乳がん早期発見のための乳房セルフケアを促す教育プログラムの効果

Effects of an Educational Program Promoting Breast Awareness for Early Detection of Breast Cancer

要旨

　目的：本研究の目的は，乳がんおよび乳房自己検診，マンモグラフィ検診に対する健康信念を高めて行動変容を促進するために，乳がん早期発見のための乳房セルフケアを促す教育プログラムを実施し，その効果を明らかにすることとした．

　方法：対照群を置かない前後比較の介入研究デザインを用いた．20歳以上で乳がん既往のない女性42名を対象に，教育プログラムを乳がん体験者と協働のもと実施した．介入効果の検討は，定期的乳房自己検診およびマンモグラフィ検診の実施状況，日本版Champion Health Belief Model Scale（CHBMS）を用いて，介入前後で評価した．

　結果：対象は，平均年齢50.6歳（SD＝11.5）で，有職者が59.5％，乳腺疾患のある者が16.7％だった．定期的乳房自己検診実施率は，介入前21.4％に比べ介入後1年で54.8％（χ²値＝9.389，p＝0.002，効果量w＝0.602）と有意に高かった．マンモグラフィ検診受診率でも，介入前23.8％に比べ介入後1年で47.6％（χ²値＝8.100，p＝0.004，効果量w＝0.569）と有意に高かった．日本版CHBMSの「乳房自己検診の自己効力感」は，介入前後で有意差が認められ（F値＝34.080，p＜0.001，効果量f＝0.586），介入前よりも介入後1カ月，6カ月，1年で得点が有意に高かった．また，90％以上の者が，プログラムを満足かつ有用と評価し，内容や方法も適切であると回答した．

　結論：本プログラムは，対象者の「乳房自己検診の自己効力感」を高め，乳房自己検診，マンモグラフィ検診への動機づけを強化し，定期的乳房自己検診実施率およびマンモグラフィ検診受診率を高める効果があることが示された．

　Purpose: The purpose of this study was to determine whether an educational program aimed at promoting breast awareness for early detection of breast cancer would encourage changes in behaviors and beliefs regarding breast cancer, breast self-examination, and mammography screening.

　Methods: We compared subjects' behaviors and beliefs regarding breast self-examination and mammography screening before and after intervention, without a control group. Forty-two women, aged over 20 years and with no breast cancer history, consented to enroll in the study. They participated in an educational program conducted by ourselves and breast cancer survivors. Study outcomes consisted of the rates of performing regular breast self-examination and having mammography screening, and scores from Champion's Health Belief Model Scale for Japanese (CHBMS-J).

　Results: The mean participant age was 50.6 (SD=11.5) years; 59.5％ had an occupation, and 16.7％ had breast disease. One year after the intervention, the percentage of women who were performing regular breast self-examinations had risen significantly to 54.8％ from 21.4％ (χ²=9.389, p=0.002, effect size w=0.602); the percentage who had undergone mammography screenings had also risen significantly, to 47.6％ from 23.8％ (χ²=8.100, p=0.004, effect size w=0.569). CHBMS-J scores for self-efficacy in breast self-examinations raised significantly at 1 and 6 months, and 1 year, after intervention (F=34.080, ＜0.001, effect size f=0.586). More than 90％ of participants stated that they were satisfied with the program and found it useful and valuable.

　Conclusion: The program successfully enhanced self-efficacy in breast self-examination and motivation to undergo breast self-examination and mammography screening, thus raising rates of performance of breast self-examination and attendance for mammography screening.