dojke i kemoprevenciji te stav o kemoprevenciji, i to tijekom uključivanja u studiju, odmah nakon edukacijske intervencije, te tjedan dana nakon edukacijske intervencije. Rezultati: Gotovo 20 % ispitanica je podcijenilo vlastiti rizik, uključujući i trećinu žena s pozitivnom obiteljskom anamnezom raka dojke kod bliskih srodnika. Žene odlične zdravstvene pismenosti značajno su točnije procijenile svoj cijeloživotni rizik od obolijevanja. Žene pozitivnog stava prema kemoprevenciji manje su vjerovale u pretjeranu upotrebu lijekova, te su vlastito opće zdravlje vidjele lošijim i imale snažnija ograničenja radi emocionalnih problema. Prijašnja biopsija dojke i dijagnoza stanične atipije nisu pridonijele pozitivnijem stavu prema kemoprevenciji. Nije bilo značajne povezanosti zdravstvene pismenosti i stava prema kemoprevenciji. Znanje o kemoprevenciji značajno se poboljšalo nakon edukcijske intervencije. U odnosu na kontrolnu skupinu, tjedan dana nakon edukacijske intervencije značajno više sudionica imalo je neutralan stav prema kemoprevenciji: 40.2 % prema 85 % (2test, P < 0,001). Također, značajno je manje bilo sudionica pozitivnoga odmah nakon edukacije u odnosu na kontrolnu grupu. Zanimljivo je i da je u početnom ispitivanju bilo 12 % sudionica s negativnim stavom, dok tjedan dana nakon edukacije nije bilo niti jedne. Zaključak: Edukacijska intervencija značajno je poboljšala znanje o raku dojke i o kemoprevenciji. Također je stav prema kemoprevenciji pomaknula prema prevladavajuće neutralnom. Istovremeno, nije imala utjecaj na točnost samoprocjene vlastitog rizika oboljenja od raka dojke.Objectives: The effect of educational intervention (EI) on the accuracy of breast cancer (BC) risk self-assessment and knowledge about chemoprevention was investigated. In addition, it was investigated how different participants’ characteristics like HL, general beliefs about medicines and self-reported health status influenced BC risk perception and BC chemoprevention knowledge and attitudes. Chemoprevention attitude was examined in a hypothetical situation. Study design: This was non-randomised controlled trial conducted in a single health centre in Croatia. Participants and Methods: 249 healthy women who attended Health Centre Osijek’s Department for Breast Diagnostics for screening mammography or diagnostic either mammography or breast ultrasound were recruited. Standardised questionnaires Health Literacy European Questionnaire 47, Beliefs about Medicines Questionnaire General, Short Form-36 were used. With questionnaire created for the purpose of this study (and validated) BC risk perception, knowledge about BC and chemoprevention and chemoprevention attitudes were examined at the recruitment point, immediately after the EI and one week after the EI. Educational interventervention in a form of a lecture was conducted and information leaflet was given to the participants. Results: Nearly 20% of participants underestimated own BC risk, including one-third of women with positive family history of BC in the close relative. Women who correctly estimated own lifetime BC risk were dominantly of excellent HL. Women with positive chemoprevention attitude had significantly more positive beliefs about medicines in the subdomain medicines overuse, worse general health perception and stronger role limitation due to emotional problems. Previous breast biopsy or personal history of AH did not contribute to higher interest in taking chemoprevention drug. No significant correlation between HL level and chemoprevention attitude was noted. Knowledge about chemoprevention and chemoprevention drugs significantly increased after the EI and was maintained one week later. In comparison to the control group, after the EI there was significantly more participants with neutral chemoprevention attitude: 40.2% vs 85% (2test, P<0.001). Also, significantly less participants had positive attitude immediately after the EI, in comparison to the control group: 12% vs 50% (2test, P=0.010, P