Awareness of Breast Cancer and Its Section Screening among Indonesian Women

Introduction: Breast cancer has a high morbidity and mortality rate worldwide. However, most developing countries with resource constrained setting, like Indonesia, encounter several difficulties to implement mass screening for breast cancer. Aim: To investigate knowledge, barriers, and behaviours of women regarding breast cancer screening among rural and urban Indonesian women. Materials and Methods: This cross-sectional study was conducted among 864 Indonesian women aged ≥18 years. A self-administered questionnaire using a validated instrument was administered from March to May 2016. The ordered logistic regression model analysis was performed to further evaluate five domains of awareness regarding breast cancer screening and its determinants. A p-value under 0.05 was considered significant. Results: Overall, 864 women participated in this study (response rate of 98.28%). The mean age of women was 30.01±11.01 years. Ordinal logistics regression analysis showed that urban women demonstrated better knowledge of risk factors for breast cancer, while they had poorer behaviours for the breast cancer screening method. A higher level of education (relative to no formal education) was associated with better behaviours for the breast cancer screening method, whereas being married and women living in East Nusa Tenggara were significantly related to barriers for breast cancer screening. Conclusion: Urban Indonesian women had poor breast cancer screening practice, whereas they were highly educated. Participant’s characteristics like marital status and locality were found as barriers to breast cancer screening. It is likely to provide valuable insight among women in general for breast cancer screening behaviours, which in turn, will improve targeted breast health promotio

Regimen-related Mortality Risk in Patients Undergoing Peritoneal Dialysis Using Hypertonic Glucose Solution: A Retrospective Cohort Study

Objectives The main purpose of this study was to quantify the risk of mortality linked to various regimens of hypertonic peritoneal dialysis (PD) solution. Methods A retrospective cohort study of patients using home-based PD was carried out. The prescribed regimen of glucose-based PD solution for all patients, determined on the basis of their individual conditions, was extracted from their medical chart records. The primary outcome was death. The treatment regimens were categorized into 3 groups according to the type of PD solution used: original PD (1.5% glucose), shuffle PD (1.5 and 2.5% glucose), and serialized PD (2.5 and 4.5% glucose). Multivariate analysis (using the Weibull model) was applied to comprehensively examine survival probabilities related to the explanatory variable, while adjusting for other potential confounders. Results Of 300 consecutive patients, 38% died over a median follow-up time of 30 months (interquartile range: 15-46 months). Multivariate analysis showed that a treatment regimen with continued higher-strength PD solution (serialized PD) resulted in a lower survival rate than when the conventional strength solution was used (adjusted hazard ratio, 2.6; 95% confidence interval, 1.6 to 4.6, p<0.01). Five interrelated risk factors (age, length of time on PD, hemoglobin levels, albumin levels, and oliguria) were significant predictors contributing to the outcome. Conclusions Frequent exposure to high levels of glucose PD solution significantly contributed to a 2-fold higher rate of death, especially when hypertonic glucose was prescribed continuously

Awareness of Breast Cancer and Its Screening among Indonesian Women

Introduction Breast cancer has a high morbidity and mortality rate worldwide. However, most developing countries with resource constrained setting, like Indonesia, encounter several difficulties to implement mass screening for breast cancer. Aim To investigate knowledge, barriers, and behaviours of women regarding breast cancer screening among rural and urban Indonesian women. Materials and Methods This cross-divtional study was conducted among 864 Indonesian women aged ≥18 years. A self-administered questionnaire using a validated instrument was administered from March to May 2016. The ordered logistic regression model analysis was performed to further evaluate five domains of awareness regarding breast cancer screening and its determinants. A p-value under 0.05 was considered significant. Results Overall, 864 women participated in this study (response rate of 98.28%). The mean age of women was 30.01±11.01 years. Ordinal logistics regression analysis showed that urban women demonstrated better knowledge of risk factors for breast cancer, while they had poorer behaviours for the breast cancer screening method. A higher level of education (relative to no formal education) was associated with better behaviours for the breast cancer screening method, whereas being married and women living in East Nusa Tenggara were significantly related to barriers for breast cancer screening. Conclusion Urban Indonesian women had poor breast cancer screening practice, whereas they were highly educated. Participant’s characteristics like marital status and locality were found as barriers to breast cancer screening. It is likely to provide valuable insight among women in general for breast cancer screening behaviours, which in turn, will improve targeted breast health promotion

Awareness Level about Breast Cancer Risk Factors, Barriers, Attitude and Breast Cancer Screening among Indonesian Women

Background: Globally, breast cancer is the second most common cancer in women and is a leading cause of mortality in Indonesia. Raising awareness of breast cancer is particularly important to help at risk women seek medical treatment for this disease. This study aimed to comprehensively investigate the Indonesian women’s level of knowledge about breast cancer risk factors, barriers, attitude and breast cancer screening. Methods: This population-based cross-sectional study administered the breast cancer awareness Indonesian scale (BCAS-I) to 856 Indonesian women. Samples were selected in rural and urban combinations from three provinces by stratified random sampling. The ordinal logistic model was used to investigate the clustering effect of the participant’s characteristics in this study. Results: Of the women, 62% lived in rural areas and 38% lived in urban areas. Living in an urban area was significantly associated with a lower knowledge of the risk factors. However, living in an urban area was significantly associated with better attitudes and healthier behaviours related to breast cancer awareness. Women with higher education levels had 70% worse attitudes toward breast cancer awareness. Women living South of Sumatera, women living in Yogyakarta, and unmarried women were 5.03, 3.84, and 1.56 times as likely to have higher perceived barriers, respectively. Conclusion: Urban women had a poorer level of knowledge of breast cancer risk factors compared to women living in more rural areas. The result of this study may reflect inadequate breast cancer awareness campaigns or a lack of breast cancer awareness campaigns. These findings suggest that additional education programs aiming to increase awareness and educate the public are needed. Keywords Breast cancer; Breast cancer screening; Indonesian Wome

Awareness Level about Breast Cancer Risk Factors, Barriers, Attitude and Breast Cancer Screening among Indonesian Women

BACKGROUND: Globally, breast cancer is the second most common cancer in women and is a leading cause of mortality in Indonesia. Raising awareness of breast cancer is particularly important to help at risk women seek medical treatment for this disease. This study aimed to comprehensively investigate the Indonesian women’s level of knowledge about breast cancer risk factors, barriers, attitude and breast cancer screening. METHODS: This population-based cross-sectional study administered the breast cancer awareness Indonesian scale (BCAS-I) to 856 Indonesian women. Samples were selected in rural and urban combinations from three provinces by stratified random sampling. The ordinal logistic model was used to investigate the clustering effect of the participant’s characteristics in this study. RESULTS: Of the women, 62% lived in rural areas and 38% lived in urban areas. Living in an urban area was significantly associated with a lower knowledge of the risk factors. However, living in an urban area was significantly associated with better attitudes and healthier behaviours related to breast cancer awareness. Women with higher education levels had 70% worse attitudes toward breast cancer awareness. Women living South of Sumatera, women living in Yogyakarta, and unmarried women were 5.03, 3.84, and 1.56 times as likely to have higher perceived barriers, respectively. CONCLUSION: Urban women had a poorer level of knowledge of breast cancer risk factors compared to women living in more rural areas. The result of this study may reflect inadequate breast cancer awareness campaigns or a lack of breast cancer awareness campaigns. These findings suggest that additional education programs aiming to increase awareness and educate the public are needed

Validation of the Breast Cancer Awareness Scale Indonesian (BCAS-I) in Yogyakarta, Indonesia

Breast cancer is the commonest issue in public health. The screening method particularly clinically-breast examination is likely to drive the leading for early diagnosis of breast cancer, and breast cancer awareness is the key to encouraging in help seeking these treatments. Several breast cancer awareness instruments have been developed that the authors report as validated. However, instruments like those are highly contextualized to particular health care settings. The aim of this study was to develop the BCAS instrument among Indonesian women. Indonesian women aged 18 to 80 years were selected by stratified random sampling in five municipalities in Yogyakarta provinces by two locations (rural–urban) combinations were collected. Parallel analysis based on confirmatory factor analysis was conducted. The association of the BCAS-I subscales with participant characteristics was undertaken using proportional odds ordinal logistic regression. The questionnaires were completed by 200 Indonesian women (100% response rate). The average age was 36 (SD = 12) and ranged from 18 to 74 years old. Most participants resided in rural areas (62%), and 60% didn’t have health insurance. According to the parallel analysis, a five-factor solution was used. The factor solution was followed: knowledge of risk factors, knowledge of signs and symptoms, attitude to breast cancer prevention, a barrier of breast screening, and health behavior related to breast cancer awareness. And the alpha value of 0.78 indicates sufficiently high reliability to provide confidence interpreting the score. This study demonstrated that the BCAS-I tool is shown to valid and reliable in Yogyakarta women, Indonesia. Psychometric properties are needed to determine the construct, concurrent, criterion, and predictive validity of the BCAS-I scale. Keywords: Breast Cancer Awareness Scale, Psychometric Properties, Indonesian Women

Validation of the Breast Cancer Awareness Scale Indonesian (BCAS-I) in Yogyakarta, Indonesia

Breast cancer is the commonest issue in public health. The screening method particularly clinically-breast examination is likely to drive the leading for early diagnosis of breast cancer, and breast cancer awareness is the key to encouraging in help seeking these treatments. Several breast cancer awareness instruments have been developed that the authors report as validated. However, instruments like those are highly contextualized to particular health care settings. The aim of this study was to develop the BCAS instrument among Indonesian women. Indonesian women aged 18 to 80 years were selected by stratified random sampling in five municipalities in Yogyakarta provinces by two locations (rural–urban) combinations were collected. Parallel analysis based on confirmatory factor analysis was conducted. The association of the BCAS-I subscales with participant characteristics was undertaken using proportional odds ordinal logistic regression. The questionnaires were completed by 200 Indonesian women (100% response rate). The average age was 36 (SD = 12) and ranged from 18 to 74 years old. Most participants resided in rural areas (62%), and 60% didn’t have health insurance. According to the parallel analysis, a five-factor solution was used. The factor solution was followed: knowledge of risk factors, knowledge of signs and symptoms, attitude to breast cancer prevention, a barrier of breast screening, and health behavior related to breast cancer awareness. And the alpha value of 0.78 indicates sufficiently high reliability to provide confidence interpreting the score. This study demonstrated that the BCAS-I tool is shown to valid and reliable in Yogyakarta women, Indonesia. Psychometric properties are needed to determine the construct, concurrent, criterion, and predictive validity of the BCAS-I scale

Validation of an Indonesian Version of the Breast Cancer Awareness Scale (BCAS-I)

Background: Raising breast cancer awareness is a key strategy to reduce associated mortality. While a paucity of adequately validated instruments for breast cancer awareness is applicable across cultures, even outside the health care setting such instruments have been developed. Objective: This study investigated the validity and psychometric properties of a breast cancer awareness scale in Indonesia (BCAS-I). Methods: This cross-sectional study was carried out among Indonesian women conveniently selected within three provinces (Yogyakarta, South of Sumatera and East Nusa Tenggara) located in rural-urban areas using stratified random sampling. First, we translated all questionnaires from English to the local language and then back-translated. The third step was to perform psychometric testing of the adapted instrument by establishing internal consistency (Cronbach’s alpha score 0.79) and construct validity by confirmatory factor analysis (CFA). Results: In the 856 participants who responded (responded rate = 98.28%), the age ranged from 18 to 80 years old (mean = 30, SD = 11). The BCAS-I was shown to have good internal consistency, and CFA demonstrated the model fit data adequately (χ2 = 922.267, df = 515, p <0.001, comparative fit index = 0.965, Tucker-Lewis Index = 0.96, goodness-of-fit index = 0.97, adjusted goodness-of-fit index = 0.97, root-mean-square error of approximation = 0.03 95% confidence interval: 0.027, 0.034). The final version of BCAS-I consists of 33 items across 5 domains that cover most key aspects of breast cancer awareness for this population. Conclusion: The BCAS-I demonstrated good psychometric properties and was found to be valid to provide a measurement of breast cancer awareness in Asian women in general and Indonesian women in particular

Validation of an Indonesian Version of the Breast Cancer Awareness Scale (BCAS-I)

Background: Raising breast cancer awareness is a key strategy to reduce associated mortality. While a paucity of adequately validated instruments for breast cancer awareness is applicable across cultures, even outside the health care setting such instruments have been developed. Objective: This study investigated the validity and psychometric properties of a breast cancer awareness scale in Indonesia (BCAS-I). Methods: This cross-sectional study was carried out among Indonesian women conveniently selected within three provinces (Yogyakarta, South of Sumatera and East Nusa Tenggara) located in rural-urban areas using stratified random sampling. First, we translated all questionnaires from English to the local language and then back-translated. The third step was to perform psychometric testing of the adapted instrument by establishing internal consistency (Cronbach’s alpha score 0.79) and construct validity by confirmatory factor analysis (CFA). Results: In the 856 participants who responded (responded rate = 98.28%), the age ranged from 18 to 80 years old (mean = 30, SD = 11). The BCAS-I was shown to have good internal consistency, and CFA demonstrated the model fit data adequately (χ2 = 922.267, df = 515, p <0.001, comparative fit index = 0.965, Tucker-Lewis Index = 0.96, goodness-of-fit index = 0.97, adjusted goodness-of-fit index = 0.97, root-mean-square error of approximation = 0.03 95% confidence interval: 0.027, 0.034). The final version of BCAS-I consists of 33 items across 5 domains that cover most key aspects of breast cancer awareness for this population. Conclusion: The BCAS-I demonstrated good psychometric properties and was found to be valid to provide a measurement of breast cancer awareness in Asian women in general and Indonesian women in particular. Keywords: Breast cancer, breast cancer awareness, instrument validation, Indonesian wome

Assessing Breast Cancer Awareness in Thai Women: Validation of the Breast Cancer Awareness Scale (B-CAS)

Background: Raising breast cancer awareness is a well-established first line strategy to reduce breast cancer mortality. A properly validated instrument is needed to gain a better understanding of breast cancer awareness. Objective: The objective of this study was to develop and validate an instrument to assess breast cancer awareness in Thai women. Methods: In this study, we develop and evaluate the validity of the Breast Cancer Awareness Scale (B-CAS). Construct validity was evaluated by using exploratory factor analysis and confirmatory factor analysis, and criterion validity was investigated using ROC curves to examine the associations between B-CAS subscales and breast self-examination. Internal consistency and test-retest reliability were also investigated. This validation process employed two independent samples of Thai women aged 20-64 years collected from communities in southern Thailand. Results: In total, 660 Thai women (mean age 41 years) participated in this study. Confirmatory factor analysis demonstrated the construct validity of B-CAS (CFI =0.91; NNFI=0.90; GFI=0.95; AGFI= 0.95; RMSEA=0.044, 95%CI 0.041 to 0.047; P< 0.05). Several of the B-CAS subscales demonstrated strong utility in discriminating between women who do and do not regularly conduct breast self-examination. B-CAS also demonstrated strong internal consistency (Cronbach’s α=0.86) and test-retest reliability. The final version of B-CAS contains 35 items across five domains: knowledge of risk factors, knowledge of signs and symptoms, attitude to breast cancer prevention, barriers of breast screening, and health behaviour related to breast cancer awareness. Conclusion: The breast cancer awareness scale (B-CAS) was shown to have good psychometric properties in Thai women, and is likely to prove useful in studying the epidemiology of breast cancer awareness in Thai women, and evaluating breast cancer prevention programs for raising awareness