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Comparison of the Levels of Fear and Perceived Social Support Among the Women Having and Not Having Mammography 306 Erciyes Med J 2020; 42(3): 306–11 • DOI: 10.14744/etd.2020.65031 ORIGINAL ARTICLE – OPEN ACCESS This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. Comparison of the Levels of Fear and Perceived Social Support Among the Women Having and Not Having Mammography İlgün Özen Çınar1 , Ayla Tuzcu2 ABSTRACT Objective: Mammography rates are low and psychosocial factors may affect mammography behavior in Turkey. This study aims to compare levels of fear and perceived social support and to examine factors associated with mammography behaviour among women who did and did not have a mammography. Materials and Methods: This is comparative- descriptive and cross-sectional study. Data were collected from women who were 40 years and older in two Family Health Centres in Denizli between April 1–July 1, 2018. Descriptive characteristics questionnaire form, Breast Cancer Fear Scale and Multidimensional Scale of Perceived Social Support (MSPSS) were used as data collection tools. Cite this article as: Results: Significant differences were found between marital status, knowledge about breast cancer, breast self-examination Özen Çınar İ, Tuzcu A. (BSE), clinical breast examination (CBE) status and mean MSPSS scores between both groups (p<0.05). There was not a Comparison of the Levels statistically significant difference between groups concerning mean fear scores (p>0.05). LR analysis revealed that being of Fear and Perceived married (OR: 0.08) and obtaining information about breast cancer previously (OR: 0.15) were found to affect mammography Social Support Among the Women Having and Not behaviour positively (p<0.05). Having Mammography. Conclusion: Being married and obtaining information about breast cancer positively affected their behaviours of having a Erciyes Med J 2020; 42(3): 306–11. mammography. Primary health care professionals should inform women over the age of forty about breast cancer and screening and refer them to mammography. In addition, it is also important to strengthen the referral of single people to mammography. Keywords: Mammography, perceived social support, breast cancer fear, primary health care This study was presented as oral announcement in congress: 1th International, 2nd INTRODUCTION National Public Health Nursing Congress, 23–26 April 2018 The mortality of breast cancer has been declining in most of the high-income countries since 1990 (1). Various Ankara, Turkey. factors, including awareness, screening programs and improved patient management, contribute to this decrease. 1Department of Public Health Nursing, Pamukkale University One of the most significant factors is mammography screening. Breast self-examination (BSE), clinical breast exam- Faculty of Health Sciences, ination (CBE) and mammography are used for breast cancer screening. Mammography was proven to be the most Denizli, Turkey effective screening method for breast cancer (2). The rate of having mammography in Turkey is only 29%, and 2Department of Public Health Nursing, Akdeniz University, the ratio is very low compared to the ratio in developed countries. The number of mammography devices per one Faculty of Nursing, million populations is 11.7 in Turkey and mammography is performed in Cancer Early Diagnosis and Education Antalya, Turkey Centers (CEDEC) free of charge. In the national standards of breast cancer screening program, the target popula- Submitted tion is the ages of 40–69 (3). Mainly sociodemographic factors and health beliefs were examined to determine vari- 03.05.2019 ables affecting breast cancer screening behaviors in Turkey (4–7). However, psychosocial and cultural factors that Accepted may have an effect on screening behaviors were not clearly understood, and these factors may have a significant 13.04.2020 relationship with breast cancer screening behaviors. Some psychosocial and cultural factors can be more important Available Online Date for some specific cultural and ethnic subpopulations. In the literature, contradictory results were obtained about 18.06.2020 the role of fear in breast cancer screenings and studies examining social support were found to be very few (8–10). Correspondence Fear is an emotional approach emerging against a danger that will damage the well-being of the individual. In- Ayla Tuzcu, Akdeniz University Faculty dividuals may develop compatible or incompatible responses against fear. Individuals may show compatible or of Nursing, Department of incompatible responses to fear by asking questions and making plans about the disease or medical procedures and Public Health Nursing, 07058 Antalya, Turkey by remembering previous experiences during similar dangers and executing acquired methods. An individual could Phone: +90 242 310 69 14 not be ready for the danger during incompatible responses and thus, he/she experiences anxiety (11). In a study, e-mail: it has been stated that health professionals should consider fear emphasizing breast cancer risk in breast cancer [email protected] screening programs (12). The study conducted by Al-Naggar and Bobryshev (13) found that 20% of women did ©Copyright 2020 by Erciyes not have mammography since they were afraid of breast cancer. In a study by Polat and Ersin (8), fear scores University Faculty of Medicine - Available online at of the women who had mammography were found to be higher. Fear was defined as a motivating, as well as a www.erciyesmedj.com preventing factor in breast cancer screening behaviors (14). Erciyes Med J 2020; 42(3): 306–11 Özen Çınar and Tuzcu. The Factors Affecting Mammography Behaviour 307 Since family, peer and neighbor relationships are important in ple-choice question, and marital status and health insurance were Turkish society, it is necessary to examine the effects of social sup- evaluated by “yes” or “no” options. In the health history form, port on screening behaviors. All interpersonal relationships having state of having mammography within the last two years, state of an important place in people’s lives, providing emotional, financial getting information about breast cancer and familial history of and mental (cognitive) support to the individual are defined as “So- breast cancer were evaluated by “yes” or “no” options. State of cial Support Systems” maintaining health. Social support can pre- having BSE and CBEand the person who referred to the last mam- vent stress formation, change how the event is perceived in cases mography (for the ones who had mammography) were assessed by where stress is present, provide assistance in cases where the indi- multiple-choice questions. vidual is having difficulty and affect the individual’s coping strate- gies (15). Nevertheless, it is stated that a strong social network may MSPSS was developed by Zimet et al. (20). Its validity and relia- lead to an adverse effect and obstruct other supports from time to bility study was performed by Eker and Arkar (21) in Turkey, and time. Thus, it is emphasized that the support the individual feels its construct validity was evaluated accordingly. Factor structure and perceives is more beneficial for the individual rather than a so- in the original scale was retested by the same authors, and the cial network (16). Determining the effects of possible factors being generalizability of the factor structure of the scale was confirmed effective in psychosocial aspects, such as fear and social support (18). MSPSS is an easy-to-use and short scale subjectively evalu- on breast cancer screening, may play an important role in terms ating the qualification of social support taken from three different of increasing mammography rate and planning interventions to sources. The scale has three subscales, including totally 12 items improve women’s health. Therefore, the purpose of our study is as four per each subscale. These items are family (items 3, 4, 8 to compare levels of fear and perceived social support among the and 11), friends (items 6, 7, 9 and 12) and a special person (items women who had and did not have mammography and to examine 1, 2, 5 and 10). The scale having a 7-Likert type is composed of the factors associated with mammography behavior. the options as “completely agree” (7 points), “mostly agree” (6 points), “agree” (5 points), “neither agree nor disagree” (4 points), “disagree” (3 points), “mostly disagree” (2 points) and “completely MATERIALS and METHODS disagree” (1 point). The subscale scores were calculated by sum- Study Design and Sample ming up the scores of four items within each subscale and total This is a comparative-descriptive and cross-sectional study. This MSPSS score is provided by summing up all subscale scores. The study was conducted in two FHC (Family Health Center) having lowest score that can be obtained from each subscale is 4 and the similar sociodemographic characteristics located in a city center. highest is 28. In addition, the lowest score of the total scale can During the data collection, considering that the researchers and be 12, whereas the highest is 84. Having a high score shows that people who had mammography could affect the people who did perceived social support is high (18). Cronbach’s alpha coefficient not have, it was aimed to collect data from two different FHC. For of all items of the scale was found to be 0.95 (18), and it was found this purpose, it was decided to remove women who had mam- to be 0.93 for this study. mography using the draw method from Kayhan FHC and those Breast Cancer Fear Scale which was developed by Champion et who did not have mammography from Dokuzkavaklar FHC. The al. (22) has eight items. It describes the relationship between the study’s sample consisted of 60 women who referred to Kayhan emotional responses of the women towards breast cancer and their FHC and 65 women who referred to Dokuzkavaklar FHC between mammography behaviors. The options of the scale are evaluated April 1–July 1, 2020. The study inclusion criteria were (1) being as 1 point for “completely disagree”, 2 points for “disagree”, 3 a woman between 40 and 69 years of age, (2) being able to com- points for “neither agree nor disagree”, 4 points for “agree” and municate in Turkish, (3) voluntary participation in this study.
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