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Factors influencing performance discrepancies in breast self-examination practices of adult female graduate… Armstrong, Ingrid Erna 1984

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C.»  F a c t o r s I n f l u e n c i n g Performance D i s c r e p a n c i e s in Breast S e l f - e x a m i n a t i o n  Practices  of Adult Female Graduate Students  by I n g r i d Erna Armstrong R.N., Vancouver G e n e r a l H o s p i t a l , Vancouver, 1969 B.S.N., U n i v e r s i t y of B r i t i s h Columbia, 1979  A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES (Department of A d m i n i s t r a t i v e , A d u l t and Higher Education)  We accept t h i s  t h e s i s as conforming  to the r e q u i r e d  standard  THE UNIVERSITY OF BRITISH COLUMBIA May 1984 © I n g r i d Erna Armstrong, 1984  In p r e s e n t i n g requirements  this thesis f o r an  of  British  it  freely available  in partial  advanced degree a t  Columbia,  Library  shall  for reference  and  study.  I  f o r extensive copying of  p u r p o s e s may  department o r  by  for  h i s or  her  copying or  f i n a n c i a l gain  be  shall  g r a n t e d by  the  not  be  of  further this  Administrative,  The U n i v e r s i t y o f B r i t i s h 1956 Main Mall V a n c o u v e r , Canada V6T 1Y3  this  Date  DE-6  (3/81)  May,  1984  my  thesis  a l l o w e d w i t h o u t my  Adult and Higher Education Columbia  thesis  It is  permission.  Department o f  make  head o f  representatives. publication  the  University  the  for scholarly  that  the  I agree that  agree t h a t p e r m i s s i o n  understood  f u l f i l m e n t of  written  i  Factors in  I n f l u e n c i n g Performance Breast  of  Self-examination  Adult  Discrepancies Practices  Female Graduate  Students  ABSTRACT  A performance discrepancy between field,  actual the  and  term  discrepancies. development concerned project of  remedies  examination Based  are  on a l i t e r a t u r e  health  measure o f b r e a s t activity  require A  to  instances  Such  such i s the  approaches  solving.  This  are  research  specific  question  behaviour  data  area  was u s e d :  i n breast  female  students  Adult  Education  paradigm  participation  self-examination. a  complex  o f a wide  collection of  a  self-  It  group because of t h e i r level  and  g r o u p o f women p r o v i d e d  the preventive was  felt  response  was  created  and newly d e v e l o p e d  classes  that to the would  proximity,  occupational  an o p p o r t u n i t y  to  using  questions.  British  were c h o s e n  geographical their  developed  range o f v a r i a b l e s .  e n r o l l e d i n the U n i v e r s i t y of Division  was  to e x p l a i n behaviour  instrument  previously  in  emotional  and t h a t any a t t e m p t  the examination  educational  such  research  end  review,  explain  involved  of cancer  combination  describe  solving i n the  A broad to  to  care  practices?  attempted  threat  problem  a t problem  which  this  program.  not  related  in  i s a difference  In the h e a l t h  used  response  self-examination.  factors  is  educational  was an a t t e m p t  breast  What  o f an  usual  when t h e r e  performance.  compliance The  with  desired  exists  _ a The  Columbia,  as the research their  uniform  backgrounds. compare  women  This with  i i  experience  in  the h e a l t h  care  field  t o women w i t h  a non-health  background. Small  sample  size  variables  tested  precluded  results.  Some  however.,  and  and  interesting several  homogeniety extensive points  subjects  statistical appear  i n d e p e n d e n t v a r i a b l e s were  related  to breast  self-examination  future  research  and  given.  do  of  for  practices.  teaching  breast  on  the  a n a l y s i s of  in  the  data,  significantly  Implications  for  self-examination are  iii  TABLE OF CONTENTS  ABSTRACT  i i  L I S T OF TABLES . . .  v  L I S T OF FIGURES  vi  ACKNOWLEDGEMENT  v i i  CHAPTER I : INTRODUCTION The  Significance  1  Of P e r f o r m a n c e  D i s c r e p a n c i e s I n BSE .... 3  P u r p o s e Of The S t u d y  6  CHAPTER I I : REVIEW OF THE LITERATURE Participation Barriers  Research  10  To L e a r n i n g  Health Education Education  8  27  And C o m p l i a n c e  41  And C o m p l i a n c e  54  L o c u s Of C o n t r o l  60  Summary  79  CHAPTER I I I : THEORETICAL FRAMEWORK  FOR THE STUDY  86  T h e o r y U n d e r l y i n g The BSE P a r a d i g m  86  Breast  92  The  Self-Examination  P a r t i c i p a t i o n Paridigm  Research Question  96  CHAPTER I V : METHODOLOGY  97  Pilot  Study  Selection  104  Of The R e s e a r c h Group  Data C o l l e c t i o n Strategies  F o r Data A n a l y s i s  CHAPTER V: FINDINGS Respondent  Characteristics  107 107 .....112 115 115  iv  Expectancy  116  Valence  131  Barriers  To BSE  Participation  138  In BSE  142  L i m i t a t i o n s Of The D a t a  146  Discussion  Of R e s u l t s  146  Discussion  Of R e s u l t s  Discussion  Of P a r t i c i p a t i o n  For B a r r i e r  Variables  In BSE  CHAPTER VI:ANALYSIS OF BSE Statistical Discussion  151 152 155  Analysis  156  Of R e s u l t s  161  CHAPTER V I I : SUMMARY AND  IMPLICATIONS  166  L i m i t a t i o n s Of The S t u d y  167  Research  171  Findings  Implications  For Research  176  Implications  F o r T e a c h i n g BSE  179  REFERENCES APPENDIX A: LETTER OF I N I T I A L APPENDIX B: QUESTIONNAIRE  185 CONTACT  195 197  V  L I S T OF  TABLE  TABLES  1: EXCLUDED BSE KNOWLEDGE COMPONENTS  117  TABLE 2: EXPERIENCE WITH BREAST DISEASE TABLE  3:  PERCEIVED  RELATIONSHIP  127  BETWEEN BREAST LUMPS  AND  CANCER  128  TABLE 4: CONFIDENCE IN PERSONAL A B I L I T Y  TO  DETECT  BREAST  DISEASE  129  TABLE 5: PRIORITY TABLE  6:  HABITS  RATINGS FOR THE VALUE OF HEALTH  DEGREE  OF  132  AGREEMENT WITH SATISFACTION WITH BSE  STATEMENT  133  TABLE 7: PERCEIVED  S U S C E P T I B I L I T Y TO BREAST DISEASE  TABLE 8: PERCEIVED  EFFECT OF BARRIERS ON BSE  134  FREQUENCY  OF  PRACTICE  139  TABLE 9: FREQUENCY OF BSE PRACTICE  143  TABLE  10: BSE PRACTICE RATING  143  TABLE  11: COMPLETENESS DISCREPANCIES  TABLE  12:  VARIABLES  WITH  A  SIGNIFICANT  PRODUCT MOMENT CORRRELATION WITH PRACTICE RATE  IN BSE PRACTICE  BSE  145  (p<.05) PEARSON  PRACTICE  OR  BSE 1 60  vi  L I S T OF FIGURES  FIGURE FIGURE  1: PARADIGM 2:  OF RECRUITMENT IN ADULT EDUCATION  CHAIN OF RESPONSE  17  (COR) MODEL FOR UNDERSTANDING  PARTICIPATION IN ADULT LEARNING A C T I V I T I E S FIGURE 3: ORIGINAL FORMULATION OF THE HEALTH B E L I E F MODEL FIGURE 4:BREAST SELF-EXAMINATION PARADIGM  24 . 49 93  FIGURE 5: BSE INFORMATION SOURCES  120  FIGURE 6: BSE INFORMATION PRESENTATION METHODS  122  ACKNOWLEDGEMENT  Special  Kjell  Rubenson  a n d Tom  for  their  and  sound a d v i c e  MarDell  thanks t o  Sork  patience,  encouragement  Parrish  for  h i s invaluable help  the  computer  Family for  and f r i e n d s their  support  forebearance seemingly Donald  with  James  and t h e i r  w i t h an u n s o c i a l a n d  p e r p e t u a l house  guest  Armstrong  for  h i s t o l e r a n c e and h i s e n c o u r a g e m e n t .  His  support  made i t a l l p o s s i b l e .  1 CHAPTER I  INTRODUCTION  T h e r e a r e many s i t u a t i o n s not  what  where what p e o p l e  someone wants them t o d o .  Mager and P i p e  termed t h i s  a  difference  between a c t u a l and d e s i r e d p e r f o r m a n c e  concern  of t h i s  preventive faced  study  health  with  (BSE). most  performance  are  is a  frequent  lifespan.  and  performance  behaviour.  women who do  While  discrepancy  Health  not  perform  The  population  breast  usual  means  is  of  women  solution. be  They  pits  poured  into  Pipe  caution  suggest which  that a  unproductively.  problem. to to  help  when  Mager and P i p e i n determining  a l a c k of s k i l l  hear  lack  this  term  teaching  great  of  involving  examination  of concern the the  information  such  program. any  such  single  approaches can  are  concerned  information  or s k i l l  the phrase  They  contend  with  or s k i l l  may n o t be t h e "oughta  whether a p e r f o r m a n c e d e s c r e p a n c y  some v a r i a t i o n  adult  o f e n e r g y a n d money may be  They p r o v i d e  o r knowledge. or  7 ) . The  to eliminate  using  approaches  have c o i n e d  a  are frequently  across  or t r a i n i n g  deal  Such  remedies not p r o b l e m - s o l v i n g . development  against  (p.  self  attempting  p e r f o r m a n c e d i s c r e p a n c i e s i s an e d u c a t i o n a l Mager and  i t as  discrepancy educators  is  (1970) have  defined  p r e - a d u l t s a r e sometimes t h e f o c u s target  doing  that  wanna" i s due  when  of i t , i t i s almost  you  certain  2  that  a skill  health  wanna  caloric oughta  intake.  already  I f women  know a b o u t  i tregularly.  remedies  knowledge changed  skill  & Pipe, Pipe  or or  skill  i s  teaching  components.  If  conditions  under  changed.  In  either  i t occurs  and  training  that  the  used or  to  exhortation Even  i s o n l y one  first  step  skill  provide i s  i s  of  toward i t . If  the  present  expected  to follow  their  performance  and  i s needed.  people  t h e r e q u i r e m e n t s c a n be  the performance  knowledge of t h e expected  when  21).  be  case,  that  wanna" s i t u a t i o n .  missing either  knowledge  which  BSE--they  discrepancy i s understanding  can  their  i s one o f t h e weakest  Information  suggest  a performance  know  on  of  i n behaviour  exists,  p.  people  Mager and P i p e c o n t e n d  change an "oughta  deficiency  (Mager and  eliminating  the benefits  change  a  If  w a n n a c u t down  for  influencing  by  precautions are f o r  them.  own g o o d "  necessarily  Mager  safety  follow  know how t o d o s o m e t h i n g .  not  which  wanna  faced  s h o u l d not smoke--they  wanna do i t f o r y o u r  when a g e n u i n e the  know  o b e s i t y - - t h e y oughta  wanna p r a c t i c e  motivators  Some e x a m p l e s  know t h e y  I f people oughta  causes  oughta  will  stop.  own g o o d - - t h e y  over-eating  "you  does not e x i s t .  educators a r e : I f people  oughta their  deficiency  I t i s to this  remedies the  missing then  the  should a  thorough  conditions  end that  be  this  in  study  aims. Identification  p e r se of a  discrepancy  desired  behaviour  action.  The d i s c r e p a n c y must be  such  a  i s not s u f f i c i e n t  response.  Does  reason  important  lack  of  in  actual  for further enough compliance  versus study or  to  justify  with  BSE  3  recommendations warrant f u r t h e r c o n s i d e r a t i o n ?  The  S i g n i f i c a n c e of Performance D i s c r e p a n c i e s  Certainly statistics cancer it,  health  about  research  breast cancer.  i n women, approximately  mortality  survival  has  rate  has  i s more l i k e l y  There  (Bullough, women  one i n fourteen  not decreased  known  lump  improving Given  those  our  expressed early  than  (Alcoe  to  C u r r e n t l y the ten-year  (less  2  cm.)  knowledge  (Alcoe  and  Edwards, 1980; Flynn,  breast  to  no  nodal  involvement  (Alcoe & McDermot).  be  McDermot,  1980; H a l l ,  cancer  i s one t h i r d , with a  of the d i s e a s e the f e l t  seems  &  McDermot,  s u r v i v a l r a t e for a l l  breast cancer  i n the l i t e r a t u r e ,  diagnosis  experience  &  prevent  f i g u r e s to 80 t o 90 percent  present  will  f o r s e v e r a l decades and  "early")  method  who have had diagnosed  smaller  sobering  i f the lump i s d e t e c t e d when i t i s small  i s no  1980).  some  I t i s the most common type of  (which does not n e c e s s a r i l y mean 1979).  produced  i n BSE  the  need, as  instigation  1979; Bullough,  Adams,  Stein,  of  1980;  Stephenson,  G o l d s t e i n & Pennypacker, 1980; S t i l l m a n , 1977; T u r n b u l l , 1978). Is  BSE  the v e h i c l e  P h y s i c i a n examination early  diagnosis.  f o r p r o v i d i n g such e a r l y d i a g n o s i s ?  has long  Bullough  been  an  accepted  should  percent  be.  She  of the sample  examination  by  a  cites  of  a  1300  physician  p h y s i c i a n involvement  to  (1980) r e p o r t s , however, that breast  examinations done by p h y s i c i a n s a r e not done they  approach  1973  women  as  frequently  Gallop p o l l had  i n the l a s t  not  i n which 24  had  f i v e years.  i n t h i s area cannot be  as  assumed.  a  breast Frequent Despite  4  this  pattern  the  main  Golstein not  of examination  sources & Stein,  appear  physicians seems  to  BSE  information  1977; T u r n b u l l , be  teach  wise  of  by p h y s i c i a n s ,  any  they  (Bullough,  1978).  research  are s t i l l  has  o r when, how o r how f r e q u e n t l y  t o know "what  i s " before  1980; H a l l ,  However,  which  one o f  there  does  determined  what  they  proceeding  do i t .  t o "what  It  should  be. " Another d i a g n o s t i c approach screening  techniques  abnormalities. are  some  of  of  the  Many  examination, Often  mammograms use  to  issues  mammogram  or  is  involved  or also  included.  their  i s some q u e s t i o n  about  whether  over  time,  risk  of b r e a s t  They may a l s o d e t e c t  borderline  and  surgery  (Alcoe  1977).  The  unreliable  &  McDermot,  cost  a l s o p r o h i b i t i v e as trained  personnel  Gastrin,  1980).  of  of s c r e e n i n g both are  Costs  which  1979;  issue While  is  are  may  for their  generally screening.  p r o c e d u r e s may,  (Alcoe  & McDermot,  too  cause  Bullough,  small  or  unnecessary  1980;  Stillman,  the e n t i r e female p o p u l a t i o n i s  sophisticated required  may v a r y ,  physical  use f o r mass  cancer  diagnosis  analysis approach.  safety  x-ray  breast  a thermogram.  change  these  changes  this  contested.  tissue  various  to detect  and/or  The  is still  remains over  increase  the  included  xeromammogram  questionable  controversy  have  There  1979).  of  i n assessing  programs  xeromammograms  investigate  accepted,  use  e f f e c t i v e n e s s and c o s t - b e n e f i t  screening  BSE t e a c h i n g  the  w h i c h have been employed  Safety, the  is  (  equipment  Alcoe  &  McDermot,  however, d e p e n d i n g  p a r a - p r o f e s s i o n a l h e l p and t y p e  of technique  and  on  highly 1979;  t h e use  (Kirch & Klein,  5  1978). been and  Regardless a  fairly  of the type of  Interval  scheduled  there  l a r g e number of f a l s e p o s i t i v e s ,  i n t e r v a l cases  1978).  screening,  (Alcoe cases  &  McDermot,  are those  has  false  1979; K i r c h  still  negatives &  Klein,  which are detected  between  examinations.  How does BSE compare as a r e l i a b l e , practice? with other interval  Kirch  cost-effective  health  and K l e i n (1978) suggest the use of BSE along  screening cases.  approaches  may  I t s importance  decrease  the number  of  would i n c r e a s e as the i n t e r -  examination i n t e r v a l between other approaches i n c r e a s e s . H a l l et a l . lesions  (1977) report that  are p o t e n t i a l l y  detectability  increases.  palpable. Since  the s u r v i v a l r a t e , the user of skill  to  detect  these  94  percent  As  size  of  cancerous  increases  the  the smaller the s i z e the g r e a t e r BSE  smaller  needs  lumps.  s t u d i e s have shown that BSE can r e s u l t the s i z e range that maximizes s u r v i v a l  to  have  sufficient  They report that some  i n d e t e c t i o n of tumors i n and  minimizes  axillary  node involvement. Hall  et a l .  (1980) report more recent evidence  who p r a c t i c e BSE had more favourably c l i n i c a l l y fewer did  involved  not.  of breast  screening  Gastrin BSE  was taught  disease,  only  i s BSE  the most  cost-  procedure a v a i l a b l e but s i n c e the m a j o r i t y  lumps are detected  r o l e to play  those  nodes and smaller tumors, than those who  They contend that not  effective  central  lymph  staged  that  by  women  themselves,  in e a r l y d e t e c t i o n and prolonged  (1980) r e p o r t s on a massive study  i t has a survival.  i n F i n l a n d where  to 56,000 women aged 20 to 80 and which  resulted  6  in  greatly  contends  reduced  that  frequently economic  mortality  since  enough  breast  i n new b r e a s t screening  cannot  f o r a l l women, t e a c h i n g  s o l u t i o n w h i c h c a n be u s e d  cancer  cases.  be  He  arranged  BSE i s an e f f e c t i v e  to reach  large  numbers  of  women. Despite  the  seemingly  performance discrepancy that  four  practice but  low  (Alcoe al.,  out  of  five  i t monthly.  1977;  exists.  is  reiterated  1981;  usually  examination. well  as  a  result  Motivation  of in  1980;  Turnbull,  p e r c e n t a g e o f lumps a r e f o u n d is  of  widespread  Flynn,  1978).  u n d e r s t o o d a n d r e m a i n s a major  this  reports  knowledge  much o f t h e l i t e r a t u r e  accident  t o employ  a  23 p e r c e n t  1981;  Hall  Although  by women t h e m s e l v e s t h e of  BSE,  (1977)  women know o f BSE b u t o n l y  1979; Edwards,  Howe,  benefits  Stillman  T h i s assessment  compliance  & McDermot,  still  obvious  rather  a  et high  discovery  than  planned  health practice  i s not  challenge.  P u r p o s e o f t h e Study Performance its  benefits.  teaching  discrepancies Providing  approaches  Mager and P i p e  suggest  BSE  occur  i n BSE p r a c t i c e s d e s p i t e  information  may n o t be t h e o n l y problem-solving  remedies.  The a i m o f t h i s  variables  which  study  influence  health  practice.  I t i s hoped  these  variables  will  w h i c h may improve BSE t e a c h i n g  traditional  or t h e best  before  solution.  rushing  in  with  i s t o examine and d e t e r m i n e t h e  participation that  suggest  using  a  in  better  this  understanding  methods, t e c h n i q u e s effectiveness  preventive of  and d e v i c e s  and -which  could  7  then  be t e s t e d i n a c t u a l BSE t e a c h i n g In  the chapters  influence the  i t will  literature  which  seems  R e s e a r c h on p a r t i c i p a t i o n learning,  describes project broad a  and  research  specific  to  of  collection  the research  BSE  Paradigm  BSE  paradigm  suggests. chapter.  i n C h a p t e r V. and  and  Chapter I I I  developed  for  i t s development.  be p r e s e n t e d .  Chapter  methodology  including  A  IV  this  single, provides  instrument analysis.  t h e BSE p a r a d i g m  C h a p t e r VI e x a m i n e s BSE  using  the  t h e r e l a t i o n s h i p s between v a r i a b l e s w h i c h i t  L i m i t a t i o n s of the r e s e a r c h a r e o u t l i n e d i n the f i n a l A summary  future research  concluding  of  topic.  education  and s t r a t e g i e s f o r d a t a  may  barriers to  be e x a m i n e d .  d e s c r i p t i o n and d i s c u s s i o n o f f i n d i n g s u s i n g be g i v e n  a review  activities,  compliance,  underlying  will  description  will  for  theory  question  development, data A  and  Participation  the  II p r o v i d e s  related  l o c u s of c o n t r o l w i l l  t h e BSE and  Chapter  in educational  health education  compliance  f o l l o w BSE and t h e f a c t o r s w h i c h  be e x p l o r e d . which  programs.  chapter.  of the r e s e a r c h  and  and f o r t e a c h i n g  suggested  implications  BSE a r e a l s o g i v e n  in this  8  CHAPTER I I  REVIEW OF THE LITERATURE  Teaching lifespan. health In  BSE i n v o l v e s  Since  educator  addition,  deliberate  adults  i n general  i s faced the  process  and s y s t e m a t i c  process.  In i t s b r o a d e s t  creative  to  motivation, host  38). or  of o t h e r  cognitive, (Cropley,  this  to  change  37) and l e a r n i n g learning  environment"  or  affective  includes  is a  affective, p.  but  ethical,  It i s a  that  involves  variables scholarly,  also  aesthetic  involves and  "process  patterns of  involved  and  (Cropley,  p.  professional "motivational,  personal  growth"  39).  an acknowledgement in general,  literature  learning  from  specific  issue  understanding  it  simple  p, 3 9 ) .  absence of a p p r o p r i a t e  a c q u i s i t i o n of  as a  through  i s not a  dynamic  (Cropley,  and c o g n i t i v e  knowledge  adult  situation.  behaviour  a t t i t u d e s t o t h e p e r s o n s and m a t e r i a l s  vocational  process  the  p,  sense  presence  Learning  As  1977,  the  c a n be d e f i n e d  p r o c e s s of s e l e c t i o n and r e o r g a n i z a t i o n  reinforcement,  a  across  a r e a heterogenous group the  o f any e d u c a t i o n  attempt  (Cropley,  adaptation  women  w i t h a complex e d u c a t i o n a l  learning  of  educating  and t h e t a r g e t  review a  of the c o m p l e x i t y  broad  will  attempt  perspective  of l e a r n i n g about of  the  group f o r  variables  of the e d u c a t i o n a l BSE  specifically,  t o examine t h e i s s u e o f before  focusing  BSE. : I t i s hoped t h a t which  on  the  a better  may be i n f l u e n c i n g BSE  9  behaviour BSE  patterns  educational With  result.  in  mind  particularly  preventive  health  and the  decision  behaviour  of  research  will  learning  is  another  category  variables  which  influence  health-related  be  specific the  issue  This  perspective  of  involves  behaviour  Perceptions  of  reviewed  term u s e d by  received.  locus  broad  which  s i t u a t i o n of This  i s the  may  in  the  category  Barriers  research  from the  the  behaviour topic health  or  change  of  to  actual  may  reveal  learning second  perspective  in  broad  of  adult  community  be  to  to  reviewed generally  i s compliance. r e f e r to  health first  and  the  advice  from  then  the  as  it  specifically. expectations  A  research  are  This  literature.  examination  the  education  related  behaviour  areas mentioned. control  health  will  c o n c l u d e w i t h an summary of  the  r e l a t e d to h e a l t h  desired  research  improve  general.  d e g r e e of  the  of  program.  in  BSE  i s to  participate  reviewed.  educational  learning  is  be  specific  which w i l l  This  aim  of v a r i a b l e s which  to  BSE,  the  category  A  ultimate  in search  participation  a  The  programs.  this  influence  will  of  variable The  this  findings  a reccurring variable i s examined by  literature  specific  follows.  area  review of  in the  will  research.  10  Participation  Rubenson's Expectancy-Valence In an e f f o r t adult  education  Research  Paradigm  to s y n t h e s i z e the and  (1977) has developed  adult  knowledge  motivation  for  the Expectancy-Valence  available  about  l e a r n i n g Rubenson  Paradigm.  It i s h i s  c o n t e n t i o n that the researcher must c o n s i d e r both the micro the macro l e v e l s of s t r u c t u r a l c o n d i t i o n s i n which an is  found,  and  the l i n k between these two  examine  into adult  education  framework  programs,  as  well  as  in  a  learning process.  the  If the  behaviour  participation  and  a  is  schools.  aspect of the  is  a  basis  for  theories The  man  hindered  i n terms of d r i v e s and as  inhibit  his  model  building,  of  motivation.  scientific-physical  instincts.  the  i s needed.  uses d r i v e t h e o r i e s rooted i n b i o l o g y and p h y s i c s .  sees  performance  knowledge of i s s u e s which  As a  d i s t i n g u i s h e d three  dilemma.  remedy for changing  in a learning a c t i v i t y  various  one  concern  i s seen as one  examined  explained  i s - to  conceptual  recruitment  activity  research  then  U n d e r l y i n g theory. Rubenson  aim  recruitment of a d u l t s  analysis  specific  learning  d i s c r e p a n c y and education undesired  his  apparatus  can be used to look at the issue of a d u l t l e a r n i n g in  Participation  initial  While h i s  a d u l t education p a r t i c i p a t i o n and  general  individual  that i n d i v i d u a l ' s p s y c h o l o g i c a l conceptual elements.  and  The  He  school  Behaviour  is  humanist school  i n n a t e l y able to reach s e l f - r e a l i z a t i o n but he i s  in this  endeavour  by  the  blocking  factors  in  his  11  environment. of  acquired  Emotions, for  The  the  concept the  experiences needs  and  motives play  underlying  a t t i t u d e one  a c t i o n may  activity to  Expectancy outcome  have.  can  or is  relationship  be  a  a  of an  be  and  the  expect be BSE  an  related  to  the  If  outcome  of  surgery  her  or  the  lump  t o be  p a r t i c i p a t i o n i n BSE  health  an the  measure.  with  lump BSE.  lump ( i e . , a  cure),  a t t i t u d e about is  possibility  anticipate  patterns  of  affective  breast  would  success  chances  a  i n d i v i d u a l valence.and  a preventive  of  a breast  f i n d i n g a breast  affected accordingly.  or  strength  of  would  a v o i d a n c e of  of a p a r t i c u l a r  to d e t e c t  increased  influence  behaviour  outcome.  s u b j e c t i v e c e r t a i n t y about  one  BSE  or  anticipated  the  The  for  of  outcome.  finding  be  perception  the  to  a certain  Desire  likelihood  act.  refers  that  t o the  cancer,  c o r r e l a t e d to as  the  i s r e l a t e d to to  result  on  expectancy  f e e l i n g s about  expect  about  Valence  based  her  negative  one  is  opts  expectancy-valence  future.  to a f f e c t  BSE.  t o BSE  the  ability  out  related  the  her  carrying  of  the  about  expected  diagnosis  in  particular  act  about  detection  to  f u n c t i o n of  expected  belief  could  Rubenson  role.  It i s connected  belief  A woman's b e l i e f  early  a major  about  dissatisfaction the  is  has  activity  following  expectancy  lead  the  satisfaction  theory  i n terms  environment.  i n h i s model.  an  behaviour  psychological  as  aversion  Her  the  chooses  c o u r s e of  could  and  explains  c o g n i t i v e a p p r o a c h and  affective  what an  c o g n i t i v e school  related of  the  that  the  Not  only  a f f e c t e d , one teaching  expectency  to  feared valence would would  programs  to  related  to  12  Rubenson r e l a t e s h i s concept by  suggesting  that  there  enrollment  i f a person  satisfying  h i s needs  will  this  make  (expectancy)  will  (valence)  and  to  a  high  recruitment  probability as  a  of  means of  and b e l i e v e s that h i s a b i l i t y lead  to  desirable  outcomes  p. 9 ) . He contends that a person's  and e x p e c t a t i o n s are c l o s e l y himself  be  sees such p a r t i c i p a t i o n  participation  (1977,  to a d u l t education  related  to  the  way  values  he  regards  the a t t i t u d e s i n the groups around him.  e v a l u a t i o n and f a c t o r s i n f l u e n c i n g  Self-  i t begin to p l a y an important  role. Rubenson examines the expectancy-valence a d u l t education p a r t i c i p a t i o n which  directly  relate  research.  theory  i n l i g h t of  Since no s t u d i e s  valence and expectancy  exist  f a c t o r s to a d u l t  education p a r t i c i p a t i o n , he supports h i s framework with  research  on  and  motives  f o r study,  on  recruitment  obstacles  on  part ic i p a n t s . One  powerful  motive  for participation  d e s i r e to make p r a c t i c a l use of the  knowledge  seems  to be the  acquired.  Non-  v o c a t i o n a l motives are more common among intermediate and higher social in  s t a t u s people  this  area.  Requirement to study because of t h e i r  was the most common particular  than among those with l i m i t e d o p p o r t u n i t i e s  reason  qualifications.  f o r people As  c y c l e s , needs and s o c i a l  roles  tasks  on  differ  depending  personal ambitions is  under.  to  people  pass  change.  A  his biological  take  situation  courses  through person's  the l i f e expected  development, h i s  and the s o c i a l pressures and e x p e c t a t i o n s  Rubenson  suggests  for  he  that f i n d i n g s show a connection  1 3  between  the  education between  s i t u a t i o n people are (Rubenson,  the  education  about  BSE?  or  lack  knowledge or or on  connection  motives between  as  have  these  of  the  (1977)  research  than  external  less those  more l i k e l y  t o be  was  more common  in older  t o women  psychological  would not  experience  school  of  personally  personal out  BSE  status?  The  might  impediments or  review  be  some  are:  were  not  "related  of  the  1977,  p.  frequent  those  interested  in  psychological  i n t e r e s t e d , both lack  of  groups  information  fear  of  the  of  most  individual's  cause  12), by  plead  living  to  aspiration,  studies  than younger p e r s o n s ; c o s t one  have  revealed  same e x t e n t ;  men;  in  points  non-participants;  is  obstacles  those  level  the  to  improve h i s  is a  much a t t e n t i o n  (Rubenson,  likely  rather than  as  environmental  Among  to the  impediments  participation  personal,  carry  there  in  learning  related  to  had  education"  named by  more  and  BSE  r e l a t e d to h e a l t h  have not  who  obstacles  was  not  recent  age,  individual, his  neglected.  impediments  was  status,  pressure  connection  participation in  External  to adult  were  any  in  factors.  been  participating  barrier  there  her  suggests  Psychological  attitude  Rubenson's  study  have m o t i v e s .  often  plead  and  participation  participation  ambitions  for  self-confidence his  Is  social  impediments  been e m p h a s i z e d .  and  social  skill,  personal  Recruitment  the  10-12).  f r i e n d s ' experience with cancer  regularly  research  Is  r e l a t e d to  family  research  pp.  their  s i t u a t i o n a woman i s i n  opportunities  of  1977,  i n and  belief  attractive; possibilities  feeling of  a  powerful  situation; a of  was  that  negative education  studying  during  1 4  working  hours  is  a  powerful  recruitment  i n c e n t i v e s d i d n o t have a m a t e r i a l among h o u s e w i v e s . external be  examined  third  research  area  Rubenson  participants  white  education  active  time  which  occupation  or  participation  is  rates.  In a d d i t i o n , to  on  studies  and  actual  follow  incongruency  not  may  fairly be  available  able  which  (Rubenson, reaction  the  individual  1977, p . 1 8 ) . and  a  It  cognitive  of a d u l t forms  of  status,  concludes  between be  low  that  of  the  participation relate  their  1977, p. 1 6 ) .  Rubenson  the  value  sees  self-  factor.  t o mean  "the  ascribes is  personal  part  to  (Rubenson,  participation,  i s taken  and  whether an i n d i v i d u a l s e e s any  as a major c o n t r i b u t i n g  Self-evaluation  are  stimulating  Rubenson  have  p e o p l e may  education  i n terms o f income,  opportunities  people  some o f t h e  t h e r e l a t i o n s h i p between e x p e c t a n c y c o n c e r n i n g  evaluation  value  must  incidence  classes  efficacy.  the o p p o r t u n i t i e s  obstacles  t o p a r t i c i p a t e more i n  those with  social  He f e e l s t h a t  under-educated  and a d u l t  tend  pay-offs  and e d u c a t i o n a l  both  recruitment.  t o have a h i g h e r  dependent  reason  of  education  tend  political  that  non-participants,  workers  provide  i n education.  pressures  Given  and  p a r t i c i p a t i o n ; upper  education  needs  f o r recruitment  r e v i e w e d was p a r t i c i p a t i o n s t u d i e s .  t h a n manual w o r k e r s ;  leisure  education  collar  financial  i s t o suggest  the problems of  f i n d i n g s a r e : formal  connected;  value  Rubenson's c o n c l u s i o n  to understand  comparing  adult  e f f e c t except  e n v i r o n m e n t a l and i n t e r n a l p s y c h o l o g i c a l  The In  factor;  based  evaluation.  general  to himself on  both Rubenson  or  global  a s an  object"  an  affective states  that  1 5  "people the  are motivated  views  around  literature  found  perception,  in  them" support  adult  others, we  see  situations  the  In  connection  of  hierarchical  to  self-evaluation.  He  structure  found  i n each  and  p.  Since s e l f - e v a l u a t i o n  and  criteria  cycle,  encourages  school  permits 23).  by  changes o c c u r , the prevent  this  Socialization examines the of  member and  Member g r o u p s  that  influences  not  situations  self-evaluation work  on  initiatives  outward  with  influence  from  the  way  Rubenson  the  seems t o  his  be  which 1977,  over  time  the  life  environmental behaviour  to  23).  individual.  i n which a person  degree  is related  m a t u r i t y and  an  and  (Rubenson,  stable  (1977, p.  the  related  environment  t o "change  stop  of g r o u p s  r e f e r e n c e groups are groups  t o show t h a t  when  to dissonance"  not  elicited  theory  is relatively  i n d i v i d u a l has  does  better  has  a p p r a i s e s o n e s e l f change o v e r  concludes  leading  succeed  s c h o o l environment  these  and  individual  w h i c h one  Rubenson  of  self-  achievement.  influence  this  evidence  the  those with a negative  t o us,  the  and  of  between  and  attitudes  with  In o t h e r words,  to a childhood,  review  self-evaluation  importance  with  others  l i t e r a t u r e i t seems t o be  c h i l d h o o d environment,  t h e work e n v i r o n m e n t .  connected  than  V a l u a t i o n s and  those of  His  generally  developmemt of  interaction.  ourselves.  examined  compatible  relationship  self-evaluation  While  especially  17).  participation  c l e a r l y e x p l a i n e d i n the  social  p.  for a direct  education  with a p o s i t i v e  self-evaluation.  to  (1977,  achievement-oriented  been  to achieve states  t h e y have a c q u i r e d c o n c e r n i n g t h e m s e l v e s ,  the w o r l d  People  t o seek  Rubenson  The  values  individual's values. is  an  acknowledged  16  member and r e f e r e n c e satisfy  individual  Member g r o u p s but  not  Houle's  finding  p.  that  Given to  a smaller  course  differences  favourable  environment.  as  has  to  b e l o n g s and friends  work  within  identifies  and  family  himself  difficult  t o r e a c h them a n d  targets  for  increased  justification  colleagues  and  the  e d u c a t i o n may e a s e Description review paradigm function  and  (Figure of  talking  increased  the d e c i s i o n  exposure  both  Lewin's 1). the  His  to  to participate  field  Based  on  well-  groups. attitude  " i t i s not  persons,  one  the i n d i v i d u a l  group  are  Rubenson  about  for  educationally  reference  enterprises.  for  and  p. 2 5 ) .  organizations  of the paradigm.  using  (1977,  1977,  tool  that  t o which  with"  work  an  individual  important  educational  useful  in  based  determined  (Rubenson,  concludes  the groups  an  a  is  under-educated  are  Rubenson  are  Based on  groups w i t h a p o s i t i v e  workers  through  another  individuals'  under-educated  enough t o t r y t o i n f o r m a n d i n f l u e n c e also  on  interests  between  collar  based  findings  access to reference  e d u c a t i o n , white  or  groups.  selection  individual  p e o p l e and d i f f e r e n c e s  their  member  way  number o f p e o p l e t h a n t h o s e  i t seems t h a t  Rubenson s e e s t h e s e  educated  are  i n one  e d u c a t i o n programs  recruited  understanding  groups  groups  by g r o u p v a l u e s t h a n  24).  whose norms a r e u t i l i z e d t o  b u t i n w h i c h membership i s n o t o v e r t .  serve as r e f e r e n c e  group v a l u e s ,  more  needs  a l l reference  interests on  g r o u p s a r e ones  While it  available sees  the  studying the  his  with  benefits  (1977,  is  of  p. 2 6 ) . literature  t h e o r y , Rubenson d e v e l o p e d h i s  premise  environment  is and  that  behaviour  the i n d i v i d u a l .  is  a  Past  FIgure Paradigm of Recruitment  S o c i a l i z a t i o n through f a m i l y , school and work Act Ive Preparedness  Congent t a i PropertIes  S t r u c t u r a 1 f a c t o r s In the environment (the degree of h i e r a r c h i c s t r u c t u r e , < v a l u e s of member, and r e f e r e n c e groups, study poss1bl11tles)  •+  1. In A d u l t  Education  E x p e c t a t i o n ' the e x p e c t a t i o n t h a t e d u c a t i o n w i l l have c e r t a i n d e s i r a b l e consequences x the e x p e c t a t i o n of b e i n g a b l e to p a r t i c i p a t e In and complete the e d u c a t i o n  Force (the strength whereof w i l l determine behaviour)  P e r c e p t i o n and i n t e r p r e t a t i o n of the environment  V a l e n c e of  C u r r e n t needs of the I n d i v i d u a l  Source: Rubenson, 1977,  The I n d i v i d u a l ' s e x p e r i e n c e of needs  p.  30.  1  education  18  experience the  i s important  person's  between  psychological  structural  apparatus  i n terms  leads which  family,  s c h o o l and  and  arising  t h r e e of which member  and  material  out  confronted.  turn,  Use  of  and  and  a major  expectancy  environment. i n the  The  environment,  structure,  v a l u e s of  possibilities,  i s influenced These  as w e l l  needs  also by  reflect  t a s k s w i t h which  the his  he i s  environmental perception  to the v a l e n c e of  influenced  As  were  Using  s t u d y of young,  participation  He  found  that  is  i n the Johnstone generally  psychological.  education  by e x p e c t a n c y .  The  force  two  control  paradigm,  undereducated as Tough  more and  this  two  which  than  R i v e r a study  k i n d s of o b s t a c l e s :  and  dominant, examples c i t e d  while were  men  in  is  (1965)  Sweden  generally he  factors  single  working  adult  found  environmental  included no  Rubenson  (1969) s u g g e s t s ,  complex  Environmental obstacles  individual's  clearly  study  the  behaviour.  education  the  influences  the  Active  within  v a l e n c e , combine t o form a  1975).  there  behaviour.  factors  to i n f l u e n c i n g  also  (Rubenson,  assumed.  of  the developmental  of t h e p a r a d i g m .  analysed  of  socialization  needs.  needs g i v e r i s e is  expectancy  determines  and  In a d d i t i o n  in  results,  directly  experience  interpretation,  which,  and  in  conceptual  of h i e r a r c h i c  groups  left  individual's  occupational l i f e  are the degree  situation  of  of s t r u c t u r a l  expectancy  individual's  out  has  interaction  the  interpretation  reference  influences  and  arises  p e r c e p t i o n s and  latter,  and  it  A study of the  interpretation  preparedness the  field.  factors to  of t h e t r a c e s  beyond  obstacle  hours,  and  care  was of  19  children  and  referred  to  ambition  internal  and  information with  those  several  who  are  measures  are  that  not  education.  Rubenson  felt,  obstacles level  Too  a strong  d i d not.  entire  In  work  must  t e r m s of  seeking  only  be  occur of  of  little deferent  Rubenson  one in  Knowledge of  about  value,  its  drew  experiences  may  related  be  evaluation activities structure situation  seems and  to to  be  BSE  a part  in  The  with  p a r t i c i p a t e and recruitment  former group and  the  attitudes  and  want  of  need  scheduled  latter are  needs  or  an  of  group,  changed.  experienced  by  internal  negative  i n f l u e n c e s of  previous  of  BSE  sources  patterns.  Self-  i n f l u e n c e on by  work  practice an  information  learning  person's or  and  beliefs  influenced  a l s o exert  in i n d i v i d u a l  external  information  information,  important  a  examine  BSE  BSE  be  educational  to  both  availability  i t seems t o  R e f e r e n c e g r o u p s may play  would  ultimate  especially and  i f their  sources  and  not  those  into account.  positive  learning  do  Different  Success  light  obstacles.  drawn between  experiences  problems  taken  BSE  patterns  and  a l l .  available  hours.  complex  participants  at  t o be  f o r each c a t e g o r y .  about  can  had  education  interested  information during  may  adult  a distinction  needed  courses  The  self-confidence,  a v a i l a b l e o p p o r t u n i t i e s was  interested in adult  who  more  toward  Psychological  wanted t o p a r t i c i p a t e but  felt  are  those  f a c t o r s s u c h as  attitude  about  of c o u r s e s .  conclusions.  He who  availability  the  hierarchial  life.  patterns  i n f l u e n c e and  BSE-related  educational  Are  connected?  their  behaviour.  work  attitudes Are  there  20  any  differences  knowledge suggest BSE  of  in  related  increasing  A l l these  t o p l a n n i n g and  their  f a c t o r s may  recruiting  for a  t e a c h i n g program. to Participation  Carp,  P e t e r s o n and R o e l f  Commission would-be things what  they  felt  to  were  t h e y wanted  cited  (1974) c o n d u c t e d  on N o n - T r a d i t i o n a l S t u d y . learners  potential  obstacle  this  indicate,  important  to learn. was  item,  In t h e i r  from  They  found  financial  barrier  the  by a t a t l e a s t  program.  Each  one-fifth  of  mentioned  by  about  more  by  constrained  choice as w e l l . Younger p e o p l e tired  of  energy  lack  cost.  Those under  n o t enough t i m e ,  chose  32  percent  school  and  of c h i l d Age  of  time  Job  cited  35 saw c o s t  classrooms.  of being  n o t enough t i m e  home as a  required  to  indicated  responsibilities  c a r e and  caused  Women were t e n felt  generally  a variance in barrier  a s more o f a d e f e r e n t .  Not  time  enough  were c o n c e r n s  and time, of  especially  among  were home  middle-  t o o o l d and n o t h a v i n g  i n c r e a s e d w i t h age and was seen  Whites mentioned  35 p e r c e n t  job r e s p o n s i b i l i t i e s  group.  and c a r e of c h i l d r e n  and f e e l i n g s  percent  o f t h e s e c a t e g o r i e s were the  asked  learning  Fifty-three  d i d n o t want t o go t o s c h o o l f u l l  responsibilities groups  from  t w i c e a s many men a s women.  times as concerned  they  o f 24 i t e m s , t h e  them  cost.  a n d 21 p e r c e n t p i c k e d t h e amount  complete  were  percent  study  t h e most w i d e l y r e p o r t e d  n o t want t o go t o s c h o o l f u l l - t i m e , 28  research f o r the  a list  i n keeping  46 p e r c e n t c i t e d  responsibilities,  age  interested  BSE and t h o s e who a r e n o t ?  implications  Obstacles  did  between t h o s e  enough women.  and home r e s p o n s i b i l i t i e s  twice  21  as  much  as blacks  not  meeting  and b l a c k s  entrance  transportation  requirements,  and  study  Researchers concluded greatest  barriers  1974).  addition,  arrangements personal ethnic  may  education  three  dispositional  barriers.  in l i f e  participation  i n educational  are  to  oneself  as a  Under of  time  do  not  s e n s i t i v e to t h i s  situational,  time.  a l l other  an  barriers.  idea  willingness  as  course  ( l e s s i s spent  (men  activities.  attitudes  People mention  thing  sex  exclude  In  "schooling" i n t e r m s of Certain  issue.  cited  i n survey  institutional  Institutional  and one's  b a r r i e r s are  or discourage  adult  Dispositional barriers  and  s i t u a t i o n a l b a r r i e r s Cross  have  addition,  influence.  self-perceptions  about  learner.  lead  a barrier.  & Roelfs,  participating.  obstacles  the  health-related  traditional  of  be  S i t u a t i o n a l b a r r i e r s a r i s e from  a t any g i v e n  one's  to  influence attitudes  t h o s e p r a c t i c e s and p r o c e d u r e s t h a t  related  in  of  as w h i t e s .  seemed  an i s s u e  learning  headings:  and l a c k  care  (Carp, P e t e r s o n  in  desirability  grouped  child  be an i m p o r t a n t  be p a r t i c u l a r l y  (1981)  under  situation  health  or  g r o u p s may  findings  time  i n the past,  cost  subjects  i s not u s u a l l y  low g r a d e s  t w i c e as o f t e n  and  and a t m o s p h e r e may  ability  Cross  time  for their  programs,  planning  cost,  facilities  that  Although cost  educational  mentioned  ability  are  found  Cost  the  cost  f e e l s that of  t o pay has n o t been  to  pay.  Factors  on p l e a s u r e  usually  various found  and  lack  t o a s s e s s as many  probably  options.  t o be  the  In same  such as the purpose of the  versus  more w i l l i n g  cost  is difficult  i t but C r o s s  of  that  job-oriented  courses),  t o pay t h a n women) and age  22  (older  people  1981,  p. 1 0 1 ) .  excuse  i s a more s o c i a l l y  course. cost  In  a r e more w i l l i n g Cross  less  situational  percent  of p o t e n t i a l  many  Cross  by  still  thought  the  relevant;  barriers  in  lack  thinks  the  to learning  importance in  to  programs  10  and  25  Cross p o i n t s out  to eliminate  admissions  that  or  five  of c o u r s e s  procedures;  and  of i n t e r e s t i n g  many o f t h e s e p l a c e s and  procedures  existed.  but  She c o n c l u d e s  c o u r s e s would n o t be o f  itself not"  acts  (p.  as  that  She  are interesting, requirements.  are inconvenient  groups  or r e l e v a n t  locations courses.  practical  The ones most and  schedules  The i s s u e  o r p e r c e i v e d v a l u e o f BSE c o u r s e s a r i s e s .  that  may be a v i t a l  information source.  barrier  a r e a s : s c h e d u l i n g ; l o c a t i o n and  and t i m e  link  a  104).  relevance  and  that  between  surveys.  these b a r r i e r s  into  mentioned  this  a  mentioned  concludes  a t more a c c e s s i b l e  perception  frequently lack  i n most  exists  barriers  transportation;  taking  defensive  primarily  but a f f e c t e d  more f l e x i b l e  i t actually  institutional  not  a s an  they a r e s c h e d u l e d o n l y d u r i n g the i n d i v i d u a l ' s  day, then  whether  existed  classes  individual  or that  about  (Cross,  using cost  for  second  have a t t e m p t e d  scheduling  " i f an  interest  They  learners  t i m e s and by c r e a t i n g many p e o p l e  ranked  learners  institutions  barriers  or  out t h a t  who were l e s s and  mentioned  i n the answers g i v e n .  barriers.  for full-time  are  a c c e p t a b l e reason  barriers  devised  working  points  often  part  Institutional  that  pay)  i n which a q u e s t i o n i s asked  p l a y s an i m p o r t a n t  that  also  one s t u d y p e o p l e  as a b a r r i e r  context  to  It  of the appears  between BSE b e h a v i o u r , i n f o r m a t i o n  23  Cross mentions dispositional acceptable  important  more  this  lack  of  as  Excuses  that  are  likely  to  frequently  d i s c l o s u r e source  Under  desirability  barriers.  are  respondents  social  dropped  issue are  in measuring  most  given. from  socially  Uninterested  studies  and  thus  for d i s p o s i t i o n a l b a r r i e r s i s  heading Cross groups confidence  be  an  such t h i n g s  i n one's own  ability  as  being  and  lack  lost.  too  of  an  old,  energy  or  stamina. In results  conclusion, of  results  research but  experimental they  say  and  explain  various  Using  this  as  to h e l p  of  learning  approach  has  been  broad  factors.  opposed  theories adult  changes  Surveys give  dispositional  what p e o p l e do  aspects  of  The  to  what  examine b a r r i e r s could  provide  under-utilized  a in  R e s p o n s e Model  examining  her  The  Chain  model  activity,  of  but  that  in organized  of  (p.  stream  Responses  the  evaluation  environment"  theories  assumes  whether  s i n g l e act  flowing  do.  methodology  learning.  minimize  studies  that  estimation.  After  an  suggests  b a r r i e r s to  to  approach  Cross's Chain  on  tend  t o o l but  Cross's  a  on  t h e y might  powerful  forward  Cross  r e s u l t of  put (COR)  forward Model  classes a chain  p o s i t i o n of  the  125).  Behaviour  is  individual  and  move  which a l s o  flow  i n the  to  by  forces  increasingly  opposite  others,  (Figure  "participation  the  influenced  by  or of  Cross  puts  2).  in  a  learning  self-directed, is responses, each  based  i n d i v i d u a l i n h i s or seen which  as  start  external  d i r e c t i o n since  a  not  her  constantly with  conditions  the but  self-perceptions  24  Figure 2 Chain of Response (COR) Model for P a r t i c i p a t i o n in Adult L e a r n i n g Life  transitions  Understanding Activities  Information  Self-evaluation  Importance of g o a l s and e x p e c t a t i o n s ^ that p a r t i c i p a t i o n . . w i l l meet g o a l s «i  <$  Attitudes education  Cross,  attitudes  activities  1981, are  p.  make  up  If  the  COR to  avoid  evaluation  of  model.  Cross the  i n f l u e n c e s and These  t h r e a t e n e d " or  which t h r e a t e n is  attitudes  chain uses  of  influences own  "deficiency  their  influenced  by  of  self-  abilities, oriented",  self-esteem.  Self-  attitudes  toward  a r i s e out of p e r s o n a l  of the past and the e x p e r i e n c e s and  friends  significant  others.  responses  motivation-for-  and a t t i t u d e s and  learning  conditions.  the  out  in  persons l a c k c o n f i d e n c e in t h e i r  situations  education.  participation  with e x t e r n a l  point  sometimes c a l l e d " f a i l u r e they  by  i s the s t a r t  achievement r e s e a r c h evaluation.  124.  changed  and i n t e r a c t i o n  Self-evaluation which  ^Participation  about  Source: and  x f  Opportunities ^ a n d barriers  experiences  attitudes  Thus unhappy c h i l d h o o d  of  school  e x p e r i e n c e s or r e f e r e n c e group d i s a p p r o v a l can l e a d to avoidance of a d u l t  education.  characteristic  Cross suggests  stance  toward  a  "relatively  learning"  (1981, p.  stable 126)  and  exists  25  which  can  stance  responds to the  that  be  participation  is  seen as  and  if  not,  both  towards Gradual trigger  the  and  a  i n the  between  desire  in  sensitivity  interest  new  which  moments r e l a t e d  events  would t r i g g e r  to  which  participate  preventive It for  i s at  individual  are  i n a BSE  an  mentions  attitudes  and  both  times  example Are  be  to  well.  can  classes.  interest  program  as  are  An  T h e r e may  change  Havighurst's  there  things.  increased  to  movement  changes  implies that  education  is  transitions,  dramatic  t o BSE?  strong  is related  participation  Cross  and  of is  there  particular  or  motivation  develop  new  health practices.  learning  special  about  is  influence  show i n p a r e n t i n g  such t e a c h a b l e  i s important  s e l f - e v a l u a t i o n and  Life  for learning certain parents  expectation  model t h e r e  adjustments,  and  the  motivation  initial  learning.  moment" c o n c e p t  and  characteristic  Self-esteem  expectancy.  life  for  This  If a goal  COR  the  expectations  transitions  "teachable special  success  and  goals  decreases.  r e q u i r e making  goals  of  through education,  a t t i t u d e s , and  which  negative.  meet g o a l s .  motivation of  or  importance  will  directions  educational periods  positive  achievable  expectations in  either  this  point  appear  in  i s motivated  opportunities  weakly  opportunities  motivated but  that b a r r i e r s  they and may  modest  Availability  of a c c u r a t e  b a r r i e r s may  seem  Cross's will  and  chain be  of  special  opportunities  responses.  encouraged  t o seek out  overcome modest b a r r i e r s . be  encouraged  barriers  may  information  unsurmountable.  by  forestall is  Once  Those  awareness  the the who of  participation.  critical.  Without  it  26  From t h i s  point  participation.  i n the  The  COR  cycle  is  influences  s e l f - e v a l u a t i o n and  motivation  i s influenced  currently  most  the  and  opportunities  motivation  before  while  influence  need t o be  external has  Thus,  as  looking  not  may  results  may  to such  Cross  model.  suggests  model,  learners  that  i n the  i s the  starting point.  concept  high  expectations g r o u p of  resources  and  facilitate  participation.  environment help  situational  which  keep m o t i v a t i o n  minimum.  As  fosters high  and  of  students and was  or weak  suggests  before  that people  removal  More a t t e n t i o n variables  there  is  as  of than  self-  emphasis  barriers. of  these  eager chain  of  With  a  adult  sample  their  responses i s the  barriers  information  a  of  selfseem  that  learning  p o s i t i v e self-esteem  influence  and  about  arrangements  mentioned e a r l i e r ,  which  key  positive  success needs  The  oh  obvious b a r r i e r s to  institutional  continued the  has  model, most  learning, motivation  self-evaluation  This  barriers  at  i s needed.  removal  f l o o d of  i n p a r t i c i p a t i o n and  surmountable.  i n the  external  wonder why  that  learning occurs  Cross  internal  and  suggests  p e r s o n who  extent  attitudes  obvious  in a  the  to  education,  Reducing  reach  some  Rubenson's  the  to  on  participation  Cross  make a d i f f e r e n c e .  given  well  and  about  stage.  backward  to  when  result.  i n the  flow  will  with  resulted  offerings.  end  not  point  educational  beyond  educator  the  may  motivated  been p r e v i o u s l y and  has  this  barriers  evaluation  complete  attitudes  barriers  enhancing  will  by  i n d i v i d u a l steps  e f f o r t s to a t t r a c t a d u l t s  opportunities  the  model the  barriers  will to  a  27  After situation such  deciding other  to  barriers exist  paricipation.  guarantee d e s i r e d behaviour factor  Involvement  and  in understanding  the  actual  influence  in a  link  an  the  learning  learning  outcome  activity  Variables  which  does  not  influence  e x p e r i e n c e s are  between BSE  of  behaviour  another and  its  variables.  to  Learning  ISSTAL Model Smith  (1980)  discretionary time or  in  after educational  Barriers  The  which  behaviour change.  during  influencing  participate  sustaining  he  behaviour  which  norms and  by  (p.  He  than these  One knowledge  not  aiming  at  presence  and  can  facilitate  in a  Smith's  i n the He  help  us  learning foremost  s o c i a l and felt  or  al.,  1980, or  culture,  living p.  that  human  of  explanation  of  factors  is  model  the  the  which  behaviour which  and  others"  time a c t i v i t y a  1).  custom,  imagined)  understand  "the  t o making a  behaviour,  The  individual  t i m e as  s o c i a l behaviour  least predictable  it will  active  integrated.  ( S m i t h et  discretionary  l e i s u r e time a c t i v i t y .  of  essential  (actual  since  examine  discretionary  i s " s i g n i f i c a n t l y s h a p e d by  decisions  barriers  defines  society"  f e e l s that  explain such  a  is  the  most v a r i a b l e  He  for a c t i v i t i e s  life.in  Specifically,  helps  d e v e l o p e d a model t o  behaviour.  available  1).  has  other  influence  influences  and  situation. c o n c e r n s was  behavioural that  that science  the  great  field  compartmentalized  fund was  of not  disciplinary  28  s t r u c t u r e s and subfield related  specialization  being  unaware  subfields  develop  a  broader  taken  has  s y n t h e s i s of our  range  a  of  account.  social  pooled  independent He  calls  refers  relevance based time is: role  t o t h e end  sequenced effects.  external  intentions); and  plans);  definition  research Smith's provide  dispositions retained and  o r d e r of  across attempt  the  (values,  (ISSTAL)  be  Model.  the  most  long-range  short-range  (images,  time-  space  and  i n h i s scheme and  intellectual  attitudes,  variables  from  background  and  feels  w h i c h must  six classes  social  both  i n terms of b r e a d t h of  the  the  about  Interdisciplinary  Lifespan  as  traits  situational  variables  This includes well  to "an  w h i c h he  progression  information  social  capacities;  expectations beliefs,  (immediate  and  knowledge  awareness  and  situation).  categories the  are  a  social  to  A brief  result  the  examination  disciplines. findings  for explaining  examination  t h e model w i l l  of  science  synthesize  a c o n c e p t u a l framework  activities. make up  proper  as  personal  of t h e  These  behaviour.  in order  is essential.  scheme  variables  contextual factors;  variables;  attitundinal  specific  effects  The  to a  one  behaviour  ( p . 3)  it  Specificity  that  in  advances i n  knowledge  six-class  Sequential  most  relevant  of  Time A l l o c a t i o n  the  or  suggests  Specificity  to  specialists  He  Sequential  general  to  participation"  developed  the broad into  parallel  theory  informal social  Smith includes  of  led  or d i s c i p l i n e s .  interdisciplinary f o r m a l and  has  of e a c h  of  h e l p t o see what has  thus  of  the  They  are  f a r and  to  discretionary  time  the  that  been  classes included.  29  External are  contextual  factors.  the external contextual  The  factors.  first  They  include  range o f d e t e r m i n a n t s  of a given  factors  B i o p h y s i c a l environmental  are  given.  all  nonhuman a s p e c t s  the  individual's  topography, Biological comprise defined or  life.  the second  Cultural  factors,  and  i n a given  skin  and  the t h i r d  systems t h a t d i f f e r e n t i a t e  linguistic  groups,  even  These a r e the b a s i c p a t t e r n s  ingrained factors,  stable during on  across  of  group w i t h i n  the s o c i e t y or s u b c u l t u r e .  expectations  f o r behaviour  or  institutional  organizations. differ  from  characterize  and  and  and  factors  mainly  a l l o r even n e a r l y a l l  included.  " a l l the s o c i a l l y beliefs, ethnic  ideas  groups, 38).  which  are  which a r e  Social-structural to role  roles,  or group t o  social  groups  in l i f e .  that of  normative  specific  particular  members  and  (p,  They a r e t h e  in  of  physiognomy,  are  They c a n be l e a r n e d a t any s t a g e cultural  level  individuals  role  in specialized  contexts  population i s  age-cohorts"  socialization. from  objects.  general  societies,  values  hand, v a r y  climate,  populations  ideas,  different  upon  society, culture  density  time and w i t h i n  childhood  the other  A single  values,  types of  as  human  includes  symbolizing  or  of  whole  impinge  things  pigmentation  general  Four  which  stature,  sub-set,  "the  factors refer to  nation,  population  of f a c t o r s  human-made  of f a c t o r s .  Average  modal  and t r a n s m i t t e d  relatively  world  characteristics  living  distribution  (p. 3 5 ) .  such  animals  (p. 38).  health,  includes  sub-set  as " a l l those  spatial  It  and p h y s i c a l  physical  created  of the s u r r o u n d i n g  pollution,  territory"  person"  class  they a  or They  do  society  not or  30  group. refers  They to  refer  the  research,  broad  i n order  sample n o t j u s t in  terms  of  individual separated Changes  contextual  to control in  different  social  distinguish Social  background  role  of f a c t o r s ,  demographic factors society  exerted  and  social role  past  assigns  must  and  a  here.  overlap  social  positions  roles,  and  which  society  Physical  become  occur  should  be made  in role  be  the a c t u a l  appropriate  to  and a c t i v i t y  such  social  characteristics  Social  The  roles  history, familiar  i n t h i s c l a s s of  characteristics.  to  ascribes  with  individuals in  (p. 40).  another  h a n d i c a p s may r e s u l t  with  positions,  One s u b - t y p e  meaning  they  must  separately.  social  physiological  social  be  other.  context  may  characterize  present"  sex, age, e t c . ,  conditions.  by e a c h  experiential  and  f i t in  i s physical  roles  Personal  the  also  influences  and p o t e n t i a l  personal  states data  factors  weight,  those  can  differ  background and s o c i a l r o l e v a r i a b l e s .  relationships, physical  versus  must  s o c i a l b a c k g r o u n d and s o c i a l  or s o c i a l  the i n f l u e n c e  that  effects  e x p e c t a t i o n s and attempts  terms of " p a s t , p r e s e n t ,  and  variables  that  factors,  interest.  o f one  culture  suggests  s o c i a l and h i s t o r i c a l  Contextual  physical  of  contextual  f o r the e f f e c t  main c a t e g o r y  Different  factor and  the i n d i v i d u a l ' s  next  Smith  b u t s i t e s and s i t u a t i o n s  charateristics  the  and  patterns.  while  t o examine t h e e f f e c t o f t h e s e  the  be m e a s u r e d .  to  social  individuals  also  roles.  t o t h e d e t a i l of s o c i a l l i f e  When  t h i n g s as h e i g h t ,  factors.  Ascribed  sub-type of f a c t o r s , a r e according  to  various  s u c h a s age o r p h y s i c a l  e x p e c t a t i o n s w h i c h may o r individual.  may  not  Someone may n o t f i t  31  into a  stereotype  of  t h e y have c e r t a i n  "elderly"  physical  or  "handicapped"  traits.  where  contends  i t i s a continuous variable  sex-typed  i m a g e r y and  social  entered about  can  treating  scales  as  the  labels studies  be  of  that of  studies data  the  thus  The  are  far.  to  a broad  He  range self-  The  memories  such  nominal  review  consensus  is  a  found  major between  43).  history, an  the  fourth  what has  often  sub-type  individual's  frequency are are  validity  literature  relationships  of  of  among  of  a compilation  Such  discrepancies  role  to  cautions  and  use  of  refers  be  to a continuum  to  Smith's  (p.  third  w h i c h may  Smith  reliability  and  a  variables.  ranks r e f e r  behavior"  T i m i n g and  roles,  roles  nominal  resolve.  activity  are  and  is questionable  strength  and  since  personal  happened  the  of  in  their  difficult  data  f a u l t y and  logitudinal  rare.  last roles  resources.  to  and  which attempt  "degree  the  They  collect  studies  been made.  Once a g a i n ,  as  membership  in t h i s category,  history.  social  social roles  r o l e m e a s u r e s and  lifetime  positions  voluntarily.  become d i f f i c u l t  factors  referring  social positions  those  left  these  Experience  to  to  correlate  determinant  have  normative e x p e c t a t i o n s ,  perceptions etcetera.  suggests  social  achieved  results to  behaviour,  political  attitudes, of  or  refers  and  generalizations  another  beliefs.  Voluntary sub-type,  because  S m i t h u s e s g e n d e r as  example  of  incorrect  just  sub-set  of  includes  While  Smith  factors  under  resources, feels  that  social  background  possessions  and  access  resources  are  a  and to  strong  32  determinant variables given  of  discretionary  usually  income,  behaviour. role  measured a r e  funds  Direct  may  not  would  power a c c o r d i n g  to  combined  self-report  perspective  of  geographical different  social  There  of  think,  (over  and  depending  on  external  cognitions,  the  physical  Smith uses c o n a t i o n contends covert  behaviour  respond respond. include  that  cannot  might  any  may  of  the  context  e s s e n t i a l as  what  people's  v a r y and  traits in  to  to  be  present  and  the  more  traits  47).  factors,  capacities.  of  individuals  until  involves  there  current temporary  individual's  not  in  react  others, not  of  intentions or  this  "relatively  influences  wanting  trait  under  as  People  simultaneously.  the  personalized  intellectual  dispositions  will,  quite  Following  individual patterns  (p.  of  settings.  e m o t i o n s and  observed  the  is  internal  personality  contextual  may  i n c e r t a i n ways and  describe  on  interaction  capacities.  personality  act  the  factors  roles  which o c c u r s  and  be  social  states,  Limitations  characteristics  measurement  situations)  but  to p a r t i c u l a r  explanatory  circumstances"  influences  a  and  social  want, and  After  p r o v i d e more a c c u r a c y  intellectual  defines  related  the  life-style  in d i f f e r e n t physical  t i m e and  feel,  strongly  Direct  personality  Smith  indicators.  social class  is available  traits  contends that  or  i s tremendous v a r i a t i o n  enduring  to  what  resources  heading.  to  Smith.  b a c k g r o u n d and  category  be  crude  he  role  s i t u a t i o n and  Personal  only  m e a s u r e s of  expectations  with  behaviour,  only  changing as  well.  intention. overt  The  as  He  well  capacity  to  is a willingness  individual individual  intellect  per  se  as  to  capacities physical (p.  48).  33  Intellectual  capacity  the  of  absence  physiological and  i s p r o p e r l y measured,  external  limitations.  may e x p l a i n why o n l y  variables  next  which  similar  in  implicitly to  suggests  the  Attitudinal ISSTAL  internal  difficult  to achieve  involve covert  personality linked.  that  situations,  Smith  they  applicability.  traits  fall  Values  along  a r e more  attitudes  across  fewer and i n t e n t i o n s a r e most Each  of  these  overt  activity.  intentions  labels  understanding  of  predictive  relevance  in  situation.  a given  personality motivation  but could  a l l such  also  as  be t h o u g h t  situation"  (p. 5 8 ) .  motivation  is  one  expectations be  feelings,  values  "one  'cause'  power  many  across  still  bound.  d e s i r e s and on  specific  limits  that  of  as  dispositions with  most  behaviour  components  motivation.  of a s " t h e n e t o r combined  the  one's  behaviour"  f o r a given  them n o t o n l y  Combined of  across  situation  i f one f o c u s e s  components  motivational  and  constructs represent increasing  and e x p l a n a t o r y He s e e s  dispositions  to  to  that  H i s o r d e r i n g of these  o r more  apply  to  (p. 5 7 ) .  enduring  likely  likely  factors  They a r e  of t r a n s s i t u a t i o n a l  involve thoughts,  the  (p. 52).  four  fewer,  attention  integration  a continuum  Smith c a u t i o n s t h a t  without  cognitive  are less  lists  behaviour.  They a r e i n t e r n a l  behaviour  but  capacity  d i s p o s i t i o n s make up  model.  w h i c h a r e l e a r n e d and i n v o l v e  situationally  of  seems v e r y  in  temporary  a s m a l l number o f i n t e l l e c t u a l  dispositions.  category  motivators and  This  or  a r e u s u a l l y i n c l u d e d i n r e s e a r c h on s o c i a l  Attitudinal the  contextual  Smith contends,  relevant  Current resultant to  current capacities, important  elements  of  that  current i n the  34  sequential to  specificity  largely  determine  behaviour  part  o f t h e ISSTAL m o d e l .  the a c t i v i t i e s  ultimately  tends  of any  to  They  combine  individual.  operate  through  Social  these  two  the  end  elements. Retained  information.  discretionary Images, class  behaviour  beliefs, of  information,  as  "continuing,  information  in  nonsymbolic,  actual  various beliefs being  and  true.  Plans,  information  action.  current,  the  have  another used  perceived  they  feel belief  i n any g i v e n  may be  such  choices.  f o r use as g u i d e s  and c u r r e n t  and e x p e c t a n c i e s ones w i l l  bits  role in  capacities,  of past  to  f o r overt  p l a y i n g a major current  to  p r o b a b i l i t y of  a r e those  Smith c a u t i o n s ,  situation.  as  a r e l a t i o n s h i p between  processing  information,  an  stock of  and may n o t c o r r e s p o n d  information  Cognitive  information  to  coded m a t e r i a l  k i n d of b e l i e f ,  intended  the  of l e a r n i n g .  information  have a h i g h  of the s i t u a t i o n ,  individual  from  i t , refers  Such  imply  n e c e s s a r i l y mean any p a r t i c u l a r  motivation  t o make up t h i s  S m i t h u s e s knowledge t o r e f e r  special  or  information.  and u s u a l l y growing  (p. 5 9 ) .  i s a personal  t h e form o f r e t a i n e d  of  be  defines  Beliefs  that  motivation.  possible  combine  images, o r s y m b o l i c ,  definition  availability not  brain"  Smith sees r e t a i n e d  individual  in  This  can  enduring,  knowledge.  people  to  of r e t a i n e d  plans  Smith  items of i n f o r m a t i o n .  reality. of  the  closer  o r from memory a s a r e s u l t  individual's  beliefs  and  Information  surroundings  Retained  step  i s the category  knowledge  factors.  immediate  One  and  experiences,  stimuli  produce  however,  based be u s e d  that  on them may to  create  D i f f e r e n t i t e m s may be u s e d  35  at  different  purposes. much of  times  Smith  more  points  out  that  situations  this  for  different  i s a v e r y complex a r e a an  and  individual's  use  determinants  of  h i s memory bank.  social  variables.  behaviour  definition process  are  of the by or and  happening"  (p. 62).  from  mind  this  immediate  any  know  emphasizes  changing  that  Smith  the  experiences, discretionary emotions,  the  suggests  that  what  behavior" i n an  the  syntheses through redefined"  immediate  i s the  most  behaviour and  p r e s e n t as proximal in  other  the  life  span,  i s part these  i s needed is.  on  This  to  there  situation  ISSTAL  information  model. or  He  and  an  situation  process  of  say  exists  i t i s p e r c e i v e d through determinant  to  controlling  the p r e s e n t  63).  terms  individual  goes  which  (p.  Smith  individual  He  present  stimuli  measure  knowing, a c t i n g ,  individual's of  and  "unique  (p. 63).  all  currently  environment to  and  it  is  self-report o f an  cognitive  puts  individual.  involves  wanting,  definition  beliefs  the  include  sensations  environment  experience  feeling,  being c o n t i n u a l l y  filtering  in  of  They  of t h e  information, sense  from  behaviour  cognitive  takes  attempt  o n e ' s own  both a c u r r e n t  result  R e s e a r c h e r s must  conscious  of  variables.  internal  "at every point  ongoing  wholistic  of  S i n c e an  that  consciousness and  stored  awareness.  the  set  " t h e end  individual  Inputs  as w e l l .  what  or  a r e e x p e r i e n c e d by  situation.  variables  an  makes  sixth  the s i t u a t i o n a l  remembers  together,  the  The  situation  which  perceptions  is  different  r e s e a r c h i s needed t o u n d e r s t a n d  Situational  of  in  of past  individual S y n t h e s i s of  stimuli,  past  or  36  present,  defines  motivation current (p.  for  The  context  examining  a t any  given  the d e p t h  time  a  ranges of  the  of v a r i a b l e s examination  t o be  when  are,  in  a  they  characteristics.  fact,  Increased  precision  is  made  gathering  and  analysis.  overlooked  and  remedial their  effective  approaches w i l l  detailed  set  by  resources" readily  barriers range  which  of  see exist  variables  animals  which  socialization  their  influences. each  experiences,  attitudes,  variables  filtered  individual  are  perception  and  to  While  more not  and  of  will  values, etc. interpreted.  continue  a  ultimately  data to  and  be of  more  accurate  resulting  model  I n d i v i d u a l s need experiences a l s o as  to  social  influence a  personal which  is  which  ever-present  factors  through It  until  instead  more  and  susceptable  has  occur  broad  v a l u e s but  some b r o a d  finite  research  research.  individual  which  factors  outcome of  collection  be  of c e r t a i n  efficiency  analysis  such  attitudes  continue  range of p e o p l e ,  the  Smith's  Broad  will  remain  but  increased.  education  Increased  o n l y be  i n the p a s t  of  relationships  provide g u i d e l i n e s in beginning  influence  indicative  adult  targets.  o n l y as a  be  understanding  in  research.  examined not  to  actions will  in  wide  limits  can  conglomerate  True  specific  still  the  broad  needs  been t a k e n  be  in current  current  have been n o t e d  have  to  and  S m i t h ' s work  categories  and  results  addressed.  Broad  more  and  " w i t h i n the  to a c c u r a t e l y understand  individuals be  situation  behaviour  current  educator  in order  must  present  which determines  capacities,  64).  that  the  this  decides  mesh such  of  broad  uniquely what  is  37  desirable,  what t h e b a r r i e r s a r e t o a c h i e v i n g  desire  i s great  these  barriers.  Personality Hand may  enough t o  Puder  interfere  that  personal  They  of  students  see  behaviour  as  well  as  (p. 1 ) .  as  Their  factors  participation  being  the  of d e v e l o p i n g  self-concept.  i f i t i s perceived  view of S e l f  of  the  hidden  i s avoided,  (Could  the  finding  a breast  rejected  rejection  of  and  BSE  lump i s r e l a t e d  only  to  of emotion in  many  within the literature  key t o l e a r n i n g thinks  Learning  related  their  premise i s  affect  for learning  positively in  and l e a r n i n g  education  educational  "hierarchies  review  which  appear  in  or m a t e r i a l l y  From t h e i r  factors  much more t h a n  experience.  see s t u d e n t s a s h a v i n g  self-concept  more r a p i d l y  Self  overcome  basic  and i n t e r n a l i z a t i o n o f what a p e r s o n  basis  learner's  adult  bring  t h e s o c i a l i n t e r a c t i o n and c l i m a t e  they  of  that  which can i n h i b i t  classroom milieu"  the  learning  c h a r a c t e r i s t i c s and e m o t i o n a l  experience  ways  the  t o the l e a r n i n g  learning  activities. and  with  presence  inhibit  continually  (1967) examined p e r s o n a l i t y  They c o n t e n d  physical  and  Factors and  students.  initially  i t a n d whether t h e  of  him,  i s internalized  relation  to  to negative  rarely  the  aspects  internalized.  be b e c a u s e o f a p e r c e p t i o n t o t h e body's  "failure"  past  experiences  that  to stay  healthy?) Hand and Puder learning anything occurs.  can  lead  new and Calling  a  suggest to  a  vicious attention  that  "closed cycle  negative self" of  which  avoidance  to the emotionally  with  i s f e a r f u l of of  loaded  learning situation  38  in  the classroom,  the  student  t e a c h i n g through  cannot  learn  and p o i n t i n g  and  not student  (p.  4).  "in  p r o p o r t i o n t o the degree  alone, and  isolated  thus a n x i o u s  Puder,  disposition  and  status  helpless  than  in  high-status  interferes  of the f e e l i n g  little  suggest  that  psychological acceptance  The  failure  closed  made  mind  to  feel  i n which they i n .store"  live,  (Hand  &  degree  ability  (Hand  feel  that  their  factor  disturbance that  and t h e i l l i t e r a t e  a s two c o n d i t i o n s t h a t  related  to h i s level  conform  to  the  individuals  are a f r a i d  amount  and of  they  as a t e a c h e r a s f e a r f u l . figures  efficiency  fall  of achievement,  efforts  and  Puder  to learning  of  this  i s able to control  own  or  emotions into  its  ( p . 1 3 ) . Any  d e c r e a s e s awareness  see a n x i e t y and r e l a t e d  Puder,  o r v i c t i m i z e d by  dogmatism may be an i n h i b i t i n g disadvantaged  &  through  Hand  determine  authority  People  t o which a student  to  persons  socio-economic  learning  o f new knowledge d e c r e a s e s  system  i n lower  them.  Hand and Puder  "directly  with  t o do w i t h what happens t o  the c u l t u r a l l y  belief  which  Of t h i n k i n g i s  are  of b e i n g m a n i p u l a t e d  f o r c e s beyond o n e ' s c o n t r o l .  and  they  holds  a  system  i n the world  of what t h e f u t u r e  Dogmatism  production  of  to a closed  r e s e a r c h shows more dogmatism  persons  10).  have  out o n l y student  as sources of  t o which  by  1967, p. 6 ) .  Other  p.  success are c i t e d  People's  t h e use o f methods  prevents  performance  and a c l o s e d situation.  h i s anxiety i s  and t h e s t u d e n t ' s  accept  authority  demands  will  academic  sucess"  (p. 16).  When  tend  t o judge  In a d d i t i o n ,  a stimulus person  instructions  which a r e d e s i g n e d t o i n h i b i t  from  their  such such  feelings  39  tend  t o enhance t h i s It  seems c l e a r  importance. attitudes educator  If of  at  least  others  i s the  ideal  initially  key  of  at  the  least  to  encouraging  some  measure  Gearing  seem t o be  of  the  in  which  the  hands  learning  positive  are  the  a positive  learning  Adults  and  observed  and  contend  Norris that  than  the  aspects a  focus  course,  what The  some  aspects  aim  anxiety  of  must be  to  surrounding  unaware them.  At  Adulthood  many  physiological  characteristically  (1977) examined  the  over  with  that  many  at d i f f e r e n t  changes o c c u r r e d  accentuated  minimize  positive  of  of  which n e g a t i v e .  P s y c h o l o g i c a l Changes of  changes  and  were  perception  s e l f - c o n c e p t and  must  psychological  gradually  and  requires,  of  experience.  Physiological  adulthood  student's  can  t h i n k i n g and  to produce This  ones w h i c h  than  l e a r n e r i s more l i k e l y aspects.  with  rather  to the  negative  the  learner  success  critical  control  then  c o n f r o n t a t i o n , which  which  emphasize  and  attitude  activities  himself  adults  with  support  paramount  learning  learning  the  foster  and  i s of  i t s development  situations  methods  w h i c h e n c o u r a g e and  of  He  atmosphere  the  source  learning  create  understanding  the  is  a positive,  use  which  students.  on  learning  emotionally-loaded, anxiety-producing  failure,  of  17).  self-concept  The  identify,  put  (p.  t h a t the  must c u l t i v a t e  students. avoid  effect  their  take  effect  physiological  on  changes  r a t e s among i n d i v i d u a l s .  time  and  were  of  them  until  this-point  generally a  in  learning. occurred Since  gradual,  traumatic  t h e a d u l t may  place  and  the most  experience  underestimate  his  40  power t o  learn  changes  or  to  i n i n t e r e s t s and  Norris  found that  the  early  The  more e x p e r i e n c e  twenties,  learning  task  individual's education be.  within  a  concept.  of  Willingness  to  need  for  expectations  and  to  adult  s o u r c e s of perceive life-long  with  learning,  easier  the  the  greater  the  the  amount  of  ability  will  i s seen  best  must  make, t h e  highly  and  addition, the  greater  in learning  motivation  or  task  science reducing  from  research the  to  learn  habits,  values  of  what and  social  how  want.  and  r e l a t e d to p e r c e p t i o n  acceptance  self-  of  to  affiliation  the  learn, and  to  in  particular  process. deal  successful  help  obstacles'to  with  research in adult  They  base.  The  t h e y have,  their  barriers  they  a r e s u l t of  who  occurs  wish  barriers must  A l l aspects  understanding, learning.  complex.  are  learning  learning  some  the  Educators the  literature  highly values  individualized.  a broad can  a t t i t u d e s and  and  r e d u c e or  overcome b e f o r e  their  the  barriers-to-learning  socialization  understand  in  they  l e a r n was  the  motivation are  peaked  almost anything  common t h r e a d s have emerged: L e a r n e r s a r e they  ability  life.  reviewing  decisions  that  occur.  needs, g o a l s ,  the  suggests  learn  In  self-esteem  from  may  slower h i s d e c l i n e  contends that  learning,  In  can  t h e y have  framework  of  to the  adults  the  Norris  although psychological  becomes.  has  tasks.  motivation  intelligence  he  Norris  value  perform  a to  adults  approach of  social  anticipating  and  41-  H e a l t h E d u c a t i o n and C o m p l i a n c e Health to  educators  the problem  they  label  many d i f f i c u l t i e s . the  term  The  Meaning  have a t t e m p t e d  An i n i t i a l  encounters  "motivation  to  advice"  the e f f e c t  compliance  many s u g g e s t i o n s Tagliacozzo  utilize  medical  (p. 772).  by  recommended selecting  the  "compliance"  clinical similar  to  ( i n terms  prescription" to  Mager  and  is a difference  Compliance  refers  specifically Sackett using  and  Ima  (1970)  f a c i l i t i e s - and  on  using  refer  (1979) i n t h e i r  symbolize of  and  life-style  study  therapy  (p. 1). Pipe's  to  the  (1976) speak o f t o which the  medication,  A l l these term:  following  situation.  definitions  performance  and  health oriented  desired of  this  performance. problem  They were c o n c e r n e d  n e g a t i v e c o n n o t a t i o n s which surrounded  seem  discrepancy.  (1976) p o i n t e d o u t t h e h a z a r d s  "compliance."  282).  changes) c o i n c i d e s with the  occurrence  and Haynes  "adherence  "the extent  taking  between a c t u a l  to  to  to  patients defined  S a c k e t t and Haynes  the  t h e term  f o r the  to adhere t o  recommendations  (1980) r e f e r  (p. 6 ) .  or e x e c u t i n g other  possible  o r even  a p p r o p r i a t e h e a l t h c a r p r o v i d e r " (p.  regimen"  patient's behavior  in  encountered  i n the l i t e r a t u r e  o f a t e a c h i n g p r o g r a m on c a r d i a c  W i n d s o r , G r e e n and Roseman  There  have  i s defining  L i n d e and J a n z  as " f o l l o w - t h r o u g h  prescribed  diets  problem  They  research  of Compliance  meaning o f c o m p l i a n c e .  of  "compliance."  similar  compliance.  One  medical  to apply  the  in a  involved about the  word.  The  42  W o r l d Book D i c t i o n a r y includes  in  "yielding  to a request  point  that  out  which as  its  (1973) g i v e s  the  i s s u e s an  would t h e  accompany  definition or  idea  e d i c t t o be  collection  failure of  "sin  to y i e l d  on  the  "yield"  r e g i m e n was  developed and  a citizen  client's is a  by  now  it  did  thoroughly  remain  of  and  Marston  compliance  with  compliance  rates  operational  be  this  any  issues  in  in  as  workers  range  results often  to  compliance.  i n the  field  which  in other  a terms  fit  advice.  the  Whether  clinician  or  professional  action  on  the  since  the  term  that,  i n compliance  serve  as  research,  the  term  i s defined?  i s made t o compare  her  part,  some  nonjudgemental.  i t make how attempt  to  1)  unhealthy connotations  as  Haynes  However, a  that  subsequent  regimens,  d e f i n i t i o n s of  (p.  authoritarian  The  compliance  review  of  literature  pointed  out  that  from d i f f e r e n t s t u d i e s  repeatedly of  an  intended  (1970)  this,  felt  i n s t r u c t i o n s and  social  medical  distasteful  compliance did  and  a r i s e when an  attributes  that  rooted  research.  She  1974  (1979) recommended  and  and  and  prescription  serfdom"  Haynes  d i f f e r e n c e does  difficulties  clinical  p r o c e s s between a h e a l t h  change  ethical  i n use  What  not  Sackett  professionals  in  and  upon by  a consensual  part.  reminder  health  decided  and  and  compliance  to  437).  and  wishes"  i n such a s i t u a t i o n .  would have s i m i l a r d i f f i c u l t i e s patient's  (p.  "submission"  another  o b e y e d would be  academics  workshop/symposium  as  a dictatorial  c o n n o t a t i o n s of  the  a synonym  "doing  command"  of  as  is usually wide  attempt  seem i n c o m p l i a n c e  comparing  misleading.  variations  This  on  sentiment  to e x p l a i n literature  in is the  the  voiced wide  (Becker  &  43  Maiman, 1975; Haynes et a l . , 1970;  1979; Linde & Janz, 1979;  Windsor, Green & Roseman, 1980).  Marston,  The problem, as Sackett  and Snow (1979) p o i n t out, i s that when a v a r i e t y of d e f i n i t i o n s have been employed  i n d i f f e r e n t ways the confidence  with  which  one can use the r e s u l t i n g c o n c l u s i o n s i s l i m i t e d . Defining In a  Non-compliance a d d i t i o n to the problem of d e f i n i n g compliance, there i s  similar  problem  with d e f i n i n g noncompliance.  addresses the i s s u e of d e f i n i n g research  and  the  p o p u l a t i o n at r i s k health  subsequent f o r any  assessment  and  the  population  effects  given  some  Gordis in  compliance  on the r e s u l t s .  health  problem,  those  who  have  Of the  some  seek  do not. Of those who seek h e a l t h  assessment, some r e q u i r e a treatment regimen and some Of  (1979)  do not.  been advised of a need f o r treatment, some  come f o r h e l p and some do not. Of those who come f o r h e l p , some f o l l o w the t h e r a p e u t i c research happens when  i n s t r u c t i o n s and some  concentrates  only  to the meaning  those  who  return a f t e r  initial  that  definition  employed  population  and bias  of the r e s u l t s  in  I f the  l a s t group of people what in  the  p a r t i c i p a t i o n are not  inclusion  in  overall  picture  the  considered?  research  of  the  Gordis explicit  f o r noncompliance i s e s s e n t i a l . Snow  in  (1979)  the  following  beginning a t h e r a p e u t i c  point  research.  s t u d i e s of i n c e p t i o n c o h o r t s . difficulty  the  not.  d i d not show up a t a l l or those who f a i l e d to  suggests  Sackett  on  do  The  out  another  issue  of  They d i s c u s s the need f o r problem  a l l members  i s that  of  regimen o f t e n p r o h i b i t  an  cost  initial  such  a  and group  sampling  44  approach.  Investigators  currently  involved  in  an a p p r o a c h  such  sought were and  s w i t c h e d t o an  are: patients patients  stopped  cross-sectional  that  s u r v e y which  would  compliance  that  obscured  of  Compliance  In  "clearly  addition  difficulties,  to  fails  discussing  the m u l t i p l i c i t y  quantifiable  illness. the  the  of  the  complexity,  implications. data.  Can  t h o s e who, follow  the  subjective between  have  Becker  much be despite  go  (p.  t o comply elsewhere;  illness.  the  initial  Maiman  suggest  that  easily  a  major  (1975), the  cause  and  social of the and  therapy  disability  quantified  adverse  characteristics,  therapy?  perceptions that  give  characteristics  issues?  What a b o u t meaning  and  to  the  data,  for  and Maiman q u e s t i o n t h e u s e f u l n e s s of  many  in  identifiable  t h e regimen  duration  many of t h e s e  of  definition  presents  seriousness, duration  done about  A  12).  and  and  and  high estimate  as d e m o g r a p h i c and  collected  and  regimen  to the  and  of the p a t i e n t ,  been  recommended  these  Becker  lost  t h e regimen  to  design  d i s c o m f o r t , and  "medically" defined illness  of time"  f o r examining  Such c h a r a c t e r i s t i c s  type,  and  dimensions  be  to look at the e n t i r e  of f i n d i n g s ,  been t h e p a s t p r e d i l e c t i o n  and  asked  patients  may  refused  compliance  researcher.  the  the  a spuriously  t h e measurement o f the  disliked  succumbed  sampling  to  has  and  the e f f e c t  challenge  T h o s e who  p a t i e n t s who  produce  the  all  disliked  t h e y were  complying  population  Measurement  study  who  who  alternative;  were so d i s r u p t i v e who  often  i n a h e a l t h program.  help elsewhere;  patients  more  What  such about  continue  to  the a t t i t u d e s  and  the  associations  compliant behaviour?  Such  45  data, not  they a s s e r t , explain  "patient  the  sometimes p r e d i c t  phenomenon  noncompliance  understood, Gordis as  may  direct  has  itself.  They  health-related  behavior"  (p.  indirect.  medication  The  differences  direct  The  variations"  among  absorption,  drugs.  These  c a p s u l e , syrup, e t c . ) i n which  The  indirect are  assessments Pill  pill  initially  counts  are  the  dispensed  for  and  comparison  has  taken  measurement d o e s not pattern  What  about  the  the  validity  form  Gordis  physician  the m e d i c a t i o n the  The  validity  necessarily  whether  of  which  given  remaining  (Marston,  (Feinstein,  from  i s administered  P a t i e n t s may  o f amount  indicate  or manner  between  issues.  drug  arise  o r p r e v e n t i v e outcome.  the time e l a p s e d .  measurement  the  a c c o r d i n g t o the  s h o u l d remain  several  i s the to  self-reports,  therapeutic  t h e amount t h a t  and  distribution,  compliance  patient and  of  m e t a b o l i z e t h e same d r u g .  measuring  t o r e t u r n m e d i c a t i o n does not  patient  desired  of  here  may  the drug  individuals  counts,  i s hampered by  medication Failure  ways  of compliance  r e m a i n i n g and  results  i n how  least  blood  refers  in  i n the amount of d r u g a b s o r b e d  from d i f f e r e n c e s  issue  This  differences  listed  of  that  compliance  involve  important  (p. 2 7 ) .  individuals  excretion  They  and  or  t o say  measuring  metabolism  (tablet,  does  methods a r e a r e f l e c t i o n  studies.  levels.  "pharmacokinetic  on  it  11).  (1979) c a t e g o r i z e s methods of or  go  but  become t h e b e s t documented, but  many m e d i c a t i o n c o m p l i a n c e urine  compliance  it  of  not  (Webb,  the  return 1980).  mean t h a t  1970). was  quantity  the  Medication  taken  in  the  1979). patient  self-report?  Even  46  Hippocrates noted that " p a t i e n t s o f t e n l i e when they s t a t e  that  they  35).  have  taken  certain  medicines"  Recent i n v e s t i g a t i o n has supported measurements (eg. p i l l to  patient-report,  wide  descrepancies  been  compliance-improving encouraging  found  overestimated  been  patient  a l . , 1980).  who  admit  1979).  educators  when  found  compliance  Windsor et a l . , 1980).  those  behaviour One  to low  show the g r e a t e s t response t o  Unfortunately,  I t has  self-report  compliant et  compared  This  i s an  i f they a r e d e a l i n g  category.  compare  compliance?  of  (Sackett,  into t h i s  How do p h y s i c i a n s  indicators.  to  for health  with p a t i e n t s f a l l i n g  patient  i s that  strategies  finding  occur with  1970; Windsor  i n t e r e s t i n g aspect of t h i s have  When other  counts, u r i n e t e s t s , e t c . ) are  1979; Marston,  compliance  1979, p.  this observation.  g e n e r a l l y r e f l e c t i n g an o v e r e s t i m a t i o n (Gordis,  (Gordis,  that  they  attempt  their  to  assess  estimates are poor  physicians  consistently  (Gordis, 1979; Marston, 1970;  G e n e r a l l y t h e i r p r e d i c t i o n s are "of very  l i m i t e d v a l u e " f o r research or day-to-day p r a c t i c a l  application  (Gordis, 1979, p. 40). Using seems,  on  the  outcome  of the treatment  the  surface,  measurement of compliance.  to  be  a  or p r e v e n t i v e regimen  reasonable  approach  Even here there are i s s u e s which the  researcher and the reader of research needs to take i n t o before  accepting  and goal i s c l e a r . tooth  filled  or  results.  mole  i n d i c a t o r of compliance  account  Sometimes the l i n k between regimen  When both are synonymous, a  to  excised,  the  goal  as  in  having  a  i s o b v i o u s l y an  with the regimen p r e s c r i b e d .  In  other  47  cases  the  of  other  man  who  link  factors.  does not  increased still  so c l e a r . Sackett  follow  exercise  other cases,  failed  The  but  and  those  t h e g o a l anyway  r e g i m e n needs  who  to  who  have  vigorous  prescribed  drug  substantially  dosage,  low  at  The  all.  compliance level  determined  compliance.  dosage  of  to  make  effectiveness, as  study  compliance  which t o l e r a t e d  (Marston,  of  1970).  no  The  conflicting Parson's In  do  alternate  the out  level  data of  from  when a  effective of  therapy  outcome  treatment  needed define  behaviour. point.  substantially regimen  attempted  hardpressed  must  as a measure of  cut-off  the  the  among  that  prescribed  differ  have  that  job  minimum  to reach the  who  have  The from  a  set  out  t o compare  only  t o make s e n s e  of  such  evidence.  S i c k Role the  or  effectiveness  arbitrary  deviation  r e s e a r c h c o n c l u s i o n s w o u l d be  suggestions  more  exceeds  of  would  reader  with  frequently operationally  degree  to t h i s  data  In  points  outcome  the c h a n g i n g  certain  a disease process.  to  reduce  needed  use  D e v i a t i o n s are t o l e r a t e d resulting  not  investigators  a  of  Sackett concludes  (1979)  therapy  B e c a u s e of  compliance  may  because  t o comply a d e q u a t e l y  enough  Gordis  weight  needed  failed  patients.  for  of  ( S a c k e t t , 1979). be  reached  because  have c o m p l i e d  compliant  be  looses  development  those  be  (1979) g i v e s t h e example of t h e f a t  his diet  or  g o a l may  t o meet t h e g o a l b e c a u s e t h e y  treatment met  i s not  Theory  quest  health care  field  association  with  to understand  many f a c t o r s compliant  and  improve c o m p l i a n c e  have been behaviour.  studied One  for  i n the  possible  t h e o r y which  has  48  frequently is  been used  Parson's  person's  sick  action  expectations include  of  and  509-510).  For  illness  that  expectation  Health A  health United 3).  belief  In  the  of  beliefs  Health  aim  undertaking  of  was  there  must  of  his pp.  be  p.  a  510).  for  chronic  1970,  The  theory  p.  312).  situation, physician  fails  to  there  is  an  recommendations.  meet  this  health  were  criteria  incorporated  psychologists Service to  action  susceptibility, of  the  psychological, to a c t i o n  behaviour.  While  this  compliance,  health  i n the  explain  working 1950's  the  is  dependent  of  s e v e r i t y of  health  a c t i o n and  financial, i s needed  model has  etc.)  at  (see  health  the  Figure of  an  action.  on  the  the  consequences,  of  the  person's  barriers  related  to t r i g g e r the  been u s e f u l  into a  chances  a recommended p r e v e n t i v e  A cue  of  1971,  follow  about  behaviour.  issue  objects  (Vincent,  1971,  the  more l e g i t i m a t e  the  several  Public  potential benefits  (physical,  will  These  a  312).  original  model,  perceptions  of  to  conditions  (Vincent,  (Marston,  frequently  model by  Stated  individual  situation.  adult  i s that  related  occur  be  the  B e l i e f Model  person's  The  to  r o l e may  patients  p.  is  of  premise  (means and  expectations" sick  action  basic  ( c u l t u r a l ) elements  regardless  that  1970,  physical  illness  behaviour  (Marston, The  the  than acute  suggests  Health  of  The  i n the  compliance of  health  reference  objects  (human),  symbolic  the  theory. of  various  "complementarity Assumption  role frame  social  actions),  to explain  to  appropriate  in approaching  i n v e s t i g a t i o n s have s u g g e s t e d  the  that  the there  Figure  Original INDIVIDUAL  Formulation  PERCEPTIONS  Demographic ethnlclty,  of  Health  FACTORS  variables  (age,  Belief  Model LIKELIHOOD  sex,  race.  Perceived  etc.)  pressure,  of  to  Perceived disease  threat  Likelihood  of  disease  seriousness  action  of  recommended  "x"  health Perceived  benef i ts  Perceived barriers to p r e v e n t i v e action  I  susceptibility  ACTION  minus  etc.)  "x"  OF  preventive  variables (personality. and r e f e r e n c e group  r Perceived  the  MODIFYING  Soclopsycholog leal social c l a s s , peer  disease  3.  taking preventive  action  (severity)  "x"  Cues Mass  media  Advice  from  Reminder  Action  others  postcard  physician Illness  to  campaigns  or  of  from  dentist  family  member  or  friend Newspaper  Source:  Becker,  M.  Patient D.  W.  H.,  Maiman,  Perceptions  Taylor,  University  & D.  Press,  L.  and L.  1979,  A.,  Klrscht,  Compliance: Sackett p..79.-  J.  or  P.,  Recent  (Eds.),  magazine  Haefner,  Studies  Compliance  of In  a r t i c l e  D. the  P.,  Drachman,  Health  Health  Care.  Belief  R.  H.,  &  Model.  Baltimore:  Taylor, In  Johns  R.  B.  D.  W. Haynes,  Hopkins  50  may be a b i d i r e c t i o n a l compliance. compliance  Health and v i c e  The Knowledge  relationship beliefs  versa  change  (Becker  best  component  survey or  f o r him."  quickly  of compliance  compliance  18  22  Under  finding  negative  her review not  their  provided (  sufficient p. 321).  that  education  or the e t h i c a l  out that  such  they  that  advances  continually, that  they  is  no  with  motivation and  made  since  intervening  potential  f o r compliance  Janz  but i s  (1970),  . (1979)  alone  contend,  the worth of h e a l t h  not  Lane  in  with  knowledge  depends  on  becomes more and  and  Evans  variable. itself  They  t o comply  since medical  treatment  report  3  f o r patients to follow  understanding  available,  an  and  knowledge  be e x p e c t e d  (p. 282).  as  indicating  Marston  that  with with  to inform the p a t i e n t .  more an e d u c a t i o n a l p r o b l e m knowledge  of d i s e a s e  association  do n o t n e g a t e  do n o t u n d e r s t a n d , and  their  association  with compliance.  obligation  in  24 a r t i c l e s  concluded  that the  association  no  with  knowledge  educators  positive  list  s i n c e p a t i e n t s cannot  regimens  the  under knowledge  a  Linde  studies  of  patient  comply  e t a l . (1979),  finding  of the l i t e r a t u r e ,  regimens  knowledge  finding  association  however,  point  and  to actual  the  he w i l l  health  list  49 a r t i c l e s  sure  research  Haynes  education  association,  surely,  convince  articles  positive  has  at  literature,  articles  and  compliance.  in  A look  i s f a r more c o m p l e x .  therapy  correspond  i s t o make  i n f o r m a t i o n and t h e n ,  should  situation  beliefs  Component  a l l the  "what's  to  health  e t a l . , 1979, p. 8 1 ) .  As a t e a c h e r , t h e t e m p t a t i o n has  between  It a  (1979) creates  significant  51  outcome (p. 33) . The  involvement  other m o t i v a t i o n s i n combination  with  Tagliacozzo  (1970).  They  that where s u b s t a n t i a l experience with i l l n e s s and  social  knowledge was found  examined by  facilitation knowledge  of  of  medical  were  as  care  likely  existed,  a significant  On  daily  affairs  the  saw  (p. 773).  motivations.  efforts  must  medically  They  not  only  approved  with  reinforce  ways  of  r e s e a r c h e r s saw  the  not  motivate  importance" E t h i c s and An  idea  themselves  to  to  word about e t h i c s  communicating illness  care  but,  conditions more c e n t r a l  seems  in  order  before  z e a l o u s l y s e t s about producing compliance.  on  three  things:  accurate  therapy; and adequate compliance wrong  by  773).  (1980) p o i n t out that achievement of  dependent  the  whole  exercise  diagnosis;  the  S e l t z e r et  treatment  goal  is  appropriate  If the d i a g n o s i s  is  i f the therapy does more  increases r i s k ;  informed and w i l l i n g to p a r t i c i p a t e  jeopardized.  a  (p. 638).  is futile;  harm than good then compliance not  medical  t h i s as a  that "teaching  conceptualizing  give  with  Compliance  initial  educator al.  (p.  patients  limited  supplied  s i m u l t a n e o u s l y , must i n f l u e n c e other d e f i n i t i o n s and which  low  knowledge  of p a t i e n t s with  motivation  address  hand,  i l l n e s s as i n t e r f e r i n g The  suggestion that knowledge can add other  patients  other  r o l e i n behaviour  experience with i l l n e s s and who their  Ima  to a t t e n d o u t p a t i e n t c l i n i c s as were  p a t i e n t s with high knowledge. played  and  his  i f the p a t i e n t i s legal  rights  are  52  Given  that  these  criteria  with the task of planning will  take  and  are met,  executing  the educator  health  i s faced  education  that  i n t o account the c o m p l e x i t i e s of the h e a l t h consumer.  Improving Compliance Haynes  (1976)  improving  compliance.  transmission attitudes focus  o u t l i n e d three c a t e g o r i e s of s t r a t e g i e s for  of  being  information the  on behaviours  b a r r i e r s , to cue reinforce  cautioned,  stimulate  and  The  review combined  however,  that  compliance  third  of  and H a l p e r i n  longer term therapy, and  efficient  the  needs seem necessary  methods  They t r y to reduce or  s t r a t e g y combines these  two  and  literature  to  indicated  that  strategies  were more e f f e c t i v e .  frequently  when  the  He  strategy  was  that, e s p e c i a l l y  with  levels.  (1979) concluded  i n t e r v e n t i o n s which provide  feedback, and  on  reward  stopped, compliance dropped to o r i g i n a l Morris  focus  Behaviour-oriented  i n v o l v e d i n compliance.  or  His  strategies  with development of knowledge and  objectives.  compliance.  approaches. behavioural  Educational  social  support  which are t a i l o r e d to the p a t i e n t ' s  in addition  to  information  communication  (p. 5). Green  (1979)  agrees  that  a  combination  o p p o r t u n i t i e s i s r e q u i r e d in h e a l t h education. of  determinants  are  predisposing  reinforcing where  which  educational  factors,  factors.  He  the  The  of  three  s t r a t e g i e s should  enabling  factors  learning types  influence and  the  r e f e r s , as an example, to an experiment  a t t i t u d e s toward the therapy  represented  the  predisposing  53  factors,  support  reinforcing the  of  factors  enabling  multicausal  relatives and  Health  more  than  l a s t i n g change (p. 160). employed  in of  clearly  diagnosis  of  the  sees i t as being  when  goes on to  that  objectives  combined  p a r t i c u l a r behaviour i n q u e s t i o n "  very  of  individuals  health  are  educator  from  (p.  a  161).  programs,  techniques  intervals,  a c t i o n i s the  for  useful  he  must  assess  each  i s required. recruiting Specific  approaches.  issue and  The  approach i t i n a  unique way.  T h i s multi-method approach i s supported by  researchers  (Lane  & Evan, 1979;  help  Methods which  when  multi-dimentional  specific  example,  issue.  techniques  to  engage i n more prompt h e a l t h a c t i o n s .  s i t u a t i o n s need s p e c i f i c and health  "on  diverse.  campaigns to  methods  derived  i s f r e q u e n t l y part of other  is  achieve  the  r e i n f o r c e s o c i a l supports are u s e f u l i f p e r s i s t e n c e Mass media  represented  asserts,  must be s e l e c t e d and  Cues at a p p r o p r i a t e  frequency  he  say  l i n k e d some s p e c i f i c methods and  situations.  represented  method i s r e q u i r e d to  delineated  While h e a l t h education  He  He  behaviour,  one  h e a l t h education  the b a s i s  friends  a c c e s s i b i l i t y of s e r v i c e s  factors. and  and  Marston, 1970;  several  Windsor et a l . ,  1980) . Another r e c c u r r i n g theme i n the involving  the  "the p a t i e n t who problems,  patient  in h i s c a r e .  p a r t i c i p a t e d in  defining  sentiment  is  objectives  supported  Clark  identifying  e s t a b l i s h i n g time frames i s more This  literature  and likely  by  many  i s the value  (1980) a s s e r t s that and  evaluation to  of  prioritizing methods  comply"  (p.  w r i t e r s (Bowers,  and 58). 1980;  54  Fiore,  1979;  Vincent,  Geyman, 1980;  1971;  Windsor  example of how written  et  goal  al.,  al., be  Commitment  punishments can  self-established 1980;  et  the p a t i e n t can  contract.  rewards and  Given  1980;  1979;  Hogue,  Wise, 1979).  involved  is  the  1979;  Just use  of  one a  to a s e l f - d e s i g n e d program with  provide  (Dunbar  i n c e n t i v e to work  et  al.,  1979;  toward  a  Windsor et a l . ,  Wise, 1979).  BSE BSE  Education and  as a u s e f u l p r e v e n t i v e  been d i s c u s s e d  but  are  many  factors  compliance with BSE Factors  has  and  already  i n v o l v i n g concerns about compliance. which  may  influence  the  degree of  Practice  (1978) examined some of the s o c i a l and  factors involved. the breast  behaviour  practices.  I n f l u e n c i n g BSE  Turnbull  health  i t seems p e r t i n e n t at t h i s time to examine i t  in terms of a s p e c i f i c area There  Compliance  She  p o i n t s out  cancer are  attitudinal  that women's a t t i t u d e s  f r e q u e n t l y emotional.  A quick  toward perusal  of  l a y magazines and  advertisements w i l l give ample evidence of  the  role breasts  i n our  symbol"  play  ( T u r n b u l l , p. 98).  preventive literature  health she  culture. Conflict  measures  and  in  motivating  that higher  BSE  education  bosom " i s a major  between emotions and result.  found that monthly breast  women to worry, that p h y s i c i a n s role  may  The  play the  In  reviewing  sex  sound the  examinations cause many single  most  important  though t h e i r r o l e p o t e n t i a l i s l i m i t e d , l e v e l s are a s s o c i a t e d  with  increased  55  practice  of p r e v e n t i v e  factors  which  women  were,  friends, The but  influenced in  newspapers,  books),  i t i s unclear  1978;  Williams,  considered. health  need  they  Turnbull  the  reminder  that  educator  is  skill  cannot  that to  well  desire  activity  a n d McDermot  t o be c h e c k e d by a  to teach  be  nursing i s (Bullough,  need  to  to achieve  Flynn  BSE j u s t  t o the (1981)  do n o t  serve  even  as a  i f the  Knowledge a n d  physicians  need  to  consistency. teaching  c l i n i c s are  whether a t t e n d a n c e may r e f l e c t professional  about  because  comments They  be  health  be g i v e n  needed  Even  (1979) r e p o r t t h a t  but q u e s t i o n  by  decreased  preventive  health professional.  f o r granted.  decreased  understanding  higher  may  a  S t i l l m a n , 1977; T u r n b u l l ,  a s change a g e n t s .  training  practicing  be t a k e n  utilized  questionable  While  These c a u t i o n a r y  of nurses  with  nurses.  change a g e n t  nurses'  a r e not prepared  radio,  those  and, t h e r e f o r e ,  r e c o g n i t i o n must  compare a p p r o a c h e s a n d t e c h n i q u e s Alcoe  seems  that  oriented  with  h e a l t h p r o f e s s i o n a l s as w e l l .  teacher a  finally  a r e some i s s u e s w h i c h  them  or females. use  f a m i l y then  frequency.  1981;  found  found  (TV,  f i g u r e s suggest  field  BSE  She r e m i n d s us t h a t  a r e nurses  media  presently-decreased  Flynn,  direct  that nurses  preclude  a  1979), t h e r e  forinstructing  suggests  and  a s an a p p r o p r i a t e  1980;  d i d not  practices.  or  influence  identified  Edwards,  doctors  women i n t h i s  to  1980;  with  whether T u r n b u l l ' s  i n teaching  frequently  the  i n i n f l u e n c i n g behaviour  to influence  "opportunity"  order,  with  Her r e s e a r c h  h e a l t h and n o n - h e a l t h  conversations  of nurses  "ability"  both  descending  conversations  role  nurses  h e a l t h measures.  person  rather  only a than  a  56  desire  to  devalue  or take  BSE  is  and  must  an  the  that  of p r o f e s s i o n a l  responsibility BSE  fact  this  lessen  is  In  a routine  her  that  most b r e a s t  fear.  Fear  was  that  susceptible degree ideal  women to breast  (Stillman,  religion,  possible age  susceptibility other  but  the  She  brushing  Williams  frequently  (1979)  i n an  Some  attempt  i n her i n i t i a l  t o p r a c t i c e BSE.  Fear can  researchers  themselves  do t e n d  ability  motivators  and  as  to practice percentage  lack  have  beliefs  have a l l been  influential  forgetting,  have  being  BSE  which  more  to  some  follow the  been  about  perceived  linked to rate  factors  cited  mentioned.  in  of the  a lump a n d l a c k  of b a s i c  Fear,  benefit  practice.  knowledge on  or Some  literature  of u n d e r s t a n d i n g , degree of c o n f i d e n c e  to detect  are  in their how  to  o u t BSE.  Techniques  f o r Improving  Edwards increase a calendar with  1977)  health.  practice like  t o share  motivator.  disease  own  p r o b l e m s a r e n o t c a n c e r and  listed  perceive  Rather,  o f m o n t h l y BSE i s s t i l l l o w . Several  carry  who  BSE does n o t  people are capable  project,  f o r not c o n t i n u i n g  a p o s i t i v e or a n e g a t i v e  found  health  teaching  that  examination.  for their  i s e s s e n t i a l information  survey as a reason be  (1981) s u g g e s t s  a f f i r m a t i o n of the a t t i t u d e that  or e a t i n g .  feels  Flynn  the place  that  stresses  to  BSE.  assume  suggests teeth  learn  BSE C o m p l i a n c e  (1980) h a s s u g g e s t e d  motivation  t o p r a c t i c e BSE.  for self-monitoring  friends  or  several  family  and peer  might  help  a p p r o a c h e s w h i c h might  She s u g g e s t s c u e s s u c h a s support decrease  such as  talking  forgetfulness.  57  Modelling  the  increase  information  modeling  alone  behaviour.  behaviour  is  She  percentage  teaching  process.  a l . (1980)  suggest  ability  has  shown  in  her  to perform  practice  this  predictive  BSE  the the  be  level  process.  of  The  involved. stimulus  the  of  an  aspects and  They m e n t i o n that  will  with  use  improve a  woman's  this  specific  be  of  great  the  woman's in  her  rate  of  teaching  training  of m o d e l s may  be  breast  confidence  to  of  feedback.  increase  since  in  be  used  reached  is to  before  value  in  the  outcome c r i t e r i a  may  be  teaching e f f e c t i v e n e s s .  with  stimuli  silastic  can  a  BSE  inclusion  c o n t r i b u t i o n to  that  could  down i n t o t h r e e  area  psychophysical  increase  that  incorporated  of a  Since  performance  use  p r e c i s e manual a c t i v i t y  physical  BSE  e t a l , (1977) s u g g e s t  breast  w e l l as  skill.  to  This  in evaluating  broken  as  revealed  the  practice  helped  changing  be  training  It i s a l s o suggested  terminates.  Hall  such  tends  of more a c c u r a t e  evaluation  can  that  use  make a s i g n i f i c a n t  develop a c r i t e r i o n  helpful  guided  examination  can  effectiveness.  training  lumps and  the  has  for  i n the  She  of c o r r e c t d e t e c t i o n s  confidence  method  encourages  BSE.  graduated  work  effective  research  also  others  Their  Her  p r a c t i c e has  modelling  significant  model w i t h  an  guided  that  of  et  retention.  suggests  instruction  Hall  or p r o v i d i n g  that  components.  s u c h as  optimal  or  the  breast  the  Motor  skills  systematic  amount of p r e s s u r e .  relationship  responding  changes  two  of  types  examination  evoke a s e n s a t i o n  between  and  the  include  search  over  Sensory changes  in behaviour  thresholds:  skills  the  are  or in  also  minimum  minimum amount  of  58  stimulus final  change w h i c h e v o k e s a  component  level.  This  observer. often  is  instances model  refers  they  detection  to  false  used  suggest  behavioural The  that  of  a  feedback  of  model  could  be  use  television for  silastic  breast  One d i f f i c u l t y i s  i n t h e home s e t t i n g .  to  technique  thoughtful (Gastrin,  in  physician  identify  specific  or  education  consultation.  combination  and c r e a t i v e d e c i s i o n s . 1980)  i s a good example  person-to-person  women were p e r s i s t i n g w i t h  Teaching  signal In a l l  available  used  in  practice.  a  decreases  specific  for  They  specialists  issues,  provision  After  two y e a r s ,  The of  a  factors.and  instruction,  and  of  of  follow-up medical  70 p e r c e n t  of  theories  to  r e g u l a r BSE.  Approaches  Howe ( 1 9 8 1 ) develop  use  e f f e c t i v e p r o g r a m w h i c h c o m b i n e s many  inquiry,  referred to  her approach  perception  understanding old  that  and  the  for evaluation.  in Finland  approaches.  the  feedback  training  clinics  calls  Mama Program  the  a  objectives  choice  techniques  highly  by  of  a change and how  Proficiency  t o improve p e r f o r m a n c e .  They  in  performance  give  when t r a i n i n g e n d s ,  or  detection  alarms?  The  o r t h e human v i g i l a n c e  do t h e y c o r r e c t l y d e t e c t  facilitated  be  difference.  often  that  offices  the  H a l l et a l . suggest  can  of  i s the s i g n a l d e t e c t i o n  How  do  sensation  to teaching  of an i n n o v a t i o n and u s e ; r e l a t i v e  approaches or ideas;  receiver's  innovation  present  BSE.  include  Criteria  beliefs  which  simplicity  advantage  compatibility  values,  adoption  or  influence ease  or the advantage  or  the  f i t with  of over the  and n e e d s ; t r i a l a b i l i t y o r  59  the  degree t o which the i n n o v a t i o n  and  observability  Howe i n c o r p o r a t e d (the and  BSE  these  procedure  found  that  pamphlet  and  BSE.  BSE  and  practice  perceived  medical  not  although  of  end  risk  a  more  simple pamphlet  elaborate  t h e media h a s become  1980)  these  to  She  label  criteria  on  Her  comment  themselves  Religion  be  as  on  that  hypothesizes  Those  may  cannot  not  Jewish  women  at higher  i n her study,  (perceived  risk while  b e n e f i t s and average  rate  percentage of C a t h o l i c who  were  embarrassed  subgroup  I t seems  that  be aware o f t h e i r  be assumed t o a c t a s  may a f f e c t r e a c t i o n s  factors a s an  that  by i t and i n t h a t  of n o n - p r a c t i c e r s .  toward  religion  t o have a h i g h e r a large  of  increase  important  being  Catholics  beliefs  tended  affected  populations and r i s k  cancer  benefits  She  from h e r f i n d i n g s  both  found  percentage  susceptibility  measure.  also  BSE was e m b a r r a s s i n g .  target  breast  d i d not n e c e s s a r i l y  may  In a d d i t i o n ,  t o be s t r o n g l y  b e l i e f s about  b e l i e f in perceived  health  longevity  lowest  practice.  motivator.  of  r e l i g i o u s b a c k g r o u n d and a t t i t u d e  susceptibility),  a higher  Since  health  a high  factor arises  scored  seemed  rejected;  sentences)  longer  (Bullough,  behaviour.  t h e y were.  women f e l t  was  and  tend  perceived  four  much  susceptibility  history,  health  they  that  of t h i s p r e v e n t i v e  influencing did  (1977) s t u d i e d  She f o u n d  influencing  development  of only  to a  f o rteaching  and  guides.  Stillman  body,  i n the  consisted  tried  t o w h i c h r e s u l t s c a n be s e e n .  i t p r o v e d more s u c c e s s f u l .  be u s e f u l  that  ideas  i n comparison  a major m o d a l i t y may  or the extent  c a n be  to content  a  there high  increased positive  and c e r t a i n  60  health  practices  determined teaching and  and  may  group  who  find  practice  health  Health  but  may  must be  i s t o be  1977;  help  to  research  have  the  understanding  powerlessness exert and  change  concept  could  behaviour.  strive  expectations  of  to e x p l a i n  that  as  be for  groups those may  susceptibility  behaviour  exactly  motivators  be to as in  i n some s u i t a b l e manner  referred (Cross,  1980;  which  the help  to  1980;  our  the  1977).  general  There  of  the  discrepancy  control  Norris, is  expectations  knowledge  of  learner's  Howe, 1981;  Stillman,  studies  locus  L o c u s of An  Discussion  perceived  i n a performance  involves  organization  One-to-one p r e s e n t a t i o n  d e a l t with  increase  behaviour  to  effective.  Smith,  research  have  d e s i r e d approach with  influence  expectations  body of  influencing That  or  Rubenson,  which  and  and  v a r i a b l e s which act  researchers  perceptions  specific  the  and  not  may  accordingly.  be  beliefs may  teaching  Several  1977;  not  they are  behaviour  health  presentation  adjusted  may  disorders  anticipated  Alternatives  topic embarrassing.  preferable.  if  certainly  have t o be  the  health  themselves.  a and  variables  situation.  concept.  Control influence increase  Proponents behaviour  i n d i v i d u a l s have  the  of by  f e e l i n g s of ability  the  locus  examining  control to of  predict control  perceptions  in given s i t u a t i o n s .  or  or  61  Perceptions  of C o n t r o l  Lefcourt  (1973) c o n t e n d s t h a t  the p e r c e p t i o n  or c o n t r o l l e d i n our a c t i o n s  i s not a g i v e n  constructive  speaks  process.  illusions--  i d e a s man  (Lefcourt,  1973,  Lefcourt that  He invents  p. 4 1 7 ) .  of  A major  caused a s t a t e of a r o u s a l  when  the  origin,  the  noise  meaning and r e s u l t s  ideas.  know what  If must  predictability  we  can  done  about  prepare  the  that  t h e same v e i n ,  Lefcourt  contends that  ability  'to  perceived The  the  put  then  was m i n i m i z e d .  the we  desirable is  of  us some effects.  coming  we  i t s impact.  "perception  arrive  and we  element  allows  minimize  The  illustrate  this  of t h e n o i s e  i t i s through  to  i s a furnace  when,  f o r i t and t h e r e b y  unanticipated  of  this  at the concept of  c o n t r o l " (1973, p . 4 1 9 ) .  effects  locus  review  something,  were u n d e r s t o o d  we c a n a c t t o c r e a t e  that  experience"  hand,  we h e a r  and  meaning  something'  Locus of C o n t r o l  The  it  a  I f , on t h e o t h e r  i f we c a n p r e d i c t s o m e t h i n g  ourselves  do  to  of  and c o n t r o l a s  was  a r e u s e d by L e f c o u r t  know t h e n o i s e  be  sense of c o n f i d e n c e Along  of a noise  it  was " p r e d i c t a b l e " and i t s impact  sounds o f a f u r n a c e  free  In h i s e x p e r i m e n t s he n o t e d  i t s s i g n i f i c a n c e was n o t u n d e r s t o o d .  his  freedom  result  f a c e t o f knowing  or  ordinary  but a  t o "make s e n s e o f h i s  states, i s predictability.  noise  of being  of  Concept  of t h i s  c o n t r o l concept.  of the subject  forward  perception  by t h i s  will  theory.  be u s e d  of c o n t r o l a r e a d d r e s s e d  Rotter's  initial  to outline  the  by  comprehensive basic  ideas  62  Rotter  (1966) r e l a t e s the r o l e of p e r c e p t i o n of c o n t r o l to  a c q u i s i t i o n and performance of s k i l l s and knowledge. of  reinforcement,  reward  or  gratification  says, by the i n d i v i d u a l ' s view of  the  idea  concept  in  the  locus  expectancies  of  for  reinforcement.  control  internal  The  perception  of  between reinforcements and behaviour nothing. bimodal  It  can  vary  in  The  is  underlying  the g e n e r a l i z e d  external the  control  causal  The  h y p o t h e s i s i s not a  a normal curve with v a r y i n g  of each ( R o t t e r , 1966, p. 57). One of the causes of reaction  i n any s i t u a t i o n  between  rewards  and  of e x t e r n a l versus i n t e r n a l  following  some  culture,  i t is  or  complexity event  as  of  upon  the  h i s own  but  h i s action,  unpredictable  because  of the f o r c e s surrounding  not  then  as  being  i n our  in  c h a r a c t e r i s t i c s , we  of  him.  external  the person p e r c e i v e s that the event behaviour  of  powerful the great when  the  i n t h i s way by an i n d i v i d u a l , we  have l a b e l e d t h i s a b e l i e f  own  subject  t y p i c a l l y p e r c e i v e d as the r e s u l t of  i s interpreted  or  R o t t e r d e s c r i b e s the  l u c k , chance, f a t e , as under the c o n t r o l others,  action  control:  i s p e r c e i v e d by  action  e n t i r e l y contingent  degrees  i s t h i s p e r c e p t i o n of the r e l a t i o n s h i p  t h e i r determinants.  When a reinforcement  his  a l l or  d i s t r i b u t i o n of i n t e r n a l i t y versus e x t e r a l i t y but rather  a d i s t r i b u t i o n approximating  concept  of  relationship  i s not n e c e s s a r i l y  degree.  role  i s i n f l u e n c e d , he  event.  versus  The  or have  control.  If  i s c o n t i n g e n t upon  h i s own r e l a t i v e l y permanent termed  this  a  belief  in  63  internal  control.  variable  i s o f major  nature  of l e a r n i n g  individual  differences  degree  t o which they  control  t o reward  strengthen  p. 2 ) .  sees  the  In  will  learning  to attribute  theory,  this  will  by  reinforcement  i s contingent  will  experiences regarding  believed  to  result  in  situations  expectations  to s i t u a t i o n s  nature  behaviour behavioural p. 2 ) .  of  and  the  will  causal  might  behaviour.  the l e s s  its  personal set  and a c t i o n s .  from  specific  Rotter  contends  between  affect  a  one b e l i e v e s a  expectancy  band o f l i f e  that  expectancy  generalize  or  person  degree  reinforcements  relationship  i n a broad  the  o f i t . Thus  individual  belief,  i t s consequences  choices  the  p e r c e i v e d as s i m i l a r .  "a g e n e r a l i z e d a t t i t u d e ,  the  an  sequence,  by t h e o c c u r r e n c e  on one's own b e h a v i o u r  t h e r e l a t i o n s h i p between  addition,  (Rotter,  The l e s s  i n c r e a s e one's e x p e c t a n c y  will  future"  or reduced  exist.  to  or event  t o which  to  acts  behaviour  upon h i s own  i t s absence  is  occurrence  (p.1)  i n the  as c o n t i n g e n t  relationship  personal  behaviour-reinforcement  be s t r e n g t h e n e d  or  i n the  "a r e i n f o r c e m e n t  by t h e d e g r e e  of  consistent  individuals  that a p a r t i c u l a r  be a f f e c t e d  reinforcement  that  among  are l i k e l y  this  kinds  that  i n t h e same s i t u a t i o n .  reinforcement  expectancy  In  different  also  exist  an ' e x p e c t a n c y '  expectation  of  in  and  that  i n understanding the  be f o l l o w e d by t h a t r e i n f o r c e m e n t  1966,  The  hypothesized  processes  situations  social  is  significance  learning  Following  will  It  a  regarding one's  own  variety  of  situations"  (1966,  64  Situation-specific One  caution  Expectations must  application  of  in  specific  any  given  this  contingent  on  expectancies  and  with  generalized  expectancies  more c l e a r l y  and  the  role  which  in  control  seems v i t a l  based  the  in  The  h i s work  of of  in  social  formula  i s that  "the  2).  and  specific  psychological situation  expectancy  t h a t the  behaviour  reinforcement"  in (1975,  that p.57).  situation  lead and  the  or  such  a  Understanding under  measure  theory.  for  "the  individual  that there  any  reinforcement  role  t o the  was  area. l o c u s of  are  four  They  are  psychological  for behaviour  potential  by  skill  in this  related  learning  will  as  premises  research  of  played  words,  the  the  reinforcements  general  role  control  ( 1 9 7 5 ) reminds' us  combine  specific  determining  the misconceptions  expectancies,  situations.  occur  of  lesser  and  locus  Specific  selection  In o t h e r  the in  to a p p l i c a t i o n  variables  behaviours,  play  solely  more  is labelled  expectancies  construct Rotter of  decreased.  ( R o t t e r , 1 9 6 6 , p.  internal-external  h i s review  classes  has  behaviour"  of g e n e r a l i z e d  developed In  would  The  t h e more t h e  in a given c u l t u r e ,  as  reinforcements final  for  behaviour  expectancies.  to determine  situation, is  Individual theorized  conditions.  i n the  expectancy  the  not  uniformly a situation  determined,  differences  is  of p o t e n t i a l  specific  implications  examined.  expectancies  exist  generalized  before  generalized  expectancies  luck  are  situation  the v a l u e  in  made  theory  these  generalized  behaviour  be  on a  which  Rotter  behaviour  to  i s a f u n c t i o n of to  a value  particular of  that  65  Using  LOC If  to P r e d i c t  we  are  behaviour with  interested  in  useful  expected  adults  to  an  accept  Surely  i n any  perception  I f the person  of b e h a v i o u r  other  hand,  one  what happens h e r e " does not m a t t e r  will.demand believes then  what  I do,  element might  a r e t r u e and we  can  the  affecting be  the  is  an  development  (Mink, will  in  as a  1975).  influence  a  particular then  their  I f , on  else  the  controls  to conclude  that  "It  happens." predictability  creates a  then  providing  could increase might  student  be more t h o u g h t f u l  acquisition  of  skills  viewpoints  of  reward.  An  might  not  individual  event  students  "rewarding" Variation  c o u l d be  expected.  "reward"  understanding  as  involved.  i n f o r m a t i o n t h e e d u c a t o r might  situation  and  for behaviour  act e f f e c t i v e l y ,  the  a l l the  to achieve that  us  outcome.  be  attempts  provide  behaviour  in c o n t r o l "  lead  what h a p p e n s ,  of a p a r t i c u l a r  by  be  of  are  r e s p o n s i b l e thought.  might  e d u c a t o r ' s view shared  "I am  c h o i c e of b e h a v i o u r  they c o u l d i n f l u e n c e  knowledge  behaviour  change  culture  emphasize  control  in educational situations Their  own  "someone o r s o m e t h i n g  one  of c o n f i d e n c e t h a t  One  western  for their  for  believes  Lefcourt's results  predictability  if  our  personal  responsibility  choice  confidence.  in  helping relationship  of  situation.  and  e x p e c t a n c i e s may  of p e r s o n a l r e s p o n s i b i l i t y  of  sense  control  Adults  acceptance  If  prediction  responsibility  objective  one's  the  i n t h e a r e a of c o u n s e l l i n g  acceptance  significant  in  then  information.  many t h e o r i s t s of  Behaviour  seek of  i n any  and  in student Part  of  given educational  these—individual  student  66  perceptions  and  their  sources.  Cultural  influences,  individual  previous  the  situation,  g e n e r a l i z e d as  present  attitudes, the  values  specific  increase  situation  help  perceptions  about  behaviour,  knowledge or  is  to  then  knowledge a b o u t can  LOC  and  In student  the  BSE  BSE  content control  might  t h a t we  the  role  that  which  would  particular  students.  expectations to  and  that  which  i n c r e a s e our  situation  we  guide skill,  i s , in part, a  it.  I f one's  that  individual's the  These  If i t i s true  accomplish  to manipulate  a  of  expectations  have a b o u t  to  that  experiences.  unique  given  individual  case  task,  aim then  expectations  components of l e a r n i n g  i s enhanced.  of  teaching  of p e r s o n a l  BSE  procedures,  c o n t r o l and  for following preventive have  w e l l as  over  information  g r o u p of  propensity  an  perceptions  preventive  of  situations.  to  perceptions  information  unique  develop  similar  Education  the  as  to  s u r e l y our  outcome  responsibility to  of  and  situation-specific  individual  situation-specific  p l a y c o u l d h e l p one  such t h a t  many  expectations  assist  and  a particular  s e n s i t i v e n e s s i n any  the  w e l l as  a l l kinds  specific  have g e n e r a l i z e d and  of  and  them  which are  understanding  accumulate  experiences  result  are  educator's  Adults  our  expectancies  situation  the  educational  and  experiences  definitions  what  of  feelings  of  health practices related  implications for planning  and  follow-up  sessions.  feeling  affects  personal  health status related  to  Are  any  of  health practices? or  related  knowledge  skills  related  Is a  there to  presentation of  particular  feelings  of  lack  kinds  control  of of  and  67  subsequent are as  preventive h e a l t h behaviour?  perceived a reward  and  as  ( i e . , related  punishment  Does  this  interest  in  and  behaviour  Could  to e a r l y  (ie., related  different  learning  BSE  BSE  patterns  Victor of  Joe  control  c o n s t r u c t and  measure  i t .  influence  the  perception. flexible,  belief  this  situation  certain  perceived  authority  t h e power h o l d e r  be  of t h e  which  perceptions  of  an  possible  BSE such  student  has  a  consistent  While  antecedents  internal-external been  internal  or  permissive,  discipline  more r e s e a r c h  behaviour  figures.  A teacher  teacher-student p a r t of or  to  the  and foster  i s needed i n for  b r i n g t o the on  part  adult  learning of  the  i s f r e q u e n t l y seen  relationship.  perceptions.  as  Certain  the p e r c e i v e d a u t h o r i t y  specific  to  external  i s more l i k e l y  kinds  of  used  experiences  warm,  in  Adults w i l l  generalized  and  t o have  p e r h a p s some i m p l i c a t i o n s  the  or the  reinforcement  inferred.  on  others?  of  the p o s s i b l e  reported  control.  i n the  behaviour  certain  studies  suggests,  can  trigger  past  toward  parent,  in internal  educators  of  scale  independence b e h a v i o u r s ,  a r e a as J o e  kinds  to a n t i c i p a t e  some  patterns  i t seems u s e f u l  some of  that  tendency Several  of  I-E  found  approving  encouraging a  He  by  I f l o c u s of c o n t r o l  i n h i s review  the  BSE  by  f o r them.  (1971) e x a m i n e d  p e r c e p t i o n of c o n t r o l  perceived  of c a n c e r )  subsequent  patterns?  plan  results  Is the m a n i p u l a t i o n  to  are c o r r e l a t e d  r e a c t i o n s and  a lump be  influence  skills?  knowledge t o enhance t h e a b i l i t y needs and  of  to m u t i l a t i n g surgery)  related  behaviour  finding  treatment  perspective  developing  components of control  "rewards?"  What k i n d s  may  These  68  perceptions  may  then  In  addition,  the  development  Examining BSE  give  of  some c l u e certain  another  and  one  review  internals,  of  They They  experienced  had  and  forces  trustful  hostility  on  interest  and  (Joe,  1971,  would  be  suspicion inability  interact  p. a  effort, 628).  deal  of  while their  to with  with  programs. related  and  more  LOC  and  suspicious  of  than  more  to  achievements are that,  learning. l e a r n i n g as frustration  They  i n achievement  tend  show  not  always  greater higher  externality  aggression  does l a c k of  per  academic  to  i t seems t h a t Anxiety,  had  manifest  measure.  l o c u s of c o n t r o l and  internals  They  frustration  prone I-E  with  aggressive  approval.  more  failure  to  than  in comparison  anxious,  thus  how  Even g i v e n  barrier  interfere to  and  that  pen-and-paper  f e a r of  i s some q u e s t i o n  achievement  the  might  l o c u s of c o n t r o l  External  for social  were  and  other?  of p o w e r l e s s n e s s and  and  teach  disease  teaching  I s one  found  needs  to  patterns  methods a r e  control  less  were more c o n c e r n e d w i t h There  the  relatively  lower  perceptions.  breast BSE  foster  i s more d e s i r a b l e t h a n  were  more f e e l i n g s  external  aggression  were  to  obvious.  research  particularly  behaviour  I n t e r n a l V e r s u s an  the  externals  dogmatic.  BSE  outcome  reactions.  methodology used  teaching  g e n e r a l l y b e t t e r than  Joe's  the  and  external  more e f f e c t i v e  a t t i t u d e s or  of an  may  or  of c o n t r o l r e l a t e d  i m p l i c a t i o n s are  Desirability  se.  internal  to planning  behaviour  behaviour  subsequent  outcomes and  perception  via  either  teacher  the  others.  teacher  r e l a t i o n s h i p between  feelings  particular  The  certain  information  specific  If  the  i n f l u e n c e student  insight  constructively.  Can  and and we  69  rightly  assume t h a t  Rotter dichotomy  (1975)  (p.  suggested  may  whether  as  of  reality that  fact  more  lead  locus  Feelings  control  for  has  might  cancer,  a belief  a  tendency  believed  that  to  that  may  ignore  harmful  Situation-specific  Predicting but  the  familiar,  more  situation  is"  actions  the that  is total early  signs be  (Rotter,  situation-specific  and,  increase  is a limit  unwarranted  of  the  on by  hypothesis  relationship  to  undesirable  beneficial. i s no  BSE.  element On  the  c o n t r o l may  and  of  questions  may  there  there  cause  indicate better  most  personal  of  other  lead  symptoms s i n c e  In  to  i t is  w i l l e d away.  Tools  from a g e n e r a l i z e d  i t becomes l e s s r e a s o n a b l e and  not  t o a v o i d a n c e of  Measurement  reasonable  the  behaviour  r e m i n d s us  be  e f f e c t s can  behaviour  adjustment.  Rotter  that  have  unpleasant  E i t h e r extreme would be  lead  there  or  see  own  curvilinear  stance  hand, a b e l i e f  61).  a  middle  control  out  Rotter  and  personal  externals  bad-guy"  which  better  their  points  p.  to breast  and  therefore,  (1971.  relation  studies failures  one's  adjustment some  "good-guy  of c o n t r o l w h i c h a r e  to trauma.  of  desirable?  acceptable.  may,  In a d d i t i o n , he  may  that  from  responsibility  control.  several  less anxiety  are  and  this  repress  arising  guilt  adjustment. personal  not  against  may  report  failures  taking  feelings  may  i s a l w a y s more  mentions  r e l a t e d to the  such events therefore,  He  internals  and  be  cautions  60).  that  experiences This  internality  the  more  1975,  p.  expectations  e x p e c t a n c y may  "the  more  unambiguous 60).  and  In the  seem  structured, a  particular  these  instances,  value  placed  upon  70  reinforcements  come i n t o p l a y .  reinforcements  begin  to  control  no  longer  i n younger  familiarity to  achieve  Research far  with  the academic  within i t .  in this  less  area  just  that  not  our  control  measurement address  or  l o c u s of c o n t r o l  of  behaviour,  concomitant  work  on  more s e n s i t i v e and  use  the  behaviour suggested  is a  joint  that just  and  a  value  Maides  (HLC)  Rotter of  development  locus  a  these  to  of  measure  developed  Scale.  They  (1954)  would  health based provide  expectancy  purposed concepts.  of a s p e c i f i c  such  findings.  to  scale  to  a better  specific  two  us  Perhaps a  (1976) have  tool  t h a t such  since  situations  would be  T h e i r r e s e a r c h examined  function as  scale  and  internal  b r o k e n down  would c l a r i f y  L o c u s of C o n t r o l assumption  of  l o c u s of c o n t r o l .  measurement  predictions.  reinforcement  of  trust  Kaplan  control  the H e a l t h  situations  f o r more p r e c i s e  which a r e  instrument  are  (1975) r e m i n d s  t h e need  instruments  ability  s k i l l s which  internal-external  suggests  f a c t o r s as v a l u e s and  locus  their  for  is  succeed.  ambiguous  Rotter  locus  student's  to  academic  more n o v e l and  He  Wallston, Wallston, a  on motor  other  t h e m u l t i d e m e n s i o n a l i t y of  measurement and related  influences his t o do  been  this  situation  has  the  the g e n e r a l i z e d expectancy  limited.  situation-specific  entrance  that  many  tools  instruments  using  suggests  measured as y e t .  measurement are  by c o l l e g e  concentrated  in these  been  but  competing  T h e r e has  achievement  knows what he  than  i n f l u e n c e of  external control  has  He has  ambiguous  perhaps the or  Rotter  other  behaviour.  of a c a d e m i c  children  apparent.  addition,  influence  some s u c c e s s f u l p r e d i c t i o n of  In  HLC  that They  instrument  71  may p r o v i d e specific of  more s e n s i t i v e r e s u l t s ,  conditions  behaviour In  tool  health  are  social  113).  In  previous  while  been  there  remains  mentioned,  accept  of i n t e r n a l  adults  definite  shift  towards  variables  Wallston  and  information-seeking of h e a l t h  as a  measurement  of  their  own  belief  tools  and  reality,  internality.  increased  habits.  degree  behaviour  of p e r s o n a l  In t h e h e a l t h  responsibility some  perceived  c o n t r o l must be b a s e d on  emphasize development  than  health,  and  care,  that  As  has  i n our western c u l t u r e a r e expected t o for  relationship.  personal  with  f o r the d e s i r a b i l i t y  health  of  one  Toward I n t e r n a l i t y  are d i f f i c u l t i e s  a helping  personal  only  suggest  a s some p o s s i b l e health  this  care.  responsibility  counsellors  measures  behaviour  to  t h e more  using  value  health-related  Orientations  perceptions  support  that  f o r using  They  list  t h e c a s e of p r e v e n t i v e  health  Control  While  of  behaviour. and  related  Even w i t h  against  may be a s much r e l a t e d t o v a l u e  in p r e v e n t i v e Shifting  support  caution  involved  supports,  (1976) s u g g e s t  behaviour  to  better prediction  r e l a t e d behaviour.  and b e n e f i t s o f s p e c i a l a c t i o n s  Maides  for  (1978) f o u n d  to predict health  factors  motivation,  relevant  of c o n t r o l l i t e r a t u r e  HLC s c a l e , however, t h e y  numerous  (p.  of l o c u s  and W a l l s t o n  to analyse  measurement  costs  or b e h a v i o u r s may p r o v i d e  review  health Wallston  specific  scale  in a particular situation.  their  concept  a belief  care  health  for of  health  field  there  internality  is  a  responsibility  increases  and  many  responsibility in  consumer  If internality  and  acceptance  preventive  health  may be d e s i r a b l e .  72  Dowell  (1977) u s e s  that  "control  instructional the  (p. 4 ) .  college  setting  internality.  He  and s u c c e e d  related  to  succeed  than  function 1977.  a  of  i t  is  one's b e l i e f  that  adults  most  important  Following  that  one i s n o t i n  experience novel play  field  control  of  in  perceptions  about  outcomes.  In  procedure  is  the context  the s p e c i f i c  reasoning  i s too d i f f i c u l t  changes learning  early  their  one  a b i l i t y to becomes  a  (Dowell, assume  b u t one o f t h e  i s one's  personal  Previous  experiences i n  the development  of p e r c e p t i o n s  the  outcome  of  a c t as a b a r r i e r  in this  any  i s f r e q u e n t l y a new  Since  the s i t u a t i o n i s  perceptions  might  instance.  of p r e v e n t i v e  health  may a f f e c t  o f BSE a s t u d e n t  or that  academic  t o any c u r r e n t  they  could  behaviour, educational  may f e e l not  enough t o make any d i f f e r e n c e .  experiences  to  closely  might  of m o t i v a t i o n  t o succeed case  more  t o succeed"  generalized  students  in  particular  "Motivation  students.  the a b i l i t y  in  externality  regarding  In a d d i t i o n , l e a r n i n g a s a s a d u l t adult  variable  t o m a s t e r o n e ' s own  settings  t o succeed. foster  a l a r g e r part with  avoid  Dowell's  one c o u l d a n t i c i p a t e t h a t  breast  ability  i n one's a b i l i t y  This could certainly  Similarly,  the  the  may  f o r many  contention  that  from  c o r r e l a t e s to l e a r n i n g success  academic  learning.  shift  may have many s o u r c e s  the  endeavour.  a  motivation.  o f one's a b i l i t y  a  crucial  suggests  expectation  to  a  and  i n academic  person's  p. 3 ) .  perception  that  support  He e x a m i n e s a d u l t e d u c a t i o n  to effect  feels  to  becomes  efficacy"  c a n be u s e d  environment  reasoning  expectancy  community  strategies  similar  a l l together  or  that  detect  They may  participate  in  73  learning  a b o u t BSE  addition,  previous  family  or  health  their  in a half hearted negative  friends  m e a s u r e s may  act  Previous  successful  personal  c o n t r o l , on  learn  and  s u c h as  to  a  with had  (1970)  found  work  BSE  and  or  carry  out  own  or  other  as  their  learning.  resulting act  In  preventive  current  a  hand, may  that  f e e l i n g of  a motivation  preventive  with  personal  health  to  measures  vocational  c o n t r o l or  productive rather  way than  of  students  and  achievement  Internals  d i d make  had  increased and  ability  and  to  work  self-reliant;  they  and  work  knowledge;  they  had  satisfaction  and  increased  need  for  seem t h a t when  these a d u l t s  their  did  perceptions  (1975), a l s o  s e t t i n g , found  reported  function of  in  a  c o n t r o l were  working  that  the  with  adults  "overwhelming  a p o s i t i v e a s s o c i a t i o n between  behaviour"  control  internality  external.  Mink  community c o l l e g e  rehabilitation  in job p r o f i c i e n c y , e m p l o y a b i l i t y  tolerance  I t would  Roueche and  (p.  7 ) . . They  o r i e n t a t i o n toward  suggest  internality  a  majority  internality  that can  in  shifting  improve  the  process.  Eckstein of  of  t h e y were more c o o p e r a t i v e  training  achievement.  learning  of  satisfaction.  increased  student  other  difference  others;  internal  experiences  perceptions  increased  more  area  a b a r r i e r t o any  subsequently  significant  training  i n the  their  results.  BSE.  Tseng clients,  w i t h poor  e x p e r i e n c e s of  as  the  way  control  interpersonal  and could  Eckstein  (1979) a g r e e  adversely  relationships.  affect They  that a  an  external  locus  person's a t t i t u d e s found  shifting  and from  74  externality led  to  to  internality  increased  using  congruence  an  experimental  between  real  seminar  format  ideal  self-  and  concepts. It  seems  p o s s e s s an internal  that  adults  internal  rather  locus  about  validated  observing  of  of  than e x t e r n a l  Conclusions by  behave more p r o d u c t i v e l y  the  achievement  control. locus  of  desirability behavioural  after  a  Tentatively,  they  a  more  c o n t r o l seems d e s i r a b l e . of  internality  change and  shift  when  to  changes  internality  could  be  in  level  has  been  accomplished. Another  v a r i a b l e which  phenomenon  of  externality  would  found, and  however,  achieved  This  the  "defensive  logically that  scores  apparent  as  passivity  valued  competitive,  This  may  explain  predictability School  age  abilities a  selected  achievement While it  with  has  ambitious  research  represent  population,  those  levels,  may  reasonable  and  studies  do. who  contain  1975,  p.  64).  by  externals.  not  with  the Since  learn  a  College have  college  to  range  of  students  represent  proven  academic  more d e f e n s i v e  the  found  students.  broader  have been done w i t h  t o assume t h a t  soon  competitively  f i n d i n g s w h i c h have  tend  students  that  in c e r t a i n s i t u a t i o n s .  but  to  the  felt  explained  passive  is  Research  behaved v e r y  children  then c o l l e g e  few  passivity.  was  s o c i e t y some e x t e r n a l s  and  the  It  been  and  i n our  some of  findings  i n t e r n a l s (Rotter,  defensive  striving  children  relatively  seems  as  contradiction of  be  create  high  research  external."  some e x t e r n a l s  differentiation i s not  influences  externals.  older  population  adults,  involved  in  75  adult  education  people  than  activities  the  predictability of  locus  with  this  of  college of  broader et  adult  there  increased  of  control  that  f e e l i n g s of  the  The  is  the  a  college  the  health  of  population. modify  meaningful  be  result  that  to c r e a t e Bielby  of  the  to  I-E  determine  scale. be  job or  Use  useful  situations  large  the  The  perception  researchers  work  machinery  environment.  t o have more  postulated  situation  environment.  This  may may  be apply  well.  tested  I-E  perception  adults  perception  or  of  and  in  indirectly and  that  behaviour,  46  with  since  new  "modification  psychological  perceived  control  r e l a t e d t o age"  and which  (p.  208).  c i r c u m s t a n t i a l changes are  (1977) examined  from  been done  c o n t r o l c h a n g e s t h a n age  of  separated  development.  t o d a t e has  (physical,  in modification  Siegler  been s u f f i c i e n t l y  research  environmental  and  not  K i v e t t et a l . suggest  internal-external locus  They  as  environment  either directly  apt  area  when  people  the  the  expectations  may  may  of  influencing  can  It  the  c o n t r o l over  from  f a c t o r w h i c h has  social) be  of  workers.  aspects  most  e x p e r i e n c e s can in  that  s u c h as  powerlessness  factors  Unfortunately, the  in research  of  Factor  Age from  objects  clerical  preventive  Age  found  perception  to other  spectrum  p e r f o r m a n c e may  s e r v i c e workers tended  than  generalized to  or  broader  population.  a l . (1977)  c o n t r o l over  Thus l a b o r e r s  used  f o r p r e d i c t i o n of  provided was  population  a  academic performance u s i n g  control  Kivett  represents  control to  49  the  per  developmental  in middle  and  old  more  se. nature age.  y e a r s o l d over a p e r i o d  of  76  eight  years.  affect  balance  has been more  They  found  than  adult  years  closely than  that  that  l o c u s of  by  a c r o s s the l i f e  change  in  as c i r c u m s t a n c e s  at s i t u a t i o n s  change.  Lao  (1976)  directly  external  control  more  internal  mastery  then  level  age  it  control  over  feelings  who  be t h a t  feel  personal  health  seems t o over  that as  age i s r e l a t e d  they  an  and  perceptions  issue  of  internal-  students  parents  with  significantly  that  y e a r s may  increased account f o r  to f e e l i n g s  health  are i n c o n t r o l .  and  act  result  to h e a l t h hazards  preventive  related  of p e r s o n a l  I n c r e a s e d age may  antecedent  status  the  and a c t  behaviour  I t may,  in  for  on t h e o t h e r  to  decreased  control  over  as  a deferent to preventive  behaviour.  Implications  Many  some  adult  former  internality.  for increased  seen  than  i n the middle  to  we be l o o k i n g more  suggests  increased s u s c e p t i b i l i t y  hand, be  health  Lao  one's h e a l t h s t a t u s .  of  change  college  the middle-aged sons.  this  o f h e a l t h i s f r e q u e n t l y p e r c e i v e d t o be  may  as a m o t i v a t o r those  their  p e r c e p t i o n s of  Since  do  this  She compared  found  and competence  increased  to  and a g e . and  span and t h e  Should  addressed  closer  Since the l a t t e r  and p r e v i o u s e x p e r i e n c e s  age o f s t u d e n t s ?  parents  was  circumstances,  the g e n e r a l i z e d p e r c e p t i o n s  the s p e c i f i c  their  control  to verbal intelligence.  t o be s t a b l e  influenced  indicate  found  f o r Adult  Educators  researchers contend  externality. points  such  While  that  internality  research findings  as the source  of c o n t r o l  are  i s more  desirable  conflicting  on  p r e c e p t i o n s and t h e  77  role generalized generally  versus  situation-specific  perceptions  i n t e r n a l i t y does seem to be more f u n c t i o n a l .  play,  With the  c a u t i o n that i t must be based on r e a l i t y ,  i n t e r n a l i t y would seem  to  involvement  be  more  situation  favourable  than  to  productive  externality.  productive  in  internality  seems more p r o d u c t i v e  activities. mind. be  specific  The  Two  fostered  some e f f o r t  and  situations  implications  When students  of  but  in more general  in a broad  spectrum  effects  of  human  should  personal  of  terms  display i n t e r n a l i t y t h i s perception  When students d i s p l a y e x t e r n a l i t y in  the  control  direction  seems  both  educator  of  increased  worthwhile.  r e s e a r c h e r s have made attempts i n t h i s area the  is  come to  reinforced.  for  external  the a d u l t educator  to h e l p them move  perceptions  defensive  in a given  and  behaviour  Several  have  and  examined  instructional  methodology. Kinder  and  influenced  Kilman  outcomes  p a r t i c i p a n t s ranging an i n i t i a l toward  p e r i o d of  less  They suggest  leader  (1976) in  in age high  group  that  leader  situations.  With  leader  structure  with  particularly  The  age  encouraging  range to  college  found a  s t r u c t u r e produced more p o s i t i v e  that t h i s sequence i s optimum f o r both  is  structure  from 18 to 52 y e a r s , they  e x t e r n a l persons (1976, p. 861). experiment  found  movement results.  internal  used adult  that  in  and this  education  situations. While t h e i r study was and  Sotile  (1976)  showed  very s m a l l - - o n l y 23 some  subjects--Kilman  i n t e r e s t i n g e f f e c t s of leader  s t r u c t u r e that c o u l d be followed up.  They found  that  internals  78  functioned externals No and  better  i n an u n s t r u c t u r e d  d i d better  single  should  be  (1976)  contract  format  Externals teacher  was  to  found  i s optimal  individual that  more  differences.  between  the c o n t r a c t  methods  Daniels  the student's  and  with a  control.  by t h e l e c t u r e method where t h e  They f o u n d  locus  that  i n t e r n a l s were more m o t i v a t e d  motivated  in control.  for a l l students  and i t has been s u g g e s t e d  s i n c e marks were w i t h i n  were  interaction that  goals  matched  Stevens  r o l e s i t u a t i o n and  in a structured situation.  i n s t r u c t i o n a l process  a l l educational  leader  that  there  was  of c o n t r o l and t h e s e  a  strong  two methods and  a p p r o a c h was n o t t h e most d e s i r a b l e method f o r  everyone. Newsom and F o x w o r t h learning. found  that  control did  They  who  with  adults  need t i m e  indicate  methods.  internality.  of  the  responsibility  i n ABE GED  of  This  makes  t o a method  learning  f o r the e x t e r n a l  were  student  seems  r e s u l t s of  them  A gradual  shifts would  to  shift  more  as  initially  externals  forced  situation.  of  internality  producing  sense s i n c e  They  locus  method t h e f i n a l  which  contract  classes.  While e x t e r n a l s  i t i s a u s e f u l method o f  t o get used  use  on d e v e l o p i n g  t o t h e use of t h e c o n t r a c t  study  towards  teaching  the  were aware of t h e c o n c e p t s of  d i d n o t have as much impact  resistant  control  worked  teachers  actual  their  (1979) s u p p o r t e d  take  o f more  likely  to  produce p o s i t i v e change. Teachers of  have  been s t u d i e d  c o n t r o l on them a s w e l l .  kindergarden  teachers  and  t o look  Powel and teacher  a t t h e e f f e c t of  Vega aides.  (1972) They  looked found  locus at that  79  i n t e r n a l i t y c o r r e l a t e d with many v a r i a b l e s which have been found to be r e l a t e d to teacher  effectiveness.  Internals  had  a  less  s e l f - r i g h t e o u s or h y p o c r i t i c a l a t t i t u d e toward o t h e r s , a g r e a t e r teaching  p o t e n t i a l i t y , a more p o s i t i v e work a t t i t u d e and a more  democratic approach to t e a c h i n g . burnout  to  educators  the  Zahn  of  work  the  teacher  jobs.  Lack  of  control  i s one of the f a c t o r s mentioned.  that the l o c u s of c o n t r o l understand  related  many e x t e r n a l i t y - p r o d u c i n g f a c t o r s which a d u l t  have to face i n t h e i r  conditions  (1980)  concept  teacher  as  can  well  as  be  useful  i n planning  over  I t seems  in  helping  the t e a c h i n g  experience. There seems to be support methodology.  If  LOC,  for  linking  LOC  or  both,  then  BSE  teaching  enhanced by a p p l y i n g knowledge of these only  one  variable  and  behaviour but adding t h i s pertinent  teaching  and s p e c i f i c a l l y HLC, i s r e l a t e d to BSE  behaviour and teaching method i s r e l a t e d to e i t h e r behaviour  and  not  an  HLC  or  effectiveness  relationships.  BSE  may be HLC  is  i n f a l a b l e p r e d i c t o r of h e a l t h  i n f o r m a t i o n t o the  variety  of  other  f a c t o r s suggested by the research c o u l d provide a key  component to BSE teaching  programs.  Summary The  felt  need i n terms of breast cancer  BSE as a v e h i c l e f o r e a r l y d i a g n o s i s other 1980;  screening  approaches  i s early diagnosis.  compares  favourably  (Alcoe & McDermot, 1979; Bullough,  H a l l et a l . , 1977, 1980; G a s t r i n , 1981; S t i l l m a n ,  Despite  with  the apparent b e n e f i t s of BSE, performance  1977).  descrepancies  80  continue  to exist  McDermot,  in  1979;  a  high  Edwards,  Howe, 1981; T u r n b u l l ,  1980; F l y n n ,  1978).  A  relationships  between  should  some g u i d e l i n e s  provide  teaching  influence  activity.  valence  theory  understanding an  better  suggests  Rubenson  i f the  what  related  and  more  effective  information,  environmental  and  the  the topic  personal  changing  obstacle  the  is  influence  internal  i s needed.  values,  Cross's  status,  interaction  of f o r c e s  between  and  personal  of  in  about  and  suggests reference  s i t u a t i o n a l requirements needs,  external  obstacles  and t h e  pressures  and  educational  influencing factors. (1974) s u g g e s t  to potential  Chain  His  affective  Rubenson  that  to p a r t i c i p a t i o n in educational  (1981)  expectancy-  and  member  psychological  and R o e l f s  the appeal  which  interested  and e x t e r n a l  be  The  factors  clients.  Responses  behaviour  t i m e may be a  endeavours.  a r r a n g e m e n t s and a t m o s p h e r e o f t h e p r o g r a m may a l s o  stream  BSE  in a  in learning  expectancies  life-cycle  a r e some p o s s i b l e  Carp, Peterson  forth  educator  d e g r e e o f c o n g r u e n c y between p e r s o n a l opportunities  participation  women t o engage  about  to  some o f t h e v a r i a b l e s actual  health  a t t i t u d e s socio-economic  which  &  of t h e  t h e p a r t i c i p a t i o n phenomenon.  influences  self-evaluation,  major  understanding  (1977) p u t s  explain  understanding  attitudes  for  (Alcoe  1981; H a l l e t a l . , 1977;  f o rplanning  interest  to  work s u g g e s t s t h a t  group  women  BSE a n d v a r i a b l e s w h i c h may i n f l u e n c e i t  research  initial  learning  that  of  programs.  Participation  BSE  percentage  in  Model emphasized t h e a  constantly  forces.  flowing  Life transitions  81  can  p l a y an i m p o r t a n t  special  sensitivity  degree  of  with  opportunities  deal  with motivation  the Once  affects  Accurate  opportunities  Cross  the  latter  will  is  occurs  the  i n f l u e n c e d by many  situation  outcome  factors.  behaviours  This  barriers  in  or  dealing  enhancing who  impact time  individual  on  sequential  end  filters  but  precise  relationships.  his  (1980) examines a  current  behaviour.  Smith  examination Behaviour  of  a  factor  given  and  point  of the p r e s e n t experiences.  in current  motivation  for  variables  of a  to  approach the  A t any  s t r e s s e s t h e need specific  His  time  definition  results  i s a result  in a  general  i n c r e a s e s as they  and p r e s e n t  detailed  from  a c o g n i t i v e s y n t h e s i s of h i s p a s t  s y n t h e s i s of past determines  progression  behaviour  learning  chooses t o i n t e r a c t .  and s p a c e o f t h e s i t u a t i o n .  through  and  Smith  a  i n f l u e n c e end b e h a v i o u r  i n w h i c h an i n d i v i d u a l a  of  and p r o v i d e s  v a r i a b l e s w h i c h a r e i n f l u e n c e d by  situation  The  not h e l p the person  specific  an  t o overcome  barriers  suggests  immediate  occurs.  e m p h a s i z e s t h e need t o  theory  whose  where  former.  o f v a r i a b l e s w h i c h he s u g g e s t s  given  things  the a b i l i t y  as w e l l as r e d u c i n g  what he t e r m s d i s c r e t i o n a r y list  certain  and b a r r i e r s .  since  moments may a r i s e  i n f o r m a t i o n p l a y s a key r o l e  participation  activity  and t e a c h a b l e  for learning  motivation  which e x i s t .  lacks  role  a  broad  and  their  uniquely  individual  process. Hand factors a  and  Puder  which a f f e c t  hidden  key.  (1967) learning.  The  looked They  educator's  at individual personality single  attitude  out s e l f - c o n c e p t and  the  as  learning  82  atmosphere can  play an  important  role  in  influencing  student  response. Norris  (1977)  points  out  occur over  the  adult  interests  and  motivation.  remains.  lifespan  As e d u c a t i o n a l  increases.  that many p h y s i o l o g i c a l changes which  may  cause  Psychological  ability,  experience i n c r e a s e s ease  Motivation  to  learn  is  best  and  Learning  life  in  of  learning  habits,  expectations.  the  health  p r e s c r i b e d by h e a l t h care  definition  issue  education  field  definition  in  providers.  It  health  context.  the  of the term compliance has  compliance  research  Norris values,  is  frequently  measured i n terms of compliance with recommendations and  discrepancy  in  however,  examined,  contends, through a framework of needs, goals, self-concept  changes  and  Gordis  is  the  performance  V a r i a t i o n s i n the  inhibited  comparison  (1979) suggests that an  f o r both compliance and  therapy  noncompliance  be  of  explicit  employed.  Accurate measurement of compliance i s d i f f i c u l t . Psychologists  with the United  developed a h e a l t h b e l i e f model. behaviour  States P u b l i c Health This  model  in terms of a person's p e r c e p t i o n s  Service  explains of  s e v e r i t y of consequences, p o t e n t i a l b e n e f i t s and  health  susceptibility, barriers.  Cues  o f t e n t r i g g e r behaviour. Examination of the indicated  that  knowledge component  acquisition  d e s i r e d behaviour, Lane and an  of  information  compliance  does not  Evans (1979) d e s c r i b e  i n t e r v e n i n g v a r i a b l e that c r e a t e s Seltzer  of  et a l . (1980) c a u t i o n  has  guarantee  knowledge  as  p o t e n t i a l f o r compliance. that an e t h i c a l  issue a r i s e s  83  when  attempting  diagnosis goals  and  can  be  increased An  to an  achieved.  compliance  indicates  that  others.  Haynes  educational  patient  may of  an  (1976)  and  (1979) which  support  provide  predisposing  factors, enabling  suggests  linked  to  that  is  i s supported  Fiore,  1979;  Vincent,  S t u d y of  women's  inhibiting frequently who  et  compliance  in  preventive  and  that  health  concerns. an  perceive  themselves  as  with  should  be  multi-dimensional the  BSE out  measures.  f a c t o r but  a  patient  in his  Clark,  1980;  Hogue,  1979;  indicates  some  1979).  of  She  and  (1979)  efficient  deal  1980;  Wise,  breast  to  (1979) s u g g e s t s  e t a l . , 1979;  professionals  Williams  inhibiting  (Bowers,  (1978) p o i n t s  the  tailored  techniques  of  health  toward  and  area  combined  reinforcing factors.  involvement  the  than  effective.  which  a  a l . , 1980;  and  most  Green  Given  Turnbull  attitudes  emotional  women  Windsor  concerns.  e m o t i o n s and  1980;  compliance  support,  that  many w r i t e r s  Geyman,  1971;  specific  Increased  by  seem  social  and  items  more u s e f u l  interventions  methods  before  two  improve  t o be  f a c t o r s and  situations  best.  latter  opportunities  specific  specific  approach care  learning  accurate  required  behavioural  information.  of  an  risk.  tend  approaches  combination  He  patient  suggests that  adequate  the  s t r a t e g i e s used to  behavioural  and  since is also  a b s e n c e of  increase the  Halperin  needs  feedback  In  therapy  p a r t i c u l a r approaches  and  and  compliance  appropriate  examination  Morris  produce  conflict  contends  cancer are  are  not  found  Stillman being  between  frequently  immune t o that  (1977)  that  these  fear found  was that  more s u s c e p t i b l e  to  84  breast  cancer  do  tend  motivators  linked  forgetting,  lack  ability carry  out  motivation  approaches  provision  of  medical  or p e r c e i v e d  should  be  deal  with  in  underlying  end the  the  this  c u e s and  combination  belief do  She  health  not  knowledge on  on  in  how  to  increasing  modelling of  behaviour  a silastic  of  (Gastrin,  education  1981).  and  and  Stillman  b e n e f i t s of  n e c e s s a r i l y l e a d to the  breast  person-to-person  in perceived  client  beliefs  for  television  suggests  accuracy  L o c u s of  behaviour,  use  of  perceived  BSE  increased  alternative  a t t i t u d e s and  two  variables  research--personal  locus  a part  situation.  concerns.  susceptibility  control  LOC  Control  may  measurement  The  theory  f e e l i n g s of c o n t r o l or  individual  measurement  expectations  personal  specifically  research.  contends that in e x p l a i n i n g  frequently  and  of c o n t r o l g e n e r a l l y or of  While  have  values  focused  increase tool  behaviour  t o o l s are  f o r p r e d i c t i o n , t o o l s which are  situation-specific Health  a high  approach  powerlessness play  their  confidence  suggested  inquiry,  Expectations  e x a m i n e d by  given  age,  included.  expectations.  a  Other  religion,  of  basic  1980); use  consultants  rates.  t e r m s of  reccurred  are  a  approaches depending  to  In  that  of  (Edwards,  susceptibility  practice  Plans  degree.  are  degree  been  use  follow-up  suggests  teaching  some  practice  d e g r e e of  have  e t a l . , 1980);  instruction,  BSE  a lump and  pract ice  (Hall  (1977)  of  understanding,  t o p r a c t i c e BSE:  guided  model  rate  to  BSE.  Several  or  to of  to detect  t o p r a c t i c e BSE  seems  in  limited  in  on  more  success.  The  to  be  more  85  accurate  f o r measuring  (Wallston more  et  than  al.,  one  expectations in health-related  1976).  W a l l s t o n et a l . support  measurement that  tool  for  prediction  behaviour  and  as  t o v a l u e o f h e a l t h as a b e l i e f  related  suggest  situations t h e use of  health  i n f o r m a t i o n - s e e k i n g b e h a v i o u r may in  of  preventive  be  health  care. The  question  of  externality  i n terms  degree  internality  of  Eckstein  of LOC  & Eckstein,  S t u d i e s have a l s o internal  LOC  shown t h a t  i s possible  account  1976;  Kinder & Kilman, may  be  investigate BSE  a  manipulable on  between  versus some  most  (Dowel,  1977;  beneficial  Roueche & Mink, a shift  from  Tseng,  externality  perceptions (Daniels  Newsom &  Foxworth,  variable  it  may  and  HLC  be  more  1970). to  more  that  take  &  Stevens,  1979).  seems  behaviour.  practices  e d u c a t i o n a l approaches  1975;  e d u c a t i o n a l approachs  specific  BSE  internality  generally  through  1976;  of  been examined and  control  i t s effect  link  particular  student  a  has  seems  1979;  into  LOC  desirability  In  Since  worthwhile  to  the  of  case  would s u g g e s t beneficial  that than  others. In explain on  the  following  participation  the  framework  literature f o r the  chapter  i n BSE review  study.  a  paradigm  is outlined. and  is  used  which  attempts  T h i s pardigm as  the  to  i s based  theoretical  86  CHAPTER I I I  THEORETICAL FRAMEWORK FOR THE STUDY  The  aim  discrepancies needs.  of  this  i n BSE  Research  practices  from a v a r i e t y  conceptual  framework  practices.  Research  framework.  This  theoretical  an  variety theory  an  attempt a Breast  of  Paradigm  arose  which from a  to  t h e BSE  teaching  to develop a  determine  BSE  conceptual  description and  of  the  the broad  investigated.  Paradigm  t o examine p e r f o r m a n c e  discrepancies  S e l f - E x a m i n a t i o n Paradigm  in carrying concern.  understand  the  issues  programs. was  to  this  study  was s u b s e q u e n t l y  i n BSE  was d e v e l o p e d .  A  were u s e d a s u n d e r l y i n g  a major  out the p r e v e n t i v e  Participation participation  analyse previous p a r t i c i p a t i o n  teaching  them  performance  paradigm.  BSE was a major  anticipate  forces  includes  Underlying  examine  relate  s o u r c e s from t h e l i t e r a t u r e  for this  effort  to  o f s o u r c e s was u s e d  questions  which  Participation of  and  the  chapter  Theory  practices,  for  was  framework d e v e l o p e d f o r t h i s  research question  In  study  Rubenson*s underlying  measure  r e s e a r c h was u s e d in  i n BSE t e a c h i n g  involved  health  BSE p r a c t i c e s , t o sessions  in participation (1977) t h e o r y base  in  and  to  in future  BSE  Expectancy-Valence i n the t h e o r e t i c a l  87  framework of  this  macro  levels  found,  the  the  of  study.  structural  individual's  link  between  attempting  to  m o t i v e s and  values  psychological conceptual  these  two  of  between an  carry  out  out  such  expectancy by  anticipated  carrying  values  and  habits could a of  part  behaviour  events in  w h i c h c o u l d be  and the  may  manipulated  when  the  needs,  An  would  and  an  of  be  to  overall  influenced  carrying t o BSE may of  of t h e  have  Personal  a particular  BSE  in this  provide  1977).  ability  values.  examination  which  about  consequences  personal  area.  activity it  may  out. play a  change.  Age,  susceptibility  increase personal  behaviour  past  considered  health practice  relation  understanding  forces  and  create  in  feelings  BSE.  i n c r e a s e our  in influencing  the  in  increased  to  apparatus  member g r o u p a t t i t u d e s and  f o r l e a r n i n g about  to produce a d e s i r e to relation  and  success  experiences  or  is  (Rubenson,  about  Expectations  of  combine  in  outcome  t o l e a r n i n g about  pressure  skill  an  attitudes  social  individual  subjective certainty  would combine t o  Reference  in relation  Motives  the  e x p e c t a t i o n s about  individual  and  Emotions,  i n the p r e v e n t i v e  t o BSE.  forces.  micro  role.  that expectations  activity  learning  role.  behaviour.  a c t and  influence expectations  Previous major  an  influence  expectations would  BSE  in relation  a number of  end  p l a y a major  In a n a l y s i n g p a r t i c i p a t i o n i t was  e l e m e n t s must be  i s a f u n c t i o n of  relationship  BSE,  c o n d i t i o n s i n w h i c h an  understand  Expectancy the  Rubenson c o n t e n d s t h a t t h e  knowledge  of changes  in  forces that An  produced  may and BSE play  understanding changes  in  i n f o r m a t i o n about v a r i a b l e s  to produce changes w i t h  others  in  the  88  future. T h e r e may be a c o n n e c t i o n specifically  in  were d i v i d e d terms  between h e a l t h  exposed  that  and n o n - h e a l t h  experience  workers  to reference  Participating  teaching  If  may r e q u i r e to increase  t h i s i s true,  does  fewer p e r f o r m a n c e d i s c r e p a n c i e s health-related be  operating  jobs?  could  Looking  help  to  w h i c h may o r may n o t o c c u r A of  person's  personal  needs  interpretation expectancy, refers  of  but a l s o  participation  finding  about  to  needs and t h a t not  satisfying  that  need,  knowledge  personal  knowledge follow  those  that  working  their and  of a given  in  differences  (Rubenson,  experience  perception  and  ultimately  related  activity.  Valence  one h a s a b o u t  may have  any  individual's  only  environment  changes c o u l d  h e r own h e a l t h  highly.  sub-groups.  BSE, i t i s c o n n e c t e d  o f BSE.  health  a greater  with  these  t o i n the f u t u r e .  breast  the v a l u e  to c o n t r o l  in  I t was  s i t u a t i o n would be  understand  between  the valence  course of a c t i o n  what BSE c a n l e a d of  their  in  a t a v a r i e t y o f f a c t o r s w h i c h may  us  influence  subjects  groups  i t necessarily  occur  to the a f f e c t i v e a t t i t u d e  certain to  current  The  t o examine t h i s i s s u e .  and member g r o u p s who v a l u e  in health  skills.  encountered  oriented  in a health-oriented  b a s e and may a c t a s a m o t i v a t o r and  influences  t h e work s i t u a t i o n and p r a c t i c e .  of o c c u p a t i o n a l  anticipated  between  the r e s u l t that a  1977).  In r e l a t i o n  to the perception  B e l i e f s about  the  a f f e c t the emotional  of  results  attitudes  I f t h e i n d i v i d u a l a c k n o w l e d g e s t h e need status  a n d s e e s BSE a s  t h i s may i n f l u e n c e  t o w a r d p a r t i c i p a t i n g i n BSE.  Lack  of  one  means  of  her a f f e c t i v e a t t i t u d e  knowledge  about  health  89  needs or the r o l e of BSE, or fear of breast d i s e a s e may c r e a t e a negative a t t i t u d e toward BSE and thereby  influence participation  in t h i s p r e v e n t i v e h e a l t h p r a c t i c e . Many  of  the  ideas  put  forward  by Cross  (1981) when she  presented her Chain of Responses (COR) model o v e r l a p theory  of  participation.  and c u l t u r a l them,  She d i s c u s s e s the s t r u c t u r a l ,  f a c t o r s which i n f l u e n c e l e a r n i n g .  however,  from  Rubenson's  the  viewpoint  She  social  approaches  of b a r r i e r s to l e a r n i n g .  These b a r r i e r s not only i n f l u e n c e an i n d i v i d u a l ' s p e r c e p t i o n and i n t e r p r e t a t i o n of the personal  environment  thereby  the  situational,  correspond  i n an a c t i v i t y  institutional  and  occurs.  dispositional  to the s t r u c t u r a l , s o c i a l and c u l t u r a l  socialization especially  experiences  in  Rubenson's  of  so i n r e l a t i o n to p r e v i o u s l e a r n i n g  Cross  stresses  participation. factors  in  transitions  the  f a c t o r s i n the is and  ability.  value of goals and e x p e c t a t i o n s about  Rubenson's  periods.  This  experiences  These ideas o v e r l a p the expectancy  influence  Many of barriers  model.  r e s u l t i n g a t t i t u d e s toward l e a r n i n g and personal  change  level  m o t i v a t i o n but they a l s o e x i s t as o b s t a c l e s which must  be overcome before p a r t i c i p a t i o n her  and  model.  behaviour.  In t h i s study  Cross Life  and  suggests  valence  that  transitions  life  involve  such change p e r i o d s were seen to  i n f l u e n c e the c u r r e n t needs of the i n d i v i d u a l with the p o s s i b l e result  of  creating  a teachable moment where that  p e r c e p t i o n of needs changes. or  her  change.  perception  and  individual's  Her a f f e c t i v e a t t i t u d e toward  interpretation  of  BSE  the enviroment may  90  Cross occurs  suggests  that e x i s t i n g  framework  barriers  behaviour.  They  activities. by  al.,  level  affect  (Carp,  activity  In t h i s  study's  valence  and in  t h a t have been  conflicting  Peterson  (Cross,  and  an  participation  to p a r t i c i p a t i o n  (1980) o u t l i n e d  suggests  ultimately  individual  i d e a s were u s e d  attempt  to  & Roelf,  1981); and  end BSE  suggested  responsibilities  1974); t h e d e g r e e  level  influence  in this  of  skill  (Hall  of et  a  broad  Cross.  overlap with  Smith's  ideas  v a r i o u s c a t e g o r i e s i n the social  properties active  preparedness  capacities  and  environmental factors; involves  used  theoretical  broad  in increasing  i n BSE.  add  role  by  of  Rubenson in  socialization  and  retained and  intellectual information;  social-structural  of  the  environment  of  the  situation.  perspective presented  the a c c u r a c y  Many  an  characteristics;  traits  definition  of  an  factors; congenital  physical  by  in  specificity  framework:  social and  to  interpretation  immediate a w a r e n e s s and  c a u t i o u s and  helpful  were  include biophysical and  which  situations  analysis  ideas a l r e a d y mentioned  influenced  perception  in  framework  comprehensive  includes personality  factors  factors  behaviour  to p a r t i c i p a t e  biological  is  of  theoretical  and  b a c k g r o u n d and  include  -end  list  a d e g r e e of p e r s o n a l d e s c r e t i o n .  study's  ultimate decision  suggestions  includes  a comprehensive  i s allowed  create  individual's  The  overcome.  between e x p e c t a n c y  ultimately  in  1977).  where t h e  and  occur  information  Smith  his  b a r r i e r s must be  Barriers  energy  accurate  His  participation  v a r i o u s r e s e a r c h e r s a r e : time,  and  he  that before  by  Smith  w i t h which data  are  should  be  analysed.  91  The before  Health  an  action,  individual a  cue  behaviour. of  in  or  to such a c t i o n  may  action.  are  They a r e  a  not  the  situation  the  and,  perception  of  variables  under  The complex as  an  active  by  the  may  needs.  and or  Health  included  the  Cues,  not  Belief  factors in  but  in  is in  involved  in  stimulate  end  Model  which  susceptibility  and  and  resulting  valence may  perceived  fit under  socio-psycological  congenital  perceived  component  in compliance.  In  and  has  properties  b e n e f i t s and  this  and  b a r r i e r s under  the  It  creates  framework form  i n t e r p r e t a t i o n of  opportunity used An  to l e a r n , the to  described Evans  study's in  been  Lane and  variable.  preparedness  information.  of  or  valence.  intervening  methodology  one  was  influences perception  demographic  f a c t o r s ; and  issue  Perception  of  illness  concept  as  health  from a v a r i e t y  automatically  socialization,  knowledge  compliance.  as  framework a r e :  needs;  e x p e c t a n c y and  This  expectancy  i n the  advice  that  appropriate  personal  framework  therefore,  ideas  study's  environmental  others.  f a c t o r which  s u s c e p t i b l e to p e r s o n a l  Other  to t r i g g e r  related  seen  turn  behaviour.  i s needed  individual's perception  themselves,  suggests  recommended p r e v e n t i v e  involve  theoretical  the  e t a l . , 1979)  i n v o l v e r e m i n d e r s and  they  study's  influencing  into  (Becker  involving significant  the  of  Model  undertakes a  Cues may  sources  illness  Belief  present  individual's  of the  source  a  very  (1979) i d e n t i f y i t potential  i t a p p e a r s as  retained  the  part  for of  information.  environment of  as  is influenced  information,  the  information  and  the  accuracy  of  perception  of  her  needs  is  92  influenced A  real  by  l a c k of  participation  significant  role  in  BSE.  end  behaviour  of many m o t i v a t o r s  The  last  large  body  theoretical  literature  i n f o r m a t i o n may  in  one  study's This  knowledge of h e a l t h needs and  or p e r c e i v e d  eventual  only  her  affects  of  control  i n the  behaviour  socialization  process.  It  through  effect  expectations  about  BSE  and  i n t e r p r e t a t i o n s of  of  the  manipulable  may  BSE. to  play  a  that  i t is  influenced  this  l o c u s of c o n t r o l  feelings  c o n t r o l or  in a given  situation  In  of h e a l t h was  this  study  seen as  influences  It  v a r i a b l e s which  I t was  of  of the  preparedness can  through personal  environment.  locus  a part  active  self-evaluation. or  research.  of p e r s o n a l  expectations  directly the  which  accordingly.  area  on  of  a barrier  i t i s recognized  i s the  that  specific  its  a c t as  knowledge  research  framework  suggests  end  role  of a c t i o n .  powerlessness creates general and  While  the  influence perceptions  perceived  as  one  influence participation  in  BSE. Breast B a s e d on  Self-Examination the  r e s e a r c h w h i c h has  Self-Examination paradigm This  an  Participation attempt  framework was  a basis was  was  f o r data  used  Rubenson's  in  used  its  participation  to develop  the  into  factors  i n the  a  collection of  Breast This  framework. tool  and  theoretical  Paradigm. and  a  developed.  major u n d e r l y i n g  Expectancy-Valence  given  was  theory a data  Paridigm  described,  While a v a r i e t y  development,  paradigm are  been  Paradigm  to organize  analysis.  (1977)  relationships  Participation  their  f o l l o w i n g diagram  as  ideas  theory The  was BSE  anticipated  (Figure  4).  FIGURE 4. BREAST SELF-EXAMINATIOH PARADIGM  SOCIALIZATION THROUGH FAMILY,SCHOOL AND WORK -previous h e a l t h experiences -previous l e a r n i n g experiences - a t t i t u d e s toward h e a l t h - e x p e c t a t i o n s of c o n t r o l over own h e a l t h (HLC)  CONGENITAL PROPERTIES - b i o l o g i c a l and p h y s i c a l c h a r a c t e r i s t i c s  ACTIVE PREPAREDNESS -self-evaluation - p e r s o n a l i t y t r a i t s and Intellectual capacities -retained Information  STRUCTURAL,SOCIAL AND CULTURAL FACTORS IN THE ENVIRONMENT - h e a l t h v a l u e s o f member and ~ " r e f e r e n c e groups - o p p o r t u n i t y t o l e a r n about BSE - s o u r c e o f BSE I n f o r m a t i o n presentat ion —  CURRENT NEEDS OF THE INDIVIDUAL - l i f e transitions -personal health status  I  EXPECTANCY - e x p e c t a t i o n s about t h e outcome o f p r a c t i c i n g BSE - e x p e c t a t i o n s about t h e a b i l i t y t o c a r r y o u t RSE  PERCEPTION ANT) INTERPRETATION OF THE ENVIRONMENT -Immediate awareness and d e f i n i t i o n o f the s i t u a t i o n  BARRIERS TO BSE -time -conflicting responsibilities _ -energy l e v e l - r e a l or perceived l a c k of accurate information or s k i l l  PARTICIPATION IN BSE  VALEUCE - a f f e c t i v e a t t i t u d e about t h e outcome o f p a r t i c i p a t i n g i n BSE  THE INDIVIDUAL'S PERCEPTION OF MEETS -value of health - v a l u e o f PSE -knowledge o f h e a l t h needs and t h e r o l e o f BSE - a t t i t u d e toward t h e t r e a t m e n t o f breast disease -cues t o a c t i o n - t e a c h a b l e moment -perceived s u s c e p t i b i l i t y to breast disease  VO  94  Participation end  behaviour  i n BSE a s a p r e v e n t i v e  of concern  seen as i m p o r t a n t  active  preparedness  background Previous  role  experiences,  of c o n t r o l  specifically  over  expectancy  influence  state and  are  i n BSE.  toward  BSE  on a p e r s o n ' s p e r c e p t i o n  arises work.  toward  from Social here.  l e a r n i n g , and  a r e some  Active  important  preparedness  directly and  a s t a t e of  represented  one's own h e a l t h  involved  are  intellectual  to create  school  attitudes  forces  and  This  factors  i s the  individual actions.  combine  family,  practice  Various  traits  i n an i n d i v i d u a l .  social  health  influence  information  through  and  expectations factors  personality  and r e t a i n e d  socialization  study.  v a r i a b l e s which determine  Self-evaluation, capacities  for this  health  or  through  interpretation  of  may its the  e n v i ronment. Perception individual's situation.  and  interpretation  immediate It  is  awareness  influenced  of the environment and  not  p r e p a r e d n e s s b u t by s t r u c t u r a l , s o c i a l the  environment  needs. in  Environmental  examining  reference BSE  and  by  that  only  of  by a p e r s o n ' s  and c u l t u r a l  individual's  include: health  perception  groups; opportunity the  values  t o l e a r n about  methodology  used  the active  factors  f a c t o r s w h i c h seem p a r t i c u l a r l y  BSE p r a c t i c e s  information;  definition  i s that  in  of her  important  o f member and  BSE; t h e s o u r c e to  present  of BSE  information. The current and  individual's perception needs  personal  which  health  i n turn  status  o f needs  i s influenced  are influenced  and by v a r i o u s  by l i f e  factors  by  her  transitions specific  to  95  BSE.  These  factors  include:  knowledge of h e a l t h needs and the  treatment  the  of  presence  the  disease;  to breast  environment  includes  about  Valence, involves  the  the  personal  participating  i n BSE.  individual's  perception  valence  determine  helps  the  The  d e g r e e of m o t i v a t i o n  may,  however, e n c o u n t e r  I f such b a r r i e r s  t o overcome  their  behaviour. restraints, perceived lack  of  Barriers conflicting lack  about  which  by  outcome  expectancy with  and  the are  must  information  energy and  the  in  BSE  and  valence  be  individual's anticipated  or  in  choice  level, or  BSE  sufficient  include  real  of  expectancy,  expectancy  motivation  responsibilities,  accurate  behaviour,  the  Together  and  of time  real  or  perceived  skill.  B a s e d on research  of  on  end  to a c t u a l p a r t i c i p a t i o n  exist,  influence  of  BSE  BSE.  of p a r t i c i p a t i n g  created  barriers  Expectancy  practicing  t o c a r r y out  needs.  perceived  interpretation  expectancy.  determinant  choice  and  outcome of  attitude  of  moment"; and  Perception  I t i s i n f l u e n c e d by  not.  practice.  exist;  "teachable  BSE;  BSE;  c u e s t o a c t i o n w h i c h may  ability  affective  of  of  toward  the  major  of h e a l t h ; v a l u e attitudes  influences  about  other  role  disease.  in turn,  expectations  expectations  the  or a b s e n c e of a  susceptibility of  breast  value  this  question  paradigm was  for  formulated.  BSE  participation,  a  broad  96  The The  two  main  discrepancies The  practice  interaction  concerns  i n BSE p r a c t i c e  end b e h a v i o u r  health  Research  practices  as  a  for  the study:  of  this  f o r teaching the  BSE.  preventive  o f BSE, was v i e w e d as r e s u l t i n g from a complex The s p e c i f i c f a c t o r s  a r e unknown.  factors  were p e r f o r m a n c e  participation in  Using  are  related  which  influence  t h e BSE p a r t i c i p a t i o n p a r a d i g m  t h e o r e t i c a l framework, a b r o a d  What  study  and i m p l i c a t i o n s  in question,  of v a r i a b l e s .  BSE  Question  to  research  end  question  behaviour  was  in  used  BSE  pract ices? It  was  suggested  influencing  An  attempt  a  selected  practices.  anticipated  would  factors  therefore  number  of  Implications  b a s e d on t h e s e  that  research  only  could  a  small  be i s o l a t e d  be made t o a n a l y s e  these v a r i a b l e s f o r teaching findings.  portion and  of the  measured.  the i n t e r a c t i o n of  and t h e i r e f f e c t on BSE  BSE  would  be  suggested  97  CHAPTER I V  METHODOLOGY  Examination was  based  on  collection carried  the  out.  performance  Breast  instrument  Self-Examination  was  and d a t a  was s e l e c t e d This chapter  pilot  study,  collection  developed  Selection  the  and t h e p l a n  on  participation  f o r data  s t u d y was A plan f o r  a  research  was s u b s e q u e n t l y  the  data  carried  development,  research  group,  the data  analysis.  Development  the  review  paradigm  of  outlined  BSE p r a c t i c e .  broadly  the  examined,  reasonable  very  pilot  formulated,  instrument  of  w h i c h may i n f l u e n c e  required  was  the  selection  a  A  of V a r i a b l e s  Based  yet  then  and d a t a c o l l e c t i o n describes  Paradigm.  the q u e s t i o n n a i r e .  analysis  Instrument  and  d i s c r e p a n c i e s i n BSE p r a c t i c e s  o u t t o improve and r e f i n e  data c o l l e c t i o n group  of  length. data  that  foruseful  narrowly  data  A wide  the a  Although  of  were r e a s o n a b l y analysis.  defined--female  wide  collection  range  literature,  While  variety  tool  detailed t h e sample  had was  BSE  of v a r i a b l e s  the topic  responses  university  the  was t o  be  to  of  be  anticipated  and s p e c i f i c population  were was  students taking courses  98  offered  by  the  Division--its  University  survey--practice  of and  wording  researcher's survey topic  attitudes  was  research, than the  be examined length..  BSE practice  i n BSE;  t o BSE;  and  BSE  used  the d e s i r e d  "complete"  2) The  systematic  the t i s s u e  after  barriers  to  the  development  and  approach of  t o the  the  BSE  could  not  workable  for data c o l l e c t i o n t o BSE;  were:  valence  in  in  BSE and  was  labelled  BSE  completeness.  i n the w i d e l y used Canadian I t C o u l d Save  Cancer Your  The  Society  Life"  was  T h e r e were f o u r components  to  examining  component- a s y s t e m a t i c  component-  of t h e BSE  time  menses.  component- v i s u a l l y  both  breasts.  approach  t o examine  involved.  axilla  as p a r t The  plus  BSE.  of r a t e  performance.  and  BSE: visual  3) The  issues  approach  in relation  Self-Examination:  1) The  4)  expectancy  i n terms  "Breast  axilla  categories  and measured  pamphlet as  major  the  potential  t o be o f a r e a s o n a b l e and  Participation  of  the  of  c a r e i n approach  a more f o c u s s e d  practice.  description  expected to  A l l a s p e c t s of e a c h v a r i a b l e  i f t h e s t u d y was  participation  was  has  These  all-encompassing  Paradigm.  four  BSE--  questionnaire  necessitated  broad,  The  relation  with  topic  special  necessary.  Adult Education  S i n c e the t o p i c  toward  subject,  inexperience  Participation  all  of p o s s i b i l i t i e s .  being a very s e n s i t i v e  question  Columbia  e x p e r i e n c e with the r e s e a r c h  i n c l u d e a wide range  for  of B r i t i s h  including  an  examination  of  both  procedure.  component-  carrying  o u t BSE  e v e r y month  just  99  Discrepancies number of  BSE  The with  w h i c h BSE i t was  fail  t o do  of  BSE  general  component was  i t on  ability  data  on  of to  BSE  influences  Expectancy  out  BSE  and  the  t i m e of  out  BSE  this  reason  frequency  the  month i n  correctly data  but  on  rate  in a d d i t i o n to  Data  These  were  i n d i c a t o r s of  Knowledge of BSE  Experience  the  of  reminders carry  BSE  BSE  Experience  from:  congenital and  cultural  interpretation  on  the  of  following  d e g r e e of c o n f i d e n c e  in  knowledge. information used  provide  BSE  BSE  learning sessions  and  follow-up  to  source,  presentation  from  BSE. and  reference  family,  f r i e n d s or  groups  through  physicians  to  BSE.  with  involving  social  the  personal  arise  work;  and  i n c l u d i n g BSE  member  out  perception collected  commencement of Influence  and  structural,  i n c l u d i n g the  of  about  expectations  school  about  expectancy:  present with  expectations  expectations  family,  information,  4.  For  includes  e n v i r o n m e n t ; and  methods  3.  carry  a c t i v e preparedness;  and  a l s o the  only  s e p a r a t e l y and  BSE.  through  their 2.  may  the  practice.  practicing  i n the  i n c l u d e d not  but  to  missing.  a monthly b a s i s .  environment.  1.  out  Subjects  carry  properties;  the  BSE  p r a c t i c e were c o l l e c t e d  socialization  factors  of  carried  done.  Expectancy. outcome  p r a c t i c e were r a t e d a c c o r d i n g  components t h a t were  time  which  i n BSE  breast  themselves,  disease, their  i n c l u d i n g outcomes,  family, their  friends  1 00  or anyone t h e y 5.  Perceptions  of BSE  breast the 6.  7.  personal  ability  to  about  and'  c a n c e r o u s would  are  i n f l u e n c e d by  her  needs.  BSE.  Value  of  2.  Value  of  3.  Perception  It  on  most  of  disease.  a t t i t u d e about  is  related reactions  breast  to are  reaction lumps  emotional  are  attitude  or a f f e c t i v e a t t i t u d e s  status  the  personal  emotional  strongly  on  has  perception  emotional  strong  that  a person's current  1.  and  following  perception  of  topics:  health BSE of p e r s o n a l  satisfaction  with  responsibility  and  BSE.  A  and  breast  These e m o t i o n a l  D a t a were c o l l e c t e d  Current  in  a  BSE  of  affective  since different  produce  effect  between  field.  t o the  expectation  likely  practicing  4.  health care  expectations.  an  the  (HLC)  to detect  refers  BSE  and  expectations  health  participating  to d i f f e r e n t  cancer  about  i n the  relationship  disease.  including  over  Valence  cancer  breast  control  of  expectations related  outcome of  Experience  outcome  i n c l u d i n g the  lumps and  Self-evaluation  Valence. the  knew.  life  current  5.  Perceived  6.  Cues t o BSE  7.  Influences  needs  current  for personal  i n terms of BSE  BSE  including  h a b i t s and  perceived  health.  i n f l u e n c e s i n c l u d i n g age,  student  occupation.  susceptibility practice. on  BSE  habits.  to breast  disease.  status  101  8.  Attitude  toward  including  has  on  w h i c h BSE Barriers  practice.  f e a r of i s an  These  and  exist  which  forces Some of  are  responsiblities,  low  lack  i n f o r m a t i o n or  2.  Lack of  time.  3.  Lack  energy.  4.  Not  5.  Fear  of  Despite the  s c o p e of resources developed  between influence  degree  forces  which  interfere be  with  overcome  f o r c e s which  restraints,  f e a r and  to.  real  may its  before  may  act  conflicting or  perceived  skill.  perceived  will  were a s k e d  to  i n f l u e n c e d how  influence of:  breasts.  find. indicate  o f t e n they  the  degree  examined  to which  their  the  breasts.  Development i t s drawbacks,  only the  the  t o examine y o u r  of what you  factors  the  must  time  level,  BSE  forgetting.  knowing how  Questionnaire  was  the  Simply  Respondents above  energy  the  in  experience.  may  action  1.  d i s e a s e , the  all  to  on  breast  b r e a s t d i s e a s e and  restricting  D a t a were c o l l e c t e d  relationship  given  occurs.  of a c c u r a t e  the  uncomfortable  i n BSE  barriers  of  Even  factors  participation as  surgery  t o BSE.  e n c o u r a g e BSE,  outcome of p a r t i c i p a t i n g  perceptions  disfiguring BSE  the  reasonable  t o p i c s t o be  available. questions  was  A  i t was method covered  decided of d a t a and  combination  used.  that a  the of  questionnaire  collection limited  given  the  time  and  p r e v i o u s l y and  newly  1 02  The Control and  p r e v i o u s l y developed  S c a l e a s i t was d e v e l o p e d  Maides and r e p o r t e d  Health  Behaviour  made t o e i t h e r The  purpose  control  the  might  of  BSE p r a c t i c e s . Part  of  to c o l l e c t this  values. added  list  this  study  study  examination  rank  the  about  examination  by R o k e a c h given  i f locus  (1973) was  to health.  t o rank e i g h t e e n  of  order  of  participants  terminal  f u n c t i o n i n g " was  this  study.  Rokeach  a l l of the v a l u e s  health in relation  other  values  were n o t a s k e d consuming  and  In  was  given. t o other  not  to  be  t o rank a l l o f t h e would  provide  a  t h a t would n o t be n e e d e d .  designed  to  had t o be d e v e l o p e d  suggestions  from  collect  data  specifically  the l i t e r a t u r e  on  breast  for  this  concerning  selfstudy.  development  q u e s t i o n n a i r e s were u s e d a s g u i d e l i n e s . In t h e o v e r a l l  is  in  the value  purpose  I t w o u l d be t o o t i m e  Questions  to  to  scale.  t o c r e a t e a new l o c u s o f  p h y s i c a l and m e n t a l  the  this  scale to determine  respondents  was c o n c e r n e d  deal of data  Several  not  worth p u r s u i n g  and s i n c e t h e r a n k i n g  values.  of  for  Kaplan  t h a t no c h a n g e s s h o u l d be  Scale developed  optimal  respondents  examined,  great  was  i n f o r m a t i o n about  "Health,  requests  values  Value  scale requests  to this  Since  study  be a f a c t o r  the  Locus of  Wallston,  or the wording of  s c a l e b u t t o use an e x i s t i n g  control  part,  by W a l l s t o n ,  I t was f e l t  the i n s t r u c t i o n s of  included the Health  i n t h e Handbook o f S c a l e s and I n d i c e s o f  (1976).  of  used  tools  c r e a t e the best recommended  sequencing  of q u e s t i o n s  p s y c h o l o g i c a l r a t h e r than  by S e l l t i z ,  an e f f o r t logical  W r i g h t s m a n and Cook  was  made  sequence as  (1980).  Berdie  1 03  and  Anderson  (1974) s u g g e s t  interesting  and  items.  a  questionnaire  flagging, suffer  the  in  I f t h e most  response  their  questionnaire  should  very  questions  questionnaire sequencing  questionnaire general  the  values  knowledge  and  and  research topic  were e a s y  The  had  questionnaire, concerning  questionnaire  its After  creating  issues  in  the the  tool.  which  The  explored  experiences to and  and  specific finally,  information  to  about  data  were which  theoretically  sound  a  Columbia had  letter of t h e  carried  out,  a  bring  with  simple questions  explanatory  derived, a description  q u e s t i o n s would not  the  as  the demographic  research  t o be  requirements  a l l the  of B r i t i s h  benefits  reminder  that  ideas behind  hand,  influences  may  begins  collection  at  be  t o answer.  to  i n c l u d e d an  may  attitudinal  One  general  topic  of  questions  exercises  been g a t h e r e d ,  the U n i v e r s i t y  ethical  interest  specific  the data  q u e s t i o n n a i r e ended w i t h  addition  a r e a t the end  r a t h e r than  through  and  views.  f o r respondents  In  with  and  more  opening  specific  behaviour  attitudes  collected.  from  beliefs  the  a v o i d ending  T h e s e were t h e g e n e r a l  q u e s t i o n s on  and  few  funnel approach. becomes  with  (1966) s u g g e s t s  factual  a  a  important  Oppenheim  and  progressed  about  the  more  proceeds.  knowledge  personal  to these  describes  of  items  attention  with  begin  q u e s t i o n s and  when  start  He  should  important  accuracy.  questions. broad  one  non-threatening  important long  that  that a  withdrawal  prejudicial  f o r study p a r t i c i p a t i o n  and  to  requirements be met.  which e x p l a i n e d procedures or  refusal  response,  to  The the be  t o answer the  time  information concerning  1 04  anonymity and c o n s e n t . With  these  ideas  questionnaire  was  four  pilot  different  and  developed study  requirements  and t h e n  Of  this  18  BSE.  initial  contact  subjects  letter,  a s e c t i o n on BSE letter  potential  (1974)  be  suggest  favourably effort  to  to  a values  total  a  that a  i n the p i l o t was  to  t o a c t u a l data  of  these  and t e a c h i n g  pilot  study be  project  section, a health  included  sent  toa l l  collection  The q u e s t i o n n a i r e  contact  i n an a t t e m p t part  was  to  t o arouse  of such a study.  university  personalized  was made t o c r e a t e  "survey  Two  as  i n c l u d e d an  beliefs  section  itself. be  approach  Berdie  to  each  and c r e a t e  and A n d e r s o n respond  more  ( p . 53) and a s p e c i a l tone.  such as "performance  a p p r o a c h " were o m i t t e d  sent  interest  undergraduates  a personalized  some o f t h e t e c h n i c a l j a r g o n and  the  which  prior  of i n i t i a l  respondent  desire  program.  b a c k g r o u n d a n d 13 h a d a t e a c h i n g o r  as the a c t u a l q u e s t i o n n a i r e .  The  instructors currently  i n developing  Of  study.  background.  research  explanatory  a  on  involved  had a n u r s i n g  of  potential  and  content  school  forms w h i c h were d e v e l o p e d  letter  well  women were n u r s i n g  actively  non-health The  a  were  course  subjects, other  Study  in a u n i v e r s i t y nursing  instructors nursing  five  the  r e v i s e d and r e f i n e d u s i n g  t h i r t y - o n e women p a r t i c i p a t e d i n t h e p i l o t  group,  teaching  mind,  groups.  Pilot In a l l ,  in  After  piloting  discrepancies"  and some r e w o r d i n g  took  place  1 05  to  increase  the  explanatory In  the  initially which  clarity  asked  s e c t i o n of  to p i c k  most  out  generally liked  made.  second  was  placed  spacing options. a very  set  i n a box  was  to  of  responses  three.  seemed t o g i v e  the  health  Health  scale  beliefs  L o c u s of  and  pilot  They  i t was  unclear.  study  scale  would The  succinct  then  breast  underwent testing  because  questions  sequencing.  In  five  indicated  that  changes  were  b r i n g a t t e n t i o n t o them  and  there  a better  b o t t o m of  was  more room between  the  data  and  values spread the  Scale.  d i d not  and of  changes  to  improve  processing  of  this  I t was  felt  the  way  but  and  reliability  consisted of  the  spacing  and  section.  question that  top  responses.  questionnaire  criticized  were  t o rank t h e  presentation  study  give  respondents  The  validity  i t was  number  Four five.  question  not  could  changed  results  for  for  this  invalid.  changes  went  the  few  the  were  page  five  self-examination  major  effort  be  testing  responses  i n t e r p r e t e d i n more t h a n one  this  and  respondents  then c i r c l e  i n d i c a t e d that  Control  i n the  be  contact  the  s e c t i o n of  respondents felt  and  that  several  completion  and  s e c t i o n and  to chose only  underwent  facilitate  values  this  so  asked  The  initial  questionnaire  Pilot  d i s c r i m i n a t i n g r a n g e of  This  of  i n s t r u c t i o n s at  subsequently  of  ten  separate  rearranged  Initial  the  important.  respondents The  letter  letter.  values  were  i n both the  during  i n t o the and  t e r m s of  the  portion  of  the  piloting.  Much of  development  of  ever  arrangement  of  the  format,  the  aim  questionnaire  is  the  pilot  more c l e a r  and  most b e n e f i c i e n t to  produce  an  1 06  attractive  and  efficiently (1966) ask, He  completed  reminds  they  interesting  us  questionnaire  which  i n t h e minimum amount o f t i m e . that while  open-ended q u e s t i o n s  a r e d i f f i c u l t t o answer a n d even h a r d e r  suggests  a  minimum  o f open-ended q u e s t i o n s  a r e easy t o  to  analyse.  and t h e use o f  type  forms, headings,  boxes  decrease  the  effort  be made by r e s p o n d e n t s .  topics then  were  examined u s i n g  information a r i s i n g  responses closed use  initially  were c o m b i n e d  questions  was  made o f t h e " o t h e r "  responses  making  while  to  open  since and  response  and  with  breast  long  more  series  were  they  revised  Important  of  parts  in  of was  order  a s t h e one c o n c e r n i n g  have  of q u e s t i o n s  failed  Liberal  emphasis  d i s e a s e , were l e f t  of  or  range  f o r some o p t i o n s  would  personal  questions  wider  where  such  and  and e a s i e r f o r what  boxed  Some q u e s t i o n s  r e l e v a n t f o r a l a r g e number  most  quicker  Several  f o r e x p l a n a t i o n of  for a  of the respondents.  anything  were e l i m i n a t e d a f t e r and  allow  e x a m p l e s were g i v e n  experience  format  to  further  response.  o p t i o n and room  underlined  questions.  complicated been  were  Specific  clarify  personal  order  t o be t h e b u l k  instructions  and t h e s e  which r e q u i r e d o n l y a yes/no  in  needed.  from t h e l i t e r a t u r e  to  questions  to create multiple choice  a n s w e r s was g i v e n  appeared  inserts  open-ended  be  Oppenheim  different  t h a t must  and  can  created  a  very  w h i c h would n o t have  respondents.  to provide  in a fairly  Some  items  d i s c r i m i n a t i n g data  and r e w o r d e d  several times.  form o f t h e q u e s t i o n n a i r e c a n be f o u n d  i n A p p e n d i x B.  The f i n a l  107  Selection Limitations a research length and  o f t i m e and r e s o u r c e s  group which c o u l d  of  time.  the research  Since  the  topic  geographical  study  be  reached  personal  contact  proximity  would have some r e c o g n i z a b l e  assist  i n data of  the  educational The Adult  level  Education they  experience Students nurses either  and o t h e r various  students  The s i z e o f that  group  an  would  important  i t was d e c i d e d  that  UBC  met t h e above c r i t e r i a .  In  an o p p o r t u n i t y field  enrolled  in  t o compare t h e e f f e c t  of  on t h e d e p e n d e n t v a r i a b l e . into  two l a r g e  w o r k e r s , and e d u c a t o r s  of the  a  the  classes generally f a l l  levels  is  in  constant.  classes  health care  was  unique c h a r a c t e r i s t i c s  and  i n the h e a l t h care  i n these  and i t was f e l t  environment  of the female  provided  participation  a group which  level  Division  reasonable  between t h e r e s e a r c h e r  Educational  would be h e l d  selection  addition,  adult  learning  a  was a l s o d e s i r a b l e .  would have t o be l i m i t e d  analysis.  within  s e l e c t i o n of  encourage  was so s e n s i t i v e ,  which  aspect  required'the  s u b j e c t s would p r o b a b l y  when t h e r e s e a r c h close  of the Research Group  provincial  school  groups,  involved in  system  or  in  education.  Data There process. potential  were  three  The f i r s t  basic  aspects  to  the data  involved the i n i t i a l contact  participants  was a c t u a l c o n t a c t  Collection  t o the research  and d i s t r i b u t i o n  which  project.  of the data  collection alerted  The n e x t  collection  step tool.  108  An o n g o i n g actions  and c o n c l u d i n g aspect  taken  t o encourage  Initial  contact  specifically  designed  letter  to  was  women e n r o l l e d Division. not  students. students found planned were  to  the  to  schedule,  accuracy  approximately  developed  with  Adult Education Winter  span  Wednesday  79  there  of  Addresses  collection—encouraging  were to the  initial  contact  f o r whom a d d r e s s e s  had been  addresses.  of the m a i l i n g l i s t , percent  of  contact  the  one c a n potential  letter. research subjects  the professors teaching the  This  term  c l a s s e s of the  schedule  ran  and i n c l u d e d day a n d e v e n i n g  i n v o l v e d was i m p o r t a n t  of  156 f e m a l e  two weeks p r i o r  c l a s s e s ( i e . , second Session).  to a l l  group  were  of  The  Education  for this  the p o t e n t i a l  help  A).  s i n c e t h e r e was  classes.  initial  with  letter  service  were r e t u r n e d b e c a u s e o f wrong  the  those  the  Adult  task  letters  students  f o r meeting  time  lists,  Approximately  A schedule  to  U.B.C.'s  addresses  class  subjects received this  Wednesday  by  i n Adult Education  questionable  U.B.C. 1982-83  of  (see Appendix  t o be a d i f f i c u l t  a l l those  assume t h a t  current  The  given  students.  letters  receipt  the regular mail  mailing  collection  Nine  research  was  132  sent  Given only  registered  data  found.  of  According  for  through  in classes  a current l i s t  the  f o r that purpose  proved  involved  participation.  involved  be s e n t  This  of the process  t o the l a s t  participation—and  aspect  will  be  from  classes. of  data  discussed  later. The commenced  r e s e a r c h e r met w i t h but  either  the students  before  after  the c l a s s e s  had  t h e d a y ' s work had begun o r j u s t  109  before  a break.  handing the  out  of  of  the  Many of initial  not  read  introduced  the  have r e c e i v e d  the  cover  the A  students  of  as  i n c e n t i v e to p a r t i c i p a t e .  people the  information  i n the  pilot  questionnaire  anticipate  a  participate. original the was  was  The  had  education appeals  any  told  that  participate. those  they  were  told  and  the  could  Only  one  students  who  could  some  itself.  Most  forms the  a n s w e r e d any in  They were o n l y  then  student  be  chose  to  obtained  if  for  returning  more  refused  to accept  campus  Education  than  given  whether  forms  asked i f  arose. one to  one  a questionnaire  classes  the  Adult  that  out  could  researcher  decide  attended  fill  they  through  the  the  given  r e t u r n i n g completed  in  enrolled  of  may  serve  they  deadline  returned  box  S t u d e n t s were g i v e n they  the  many  also  that if  the  letter  aspects  were, t h e r e f o r e , s u b j e c t e d  for p a r t i c i p a t i o n .  questionnaire. and  were  and  and  might  of  students  minutes to  commitment  marked  questions  and  t o 30  method of  distributing  students class  a  and  15  where c o p i e s  The  letter  questionnaire  forms were t o be  into  Before  Some  time  were l o s t  given.  or d r o p p e d  students  from  They were t o l d  explained.  building.  took  in  some  these  rights  aspects  introductory  contact of  before  were  S t u d e n t s were a l s o the  similar  i n the  and  various  however, t h a t  their  students  questionnaires  forms  mail  so  again  about  study  professor  were c o v e r e d  repetition  would  processing  that  initial  letter.  the  discussed  felt,  study an  remind  and  I t was  by  she  points  contact  questionnaire.  would not  was  the q u e s t i o n n a i r e  project.  letter  She  during  several  c o p y of for  they the  adult  perusal  wanted form.  the  the  week  to Only of  110  questionnaire appeal  by  distribution  the  were  researcher.  subjected  In t o t a l ,  to  this  personal  119 q u e s t i o n n a i r e s  were  distributed. The she  researcher,  handed o u t t h e d a t a  this  opportunity  increase  to  interest  participation  not j u s t  an o p p o r t u n i t y  to  examine  researcher might  a  in this  to  data  hoped  that  the researcher  would  an  of f i l l i n g  attempt  to  out y e t another in a sincere  of concern.  make form,  attempt  I t a l s o gave t h e  c o n c e r n s and answer q u e s t i o n s  faculty  attempt  remind  as  members  that  introduced  students  well  a l s o seen a s a  to sent  students a  The  by  request  their by  the  i n subsequent c l a s s e s t o r e t u r n  Such as  was  to encourage p a r t i c i p a t i o n .  members were  forms.  a  serve  reminder  would  support  a s an encouragement  to return  r e m i n d e r was p r o v i d e d  w h i c h were p l a c e d  at strategic  These p o s t e r s  letters.  awareness  I t was  was  forms.  A visual  black  of  A l l faculty  participation  building.  question  topic  personally  completed  completed  It  as  i n her w r i t t e n m a t e r i a l .  was  professors.  tools.  appeal  she h a s n o t a n t i c i p a t e d and had, t h e r e f o r e ,  endorsement  researcher  made a p e r s o n a l  a fellow student  worthwhile  valuable asset  their  and  a matter  to join  but that  addressed  researcher  meet  a chance t o a l l a y  exist  The  collection  i n the p r o j e c t .  but  not  a fellow student,  of  spots  announced  by b r i g h t l y around  coloured  the Adult  the p r o j e c t  collection.  project  especially  Education  i n l a r g e r e d and  They c r e a t e d d i s c u s s i o n and seemed the  posters  to  i n the i n i t i a l  increase stages of  111  The  aim  awareness  was of  still  to  data  a s s i g n m e n t s and  faced,  by  their to  to  about  one  the  each  their timing  the  on  workload  but  students data  An  Education class  in  classes.  in  the  academic  with  end  of  after  difficulties as  she  an  did  being they  presented  the  concern  opportunity  matter.  term  that  for  Subsequent  not  voice  from  individual  about  students groups d i d  strong  feelings  strategically building.  placed  in  While  within  the  students  the  the first  and  foyer  of  majority  of  two  a month i n w h i c h t o c o m p l e t e and  of  All  156  During  the  response  research  second  Division  lists,  up  the  weeks,  return  the  tool.  examination  enrolled  this  returned  were g i v e n  information.  the  fresh.  for preparing  acknowledged her  were c o l l e c t e d  were  collection  awareness  the p r o j e c t .  Education  questionnaires  while  researcher,  of  topic  This  feelings  of  The  raise  completed  still  late  overwhelmed  tools,  gather  t i m e span  occurred  also provided  w e l l - m a r k e d box  Adult  this  and  requirements  students  class.  Questionnaires from t h e  time  often  g r o u p of  their  about  project  upcoming exams.  o b l i g a t i o n s and  vent  talk  are  collection  to p a r t i c i p a t e  collection  t h e r e a f t e r brought  project  data  short  inclination  Students  reminded  fairly  unanticipated  questionnaire, year.  out  research  within a  h i g h and  Due  hand  the  questionnaires was  to  term i n the  female the  r a t e produced  subjects  classes  were  given  1982-83 W i n t e r students  wee-k  of  were  data  by  the  following  female  students  U.B.C.'s  Session.  According  registered  collection  Adult  120  in  to  these  potential  1 12  research a  subjects attended  questionnaire  which  distributed.  Of  questionnaires.  This  In  general  left  a  this  One  student  total  of  group,  represented  a  few  exceptions  topics  concerned are would  be  and  these  66  will  not  a v a i l a b l e on  u n i q u e and  no  Anonimity  was  the  the  t o compare  previous an  aspect  in  this  ordinal  and  analysis  of  variables  educational A third  research  volunteers  percent.  questions.  There  as  those  level  The  subjects  Unfortunately, The  research  the  had  been  current  were  data  were  group  was  collected.  research  experiences, not,  the  since  feelings  therefore,  be  Analysis  by  the  form of measurement  majority  into  is  the  also  was  the  limited  sample  In  only  of d a t a  this  of by ex  variable  select  in  collected nominal  or  researcher post which  a n a l y s i s i s the  in this  from a h i g h l y e d u c a t e d  of d a t a  category  measured.  limitation  sample.  respondents to  research  could  The  Analysis  controlled. the  limited  measurement.  research,  of  is  project f a l l  the  the  personal  f o r Data  have been c o l l e c t e d .  over  55  comparison.  research  control  of  Non-respondents  Strategies  which data  group.  sharing very  for examination  Data  completed  discussed  group c h a r a c t e r i s t i c s  important  attitudes.  identified  research  the  non-respondents.  r e s p o n d e n t s would be and  returned  be  accept  discussed. desirable  of  to  questionnaires  r e t u r n r a t e of  n o n - r e s p o n d e n t s t o d e t e r m i n e whether representative  refused  119  a l l respondents completed a l l the  were a  It  class.  facto was  make-up  research  consisted  g r o u p of  university  113.  students. in  the  an  chapter  of  was  decided  that  examination  distributions. indicate The  of  data  variables.  After  relationships  for  or  data  Possible  some  In  of  regression  been  of  project  w o u l d be  was  relationships  independent discrepancies  and  examined type  analysis.  The  Coefficient  would  usually  association  between  of  be  between  ordinal  frequencies  test  usually  the  independence  may  might  calls  Product  used  In  or  variable,  BSE  were t h e  main  exist be  between  helpful  sets  of  Moment  in  well.  scores.  for c o r r e l a t i o n  the  of  independent.  and  Correlation  t o measure t h e  interval variables.  this  application  variables  paired  in used  While  t h e s e were examined as  data  Pearson  collect  or  statistic.  which  as  to  tallied,  nominal  dependent  variables  to  and  statistically  independent  help  indicated.  compared as  the  and  just  testing  are  frequency  examined.  applications,  between of  be  Chi-square  variables  this  would  grouped  statistical  be  analysis  relationships  The  Data would a l s o Examination  possible  to  a variety  BSE  not  had  addition,  understanding  was  data  possible  the  s c o r e s were  of  whether  length  variables  were c o l l e c t e d as  three  and  the  data  this  more  i n t e r m s of  the  relationships  practice, concern.  had  i s the  for  at  data  variables  explore  such data  has  determining  the  s t e p of  g r o u p i n g s of  more c a t e g o r i e s .  statistic  first  this investigation  sets  examining  interest  the  to  discussed  report.  between v a r i a b l e s  measurements,  are  would summarize  but  S i n c e much of  two  study  e a c h of  where l o g i c a l p u r p o s e of  the  this  This  descriptive  in  of  last  It be  Limitations  strength  strict  of  sense  1 14  this  s t a t i s t i c a l method cannot  of the  data  were  in  true  be used  interval  f r e q u e n t l y used with o r d i n a l v a r i a b l e s a  more  powerful  interpreted multivariate possible  statistical  results  and  it  statistics.  (Borg  &  form.  is  However,  i t is  f o r three reasons.  method,  Its  Gall,  i n t h i s study s i n c e none  It i s  i t p r o v i d e s more e a s i l y  necessary  for  most  of  the  use i s g e n e r a l l y p r e f e r r e d when  1983,  p. 586).  The  Spearman  Rank  c o r r e l a t i o n t e s t was used to measure the s t r e n g t h of a s s o c i a t i o n between  pairs  of  .05 s i g n i f i c a n c e  ranked  A l l t e s t i n g was done using the  level.  Data were coded researcher.  data.  and  prepared  Verification  of  the  for  the  coding  computer  by  was accomplished  randomly s e l e c t i n g s u b j e c t scores and comparing the coding with  the o r i g i n a l data.  an  comparing computer data with o r i g i n a l coded data.  Data  was c a r r i e d out using the UBC S t a t i s t i c a l  Research following  two  variables  will  chapters.  between independent as  well.  An  crosstabulation Chapter V I .  data  assistant analysis  Package f o r the S o c i a l  ( L a i , 1983).  results  be  by  Data were entered i n t o the computer by  the researcher and v e r i f i e d by the researcher and  S c i e n c e s , V e r s i o n 9.00  the  will A  presented  be  presented and d i s c u s s e d i n the  descriptive  presentation  i n Chapter V.  of  BSE  using  the  and c o r r e l a t i o n r e s u l t s w i l l  the  The r e l a t i o n s h i p s  v a r i a b l e s w i l l be explored i n  analysis  of  BSE  then  this  chapter  Paradigm and be  given  in  11 5  CHAPTER  V  FINDINGS  The  purpose  presentation those are  of  findings. also  which  of  the  this  The  and  behaviour  or  The  for  four  are:  barriers  to  dependent  Expectancy,  chosen  relationships  studied  valence;  is  variables  examined.  were  chapter  valence  and  and  barriers  brief  description  of  the  i n BSE  was  the  discussed  indicators  on  these v a r i a b l e s  respondent  suggested by  which data are  end  last.  represented  factors Before  expectancy;  are  influencing analysed.  Paradigm  were t h e  variety  and  BSE  BSE;  be  variables  BSE  These v a r i a b l e s or  the  discuss  to  variables.  collected  in  will  to  independent  Participation  variable  descriptive  and  components of  participation BSE.  give a  study  between  independent of  to  a  were  discussed  a  characteristics will  be  given.  Respondent T h e r e were 66 were  under  Characteristics  respondents. or  over  categories  which covered  a ten  contained  46  thirty 27  to  percent  thirty-nine  percent,  percent  twenty  were  were f o r t y  of  y e a r s of  twenty to  the  to  None of sixty. year  the  research  Age  was  span.  The  s u b j e c t s and age.  The  collected modal  covered  next  the  largest  twenty-nine years o l d .  forty-nine  and  only  subjects  four  in  category ages group,  from or  Twenty-one subjects,  6  1 16  percent, The  fell  bulk  twenty  of  to  into  the  sample,  fifty 73  to  fifty-nine  percent,  were  year  old  between  category.  the  ages  of  thirty-nine.  Forty-one full-time. student  the  percent  Thirty  status  of  research  percent  could  were  not  be  subjects  part-time calculated  attended  school  students. f o r 29  Current  percent  of  the  subjects. A  final  demographic  occupation.  Of  those  characteristic  who  were c u r r e n t l y employed  health  care  occupational  interest  was  returned completed q u e s t i o n n a i r e s ,  percent  field.  of  The  o r had  remaining  past 41  experience  percent  had  in  59 the  non-health  experiences.  Expectancy D a t a were g a t h e r e d research  results  crosstabulation will BSE  be  seven  be  given  between  them  aspects  f o r e a c h of and  other  deemed  to  of  expectancy.  these  aspects  The  and  the  independent v a r i a b l e s  discussed.  Knowledge  Complete components BSE.  will  on  One  knowledge  described individual  was  be  i n the Canadian Cancer failed  to  fill  out  knowing  the  four  S o c i e t y pamphlet  this  on  portion  of  the  components of  BSE  some  questionnaire. Although subjects that  failed  they  did  they  were aware of c e r t a i n  t o c a r r y them o u t . not  carry  out  Fourteen in their  people  practice  at  indicated least  one  1 17  component  o f BSE t h a t  they  subjects  failed  carry  to  components o f i t . carried but  out  by  not c a r r i e d  known  but  The  knew t h e y out  visual  should  component  not c a r r i e d  women and  o u t by t h r e e  percent),  when i t was known  complete percent  of  the  knowledge o f BSE. of  the  components o f BSE i n t h e i r  they  component  was known  component  Although of  the a x i l l a  subjects  as being  research  subjects  who  (47  practiced.  subjects sharply  was  were  indicated a with  included  the  5  a l l four  practice.  to  determine  the frequency  the  described  recommended  Excluded  knew two but not  E a c h o f t h e knowledge components was e x a m i n e d  Excluded  these  o f knowledge components  This contrasts  research  of  known  time  number  i t was r e p o r t e d  When a l l p o s s i b l e c o m b i n a t i o n s percent  the  women.  was n o t known by t h e h i g h e s t  24  was  f o u r women, t h e s y s t e m a t i c  o u t by n i n e  Two  any BSE a l t h o u g h  component  examined,  do.  with  w h i c h i t was m i s s i n g  BSE p r o c e d u r e .  T a b l e 1. BSE Knowledge (n=66)  Components  Components  % Missing  % Not Missing  No  visual  45  55  No  systematic  18  82  No  axilla  48  52  No  time  35  65  individually as p a r t o f  1 18  Note t h a t percent  of  the  the  s u b j e c t s who  systematic  subjects.  excluded  Another aspect was  the  of  individual's  Subjects  were  disagreed  with  present  level  the  moderately  data  revealed  were  the  was  confidence  with  strongly  agreed"  BSE  BSE  commencement; BSE  knowledge. agreed  or  confident with  my  with  the  respondents  the  statement.  knowledge  and  the  a l l  of  following the  presentation  variables  i n the h e a l t h c a r e  were s i g n i f i c a n t l y  BSE  related  BSE variables:  BSE  information  methods; t h e  experienced;  follow-up sessions;  experience  and  variables.  the  total  i n f o r m a t i o n p r e s e n t a t i o n methods e x p e r i e n c e d ;  ability;  self-  research subjects. of  BSE  breast  significant.  with  information sources  of  with  of  collected,  BSE  out  a l l 66  independent  knowledge;  information  I feel  percent  were not  crosstabulated  BSE  number of BSE  80  18  the number  were  present  carrying from  by  components.  which data  about  with other  BSE  below  three  statement:  that  relationships  knowledge  and  or  excluded  the degree t o which they  crosstabulated  Crosstabulation  sources  to rate  D a t a were a v a i l a b l e  "slightly,  practice,  knowledge on  knowledge  data  These  of t h e o t h e r  following  Frequency  was  T h i s i s markedly  c o n f i d e n c e w i t h her  asked  of  examination.  any  .component  u s i n g the  number  t h e age  confidence field.  total  with  None of  .05  of BSE  these  significance  level. Experience  with  BSE  D a t a were c o l l e c t e d BSE  as  a  information  preventive was  on  several  health  a s p e c t s of  activity.  examined as were t h e  The  t y p e s of  experience source teaching  of  with BSE  methods  1 19  experienced.  Data  BSE f o l l o w - u p  learning  t h e commencement BSE  of  then  concerning  of t h e i r  information  personal  were  most u s e f u l . ratings. sources  asked  Data  were  sources.  The  category  the  "other"  w h i c h were n o t a l r e a d y  indicated training;  another  source  5 mentioned  situations--public  a  film,  a  office.  These  times.  Nursing  times,  a film,  sources  data  the s e l f - h e l p  a l s o u n d e r l i n e d a s most Note  in  information most  Figure  experiencing source  ( i e . , choice  which  source  and  or sources  were  information  to l i s t  Of t h e 25 p e o p l e  2 mentioned  nurses  prenatal  as  in  class  most  who  nurses special  instructor.  self-help  on BSE and a v i d e o  group,  TV  i n the d o c t o r ' s useful  eleven  was u n d e r l i n e d a s most u s e f u l  seven  g r o u p a n d t h e workshop on BSE  were  that  the  pamphlet  as  a  source  i n each of the c a t e g o r i e s .  of  I t was  i t was t h e one c h o s e n most o f t e n a s  source  chose  of "most u s e f u l "  that source).  the r a t i n g  source  respondents  and i t had t h e h i g h e s t p e r c e n t a g e  a particular  who had e x p e r i e n c e d in  5  was r a t e d h i g h e s t  "most u s e f u l "  asked  useful.  frequently experienced,  being  s u b j e c t s were  on  allowed  were u n d e r l i n e d  education  two  which source  nurse,  workshop  on  particular  E a c h o f t h e f o l l o w i n g was m e n t i o n e d o n c e : show,  about  i n f o r m a t i o n , 14 m e n t i o n e d  textbooks;  health  a  indicated.  of  collected  First,  to indicate  F i g u r e 5 shows  were a s k e d  BSE p r a c t i c e s .  i n f o r m a t i o n was r e c e i v e d from  they  the o c c u r r e n c e of  s e s s i o n s and r e s p o n d e n t s  information sources.  aspects whether  were c o l l e c t e d  "most u s e f u l "  i t  as  a  when  "most  as a p e r c e n t a g e  The s e c o n d  highest  as a percentage  those  useful" of those category  of those  who  FIGURE 5. BSE INFORMATION SOURCES Percentage of n 100 95_ 90  Pamphlet D o c t o r (57) (54)  Information — —  — —  Magazine (51)  Nurse (29)  Other (26)  Friend (21)  Television Work Family a d v e r t i s e m e n t a s s o c i a t e member (19) . (18) (12)  Radio avertlsement (9)  Source — —  =source e x p e r i e n c e d as a p e r c e n t a g e o f the t o t a l number o f r e s p o n d e n t s (n=66) ="most u s e f u l " s o u r c e as a percentage of t h e t o t a l number o f r e s p o n d e n t s (n=66) =chosen "most u s e f u l " by those who have e x p e r i e n c e d t h e s o u r c e i e . "most u s e f u l " as a percentage of those who have e x p e r i e n c e d t h i s s o u r c e (n g i v e n below each s o u r c e )  121  had  experienced  whole this  t h e c a t e g o r y as compared  sample, c h o i c e as  greatest  was  "other."  "most u s e f u l "  number  of  training  chose  nurses  doctor  as a s o u r c e was  the  "most  "most u s e f u l " useful  Many  of  when  these  significant  of women. and  percent  of  BSE  second  source  categories  large yet  of t h e  t h e whole  in  manner  behind  methods t h a t useful.  category  was  experienced  it  While  "other"  been e x p e r i e n c e d " not  this  even  the  in  Only  50 p e r c e n t population  the  category.  experienced  i n f o r m a t i o n on  that  similar  presentation most  The  t h e number e x p e r i e n c i n g i t  more t h a n  presentation  a  increase in  source.  sample p o p u l a t i o n .  of  the  by  a  pamphlets,  of t h i s  group  consisted  of  BSE  for only  44  on  methods  of  experienced  was  group.  sources.  Data  had  to  been  data  collection  R e s p o n d e n t s were a s k e d they  had  to indicate  experienced  F i g u r e 6 shows t h e d a t a  on  and  BSE which  which  f o r the  had  ratings  of  p r e s e n t a t i o n methods. The  category  mentioned as  has  provided  information  BSE  had  i n f o r m a t i o n p r e s e n t a t i o n methods.  collected  in this  who  fell  were  percentage nurses  information  been  it  of  been e x p e r i e n c e d .  "most u s e f u l " i n both  source,  a dramatic  sources  of t h o s e  a  magazines reached A  nurses  as  the  portion  d o c t o r s and  BSE  79 p e r c e n t  training  was  when i t had  "most u s e f u l "  nurses  and  and  There  to a percentage  by  5 of t h e s e  "most u s e f u l "  "touchy nodules  "other"  by  feeleys",  4 out  drew  six  respondents of t h e  5.  responses. and  One  this  chosen  mentioned  using  person  to p r a c t i c e  were  method was  a teaching device consisting  i n them w h i c h a r e u s e d  Films  of  sponges  p a l p a t i o n of  with  lumps.  FIGURE 6. BSE INFORMATION PRESENTATION METHODS Fereentage of n 100__  Written Information (61)  Pictures or sketches (57)  Spoken information (57)  Demonstration on self (Al)  Two-way discussion (31)  Guided practice on 6elf (23)  Demonstration on o t h e r (19)  Guided practice on o t h e r (11)  Demonstration with teacher model (11)  P r e s e n t a t i o n Method  —  ' " p r e s e n t a t i o n method e x p e r i e n c e d as a p e r c e n t a g e o f t h e t o t a l number o f r e s p o n d e n t s (n-66) -"most u s e f u l " p r e s e n t a t i o n method a s a p e r c e n t a g e o f t h e t o t a l number o f r e s p o n d e n t s (n=66) — -chosen "most u s e f u l by those who have e x p e r i e n c e d t h e method i e . "most u s e f u l " as a p e r c e n t a g e of t h o s e who have e x p e r i e n c e d t h i s method (n g i v e n below each method) .  Demonstration mechanical model (9)  Other (7)  Guided practice mechanical model (5)  1 23  This  individual Only  the  found  four  methods  sample: w r i t t e n  information;  greatest  method  demonstration were  number of r e s p o n d e n t s on  the  "most u s e f u l "  practice  with  you  were  w i t h one t h i r d  of  spoken  respondent.  a s "most u s e f u l "  pictures  or  The by t h e  sketches  and  E a c h of t h e s e methods were of  yourself  the  50 p e r c e n t o f  sketches;  the  indicated  by 45 p e r c e n t  examining  or  on  respondent.  indicated  category  useful."  were e x p e r i e n c e d by o v e r  methods t h a t  demonstration  "most  information; pictures  and  presentation  this  the  was  sample  sample.  the next  choosing  Guided  most  it  chosen  as  "most  useful." When by  one  t h o s e who  than  e x a m i n e s t h e "most u s e f u l "  had e x p e r i e n c e d them, 5 methods were c h o s e n  50 p e r c e n t  demonstration another  of  the  on  person;  the  sample:  and p i c t u r e s  very  low f r e q u e n c i e s .  only  seven  people  and  people.  55 p e r c e n t  numbers  guided  respondent;  had  eleven  c h o i c e s of c a t e g o r i e s  other;  "Other"  of r e s p o n d e n t s  chose  involved  oneself;  practice  Of t h e s e  five,  on two  methods were e x p e r i e n c e d by on a n o t h e r  of the people  respectively  on  guided  and s k e t c h e s .  and g u i d e d p r a c t i c e Although  practice  by more  person  by  only  i n t h e s e c a t e g o r i e s 71  i t a s "most u s e f u l " ,  the s m a l l  lessens  of  the  power  these  f indings. Two  of  the  experienced  by  subsequently  chosen  who  experienced  experienced  other  over  50  three percent  a s "most u s e f u l "  them.  presentation of  the  by o v e r  Demonstration  on  methods  sample  were  and  were  50 p e r c e n t of t h o s e the  respondent  by 62 p e r c e n t o f t h e sample and was c h o s e n  as  was  "most  124  useful"  by 73 percent of those who experienced  it.  P i c t u r e s or  sketches were experienced by 86 percent of the sample chosen  "most  them.  Guided  endorsed  useful"  by  practice  53  on  of a l l the methods.  percent of those who experienced  yourself Only  was  the most  strongly  35 percent of the sample had  experienced t h i s method of teaching but of those percent  and was  chose i t as a "most u s e f u l " method.  23  Another  women,  respondent  who had not experienced t h i s t e a c h i n g method commented that felt  96  she  i t would have been most u s e f u l had i t o c c u r r e d . Follow-up  learning sessions.  Experiences  of l e a r n i n g BSE  were a l s o examined i n terms of follow-up l e a r n i n g s e s s i o n s . the q u e s t i o n n a i r e respondents follow-up 18 people  sessions  were asked  and were then asked  i n d i c a t e d follow-up s e s s i o n s .  In  i f they had experienced to d e s c r i b e them. Nine of these  Only  sessions  i n v o l v e d p h y s i c i a n s and 5 of them i n d i c a t e d that t h e i r doctor at l e a s t asked people  them about t h e i r BSE h a b i t s at each v i s i t .  said  BSE at each  that  t h e i r doctor asked  them to demonstrate t h e i r  visit.  Commencement of BSE. experiences  with  It  was  thought  that  initial  BSE may have some bearing on present h a b i t s .  Those people who p r a c t i c e BSE were asked  i f they remembered when  they s t a r t e d and what i n f l u e n c e d them at that time. collected  Only two  on 62 s u b j e c t s .  Data  were  Three women d i d not p r a c t i c e BSE and  t h e r e f o r e t h i s t o p i c was not a p p l i c a b l e and one person  f a i l e d to  answer  data  the q u e s t i o n .  Of  the 62  women  on  whom  are  a v a i l a b l e , 83 percent remembered when they s t a r t e d BSE. The a c t of  remembering the event was u n r e l a t e d t o present BSE knowledge  125  or p r a c t i c e . age.  The  Age  highest  twenties.  Another  younger.  Only  commencement  27  percent  The  i t .  following  Other  percent;  of  percent  of  family  cysts  about  BSE  in  hearing  i t a t a women's h e a l t h c l i n i c - 2  how  doctors Families  accounted only  gave  f o r the  to  the  largest  of  anyone.  their  least  "never"  their  and  gave r e m i n d e r s .  was  nurses  their  doctor  of 16  in  cancer percent;  friends-  personal  about i t or  4  10  family  percent;  the  i n f l u e n c e of  behaviour.  Respondents  of BSE  reminders.  giving  and  to  give  and  consistent  of d o c t o r s  p a t i e n t s a BSE 30  reminders  They  F r i e n d s were a c l o s e  percent  While  friends  BSE.  failed 11  on  family, their  f o r 2 women.  Although  or  percent.  "never"  sample of women " a l w a y s " gave t h e i r percent  BSE  number  g r o u p of  reminders  19  during  polyps)-  them t o c a r r y out  "frequently"  in lack  reminders  felt  related  some d a t a  p h y s i c i a n s on  reminded  their  Groups  made t o c o l l e c t and  or  of  forties.  friends-  cervical  Reference  o f t e n they  reminded  second  smears,  of Member and  were a s k e d their  pap  friends  were  m a g a z i n e s or h e a r i n g  (positive  family,  they  after  personally  p u b l i c i t y - 1 0 percent;  was  in  started  or  disease  effort  started  in their  started  similar  An  years  i n f l u e n c e s surrounding  through  Influence  t o 40  i n f l u e n c e s m e n t i o n e d were: f e a r  breast  reading  when  started  percent  experiences  development  14  i n f l u e n c e m e n t i o n e d most o f t e n  Thirty-five  Twenty-two  from  percent,  started  (5 p e r c e n t )  BSE.  training.  suggested  46  women d e s c r i b e d t h e  of  training.  ranged  percentage,  3 women  Forty-nine  nurses  of commencement  percent  for  this  reminder,  29  of  physicians  126  gave r e m i n d e r s  fairly  percent  "occasionally,  only  consistently,  a much  hardly  greater  ever  or  number,  never"  68  gave BSE  remi n d e r s . Experiences  With B r e a s t  In an a t t e m p t this  to organize  q u e s t i o n the data  disease  involving:  or  anyone t h e y  any  of these  involving  were  the respondent;  knew.  cancer,  treatment,  unknown  then  breast  others  of  disease  outcome  had  a  experience  with  Although experience covered  was  o r symptoms.  of  family;  who  breast  as  successful  c o u l d not  In t e r m s o f b r e a s t  frequency  disease  lapse to assess)  Some p e o p l e  f o r whom i n s u f f i c i e n t  provides  disease.  had had p e r s o n a l  time  outcomes  as  was  be  disease  possible  and  a s an outcome.  data  existed  data  for  the  the  respondents  for  type of  breast disease. a  with  in  with  rated  large  percentage  of  b r e a s t d i s e a s e t h e outcome o f t h o s e  t h e whole r a n g e o f p o s s i b i l i t i e s  seen  category  2  the  categorized  t o be expanded t o i n c l u d e d e a t h  Table  to  of b r e a s t  and b e n i g n  those  (insufficient  variety  t h e r e were t h o s e  rating.  further  disease or cancer  due t o a l a c k o f i n f o r m a t i o n .  categories Again  was  outcome  c o n t i n u i n g treatment  involving  were  it  The  with  responses  a close friend;  t h e outcome of t h e e x p e r i e n c e s  experience  of  I f b r e a s t d i s e a s e had been e x p e r i e n c e d i n  benign  tabulated.  rated  t h e wide r a n g e  were c a t e g o r i z e d as e x p e r i e n c e  categories  In a d d i t i o n ,  and  Disease  the  prevented  data.  The  statistical  and no  s m a l l numbers  analysis.  had  experiences  obvious  trends  i n each p o s s i b l e  1 27  T a b l e 2. with Breast (n=66)  Experience  Disease  Type o f E x p e r i e n c e (percentages) S o u r c e of  Experience  Cancer  None  Benign Cancer and Benign  No Data  Total  Personal  82  1  15  0  1  1 00  Family  68  18  9  3  1  1 00  71  18  9  1  0  100  56  30  6  4  3  100  Close  friend  Anyone you know Perception Two with  o f BSE  questions  the p e r c e i v e d  disease their  and  the  relationship  expectations In  about  this  frequency  were r e l a t e d  i n f l u e n c e o f BSE on other to what  improve  the  definitely Eighty  percent  improves  most  felt  about  second  breast  One  outcome  of  dealt breast  breast  lumps and  question  explored  lumps mean.  p r o j e c t women were a s k e d  to i n d i c a t e the  lumps a r e c a u s e d by c a n c e r .  t h e i n f l u e n c e o f BSE respondents  outcome.  positive  The  of BSE.  Table  3  data.  When a s k e d a b o u t disease  the  perceptions  finding  which b r e a s t  shows t h e f r e q u e n c y  breast  with  cancer.  research  with  to perception  The in BSE  majority  their  support  "almost  t h e outcome of b r e a s t  felt  the  outcome  that  BSE  does  indeed  respondents  were  of  of  of t h e b e n e f i t of BSE.  always  disease.  on  or  always"  greatly  1 28  Table 3. P e r c e i v e d R e l a t i o n s h i p Between Breast Lumps and Cancer (n=66)  Cancer as a cause of breast lumps  %  Never  3  Hardly  ever  6  Occasionally  64  Frequently  26  Almost  1  always  Always  0 Total  1 00  P e r c e p t i o n s of Personal C o n t r o l In  any  issue  dealing  with h e a l t h , a general  about personal c o n t r o l over your h e a l t h expectation  exists.  expectation  This  general  about h e a l t h was measured using the Health Locus of  Control Scale. Health Locus of C o n t r o l . individuals.  None  HLC data were missing  these women answered q u e s t i o n number  T h i s was the q u e s t i o n which caused d i f f i c u l t i e s pilot  test  for  subjects.  They  objected  to  three five.  f o r some of the  the  wording of the  question. The computed HLC scores ranged from 14 to 52.  The  median  score, the one used to determine i n t e r n a l i t y or e x t e r n a l i t y , was 31.  This resulted  i n 30 i n d i v i d u a l s with an i n t e r n a l HLC and 28  i n d i v i d u a l s with an e x t e r n a l HLC.  1 29  It feeling  was of  felt  that  responsibility  true,  however,  and  percent  of  that  they  51  extent their  own  the  since  HLC  own  percent  of  with  were  would r e l a t e  f o r your 49  those  score  an  health. those  external  to the This  with HLC  an  was  internal  agreed  personally responsible  general  for  to  not HLC some  maintaining  health.  Confidence expectations  i n BSE  ability.  concerning  about  confidence  i n your  Table  4 shows t h e  BSE  A more s p e c i f i c was  ability  frequency  data  attempted to  detect  for this  D e g r e e of agreement w i t h s t a t e m e n t of confidence in a b i l i t y  %  Strongly  9  Moderately  disagree  Slightly  disagree  Slightly  agree  Moderately Strongly  1 1 4 15  agree agree  47 14  Total  with  100  the  breast  question.  T a b l e 4. Confidence in Personal A b i l i t y To D e t e c t B r e a s t D i s e a s e (n=66)  disagree  measurement  of  question disease.  1 30  Experience The  i n the H e a l t h Care last  experience  in  contained field:  27  a  of  expectancy  health  care  that  field.  The  background  and  This categorization  crosstabulate  this  That 59  percent  had  data  with  other  with  a h e a l t h background  this  Although health their  was a l s o  background rating  chose  of the value  18 p e r c e n t  of non-health  a  background  health  single  group of those  number  one p r i o r i t y  non-health values. number  " f r e q u e n t l y , almost  of those  to  health  health  that  A l l of those t h e outcome  always  or  of the non-health  (32 p e r c e n t  respondents),  Women  improve  a s t h e number  of h e a l t h  was  feel  with a h e a l t h versus  always" group. a  non-  one p r i o r i t y i n of h e a l t h  21 p e r c e n t  versus  of those  d i d not chose h e a l t h a t a l l .  with  The l a r g e s t  with a h e a l t h background chose h e a l t h as a  and t h e l a r g e s t  background d i d not r a t e  single health  group of those in  their  with a  top  five  However, when t h e t h e g r o u p s w h i c h c h o s e h e a l t h as t h e one o r number  the  health  into  this  large  t h a t BSE would  t r u e f o r 85 p e r c e n t  a g r e a t e r number  a  variables.  t h e outcome of b r e a s t d i s e a s e .  breast disease either  had  i n t o h e a l t h and n o n - h e a l t h  will  but  women who  meant t h a t 41 p e r c e n t  BSE  felt  group  i n the health care  a h e a l t h b a c k g r o u n d were n o t any more l i k e l y improve  was  research  with  of  examined  1 p h y s i o - t h e r a p i s t ; and 5 o t h e r  non-health  to  was  women w i t h p r e v i o u s e x p e r i e n c e  of h e a l t h care e x p e r i e n c e .  background. used  the  33 n u r s e s ;  some s o r t had  aspect  Field  group  two p r i o r i t y and  47 p e r c e n t  combined c a t e g o r y .  percentage  were combined,  Health  50  of the non-health  percent group  was a h i g h p r i o r i t y  of a l l t h e women i n t h i s  r e s e a r c h group.  of fell  for a When  131  experience effect  of  health  BSE  on  g r o u p and  increased This  i n the h e a l t h c a r e  their  fear 87  field  only  r e l a t i o n s h i p was  c r o s s t a b u l a t e d with  of b r e a s t d i s e a s e 89  percent  fear  was  not  of  the  percent  health  "occasionally, statistically  of  group  h a r d l y ever  the  the  non-  felt  BSE  or  never."  significant.  Valence Data  were c o l l e c t e d  e a c h of t h e s e between  on  aspects w i l l  them  and  those  results  will  Value  of  other also  be  be  functioning,  of was  ratings  or v a l u e  Value  of  was  one  BSE: breast  The  of  Health, the  significant  of h e a l t h and  of  was  carried  out,  their  top  five  priorities  optimal physical  choices. c h o s e n as a  Table  5  and  mental  shows  the  priority.  statistical  relationships  experience  in  the  between  health  care  BSE.  wording several  asked  agreement  variables  crosstabulation  BSE  changed  version  to chose  w i t h w h i c h h e a l t h was  field  The  when  Data f o r  given.  19 v a l u e s .  T h e r e were no priority  and  of v a l e n c e .  Health  of a l i s t  frequency  given  independent  R e s p o n d e n t s were a s k e d out  eight aspects  of  the q u e s t i o n s times  during  respondents  or disagreement  to  with  concerning pilot  indicate the  the v a l u e  testing. the  following  degree  The  m a j o r i t y of t h e  of  statement  most v a l u a b l e p r e v e n t i v e h e a l t h p r a c t i c e  self-examination.  The  of  BSE  final their about  f o r women i s  sample  supported  1 32  T a b l e 5. P r i o r i t y Ratings For the Value of H e a l t h (n=65) Health P r i o r i t y Rating  %  #1  Priority  26  #2  Priority  23  #3 P r i o r i t y  1 4  In t o p f i v e  1 1  Not  26  chosen Total  the  value  o f BSE a n d 73 p e r c e n t  100 agreed  was  t h e most v a l u a b l e h e a l t h p r a c t i c e  BSE  and P e r c e p t i o n One  aspect  general  of P e r s o n a l  of p e r c e p t i o n  feeling  of  R e s p o n d e n t s were a s k e d statement: health. the  strongly  and  agreed.  carried  discrepancy no HLC  am  Needs of p e r s o n a l  responsibility  and they  health  needs  f o r one's  t o agree or d i s a g r e e with  i s the  own the  health. following  personally responsible for maintaining  89  percent  Only out  of  the  one r e s p o n d e n t  BSE  monthly  i n h e r BSE p r a c t i c e .  BSE p r a c t i c e  t h a t BSE  f o r women.  R e s p o n s e s were h e a v i l y w e i g h t e d  scale  still  I  t o some e x t e n t  on t h e p o s i t i v e  respondents strongly  and  had  end o f  moderately  disagreed.  or She  only a completeness  Two o f t h e t h r e e  d i s c r e p a n c i e s were r a t e d a s h a v i n g  a l l s t r o n g l y supported  my own  t h e statement  women who had an about  internal personal  responsibility. It  was  thought  that  felt  n e e d s i n t e r m s o f BSE would be  133  measured t o  some e x t e n t  satisfaction given  with  in Table  by  asking  current  BSE  about  the  habits.  degree  The  of  personal  frequency  data  are  6.  T a b l e 6. L e v e l of Agreement W i t h S a t i s f a c t i o n W i t h BSE H a b i t s S t a t e m e n t (n=66) Level  of  Strongly  %  Agreement disagree  Moderately  1 5  disagree  21  Slightly  disagree  1 1  Slightly  agree  1 1  Moderately Strongly  agree  24  agree  1 8 Total  Current  Life  Influences  General this  aspects  sample  the  Perceived  These  life  research  Susceptibility  susceptibility to r a t e t h e i r ranged  breast  current  at  the  were  high  s t a t u s and  of  this  for  current  are  given  chapter.  Disease about  i n two  to breast  to very  collected  characteristics  beginning  asked  disease  were  student  population  susceptibility  from very  which data  to Breast  subjects to  on  age,  sample d e s c r i p t i o n  Reasearch  that  of  included  occupation. with  100  low.  ways.  disease  their  perceived  They were  asked  using  scale  a  They were a l s o a s k e d  to  1 34  rate had  the degree of i n f l u e n c e f e e l i n g s over  their  The  had  a "very  was  "very  spread  over  perception  low" r a t i n g high."  susceptibility  susceptibility  BSE p r a c t i c e .  sample  susceptibility  of p e r s o n a l  the e n t i r e  ratings.  Twenty-one p e r c e n t  and 5 percent The  perceptions  range of b r e a s t  felt  dispersion  their for  disease  felt  they  susceptibility breast  disease  follows.  T a b l e 7. Perceived S u s c e p t i b i l i t y To B r e a s t D i s e a s e (n=65) Susceptibility Ra t i n g Low  %  o r v e r y low  45  Average  35  High or very  One  woman r a t e d h e r s e l f  practice discovered bone  BSE  said  something  metasteses  susceptibility the  and  20  Total  1 00  high  she  in susceptibility  would  on e x a m i n a t i o n .  after  breast cancer  to breast  i n f l u e n c e of f e e l i n g s  were n o t s i g n i f i c a n t .  high  not  do  Her  mother  but d i d n o t  anything  treatment.  had  personal  died  of  When p e r c e i v e d  d i s e a s e was c r o s s t a b u l a t e d w i t h of  i f she  susceptibility,  age and results  1 35  Cues t o BSE P r a c t i c e Another the was  influence  presence  of  cues  which  some m i s u n d e r s t a n d i n g  data.  I t suggested  remind true  that  women t o c a r r y  f o r them.  I remember  described  what  could  questions  rather  than  Thirty-nine their  breasts.  -articles, -hearing -sore  sometimes p a r t i c u l a r  o u t BSE a n d a s k e d they  were  be termed i n response  cues  cues  a new p a c k e t t o the doctor  myself  Influences  things  which  change  BSE  the  Some women  answers t o o t h e r  mentioned  them t o examine were:  BSE (23 p e r c e n t )  i n o t h e r s (13 p e r c e n t )  nude  (8 p e r c e n t )  of b i r t h  control  pills  (8 p e r c e n t )  (5 p e r c e n t )  (3 p e r c e n t )  b r e a s t d i s e a s e (3 p e r c e n t ) on I n i t i a t i n g  related  influences  i f t h i s was  complete .  to  arms o r b r e a s t s (10 p e r c e n t )  -starting  Closely  d i d remind  o r TV shows m e n t i o n i n g  i n t h e t u b o r shower  -personal  helped  t o t h i s one.  -relaxing  -seeing  to  in their  o f b r e a s t lumps o r c a n c e r  -a v i s i t  respondents  this  (31 p e r c e n t )  displays  under  things  asked  There  gathered  t o examine my b r e a s t s when  women i n d i c a t e d  cycle  to action.  t h e q u e s t i o n which  Some o f t h e r e m i n d e r s  -menstral  p e r c e p t i o n o f needs i s  a c t as reminders  about  I f i t was,  statement:  of  on an i n d i v i d u a l ' s  on  t o cues BSE h a b i t  o r Changing  f o r BSE i s t h e more change.  rather  than  general  T h i s meant t o c o v e r  may have been an i n f l u e n c e habits  BSE H a b i t s  those  to i n i t i a t e which  BSE  topic those or t o  a c t as ongoing  1 36  reminders.  A variety  initiating  BSE  -nurses  (55  of  responses  (33  percent)  -doctor's advice  (22  percent)  of  fibrocystic  -a magazine a r t i c l e -family  -concern  pap  -birth  The  smear  (2  of  first  training  (13  (4  (9 p e r c e n t )  (7  child  (5  c o n t r a c e p t i v e s (2  percent)  percent)  percent) (2  percent)  (2  BSE  (2  percent)  percent)  in a post-natal  responses  percent)  percent)  from husband t o p r a c t i c e  following  habits  oral  of b r e a s t c a n c e r  -reminders  -BSE  by a n u r s e  involving  -positive  class  were g i v e n as  (2  percent)  reasons  for changing  responses):  -initial  i n c r e a s e i n BSE  after  breast  surgery/  learning  the p r o c e d u r e /  first  finding  a lump/ h e a r i n g  other time  people passed  talk (77  about  consistency  friends  had  -temporary breast result  (8  after  less  consistency  worrying  breast biopsies  decrease  lump  i t , but  first  as  percent)  -increased who  for  (9 p e r c e n t )  experience with breast disease  -recommendation  -fear  breast disease  experience with breast disease  -friends  influences  responses):  training  -development  were g i v e n as  and  percent)  in being  BSE so  with  several  (8 p e r c e n t ) ,  habits  after  frequently  finding  a  e x a m i n e d as a  BSE  1 37  -increased breast The  cancer  largest  initial  concern  a  Attitudes to  particular  aspects  asked  to  aunt's  a new lump.  only  t o w a r d BSE c a n be breast  disease.  Unfortunately  an i n i t i a l  increase  which  of t h i s  t i m e p a s s e d and  Disease  influenced  Perceptions  their  they  disfiguring  felt  affective the  fear  surgery.  tap the strong the  of b r e a s t  by  the  about  disease  majority  not  r e q u i r e such d r a s t i c  was  t o determine  felt  The  and t h e f r e q u e n c y  with  they  during  BSE  lead  to  I t was meant  radical  changes found  that  greatest  mastectomies. during  largest  17 p e r c e n t , that  felt  found  i t "hardly  "disfiguring"  a l w a y s " a n d two women f e l t  percentage  disfiguring  t h e outcome o f change  "almost  were  BSE do  t h e d e g r e e t o w h i c h s u c h an outcome o r t h e f e a r  percent,  felt  subjects  The p u r p o s e o f t h e q u e s t i o n  "occasionally"  person  are  i s "disfiguring."  treatment.  i t influenced behaviour.  group,  disease  BSE  found  of breast  surgery  felt  f e e l i n g s a s s o c i a t e d with  course,  68  which  affective  breast  Research  with  changes  A key word  Of  sample,  attitude.  frequency  breast  in  decreased.  t h e Outcome o f B r e a s t  indicate  increased  one  an  t h e r e l a t i o n s h i p between BSE a n d f e a r o f b r e a s t  two  of  about  i n c i d e n t and a f t e r  d i e d down, h a b i t s  A t t i t u d e s Toward  to  was f i n d i n g  g r o u p o f women r e p o r t e d  after  and  hearing  f r e q u e n t l y mentioned as a stimulus f o r  examination  habits  reaction  after  (8 p e r c e n t )  i n f l u e n c e s most  more f r e q u e n t the  consistency  that  surgery  during ever"  surgery  BSE.  of t h e was o n l y The n e x t  occurred. was  an  Only  outcome  i t "never" r e s u l t e d .  1 38  Another relation  to  frequently breast  question breast breast  disease.  percent,  disease  BSE  percent,  that  increased  practice A to  or  which  not  percent  of  an  uncomfortable  the  group BSE,  comparison  with  other  confidence to  breast  by  cancer,  disease  was  the  found  breast  not  with  BSE  perceived  experience  with  only  group,  degree  to  related  an  47  which  to  BSE  felt  degree  uncomfortable  that c a r r y i n g  While  out  some d e g r e e of d i s c o m f o r t  was  in  this  each  difficult. i n the  f e a r of  that breast or  made  significant  health care  breast  disease,  rating  No  disease  knowledge, p e r c e i v e d  breast  disease  38  number  degree  88  left  experience  increased  sample,  i n v o l v e d the  be  experience.  low  of  field.  percent,  felt  how  fear  large The  in  asked  the  A  was  to  variables  present  disease,  62  who  t o w h i c h BSE with  BSE  field, ,  age,  susceptibility  lumps a r e  outcome of  caused breast  experiences.  Barriers Data barriers  f e a r of  fear  their  in  health care  majority,  with  degree  women  never."  of  which  increased  disease  found  associated  the  their  one  measure of a t t i t u d e t o w a r d BSE  The  relationship  the  feelings  "never" occurred.  i n the  respondents  was  the  or  breast  experience  experience. BSE  ever  this  f e a r of  final  of  increased  hardly  BSE  was  majority  "occasionally, felt  with  self-examination  The  felt  concerned  were t o BSE  these v a r i a b l e s .  collected practice.  on  to  five  Table  BSE areas  w h i c h may  8 provides  be  frequency  acting data  as for  1 39  Perceived  T a b l e 8. B a r r i e r s on BSE  E f f e c t of  of  Practice  F r e q u e n c y of i n f l u e n c e (percentage)  Barr i e r 1 . Simply forgetting Lack time  Frequency  2.  14  (66)  of (65)  8  3.  4.  1 7  12  6.  5. 21  Total  29  1 00  46  25  19  3  6  1  100  L a c k of energy (64)  45  28  1 1  9  5  2  100  Not knowing how t o examine your b r e a s t s (65)  68  14  9  1  1  6  1 00  Fear what will  58  17  14  3  3  6  100  of you find  (66)  Frequency Ratings: 1= n e v e r i n f l u e n c e s 2= h a r d l y e v e r i n f l u e n c e s 3= o c c a s i o n a l l y i n f l u e n c e s 4= f r e q u e n t l y i n f l u e n c e s 5= a l m o s t a l w a y s i n f l u e n c e s 6= a l w a y s i n f l u e n c e s N o t e : The number of s u b j e c t s f o r e a c h b a r r i e r category i s given in parentheses. Simply  Forgetting  Simply the  forgetting  respondents.  "occasionally"  I t was and  was  perceived  indicated  frequently  as  t o be an  more o f t e n  a  f a c t o r by  influence  most  at  by  79  percent  influence  on  practice  of  least of  the  sample. When c o m p a r i n g presence  of  cues  f o r g e t t i n g as to  an  p r a c t i c e , there  was  no  relationship.  with Of  140  those or  who  mentioned cues,  never"  simply  always or always" Full-time than  background health Lack  simply  any  more  54  "occasionally, percent  hardly  ever  " f r e q u e n t l y , almost  forgot. were no more Nor  likely  likely  were  to simply  to simply  those  of  a  forget  than  forget  BSE  non-health those  with a  background.  o f Time percent  of the respondents  a b i g i n f l u e n c e on t h e i r  increasing influence  j o b or s c h o o l of t h i s  Full-time influence never"  students than  Lack o f  but t h i s  did  those  who  not  that  I t was might  lack  chosen  by  of p a r t - t i m e  93  The  was  thought  that  increase  of time  part-time.  time  by t h e d a t a . any b i g g e r an  "occasional  percent  the  of  to  full-time  students.  energy  Lack  of energy  was n o t seen  practice  rate.  or  i n f l u e n c e d them.  never"  BSE p r a c t i c e ,  Not an  i n f l u e n c e on t h e i r  It  was  as "never"  felt  Lack o f e n e r g y  student  i n f l u e n c e on  felt was  s t a t u s or c u r r e n t  t o Examine Your  knowing how  seen  as a f r e q u e n t  The m a j o r i t y , 73 p e r c e n t ,  present  Knowing How  percent  felt  was n o t i n d i c a t e d  find  were  were  and 90 p e r c e n t  BSE p r a c t i c e .  responsibilities  factor  categories  students  Not  and  students.  Eighty-nine not  forgot  students  part-time  46 p e r c e n t  i t "hardly not  related  BSE ever to  occupation.  Breasts  t o c a r r y o u t BSE was a l s o  n o t p e r c e i v e d as  BSE h a b i t s by t h e m a j o r i t y o f t h e sample. influencing  i t "hardly ever"  68  or only  percent  and  another  23  "occasionally" influenced  141  them.  This  important Fear  makes a t o t a l  factor  12  with  the  Other  o f t h e sample  "occasionally."  degree  experience  t h i s as  an  Find  percent  them more t h a n  who r e j e c t e d  i n t h e i r BSE h a b i t s .  o f What You W i l l Only  o f 91 p e r c e n t  to  which  i n the health  felt  No  this factor  relationship  was  BSE was u n c o m f o r t a b l e  care  field.  asked  about  influenced apparent  or with  past  influences  Respondents  were  practice  other  described  cues t o a c t i o n  following  are the other  -feeling  than  get  w h i c h have a l r e a d y  about  -not  being convinced  -not  described:  (3 women)  breast  even  disease  established  the habit  i f I did  because  I never  that  (1 woman)  discovering  have more p o s i t i v e c o n s e q u e n c e s  late  mentioned.  (1 woman)  having  it  their  been d i s c u s s e d .  subjects  happen t o me"  -not  will  been  on  (1 woman)  of concern  sick  had  I would n o t t a k e any a c t i o n  something  -lack  which  influences  " I t can't  -realizing find  those  influences  a then  lump  early  discovering  (1 woman)  knowing what an a b n o r m a l i t y  would  feel  like  (1  woman) -negative  attitude  d a y s of m e n s t r a l -feeling  silly  t o w a r d s my f e m a l e body a f t e r  cramps makes me f o r g e t  (1 woman)  3 or 4  (1 woman)  BSE Some The  1 42  -fearing  I  would  not  d e t e c t c h a n g e s soon enough (1  woman) -being  aware t h a t  early  detection  is  important  (1  woman) -increasing Only  r a t e of cancer  the  practice.  last  i n C a n a d i a n women  three  influences  The o t h e r s a l l d e c r e a s e d  Participation  be  a closed question  made, r e q u e s t e d  how  BSE  of  described  what  options  were  they  felt  indicated  data  from  t h e knowledge q u e s t i o n personal  the  response  #6),  each  BSE  whether  this  i s what  they  (BSE q u e s t i o n  BSE p r a c t i c e  question  from t h e r a t e of p r a c t i c e  rating  Data  on  with a  respondents  was a v a i l a b l e  do.  Using  the  #5), t h e r e s p o n s e  (BSE q u e s t i o n  question  s u b j e c t was g i v e n a BSE p r a c t i c e  practice  was t o  o u t were c o l l e c t e d First  The  t h e recommended method of BSE was a n d  they  the  rate of p r a c t i c e .  questions.  then  from  by two q u e s t i o n s .  from w h i c h a c h o i c e  carried  open-ended  increased  i n BSE  i n f o r m a t i o n about  examinations  combination  with  mentioned  practice.  D a t a on BSE p r a c t i c e s were c o l l e c t e d first,  (1 woman)  (BSE  rating.  f o r 92 p e r c e n t  #7) a n d question  In t o t a l ,  a  of the research  subjects. Tables BSE  9 and 10 p r o v i d e  the data  that  were  collected  for  practice. Table  9  t h r e e months.  indicates This option  that  the  received  mode was once o r more 17  percent  more  every  responses  1 43  Table 9. Frequency of BSE P r a c t i c e (Percentages) (n=65) Frequency of P r a c t i c e  Frequency  Cumulat i v e Frequency  BSE monthly  25  25  BSE once or more every three months  20  66  BSE once per year  20  86  BSE l e s s than once per year  9  95  No BSE  5  1 00  Table 10 BSE P r a c t i c e Rating (percentages) (n=61) BSE P r a c t i c e Rating  Frequency  No d i s c r e p a n c i e s Rate discrepancy  than  the  5 only  Completeness d i s c r e p a n c y only  20  Rate and completeness discrepancy  61  closest  category—monthly  than the other three c a t e g o r i e s . practice indicated  15  were  combined,  that  irregular basis. c a r r i e d out BSE.  they Only  95  B S E — a n d c o n s i d e r a b l y more  When the v a r i o u s c a t e g o r i e s of  percent  practiced  BSE  3 respondents  of oh  the  research  either  i n d i c a t e d that  a  group  r e g u l a r or they  never  1 44  Of  those  who p r a c t i c e d  BSE, o n l y t h r e e were r a t e d  no  discrepancies according to their  the  largest  and  completeness  who  had  group,  Only from  one  noted  that  inspection,  carry  out  in  BSE  a quick,  they  just  they  after  that  t h o u g h she c a r r i e d  not  necessarily  menstration  once a month.  percent  Two  discrepancy. t h e i r BSE Three  " s h o u l d " do a  d i d not  admitted  said  admitted  out a complete  carry  hoping  they  they  not  d i s e a s e , however, she a l w a y s  she was r u n n i n g  that  Details  "I h a t e  stated she d i d  i n not  She d i d d i d BSE  S i n c e she had f i b r o c y s t i c  found  made i t a v e r y n e g a t i v e e x p e r i e n c e  the r i s k  she  very  i t but  person  BSE c o n s i s t e n t l y ,  that  they  d i d t h e i r BSE  were  One  One woman a d m i t t e d anything.  always  that  o u t a l l t h e s t e p s a t one t i m e .  not t o f i n d  a  b u t one o f t h e s e women  Two  Three  had  method.  they  they  b r e a s t a c u r s o r y check.  them a t h e r c o n v e n i e n c e .  concluded  that  rate  Of t h o s e  One s u b j e c t had one s o r e b r e a s t and c h e c k e d  gave h e r o t h e r  this  57  By f a r  had both  they m o d i f i e d  Two s a i d  short-hand.version.  only  breast  that  realized  d i d not.  t h e shower o r b a t h t u b .  quickly  they  BSE p r a c t i c e s .  discrepancy,  indicated  while  d i d BSE more t h a n  systematic.  of  of  that  had d e s c r i b e d a s t h e recommended  visual  did  indicated  d i s c r e p a n c y a n d 43 p e r c e n t h a d a r a t e  what t h e y  still  kind  15 r e s p o n d e n t s  subjects  reported behaviour.  discrepancies in their  only  completeness  61 p e r c e n t ,  as h a v i n g  something. and w h i l e  doing  a  She  felt  she was aware  thorough  BSE  she  a r e found  i n Table  t h e whole b u s i n e s s ! "  o f d i s c r e p a n c i e s i n BSE p r a c t i c e  11. There  d o e s n o t seem t o be any s i g n i f i c a n t  difference  i n the  145  Table Completeness  11.  Discrepancies  in  ESE  Practice  Only Type  of  Discrepancy**  Completeness  Completeness  and  Discrepancies  Rate  Discrepancies  Frequency  Frequency  n-=37  n=12 T line  4  (33)  19  51  Systemat1c  3  (25)  14  38  Visual  7  (58)  23  62  Axil  7  (58)  21  57  la  Only #  of  Misslnq  Components  Completeness  Completeness  and  D 1 screpanc i es  Rate  X*  Frequency  Discrepancies  %  Frequency  n=37  n= 12 four  0  (0)  5  13  three  1  (8)  6  16  two  4  (33)  13  35  one  6  (50)  13  35  1  (8)  0  O  missing  data Total  •Brackets  have  been  used  number of subjects and effect on percentages. **Note that the columns  because its do  of  the  of  discrepancies  completeness  not  total  to  rate  and  as  completeness  discrepancies of  indicated  discrepancy  components.  Of  for  discrepancy,  13 p e r c e n t  percent. one type than  those  who  Visual  discrepancy  missing had  failed  both to  who  had  only  a  t o those who had both a  both g r o u p s .  none were  those  by  compared  those who d i d not have a r a t e only),  100 than more  discrepancy.  were h i g h e s t  discrepancies  low  resulting  This Is b e c a u s e many s u b j e c t s had more of discrepancy and therefore appear in one category.  types  100  100  all  Note,  axilla  however,  that  (ie.,  completeness  four  completeness  a rate  mention  and  and completeness  any  of  the  four  146  completeness components.  Those who  monthly  doing  basis  correctly. only  reported  at  least  one  BSE  components.  component. While  completeness  only  discrepancy  on  component of  In a d d i t i o n , of t h i s group, 50 percent  one  percent  were c a r r y i n g out BSE  were  BSE  missing  Another t h i r d were missing only one  of  was  the  8  missing  of those with both a rate and  women three  with  two  only  components,  completeness  were missing e i t h e r three or four components of  a  a 30  discrepancy  BSE.  L i m i t a t i o n s of the Data Data size  analysis  and  the  categories  into  was  lack  of  severely  hampered by the small sample  sufficient  numbers  which data were d i v i d e d .  around the mean and d i d not allow  in  The  multivariate  discussion  limitations  that  various  Data tended to group  for examination  range of responses that such data might cover. advanced  the  of  the  total  As a r e s u l t more  s t a t i s t i c a l a n a l y s i s c o u l d not be done. follows  should  be  examined  with  these  i n mind.  D i s c u s s i o n of R e s u l t s R e s u l t s w i l l be d i s c u s s e d in the groupings BSE  Paradigm.  The  then  b a r r i e r v a r i a b l e s - - w i l l be d i s c u s s e d  r e s u l t s for the dependent v a r i a b l e — B S E  be examined.  the  independent v a r i a b l e s - - e x p e c t a n c y v a r i a b l e s ,  valence v a r i a b l e s and and  i n d i c a t e d by  first  practice—will  1 47  Discussion  of R e s u l t s f o r Expectancy  When  the  frequency  components was m i s s i n g excluded three  While  common  looking  looking the  by a m a r k e d l y  good  lower  forspecific  skin  sense.  at  I t requires  systemic  be  that  a  and i s , t h e r e f o r e , your  details  or changes  o f t h e BSE knowledge component  number o f s u b j e c t s t h a n  I t may  sense  closely  which each  i s examined, t h e  o t h e r components.  makes  with  Variables  breasts  like  in size  nipple  any o f t h e  systemic easily  makes  approach  remembered,  sense  as  well,  d i s c h a r g e , p u c k e r i n g of  o r shape r e q u i r e s more t h a n  some f u r t h e r  is  knowledge a b o u t  common  what one s h o u l d  look f o r . Data  on t h e s o u r c e o f BSE i n f o r m a t i o n s u g g e s t  of p e r c e i v e d u s e f u l n e s s , p a m p h l e t s , training  and  teaching most  merit  courses  most  rated. nurses  only provided information to less  Data planning  or  to  appeal  sketches,  practice  practice  percentage  felt  o r spoken  found  more  attention.  Nurses  were than  find  in  the i n s t r u c t o r s . half  the s u b j e c t s ,  o f s u b j e c t s were that  an  nurses. educator  the f o l l o w i n g  methods  on  the  herself  percentage  of  learner,  and g u i d e d  this  sample  o r s k e t c h e s were o f more use t h a n  i n f o r m a t i o n and by  examining  A large  pictures  useful  nurses  demonstration  the learner  person.  that  would  magazines,  t o t h e g r e a t e s t number o f r e s p o n d e n t s : films,  with  on a n o t h e r  obviously written  a large  i n terms  I t i s assumed t h a t  on BSE p r e s e n t a t i o n methods s u g g e s t  likely  guided  though  a BSE t e a c h i n g s e s s i o n  pictures  was  to  were h i g h l y  training  however, even  most  seem  other nurses  nurses  Nurses  nurses  doctors,  that  an  demonstration  on  themselves  even h i g h e r p e r c e n t a g e .  These  1 48  preferences  may  education,  however,  collected  was  be  true only since  made up  of  only  descriptions provide one  part  of  many  of  the  would  like  is:  frequency  with  which  lapse  s i n c e the  indicated to  that  describe  manner  data  important  described.  of  with  relationships practice  process these  but  the degree  or  to  data  sessions;  the  and  the  time  respondents they  failed  seems t o have been  influencing  factors  that In  about  breast  related  disease  may  The  the  a failure  on  behaviour.  to which t h e i r  and  the p a r t  relationship  t o some  of  between  People  behaviour  to  are  one's  extent. increase  significant  personal of  (1980)  following  i n o n e s e l f or  also act  an  nurses  as C r o s s  disease  BSE are  addition,  lack  commencement d a t a  on  physicians  moment s u c h  experiences  end  to  asked.  teaching.  and  their  Some of t h e  occur;  i n f l u e n c e behaviour  a l a c k of  In  A number of  problem  teachable  such  suggest  situations  the  were  failed  s e s s i o n s but  information.  between  r a t h e r than  was  anxiety  to  may  session.  the  of  sessions  needed.  sessions  BSE a  learning  follow-up  contention  breast  of  of  follow-up of  level  respondents  the  ones a l s o a p p e a r s occurrence  them  Part  create  susceptibility  of  had  high  would want.  number  follow-up  Personal  experiences  one  follow-up  support  may  follow-up  information  details  had  a  students.  s e s s i o n s most  concerning  source  training  and  the  the  them.  commencement  The  they  from w h i c h t h e d a t a  sample  BSE  i n which the q u e s t i o n  The  loved  last  the  on  follow-up of  with  university  In r e t r o s p e c t , d a t a provide  f o r women  the  knowledge education  the i n f l u e n c e i n f l u e n c e d by  changes because  of  1 49  them may  be  factors. and  related The  to  time  present  may  In  general  these  also  encouragement  friends  or p h y s i c i a n s .  topic  may  from  giving  little  BSE  with  out  taboos  to  as BSE.  it  'The  its is  complexity  obvious  and  this variable.  This area,  behaviour,.was p o o r l y problem  between  HLC  responsibility t o deny  S c a l e may  more  s u r f a c e you  hand a  personal  do  them  hand,  about  to  have  preventive  not  e x p l a i n the  with can  be  personal  emotional experiences  for a single  data  question.  i t i s not  correlations provide  collection and  own  such  was  may  the  health.  statement  surprising  were f o u n d  important  e x p l a i n the general  I t may too  be  with  clues  to  then  t h a t you  feeling  superficial  responsibility  l a c k of a  t h a t the and  at a conscious  t a p i n g a deeper c o n s c i o u s n e s s  control agree  for  examined.  data  f o r your  present  w h i c h may  with  responsibility  on  f a r t o o complex  statistical  deal  on  the o t h e r  of  family,  discourage  potential  t h a t the data  significant  HLC  and  data  no  The  friends  way  their  d i s c u s s i n g such  present  that  difficult  other  experiences  the  a l w a y s be  ask  of t h e  is  in  from  least  shortcomings  health  on  at  the  relationship  of  results.  b r e a s t d i s e a s e were  A  BSE  P h y s i c i a n s , on  Given  end  influencing  not  f a m i l y and  reminders.  B e c a u s e of upheaval,  strength  factor.  F a m i l i e s may  for f a i l i n g  f o r the  these  carry  Societal  h a b i t s such  reason  a  to  i n f l u e n c e both  excuse  health  be  and  subjects received l i t t l e  regular  reminders.  existence  span between  the  give  the  where  perceived responsibility. should  not  abuse y o u r  of  general that  it  level. people On  body but  the on  1 50  a deeper  level  Part  of  setting. and  y o u may the  knowledge  help  occurs  and o n g o i n g  experiences  with  our  involving  university  in  lives  health  process  and  educated their  perception  health  question  regardless  health  and  their  f o r Valence  answer  format.  i t to other  practice.  examination desirable  work  h e a l t h , o u r own  interpretation  In t h i s  past  of  group of h i g h l y priority  experiences  i n the  to  from  separate about  that  preventive  to give  strongly  worded  f o r BSE.  pilot  study  about  degrees of v a l u e  and  such data  for general  rating  of  the researcher statement  value  as  T h i s d i d produce a wider  of BSE was c e r t a i n l y  not e n t i r e l y  partial was  on BSE.  to  also  would  be  t o want.  A  produce  personal  r a n g e of r e s p o n s e s  of measuring values  overcome.  A  i t is  BSE would  respondents  A  receive  o f h e a l t h when  expected  but the d i f f i c u l t y  a  would.be o f no v a l u e .  what she i s p e r c e i v e d  was  preventive  likely  i s d e a l i n g with BSE  thus  statement  placed  most  simple  and  i s only  A strong  a  BSE w h i c h was  some o t h e r  question  on BSE.  questionnaire  produce a high  tempted  feelings  placed  about  health practices  i t s b e n e f i t s would  everyone  the  t o measure w i t h  The s t a t e m e n t  the  such as t h a t used  obvious  Variables  In r e t r o s p e c t t h i s  of the v a l u e  statement  support  the  issues.  of  may be i n f l u e n c e d by s t r o n g  rating  and  and a t t i t u d e s a r e d i f f i c u l t  used compares  likely  the  women, h e a l t h was f r e q u e n t l y a h i g h  of R e s u l t s  Values  format  in  field.  Discussion  simple  do so much.  t o form our a t t i t u d e s t o w a r d h e a l t h , o u r h e a l t h  base  situations  t h a t you can o n l y  socialization  Previous  others,  feel  in  i n terms  151  The to  fact  that  some e x t e n t  with  preventive  health  knowledge  of  responses. had  the statement  practice  other  that  background  disagreed  BSE i s t h e most  valuable  f o r women may i n d i c a t e t h a t  preventive  health  measures  I t does n o t n e c e s s a r i l y mean t h a t  a  greater  influenced  they  their  thought  BSE  no v a l u e .  Discussion  of R e s u l t s  Simply variable. due  to  may  forBarrier  was  as simple a t h i n g  not t o c a r r y explored.  reasonable  to  fear,  discomfort,  factors.  On  to explain that  menses.  be  done  the  memory.  is  a regular  other  fresher  to  say  be done o n l y  I t i s much e a s i e r  f o r simply  reason  habit  or that  "I f o r g o t "  apathy,  d i d not occur  magazine a r t i c l e s  on  i t  respondents  forgot.  a  than  or other  i t i s easy once  most  f o r not  It i s d o i n g BSE  month  t o remember  more  and  things  have b u i l t - i n  It i s  t o admit t o personal  t o simply  f o r g e t an preferably  that  have t o  reminders  every  and y o u r mouth f e e l s  afterwards.  or  forgetting  one's b e h a v i o u r .  We remember t o b r u s h o u r t e e t h daily  I t m i g h t be  responsibilities  "why" t h e y  this  hand,  more f r e q u e n t l y  factors.  a n t i c i p a t e d that  embarrassment,  which should  subjects  The c a u s e  was  acceptable  the  indicated barrier  f a c t o r s as a c o n s c i o u s or u n c o n s c i o u s  i s an e a s y way o f e x p l a i n i n g  socially  after  It  suspect  more  action  as c o n f l i c t i n g  o u t BSE.  n o t have been a b l e  regularly  frequently  I t may be t h e r e s u l t o f s e v e r a l  not  would  Variables  f o r g e t t i n g was t h e most  be due t o s u c h complex  desire  and  more women w i t h a h e a l t h  day b e c a u s e i t much  cleaner  Many o f t h e c u e s m e n t i o n e d by  research  a  regular  on BSE, a t r i p  basis.  t o the doctor  so  to jog  Such  things  or breast  as  disease  1 52  in  your  Simply of  family  or  friends  forgetting obviously  i s perceived  BSE r a t e d i s c r e p a n c i e s .  clear  nor  is  the  enough t o overcome barrier. breasts  There  do n o t o c c u r  Unless  i t , simply  does n o t make them  other  forgetting  no s p e c i f i c feel  basis.  t o be a f r e q u e n t  The c a u s e o r c a u s e s  remedy.  are  on a m o n t h l y  for this  motivators may  cause  be  a r e not  are strong  a  formidable  r e m i n d e r s and e x a m i n i n g  better.  It  may  even  one's  increase  anxiety. The were  "other"  mentioned  statistical these  influences described by  too  analysis.  f e e l i n g s might Another aspect  that  it  that  data  only  was  provide  explanations not  The  that  they  Many  rating  information  of  practice  of  questionnaire.  they  i t .  a  be  than  as  further  basis.  remembered  Subjects  In a d d i t i o n ,  had.  is  provided  they  They c o u l d  could  not p r o v i d e  which  the i n f l u e n c e s explored  they  did  may e x i s t  to a  i s i n d i c a t e d by t h e d a t a .  i n BSE on  what  t h e recommended method o f BSE.  This  with  their  was  very  result  partly  indication  Data c o l l e c t i o n  therefore, As  should  to share.  discrepancies  was combined  was,  that  d i d n o t know n o r i n s i g h t  described  out or m o d i f i e d  warrant  educator.  data  that  of P a r t i c i p a t i o n  respondents  it  wished  to  subjects  knowing a l e a r n e r h a s some o f  on a v o l u n t e e r  or l e s s e r degree  Discussion  the  information  possess.  greater  help  of t h i s  they  subjects  However,  provided  which  few  by t h e r e s e a r c h  based  that  they  carried  on BSE knowledge and BSE  closely  i t i s very  linked difficult  in  this  to entirely  1 53  separate  t h e two v a r i a b l e s .  the  pilot  with  the l e a s t  data  seem t o have been It  the in  study  make  their  BSE  that  period  Obviously y e t they  further  subjects others  was they  failed of  BSE d e s c r i p t i o n s .  felt  that  data  they  correspond  Stillman  in  were  have t e m p o r a r i l y  analysis  this  research  Although there  serves  aspect  obvious  of p r a c t i c e  these  perhaps  to include  them i n  for  granted, may  definitely research  subjects  o f women  practice  t o t h e 24 p e r c e n t  of those  practiced  some  figure  hampered  research.  monthly  may be r a t e  for that  them  23 p e r c e n t  close  of  clues  reported  indicated  the d e f i n i t i o n  When s u c h  rating  f o r these  who  this  their  them.  i s very  compare  time f o r  t o be d e t a i l e d o r t h e y  questionnaire  only  their  in  to i l l u s t r a t e  rate  95 p e r c e n t ,  since  timing  They may have t a k e n  that  that  was t h e recommended  the  forgotten  of  o u t BSE (BSE q u e s t i o n  t o some d e g r e e w i t h p r e v i o u s l y  This  to  to carry  of BSE b u t f a i l e d  too  aspects  indicated  t h e knowledge  This  i n the  the rates  study  percentage, difficult  faults  (1977) r e p o r t e d  monthly.  some  t h e recommended BSE p r o c e d u r e .  changed.  important  though they d i d not i n c l u d e i t  this  include  knew o f some a s p e c t s  Although  and p e r h a p s  knew  Some s u b j e c t s  knew t h a t  their  simply  f o r respondents t o respond  subjects  even  knowledge a p p e a r e d , was  during  i n the process.  a reminder  to  were a d j u s t e d  and s u b t l e  several  BSE d e s c r i p t i o n .  description  BSE  lost  recommended BSE r o u t i n e  #9).  did  i t easier  amount o f e f f o r t  i s obvious  menstral  to  to  The q u e s t i o n s  BSE.  form  with  of  A  BSE.  previous  compliance  very  varies  high It i s  compliance greatly.  or completeness d i s c r e p a n c i e s ,  does a  154  similarly some  high  form?  The  Perhaps the that was  the not  percentage  of  literature  problem  i s not  majority  do  Educational  constant  for  students.  this  uniformly  do  the  level  p u b l i c c a r r y out reports  low  The  g e n e r a l .population  was  the  research i n at  but group  least  r e s p o n d e n t s were  levels  may  in  BSE  o n l y v a r i a b l e w h i c h was  All  educational  BSE  compliance.  t o c a r r y out  i t correctly.  project.  Different  general  t h a t women f a i l  not  r e p r e s e n t a t i v e of  aspect.  the  one held  university  produce  different  results. In (ie.,  this no  research  rate  group those  discrepancy),  completeness  components  completeness  discrepancies.  individual  does  more l i k e l y  t o have more  someone motivated be  who  do  a  were those The out  who  data BSE  on  i t out  related BSE  carried  generally  discrepancies  Is t h i s  to c a r r y  to  had  BSE  monthly  missing  fewer  both  suggest  that  a monthly in  her  correctly  than  Is t h i s  you  rate  and  if  an  b a s i s , she practice  to motivation?  monthly are  m o n t h l y BSE?  out  than  I f you  more l i k e l y  someone who related  is  to the  is  are to not  value  t o BSE?  In t h e using  carry  enough t o c a r r y out  motivated  BSE  does.  motivated  attached  not  than  who  chapter  the  which  f o l l o w s an  r e l a t i o n s h i p s suggested  attempt by  the  i s made t o BSE  explain  Paradigm.  155  CHAPTER VI  ANALYSIS OF  The review  BSE and  Participation was  participation was  P a r a d i g m was  intended  in  the  to  the  data  a Pearson's  of  choice  where  correlation Gall,  At  p.  this  variables.  expected of  the  For test  frequency  variables  sample  subjects  in  studied.  T h i s throws  into  statistics  computed.  The  statistical  study  each  1978,  category  five p.  was  In an  (Borg  the  sample  &  clearly  effect  statistic  of  between to  test  l a r g e enough so t h a t when  The  the  test  done.  there  is  i s more t h a n  l a c k of  a problem with  small  category  ten  341).  error  relationships  be  was  bivariate  w h i c h were  when t h e r e  question  impossible.  each  should  interval  stable  about  study  least  least  freedom  said  Those  statistical  t h e most  the C h i - s q u a r e  i s at  at  (Kirk,  to  of  t h a t the  f r e e d o m and  for  those  as  BSE  Coefficient  smallest standard  attempts  d e g r e e of  frequency  is  on  of BSE.  treated  f o r i n d e p e n d e n c e was  assumption  is  It  literature  variables.  i t i s the  a word s h o u l d be  on  One  independence  degree  with  587).  size  the  influences  Moment C o r r e l a t i o n  possible.  time  were  been m e n t i o n e d ,  a chi-square  sample  every  Product  technique  1983,  nominal,  has  the  independent  w h i c h were q u a s i - i n t e r v a l  As  on  preventive h e a l t h behaviour  variables  calculated.  based  explain  c r o s s t a b u l a t e d w i t h a l l of  and  BSE  one one  sufficient  every  variable  reliability  of  size  further  attempt  to  makes  increase  the  the  a s m a l l e r number of c a t g o r i e s f o r  1 56  each v a r i a b l e was f r e q u e n t l y Pearson affected  Product  by  many  underestimated nonlinear,  Moment  factors.  when  when  created.  the  the  Correlations  Coefficients  are  The magnitude of r e l a t i o n s h i p s a r e  relationship  range  between  of e i t h e r v a r i a b l e  variables  is  i s truncated or  when d i s t r i b u t i o n s are skewed and the magnitude of r e l a t i o n s h i p s are overestimated when the sample c o n t a i n s subgroups with that  differ  f o r both  extreme groups ( K i r k , The and  then  means  v a r i a b l e s or the sample i s comprised of  1978, p. 115).  r e s u l t s of the s t a t i s t i c a l a n a l y s i s w i l l  be  presented  discussed.  Statistical  Analysis  Nominal Data Chi-square the  following  statistics variables  were c a r r i e d out between BSE and the (the r e s u l t i n g  chi-square  degrees of freedom are given i n p a r e n t h e s e s ) : Expectancy health BSE  Variables  locus of c o n t r o l  information doctor  (1.38, df=3)  sources  (5.64, df=6)  nurse (2.98, df=6) pamphlet  (1.35, df=6)  magazine (4.86, df=6) t e l e v i s i o n advertisement r a d i o advertisement family member  (4.34, df=6)  (4.38, df=6)  (2.28, df=6)  and the  157  friend  (13.24,  df=6)  work a s s o c i a t e (5.62, total BSE  df=6)  number o f i n f o r m a t i o n s o u r c e s  (9.65,  df=9)  information p r e s e n t a t i o n sources spoken  i n f o r m a t i o n (5.91,  written  i n f o r m a t i o n (15.23,  pictures  or sketches  two-way d i s c u s s i o n  df=6)  (2.58,  with  df=6)  the respondent  (10.50,  demonstration  on t h e r e s p o n d e n t  (7.21,  demonstration  with a mechanical  model  demonstration  with another  demonstration  with  person  practice  with a mechanical  guided  practice  with another  guided  practice  with  follow-up  commencement personal family  of BSE  experience  (5.62,  df=6) (9.80,  df=6)  (3.62,  df=6)  df=6)  the respondent  (15.02,  df=6)  experienced  s e s s i o n s (1.56, (1.04,  model  df=6)  (10.30,  (4.49,  df=8)  (14.77,  df=6)  df=3)  df=3)  with breast disease  experience with breast disease friend  (2.66,  person  number o f s o u r c e s learning  df=6)  df=6)  t h e t e a c h e r a s model  guided  total  close  df=6)  (4.49,  df=6)  anyone known w i t h e x p e r i e n c e w i t h b r e a s t d i s e a s e  (5.96,  df=6)  outcome  with  df=6)  breast disease  personal  with experience  (4.34,  outcome o f b r e a s t d i s e a s e of b r e a s t d i s e a s e  experience  in others  i n the h e a l t h care  field  (4.65,  df=9)  (17.39, (7.27,  df=l8) df=3)  1 58  Valence  Variables  c u e s t o BSE (3.30, influences  df=3)  on c h a n g e s  of BSE h a b i t s  current  o c c u p a t i o n (9.43,  student  status  age  at last  When applied,  i n school  birthday  the  of  less  df=6) (0.90,  (4.76,  of  none o f t h e r e s u l t s  than  Interval  df=3)  df=3)  assumptions  Many o f t h e c a t e g o r i e s  (3.59, df = 3)  the  were  formed  chi-square  statistic  statistically  by c r o s s t a b u l a t i o n  were  significant. had f r e q u e n c i e s  five.  Data  Pearson calculated  Product between  according  to  the  Moment  the  o f BSE p r a c t i c e  variables  ( an a s t e r i s k  Expectancy  BSE  number  frequency  Correlation practice  of  Coefficients  ratings  discrepancies  (BSE p r a c t i c e  in  (calculated p r a c t i c e ) and  r a t e ) and t h e  indicates a significant  were  following  Pearson's r ) :  Variables  *BSE knowledge  (r=0.264,  n=60)  Confidence  w i t h BSE knowledge  Confidence  w i t h BSE a b i l i t y  *BSE i m p r o v e s  (r=-0.236,  (r=-0.282,  outcome o f b r e a s t  *BSE r e m i n d e r s from y o u r d o c t o r BSE  reminders  from y o u r  family  BSE  reminders  from y o u r  friends  relationship  betweem b r e a s t  disease  n=61)  n=6l) ( r = - 0 . 3 l 3 , n=6l)  (r=-0.209,  n=60)  (r=-0.057,  n=6l)  (r=-0.164,  n=6l)  lumps and c a n c e r  (r=0.143,  n=61)  159  Valence *value  Variables of h e a l t h  *perceived  (r=0.135, n = 60)  susceptibility  *satisfaction  with  to breast  BSE h a b i t s  disease  (r = -0.434, n = 61 )  *BSE a s an u n c o m f o r t a b l e e x p e r i e n c e *value  (r=0.240, n=6l)  o f BSE (r=-0.285, n=61)  BSE e f f e c t personal  Barrier  on f e a r o f b r e a s t  responsibility  BSE l e a d s  *lack  (r=-0.286, n=60)  to disfiguring  for personal surgery  health  n=6l)  (r=-0.154,  n=6l)  (r=-0.043, n=60)  ( r 0.146, n=60)  f o r g e t t i n g (r=0.475, n=61)  lack  of time  lack  of energy  fear  o f what y o u w i l l  feeling  (r=-0.l06,  Variables  of BSE a b i l i t y  *simply  disease  (r=0.008, n=60) (r=0.l84, n=59) find  (r=0.114,  n=6l)  p e r s o n a l l y s u s c e p t i b l e (r=-0.097, n=61)  Table  12  provides  the s i g n i f i c a n t  Pearson Product  Moment  c o r r e l a t ions. The The  f o l l o w i n g r e l a t i o n s h i p s a r e found  number o f m i s s i n g  BSE i n c r e a s e s simply  BSE p r a c t i c e r a t i n g . disease, the  knowledge components,  fear of breast disease  forgetting  between  and  the perception  the  perception  i n f l u e n c e s BSE a r e p o s i t i v e l y The p e r c e p t i o n  the degree of c o n f i d e n c e  degree of c o n f i d e n c e  with  related  of s u s c e p t i b i l i t y  with  present  variables.  present  BSE  BSE a b i l i t y ,  that that  to the  to breast knowledge,  the degree of  1 60  Table 12. V a r i a b l e s with a S i g n i f i c a n t (p<.05) Pearson Product Moment C o r r e l a t i o n with BSE P r a c t i c e or BSE P r a c t i c e BSE P r a c t i c e  Var i a b l e s  Rate  BSE P r a c t i c e Rate  r BSE knowledge  r  0.264  0.231  P e r c e i v e d s u s c e p t i b i l i t y to breast d i s e a s e  -0.286  Confidence with BSE knowledge  -0.236  -0.407 .000  Confidence with BSE a b i l i t y  -0.282  -0.281  S a t i s f a c t i o n with BSE  -0.434  -0.500 )  Value of BSE  -0.285  -0.352  BSE i n f l u e n c e on the outcome of breast d i s e a s e  -0.313  -0.460  BSE as an uncomfortable experience  0.240  0.223  Simply f o r g e t t i n g as an i n f l u e n c e on BSE p r a c t i c e  0.475  0.543  habits  Lack of BSE a b i l i t y as an i n f l u e n c e on BSE p r a c t i c e  0.328  BSE reminders by d o c t o r s  -0.274  Value of h e a l t h satisfaction  0.268  with present BSE h a b i t s ,  a preventive health the  outcome  practice  of  rating.  correlation,  the  the value given to BSE as  p r a c t i c e and the b e l i e f  breast When same  that  d i s e a s e were n e g a t i v e l y only  the  rate  relationships  p r a c t i c e was r e l a t e d to the v a r i a b l e s  of are  BSE  BSE  improves  r e l a t e d to BSE was  apparent  used (rate  for of  i n the same way as the BSE  161  practice disease other  rating), was  related  variables  practice  but  practice. BSE  not  except  were  not  t o the  The  p r a c t i c e and  related  to  t o BSE  related  overall  of  level  the  given  by  In  significantly  that  value  rate  susceptibility  rate alone.  perception  the  reminders given  that perceived  breast  addition,  three  t o the  r a t e of  discrepancies  l a c k of BSE to  to  ability  health  BSE  p r a c t i c e and  the  doctors  was  negatively related  in  BSE  influences  were  of  BSE  positively  frequency t o the  of  BSE  r a t e of  practice.  Discussion As the  has  been d i s c u s s e d ,  limitations  of  Chi-square results. and  questions  investigation  BSE  p r a c t i c e and  When t h e r e there  of  was  of  the  produce  development  individual  significant of  validity  focus  serve of  analysis  BSE  using  was  A high also  larger  BSE  the  Pearson  and  (a low  t h a t BSE  likely  to  Moment results.  components, number  increases  occur  on  Paradigm.  Product  knowledge  rating  more  influences  significant  BSE  perception more  a  Participation  some  number of m i s s i n g a high  and  to c l a r i f y  the  provides  t o be  responses  specific  further  more l i k e l y  disease  light  r e l a t i o n s h i p s between v a r i a b l e s and  discrepancies). breast  precludes  g r o u p might  a low  in  raise  Coefficients was  viewed  a n a l y s i s d i d not  a more d e t a i l e d  the  be  do  statistical  Correlation  BSE  with  research  The  this  the  must  data.  conclusions,  about  Results  results  statistical  Although  definite  varied  the  of  when  of fear BSE  1 62  discrepancies infrequent more  were  low.  likely  be  also  to  high.  be  low.  more  A high  likely  susceptibility the  f o r g e t t i n g was seen a s an  i n f l u e n c e o f BSE p r a c t i c e ,  knowledge o r BSE a b i l i t y to  When s i m p l y  subject the  most  that  BSE  improved  perception  breast  valuable  that  with  the  to  disease with  a  high  her present  preventive outcome  BSE h a b i t s , t h a t  BSE  h e a l t h p r a c t i c e f o r women o r  of  breast  disease.  (1978) p o i n t s  out that  r  applicable  which  is  appreciable explained the an  r i s over r of  or  linear with  to of  results  doctors  a l l  high  were  more  be i n t e r p r e t e d ?  Kirk  f o r the s i z e of  situations  variance  between  (p. 108).  An  v a r i a b l e s i s not  r e l a t i o n s h i p a s m e a s u r e d by a P e a r s o n  r until  o f 50 p e r c e n t  of variance  requires  r e l a t e d t o BSE p r a c t i c e w i t h  a Pearson's  r  .71).  greater  than  .30 (9 p e r c e n t  of variance  explained  r e l a t i o n s h i p between t h e v a r i a b l e s ) , i n c l u d e  BSE h a b i t s , p e r c e p t i o n  outcome  by  i s no s i n g l e r a t i n g  .7 ( e x p l a n a t i o n  Variables to  there  proportion  by t h e i r  infrequently  significant  A  i n f l u e n c e s BSE p r a c t i c e and  a low r a t e o f BSE p r a c t i c e .  these  were  that  likely  can  likely  disagreement  very  How  BSE  of  and g r e a t e r  l a c k o f BSE a b i l i t y  with  personal  perception  BSE r e m i n d e r s g i v e n to occur  also  o f BSE p r a c t i c e d i s c r e p a n c i e s  correspond  was s a t i s f i e d  was  confidence  were  was low, BSE d i s c r e p a n c i e s were  number  to  to  When  discrepancies  of  forgetting confidence  breast  disease  influenced with  BSE  of  the  and  frequency  influence  the  of  perception  o f BSE p r a c t i c e .  knowledge,  value  equal by t h e  satisfaction BSE that In  on  the  simply  addition,  of BSE and a p e r c e p t i o n  163  that  lack  were  of BSE a b i l i t y  related  .30 a s  to rate  practice  and  components  was  with  guarantee  that  out  likely  of BSE p r a c t i c e  with a Pearson's  r of over  BSE  was  elicited  part  action.  of  this  the  time. used.  BSE  use t h e may  not  time  and  of d a t a was  they  know  specifically  not  i t i s obvious  in their practice.  have not been  not  know a b o u t on a  In any e v e n t ,  though  not  a l l of t h e  detail  number  did  subjects they  of  knowledge  a low  did  some  This  through  seem t o i n d i c a t e  knowledge  are  likely  to  comes  first.  correctly  retained,  follow.  discrepancies  in  who  desired  what The  they  reasons  investigated in  or  the r e t e n t i o n only  when more of t h e c r u c i a l  more  greater  practice  strive  level  that  However,  Does  motivate  educators the  women  that  rate  research. Data  of  of  do some t h i n g s  some of t h e p e o p l e ,  behaviour  knowledge Many  to  missing were  components  They may  of  when t h e r e  In a d d i t i o n ,  the  s h o u l d do, do not f o l l o w  this  of  related  number  practice,  by t h e q u e s t i o n n a i r e  at l e a s t  for  low  t o be p r e s e n t  they had.  basis.  only  knowledge a  i n BSE  a l l of  consistent  that  practice  appropriate  knowledge  some  BSE  although  discrepancies  carry  frequency  well.  Confidence  of  influences  appropriate  there  does  a  will  will  fewer  to p r a c t i c e  knowledge?  knowledge follow  more  motivate  desire  of g r e a t e r  is  i n d i c a t i o n of w h i c h  knowledge  to provide  of c o m p l i a n c e  i s no  action  aspects  BSE  Health  i n t h e hope undoubtedly  that be  disappointed. The  d e g r e e o f s a t i s f a c t i o n w i t h BSE h a b i t s  may  not i n f a c t  1 64  be  a measure of f e l t  their  knowledge  discrepancies they in  do  outcome  differed.  breast  health  reluctance  BSE.  Although  been  cancer  aware  A high  in this  data,  perceptions  Fear  the f i n e r  BSE  of  On  are  the  BSE  the  personal disease due  to  may r e s u l t i n  t o be v e r y and  on  breast  of cancer  regularly.  about  about  problems  a c t as a s t i m u l u s  perceptions  than  disease.  i t s influence  i f expectations  breasts  that  a c t u a l BSE p r a c t i c e .  and  breast  the  rather  BSE  many  of  discrepancy  about  and  of  suggested  s e r i o u s and t h r e a t e n i n g  not cancer.  might  because  a very  reality  t o monitor  of  doing.  affecting  disease  disease,  fear  were  authorities  were a c t u a l l y  would d i f f e r  In  fibrocystic  related  still  expectations  susceptibility  women  that,  p r o d u c e a low r a t e o f s a t i s f a c t i o n  is  of  indicate  these  degree of d i s s a t i s f a c t i o n  Presumably  other  hand,  meticulus in  practice  p o i n t s of the s i t u a t i o n  were  have n o t  clarified. Simply  already  forgetting  i n f l u e n c e of simply practice  perceptions However, this  could  may  The r e l a t i o n s h i p forgetting be  more  memory  helpers  be examined values  behaviour.  of  may h e l p  an  has  between p e r c e p t i o n s o f practice  indication  father than improve  and  of p e r s o n a l  poor  memory.  r a t e o f p r a c t i c e and  experimentally.  are related It  f o r behaviour  on t h e r a t e o f  and s e l f - r a t i o n a l i z a t i o n  Personal cause  a s an e a s y e x p l a n a t i o n  been d i s c u s s e d .  actual  too  I t may  BSE,  and what t h e y  Cancer  the  of  between what  BSE may t h e n  the  need.  t o behaviour  may be t h a t a g e n e r a l  non-specific to explain a single  specific  but they value  may' n o t  of h e a l t h i s  health  behaviour  1 65  such  as  BSE.  Rokeach  in a p a r t i c u l a r  context,  been  taught  value  i s ordered  values. result that  into  the  or  situation,  relative  even  influence  the  supported  significant  is  The  BSE in  results  supported. exclusion  it  the r a t e a t which  Although solidly  if  i n order  relative  Obviously  have  to  the p r a c t i c e  each other  outcome w i l l  of a l l the competing  be a  values of  BSE  t o encourage v o l u n t a r y p r a c t i c e of  valued,  other  f o r c e s may combine t o  i t i s carried out.  Participation i t s entirety,  and t h e i r  limited  we  s y s t e m where  the behavioural  importance  experience  values  organized  importance  have been a c t i v a t e d ( p . 6 ) .  but  t h a t , through  integrate absolute  in p r i o r i t y  must have some v a l u e it  we  a hierarchically  In a g i v e n of  (1973) s u g g e s t s  Paradigm  has  inclusion  which  been  some v a r i a b l e s d i d p r o d u c e in  the  paradigm  sample does n o t , however,  of a l l the v a r i a b l e s  not  produced  was  j u s t i f y the  non-significant  results. The outlines BSE  following chapter  summarizes t h i s  r e s e a r c h p r o j e c t and  i m p l i c a t i o n s f o r f u r t h e r BSE r e s e a r c h and f o r  teaching.  planning  166  CHAPTER V I I  SUMMARY  Breast One  cancer  i s t h e most common t y p e o f c a n c e r  i n f o u r t e e n women w i l l  survival  have  ten-year  not  survival  AND IMPLICATIONS  e x p e r i e n c e i t and  decreased  rate  i s 33 p e r c e n t .  2 cm. and t h e r e i s no n o d a l to  80  percent. that  maximizes s u r v i v a l .  found  t o be a r e l i a b l e , result  that  there i s widespread  found  accidental.  women  from c a n c e r .  Although  themselves,  performance)  (differences  remedy  show  many women do  actual  or  of t h i s  examine BSE a s a p r e v e n t i v e h e a l t h are related  lumps  are usually performance  and  the u n d e r l y i n g  may n o t be t h e o n l y o r t h e major  The p u r p o s e  of  desired  B e f o r e s u c h a remedy c a n be  Knowledge  f o r c e s which  Many s t u d i e s  f o r such  between  however, one must u n d e r s t a n d  the problem.  which  a high percentage  effective,  of  increase  approach  such d i s c o v e r i e s  i s a t e a c h i n g program.  skill  than  lesions are palpable i n a size  A frequent attempted  discrepancies  The c u r r e n t  rates  knowledge o f BSE b u t t h a t  i tcorrectly. by  survival  of  B r e a s t s e l f - e x a m i n a t i o n h a s been  i n reduced m o r t a l i t y  not p r a c t i c e  decades.  s a f e and c o s t - e f f e c t i v e  can  chances  I f t h e lump i s l e s s  involvement,  Most c a n c e r o u s  range  are  forseveral  their  i n women.  research  activity  to i t s practice.  issues. components  project  was  to  and t o determine the  167  Limitations This  project  This  t y p e of  has  already  research  for  There  e f f e c t of  presence the  of  time. a  when v a r i a b l e s to  selection those a  independent  control  not  but  r e s u l t extraneous of  the  account  the  investigator  in  small  responses  limited.  sample and  unique scheme  statistics  is  (Kirk,  are  and  and  chosen 1978,  p.  Cook  studied  be  indicate  the  explain  the  reason  possible  causes  be  randomly  themselves that  interested may  be  through  this  (p.  self-  which are  not  research  attempt  improve  are  data lost.  formed  a f f e c t s the  of  values  and of  the  taken  into  the  spread data  was  increase of  has In  to  large  reliability  grouping  invariably  to  As  findings.  provide a very  an  than  362).  related  aspects  in or  c h a r a c t e r i s t i c s other  specific  in  distributions  Data c o l l e c t i o n r e l i e d Wrightsman  of  grouped  Data  frequency which  not  Unfortunately,  disadvantages.  may  out  influence  size did  f o r each c a t e g o r y  test.  of  which  may  not  variable  variables  variables  assign  p r o b l e m but  analysis  D a t a were  frequency square  research  are  S u b j e c t s cannot  basis  variables  variables  The  variables  points  research.  dependent  independent  they  (1967)  investigator  facto  a wide r a n g e of  rather  the  post  the  t h e y do  controlled.  done on  i n which the  by  over  There are  Kerlinger be  ex  Correlations.between  groups  may  Study  in that  r e l a t i o n s h i p but  are  self-report.  and  i s no  the  example of  is limited  relationship.  assigned  an  occurred  retrospect. the  was  of  the  chi-  its  addition, the the  the  own non-  grouping  descriptive  27). on  (1980)  subject point  out  self-report. several  Selltiz,  limitations  to  168  self-report. able  to report  unconcious ability  truth  and  These  very  and  subject  limitations  strong  own  of  be  breasts  admitted  taking  h e a l t h has g a i n e d  might  responses. capable doubt the in  only  reluctantly.  p r o d u c e embarrassment Cancer  is  of a r o u s i n g  still  strong  that  various,  participation co-operation  were was  not  Generalizability  of  not  those  a v a i l a b l e on  research  subjects  effect  to  (p. 147).  serious  effect  responsibility  for  i n c r e a s i n g support  contrary Issues  to  this  Research  in idea  i n v o l v i n g women's strong  emotional  frightening disease  be  subjects  provide  representative  subject  they  who  to  Samples w h i c h  of  and i s  were  no  i s s u e s and  results did  those  who  rely of  (Borg  &  i s limited  not  data.  Their  on  volunteer  the  research  volunteers  do d i f f e r  research  with  when t h e  would, t h e r e f o r e , a l s o be a f f e c t e d  obligated  the  h a s shown t h a t  reports  attempt  by some o r a l l o f t h e s e  voluntary.  on  individual  ways.  may no l o n g e r  Research  volunteers  provided  unpredictable  Subjects  group.  they  a very  of  i s s u e s can produce  and o t h e r  emotions.  a f f e c t e d t o some e x t e n t data  might  Health  C a n a d i a n c u l t u r e and a c t i o n s and b e l i e f s might  by  verbal  may have had a  project.  The i d e a  unaware  be e m b a r r a s s i n g ,  a certain social  for this  one's  i s w i l l i n g and be  in  o r when s u b j e c t s  create  reactions.  maintaining  may  Confidence  of s e l f - r e p o r t  collected  Subjects  matter might  be u n f a v o u r a b l e or  the subject  self-diagnosis i s limited  self-awareness.  astonish  data  that  c a n be c o l l e c t e d .  when  might  amuse,  that material  drives  decreases  on  Only  versus  Gall,  non-  1979).  s i n c e data a r e  participate.  d i d not v o l u n t e e r  Comparing helps to  169  d e t e r m i n e d i f f e r e n c e s w h i c h might  affect  results.  The  available  f o r the  group  is  all  were  the  at  population  entire research  university  level  characteristics  Since  educational  research  group,  the  variable  cannot  be  of v a r y i n g  are  level  of  was  the  of  Further  are  data  subjects  Other  sample  comparison.  v a r i a b l e used  education  determined. levels  education.  unavailable'for  effect  educational  that  only  on  to c r e a t e the  research  dependent  using  needed t o a s s e s s  the  the  samples  effect  of  this variable. Research At  the  t i m e of  coming  to  be  and  Rate of  there  the  university  were many end  because  of  r e s p o n s e was  of  would  be  under  the  year  similar  that  they  other  on  would  that  affected.  pressures  those  was  t e r m demands  time p r e s s u r e s  undoubtedly  have been a f f e c t e d by  they Those  and  their  demands on  their  research  were  energy.  Most of  the  statistical  nonsignificant.  This  in research  faults.  Kerlinger may  be  inappropriate measurement  or  (p.  Collecting  can  results  does  t e s t e d were not  findings  results  collection,  participating  r e s p o n s e s may  variables  data  close  responded  t i m e and  were a l l c u r r e n t l y a t t e n d i n g u n i v e r s i t y .  Some p o t e n t i a l p a r t i c i p a n t s a d m i t t e d  were u n d e r . who  the  a  students. not  subjects  not  related result  of  necessarily to  BSE  from any  (1967) s u g g e s t s t h a t due  to  this  incorrect  mean  practice.  negative  faulty  all  Negative  of a number of  theory  i n c o r r e c t methodology,  that  research  or  inconclusive  and  hypotheses,  a n a l y s i s or  poor  620). valid  and  reliable  data  using  a  questionnaire  1 70  requires tool. both  the development Using  a  questionnaire  a d v a n t a g e s and  anonymity being  more  spontaneous  and  with  can a  questionnaire length,  of  format,  makes  or  and is  be c a n v a s s e d  minimum  with  it difficult  respondent  ended  response  wording pilot and  of  i n every  each  testing  cannot needed  are  be e x p l o r e d for  question is  difficult  on  i s not always  to  encourage topics  Although  some  which  collecting  data  of o c c a s i o n s  the data  were l o s t .  made i n t h e d e v e l o p m e n t  The  entirely.  Topics  more  the  data  anonymity to  are of  provide  a  more  embarrassing  or  lacking  when  i s s u e s o f BSE.  On a  provided  were i n s u f f i c i e n t  Although  considerable  of the q u e s t i o n n a i r e , t h i s  i t was u s e d and v a l i d i t y  f o r an open-  errors  seriously  on many o f t h e more complex  s u b j e c t s and d a t a  time  is  force  clarity,  are p a r t i c u l a r l y  the q u e s t i o n n a i r e format  number  wants t o  when  respondents  emotional,  resonable  desirable.  question  basis  and  the  i m p o r t a n c e and t h o u g h  eliminate  on an i n d i v i d u a l  period  p o s s i b l e answer.  and an o p p o r t u n i t y  i n improving  time  of  However,  f o r every  o f utmost  number  short  personnel.  might  when o n l y an  large  when t h e r e s e a r c h e r  clarification.  q u e s t i o n n a i r e may information  in a relatively  without  questions  answers A  provides  freely  i t s aim f o r s i m p l i c i t y  question  can a s s i s t  omissions  requested.  t o make a c h o i c e  t o o l has  questionnaire  accurate  t o account  collection  collection  embarrassing  research  In a d d i t i o n , t h e r e a r e t i m e s the  A  data  t o answer q u e s t i o n s  Sensitive  anonymous w r i t t e n r e s p o n s e respondents  as the data  disadvantages.  and an o p p o r t u n i t y  confronted.  receive  of a w e l l c o n s t r u c t e d  and r e l i a b i l i t y  to rate  effort  was  was t h e f i r s t  i s questionable.  17 1  Selltiz,  W r i g h t s m a n and  external there only  validity  is a a  Cook  of  (1980) s u g g e s t  research  larger research  s i n g l e instance  of  program survey  Research Given confirm  its  nor  study.  Some  research  or  of  on  discrepancies.  out  breast  BSE  examination.  interact  to  suggests  of  that  been e s t a b l i s h e d w i t h W h i l e a l l of  percent  the  indicated  practiced  BSE  compliance necessarily components  result of  BSE  the  to  variety  were  BSE  with of  BSE  was  the  future  the  of  of  a  more the  of  only  i s i n keeping with  indicates  appropriate remembered  that  varying  to  theoretical  sources i n BSE  BSE  and  and or have  24  3 individuals much  of  knowledge does  action. in  out  complete  combine  Specific  knowledge,  practice  motivation  factors  knew  previous  completeness  influence participation  This  for  carried  fewer  behaviour.  complete  of  neither  in planning  support  subjects  in  use  greater  research  which  framework  be  research.  correctly.  research  when  this  a  results  findings  consistent  to  tends  end  sources  of  likelihood  a  when  81).  percentage  sample,  the  assessed  sessions.  high  mean t h a t  influence  combinations  a  This  (p.  and  the  research  were  likely  greater  than  internal  Findings  teaching  this  T h i s may  framework w h i c h  not  BSE  were  the  research  f i n d i n g s may. be  indicated  there  rather  theoretical  practices  For  discrepancies. carry  BSE  which  monthly  the  more r e a d i l y  the  initial  organizing  Findings research  limitations,  negate the  is  that  The  the not  various  degrees.  The  1 72  systematic  component  component  was and  frequently  as  components  require  systematic  sense. four  remembered most  least  inspection  the  was  frequently  the  correct  palpation some  component  A simplified components  remembered.  time  of  frequently.  the  i s easy  forgotten  axilla.  The  to  improve  guess  knowledge  knowledge  i s a p r e r e q u i s i t e f o r c o r r e c t and  related,  knowledge the  relationship  The  of  was  and  learner,  were  The  frequently sketches, you  t r u e when t h e y  are  as  guided "most  end  were  were  them  behaviour, practice. statistically  not  this  collected  A closer  might  look  provide  BSE  f r e q u e n t l y as a  "most  useful."  Nurses, to  a  at  the  better  be  once  teaching  I t seems t o be  they  effective other  source  contacted  teachers.  and an the  This is  nurses.  i n f o r m a t i o n p r e s e n t a t i o n w h i c h were most as  demonstration  f i l m s and chosen  as  perceived  examining  Although  complete  variables.  r e p o r t e d most  useful tool.  perceived  common  interaction.  chosen  methods of  while  makes t h e meaning o f  Data  these  three  only  levels.  correct  collection  as  women t o remember a l l  practice  between  their  frequently  important  with  f o r e a c h of  pamphlet  especially  BSE  of d a t a  relationship  understanding  most  and  ensure  questionable.  independently complex  flaws  not  almost  latter  using  knowledge  complete  While  does  visual  of b r e a s t d i s e a s e  reminder which h e l p s  might  axilla  The  were  understanding  The  "most on  yourself.  practice  on  useful."  the  useful"  were  respondent,  When t h e y another  had  and  pictures guided  been  and  practice  experienced,  person" were a l s o f r e q u e n t l y  Guided p r a c t i c e  on  y o u r s e l f was  the  1 73  most  strongly  had  been e x p e r i e n c e d .  guided  endorsed of a l l the p r e s e n t a t i o n  p r a c t i c e on y o u r s e l f  make t h i s  follow-up  question  about  regular  basis,  only  requires sample from  habits  further did  in will  be  their  this  The  with breast  in  i t seems l i k e l y studied  disease  that  this  i n the h e a l t h  greater  compliance  with  quite  likely  level  of  majority to carry  on  a  Since  of  the  o u t BSE  doctor. be  very  complex  Because  possible  influence  project  that  BSE.  care  and  of  its  on  concerned  BSE  solely  BSE  knowledge.  there  may  concept be  a  even  One c a n n o t  background  t h e BSE v a l u e  f i e l d does not  Women w i t h a h e a l t h  have BSE d i s c r e p a n c i e s  when a h e a l t h  Although  i f  result  background  they  have  a  assume knowledge o r  i s present. was  poorly  measured,  data  r e l a t i o n s h i p between t h e v a l u e  on BSE and BSE p r a c t i c e .  BSE current  a  relationship  project.  in a research  just  was shown.  reminders  can  this  experience  placed  beyond  demonstration  greater  f r i e n d s or t h e i r  Having  suggest  sample  variable.  compliance  that  return  any r e g u l a r  investigated  better  went  degree of compliance  investigation.  family,  poorly  high  i n the  t o two i n d i v i d u a l s , however, t h i s  receive  complexity,  with  numbers  sessions  and i n c l u d e d  not  Experiences  would  it  seemed r e l a t e d t o f i l m s and  but t h e s m a l l  learning  a higher  applied  their  were  when  r e l a t i o n s h i p tenuous.  When  this  BSE p r a c t i c e  methods  p r a c t i c e and t h e d e g r e e o f p e r s o n a l BSE  habits  the greater  were  related  in this  satisfaction sample.  t h e amount o f BSE d i s c r e p a n c y  the  with  I t appeared greater  the  174  dissatisfaction of  the  with  s t a t u s of  their  produce behaviour measured to  but  affect  breast  BSE  change.  the c u r r e n t  current  sample. disease  life  student  The was  amount of a n x i e t y  a barrier  Although by  cues  BSE  practice  the  practice, precise of of  of  were  strong  the  data  and  not  enough  a r e g u l a r cue  some  with  one  beyond  to  which  influence.  susceptibility  may  hearing  i n f l u e n c e , of  provide  to  be  stimulated  the  practice  of  instigated  disease  results.  was  prove  The  change and  most  in others. related  faulty  and  to more  In a d d i t i o n , many the  use  beneficial.  particular BSE.  A  cycle,  r e g u l a r m o n t h l y c u e s and  magazine a r t i c l e s  was  their  The  menstral  statistically  collection  in  cues.  the  breast  not  different  seem  are  about  was  a b o u t what  less discrepancy  of cues  did  training,  practice  i n f l u e n c e s were m e n t i o n e d . or  the  sources  of c u e s  of  to a c t i o n might  having  a point  misunderstanding  a variety  There  mentioned as  current  susceptibility  personal  m e t h o d o l o g y of d a t a might  be  t o BSE  t o a c t as a n e g a t i v e  t h e c u e s m e n t i o n e d were not  nurses  t o be  related  T h e r e may  about  mention  mentioned  presence  status--were  begins  was  those  did  coverage  While  appear  not  BSE.  t o BSE,  percentage  frequently  to  there  high  media  dissatisfaction  aware  did  i n f l u e n c e s measured--age,  unclear.  A certain  meant  of  dissatisfaction  i n f l u e n c e of p e r c e i v e d  susceptibility  as  p r a c t i c e but  i t d i d not  perceived  act  T h e s e women seemed t o be  Levels  i n most c a s e s  of  occupation, this  habits.  behaviour.  None  for  BSE  experiences f o r c e s most  were  which  frequently  doctors'  f a m i l y or p e r s o n a l  advice, breast  175  disease.  Doctors  change and, with  their  although  experiences  Attitudes  indication  affects that  motivating  women w i t h experiences may  of  anxiety  act  as  are be  programs through  levels  as  a positive the  overcome h i g h  the  High  development  of  more  of  some  of  other  anxiety, Some  or The  family level  What  when does  way  is  practice.  BSE.  are  The  presence  personal  of  degree  i t begin  strongly  to  positive  h i g h - r i s k women w i t h  intense  anxiety  were  questions  cancer.  t o BSE  of  BSE  Many women  behaviour.  Could  moment."  the  levels  tragic  such  practice.  There  i n the  development  to decrease  of  breast  f o r c e and  anxiety?  i n BSE  "teachable  practicing  b e n e f i t from more  aim  i n d i c a t i o n s that  surrounding  a barrier  not  themselves  clear.  t o e x p l a i n i n g end  Could  level  not  and  involve  responses.  s t i m u l a t e BSE. a c t as  forces for  format  of a n x i e t y  adamant a b o u t  a key  which  is  susceptibility  acts  anxiety  and  powerful  change  in p a r t i c u l a r ,  behaviour  hand, can  a barrier?  motivators high  are  anxiety  superficial  and,  low  a high  and  wording  f a c t o r s may  other  anxiety  BSE  The  about cancer  the  regularly  seem t o c r e a t e a  t o measure o n l y  such a n x i e t y  on  not  t o be  habits, there  do  toward  measured.  anxious  potential  c o u l d produce a s i g n i f i c a n t  Particular  appeared  many do  p a t i e n t s ' BSE  involvement  poorly  have t h e  personal  and  increase  positive  a  teaching motivation  attitudes  and  expectat ions? Examination r e s p o n d e n t s was  of  the  limited  barriers  by  their  w i l l i n g n e s s to share  only  suggested  barrier  the  to  insight  negative  BSE of  as  the  aspects  which d i d s o l i c i t e  of  perceived  individuals themselves.  significant  by and  the by The  response  176  was  "simply  compliance acceptable does  not  forgetting."  T h i s excuse  is  one.  an  easy  excuse. reflect  It i s a  not the  doing  BSE.  i n c i d e n c e of  happen  to  easily  beliefs.  of  of  interferes  with  flawed the  of  the  research  results  The  different  size  on  will  not  positive  or d a t a that  was  many  levels  more  i t was  emotional  appropriate  design  of  backgrounds might a  saying  not  which  Only a  few  doing  or  d e n i a l of going  to  r e a c t i o n s are  not  information  and  overcome s u c h motivators  strongly held  exist  something  action.  for  Research  collection  have been due  instrument.  further research  Some  i s needed t o  to a of  clarify  between v a r i a b l e s .  sample  homogeneous  for either  n o n - s i g n i f i c a n t r e s u l t s may  suggest  relationships  self-image.  of  socially  one  indicated a personal  by  Implications Many  and  p r e s e n t a t i o n of BSE  cancer  Even when many  answer  on  lack  in general, a  reasons  powerful  Simple  breast  them  disease  Such  dealt with.  incidence  often  breast  them.  poorly  more p e r s o n a l  Several  is,  superficial  particularly  respondents provided  It  for explaining a  small  factors.  education  provide  specific  and A  the  research  larger  and  a  research  variety  of  more d i s c r i m i n a t i n g d a t a  analysis  of  a  greater  group  was  group  with  occupational and  allow  for  of  data  interval  data  variety  categor i e s . A study might in  this  designed  provide data.  specifically  stronger  support  to  f o r the  collect  r e l a t i o n s h i p s suggested  1 77  The asked  use  as  personal  of  necessary habits  collection. requested It  i n t e r v i e w s where more p r o b i n g or  might  where increase  Questions  as  may  beneficial  data  they  do  questionnaire could in  be  their  BSE.  own  on  knowledge as  asked  they about  The  format  which  compliance  those  to  know  data  more  data  The  physicians.  for  professionals  d i d not  BSE are and  to  then  describe  later  in  the  describing their  behaviour  a  list  then  of  "should"  behaviours be  part  of  d e s c r i p t i o n s of s e v e r a l  have r e s p o n d e n t s  with  have any  greater  pick  out  knowledge  or  background.  t r e n d was  true  f e m a l e d o c t o r s and  same q u e s t i o n  in  Would i t  question  a non-health this  personal  interactions  asked  The  t h i n g s which  and  between  first  to provide  S i n c e d o c t o r s can  their  separation  and  knowledge?  BSE  if  teach  information  their  of  to p r a c t i c e .  BSE  s e c o n d c o u l d be  with  especially  support  and  be  correct.  professionals BSE.  out  respondents  study  than  opposed  carry  would be  i s most  in this  interesting  their  depth  explained  i f s u b j e c t s are  BSE  c a r r y i n g out  Nurses  habits,  data  s u b j e c t s chose those  Another  one  when  words.  individuals the  be  demonstrate  and  t o make a d e f i n i t e  open-ended w i t h  from w h i c h  accuracy  could  p r o d u c e more i n d e p e n d e n t what  can  can  necessary. be  collecting  subjects  questions  be  a positive  attitudes others  the  to a great  on  this  medical extent  encouragement,  and  f o r other  those  a p p l i e s to the  who  currently  influence  p r a c t i c e s would Is there  profession? major  further research  Since source  be  health  a t t i t u d e s of  topic.  the  I t would  male  on  BSE  affect uniform health of  i n the area  BSE of  1 78  h e a l t h p r o f e s s i o n a l s and a major  flaw  i n the  Experimental use  of  cues  stimulating  of  r e g u l a r BSE  "simply  Personal of  actions  should  disease used.  be  More  Separation  with  the  clarify  cues.  The  i n an  effect  the  effort  of  frequent  potential  effect  breast  topic  results  research  disease  comprehensive  of t h e  clarify  Separate  might  studied  experiences  might  reveal  hierarchy.  w h i c h examined  using  might  of  for  a variety  to  decrease  cover  a wide  of the  forgetting."  possibilities.  interviews.  a t t i t u d e s t o w a r d BSE  teaching  research  to  memory h e l p e r s influence  BSE  their  which  data  might  result  into malignant  and  when t h e q u e s t i o n n a i r e focusses  on  this  range from benign  format  is  may  be  subject  needed. The of  effect  a specific  control with  of  BSE  and  scale.  BSE  different  l o c u s of c o n t r o l may The  relationship  p r a c t i c e s might  education  levels  r e q u i r e the  a l s o be  and  BSE  development  between  clarified  knowledge  locus  of  i f subjects levels  were  compared. In on can  the  addition,  more s p e c i f i c  and  precise collection  f o l l o w i n g t o p i c s i s needed b e f o r e  be  understood:  between  perceived  present  BSE  cancer;  level  degree attitudes  of and  follow-up influencing  habits; of  strongly  anxiety  perceived values  teaching  on  emotional breast  susceptibility BSE.  data  i n f l u e n c e on  BSE  s e s s i o n s ; the  factors  surrounding  surrounding  their  of  to  BSE  time  span  practice  and  responses  to  cancer  BSE;  the  cancer;  and  breast  and  breast  1 79  Implications Breast  f o r Teaching  self-examination  activity.  The  participation  i n BSE r e m a i n s p o o r l y  however,  that  demonstration appropriate out  to  BSE.  complex  is  a  simple  of what  action.  this  research  approaches  if  have  improve  limitations  merit.  The  it  many  out c o r r e c t l y ,  providing reach  initial  those  and  other  programs,  skills,  Providing  as important  information. motivational of  breast  must  a part  the  Although  data  to  suggest  to determine  suggestions  are  such  in practice.  An  BSE b u t f a i l t o c a r r y not focus  attempt  providing  solely  should  on  be made t o  information  and  address a t t i t u d e s , expectations,  fears  motivation  disease  should  and  breast  f o r c a r r y i n g o u t BSE  of the t e a c h i n g  program as not  power o f f e a r o r knowledge. and t h o s e  some  know a b o u t BSE.  while  Assumptions  cancer  clear,  be e v a l u a t e d  know about  b a r r i e r s r e l a t e d to breast  examination. be  information.  produce  a n s w e r s , one c a n p r o j e c t  programs s h o u l d  women who a l r e a d y  Teaching practical  teaching  i s not  the s i t u a t i o n .  following  women a l r e a d y  to  i s c o r r e c t and r e g u l a r  of  then  enough  BSE and even c a r r y i t  f o r noncompliance  p r o j e c t i o n s and r e q u i r e v e r i f i c a t i o n Since  with a  i s not  It  on  of the f a c t s along  The g o a l , however,  which c o u l d  influences  clear,  Many women know a b o u t  and  emotional  is  p r o j e c t does n o t p r o v i d e  teaching  of  understood.  be done  a p p r o a c h s may  beyond t h e c o n f i n e s  they  interaction  should  some e x t e n t .  teaching  potentially  presentation  Although the reason  specific  a  BSE  who have s t r o n g  be  is  selfshould  providing  made  about  the  Women w i t h  a high  risk  emotional  reactions  180  to  BSE  and  breast  cancer  may  benefit  from more  individual  attention. Particular to  l e a r n about  and in  experiences  a n d p r a c t i c e BSE.  make  special  nurses  training  own has  health  the p o t e n t i a l care  effort  during  t o reach  Since  this  in  these  women.  open t o  future  BSE  t o be open t o l e a r n i n g and p r a c t i c i n g  have r e c e n t l y d e v e l o p e d friends  with  breast  breast  disease  This could  g r o u p f o r BSE t e a c h i n g  programs.  Using  magazines,  an  be  effective  unaware o f BSE and t o s t i m u l a t e Having  such  practice desired  a  stimulus  BSE r e g u l a r l y .  their  agents  i n the  concentrated  i n and  group  active  o f women who  BSE a r e  those  who  o r who have had f a m i l y o r  disease.  could  of  b e n e f i t them b u t  belief  Another  aware  improving  t o make a  to stimulate  practice.  be  Women i n v o l v e d  change  i t seems w o r t h w h i l e training  and m o t i v a t i o n  should  would n o t o n l y  for creating  nurses  interest  Educators  may be p a r t i c u l a r l y  system,  participation appear  efforts  habits.  health  may i n c r e a s e  be a s p e c i a l  the  media,  way t o i n f o r m  BSE i n t h o s e  target  especially  those  who a r e  who a r e  informed.  on a r e g u l a r b a s i s may a c t a s a c u e t o More r e s e a r c h  i s needed  to v e r i f y  this  effect.  Specific learners  approaches  should  be kept  w h i c h have been g i v e n  i n mind when s e l e c t i n g  Demonstrations  methods  on t h e l e a r n e r and g u i d e d  practice  tools.  with  the l e a r n e r examining h e r s e l f responses.  The  activities  would be e s s e n t i a l  Pamphlets  could  by p a s t  teaching  and  positive  support  have  provision i n order  received of  privacy  to allay  be u s e d a s a method o f r e a c h i n g  particularly for  these  embarrassment. a wide r a n g e o f  181  learners, home  as  a way  reminder  Presenting  BSE  of  reinforcing  and  reference  in simple,  easy  to  and  practice.  a reminder c r u t c h  will  be  described,  components of  might  to  a  verses  or  the  might  the can  words  gives The  learner  that  them.  paying One  L-  stands  A-  S-  four  improve  excuse  for  LAST s y s t e m  poor which  the  their  BSE.  November  teacher  step  Many  plan  four  etc.). set  would be  as  catchy days  has  phrase  stage  signals  t o h e l p make y o u r  use  ( i e . , 30  body must LAST a l i f e t i m e the  BSE.  t o a i d i n g women  A catch the  teaching  for  people  things  would  a t t e n t i o n to  t o BSE  approach to  beneficial  remember  for a x i l l a  by  reminding  and  that  for  that  they  their  body  body LAST i s r e g u l a r  BSE.  follows: inspection  or a r m p i t ,  remember  t o examine  under  arms stands  for  systematic breast T-  the  simplified  for looking, a visual  stands  your  of  help  The  way  LAST a p p r o a c h  a  developed a  June and  LAST.  by  could  an  take-  teaching.  i n d i v i d u a l s remember  a p p r o a c h would be  to  be  help  s u c h as  help  components  September, A p r i l , BSE  She  similar  remember  steps  a  BSE.  is beneficial.  Perhaps  learn  as  formal  " f o r g e t t i n g " as  Howe (1981) b e l i e v e d t h a t BSE  l e a r n i n g and  following  knowledge l e v e l s Using  decrease  past  or  stands  basis with  systematic,  examination lymph  just  which w i l l  not  a  random  m i s s any  part  but  a  of  the  system  for timing,  a regular  a recommendation  examine j u s t  not  after  that  examination the  menses when any  breasts  on  a  are  easiest  engorgement  is  monthly to  decreased  182  This assist must  is  example  i n mind, of c o u r s e ,  necessarily However,  translate  one  Educators  does  into  have  forgetting  should  families  completely  BSE.  One  knowledge does n o t  correct'  practice.  have t h e knowledge b e f o r e  i s seen  cycle  are personal  as a  physicians  or  one c a n  f o r many  t h e use of cues t o a c t as  of  cues  that  can  be  a n d encouragement  should  included  in  friends  or  together  w o u l d make BSE a t o p i c  encouraged Awareness starting  habits. heighten Increased appraisal  An  support.  place  the  status  personal  efforts  the  then  confront  increase  Family  members  and encouraged  classes  BSE  to get  f o r groups  associates  of p e r s o n a l  of  could attend women  could  BSE h a b i t s may be a  wishing  factors  awareness  assume  one a n o t h e r .  f o r the educator  of  not to  f o r d i s c u s s i o n and  behind  might  of the issues surounding could  should  to  e x p l o r a t i o n of personal a t t i t u d e s  awareness  as sources f o r  order.  where  t o r e m i n d and s u p p o r t of  used  Friends,  of  Holding  settings  used.  source  teaching e f f o r t s  and p r o v i d e work  reminders.  powerful  seems i n  involved  in  Special  potentially  information be  Educators  involved.  this  women.  a s a r e g u l a r c u e f o r BSE and marks on  reminders.  are actively  involvement  student  barrier  a n d p h y s i c i a n s have n o t been w i d e l y  encouragement  good  t h a t complete  to  encourage  of the menstral  the c a l e n d a r  be  o f a memory h e l p e r w h i c h m i g h t  out a l l the steps of the procedure. Simply  Use  an  l e a r n e r s t o remember a l l o f t h e components o f keep  carry  just  those  and  factors  those  and v a l u e s  personal  l e d to  BSE  improve  a  both  might  habits.  more  honest  teacher  which  and  seemed t o  183  prevent  appropriate  would,  of  teacher  and l e a r n e r and such an approach would  one  BSE  course,  practice.  require  the  or small group i n t e r a c t i o n .  general  Such  personal  development  discussions  of t r u s t between require  one-to-  T h i s would be i n a p p r o p r i a t e f o r  BSE teaching but i t might be u s e f u l f o r high r i s k women  who have BSE p r a c t i c e d i s c r e p a n c i e s . Nurse educators,  i f they wish to play an important  role  in  teaching  BSE, must contact a g r e a t e r p o p u l a t i o n .  They can take  heart  the  a  in  fact  that  when  they  have  been  source  of  i n f o r m a t i o n they have been rated h i g h l y . Educators in In in  should examine t h e i r own a t t i t u d e s and behaviour  terms of BSE.. I t i s d i f f i c u l t order  of  the  teacher  self-examination.  must Egan  first (1975)  go  others achieve behaviour  examination Our  before  he  understanding  understood.  in  this  Educators  knowledge.  researchers.  scientific  that to  a  help  explore and understand h i s  assist  of BSE and the preventive  others  They should The  and  outcome  recorded.  observer  factors  health  should be a c t i v e l y  monitored and experimental controlled  can  hopes  the  in  their  self-  (pp. 22-24).  participation  our  and that he must f i r s t  through  suggests  s k i l l e d helper must model the behaviour that he  own  biases.  to h e l p others to examine themselves and make changes  t h e i r behaviour,  process  t o cover-up p e r s o n a l  not only  be  which  influence  measure  is  poorly  involved in increasing educators  but  active  of t h e i r teaching e f f o r t s should be approaches to  teaching  The e f f e c t i v e teacher  BSE  closely  must a l s o be a  and respond to the r e s u l t s of each  teaching  1 84  effort. BSE There  can  be an e f f e c t i v e  i s some e v i d e n c e  beginning  that  to appreciate this  tool a  i n combating  greater  fact.  number  Mahoney  between  1981 a n d 1982 t h e r e was a s i g n i f i c a n t  number  of  women  satisfactory was  also  reporting  h i sc l i n i c  breast examinations.  a  significant  found  accidentally  While  this  this  simple  or through  i s encouraging, but  the influences  knowledge  to  on  women  are  increase  i n the  who were p e r f o r m i n g  1978 and  1982  there  i n the p r o p o r t i o n of b r e a s t  o f BSE  and  a  decrease  in  those  a routine p h y s i c i a n ' s examination.  procedure. BSE  h e l p women improve  t h e major c a u s e s  of  (1983) r e p o r t s t h a t  many women a r e s t i l l  effective  understand  Between  increase  cancers d e t e c t e d as a r e s u l t  of  to  breast cancer.  of m o r t a l i t y  Efforts  behaviour their  not c a r r y i n g out must be made t o  and  to  use  chances of combating  f o r women--breast  cancer.  this one  185  REFERENCES  Alcoe,  S. Y., & McDermot, R. S. R.  breast  self-examination?  Health. Becker,  & Maiman, L. A.  compliance with Medical  Care,  D. D.,  Control  Jersey:  &  Sociobehavioral care  determinants of  recommendations.  Siegler,  1977.  Questionnaires:  Scarecrow  Press,  I . C.  i n m i d d l e and l a t e r  validation.  Borg,  of P u b l i c  1975, j_3 ( l ) , 10-24.  M e t u c h e n , New  ED  for teaching  Canadian J o u r n a l  h e a l t h and m e d i c a l  D. R. & A n d e r s o n , J . F.  Bielby,  a case  1979, 70^ 418-422.  M. H.,  Berdie,  Is there  Design  and U s e .  I n c . , 1974.  I n t e r n a l - e x t e r n a l Locus of  Life:  the search  for construct  (ERIC Document R e p r o d u c t i o n  Service  No.  155548) W.  R. &  edition. Borg,  W.  Gall, New  R. &  edition. Bowers, K. A. model.  M. D.  Y o r k : Longman Gall,  New  Educational  M. D.  Y o r k : Longman  Explaining health Nursing  Research.  Third  I n c . , 1979. Educational  Research.  Fourth  I n c . , 1983. behavior:  Administration  the  Quarterly,  health  belief  1980, 4 ( 2 ) , 41-  6. Bullough,  B.  breast Carp,  A., and  Discovery cancer. Peterson,  experiences.  Planning Bass,  of  first  signs  Nurse P r a c t i t i o n e r , R. , & R o e l f s ,  P.  In K. P. C r o s s ,  NonTraditional  1974.  the  Programs.  and  symptoms  of  1980, 5 ( 6 ) , 31-32 47. Adult &  learning  interests  J . R. V a l l e y San  Francisco:  (Eds.), Jossey-  186  C l a r k , M.  D.  The  utilization  education.  Nursing  of  theortical  Administration  concepts  Quarterly,  in  patient  1980,  4  (2),  55-60. Cropley,  A.  J.  L i f e l o n g Education;  O x f o r d : Pergamon P r e s s , Cross,  K.  P.  Adults  as  A Psychological  Analysis.  1977.  Learners.  San  Francisco:  Jossey-Bass,  1981 . Daniels,  R.  L.,  & S t e v e n s , J . P.  internal-external college  G.  poverty  1976,  J_3_j_ 103-113.  P.  Adult  J . M.,  W.  Care.  Taylor  1980,  J . P.,  "Adventures seminars. ED Egan,  & D.  L.  29  &  between  control  and  American  Educational  i n the  &  ED  methods of Research  1977.  (  the ERIC  149802)  H o v e l l , M.  compliance.  Sackett  the  community c o l l e g e :  research.  D.,  two  F.  In  Behavioral  R.  B.  (Eds.), Compliance  self-examination  Haynes,  in  Johns Hopkins U n i v e r s i t y P r e s s ,  Changing breast  Research,  G.  improving  Baltimore:  Edwards, V.  Eckstein,  for  interaction  S e r v i c e No.  Marshall,  strategies D.  learners  of c o n t r o l e x p e c t a n c y  Document R e p r o d u c t i o n Dunbar,  of  instruction.  Journal, Dowell,  locus  The  Health  1979.  behavior.  Nursing  ( 5 ) , 301-306.  Eckstein,  D.  G.  A systematic  study  of  i n A t t i t u d e s " s t r u c t u r e d human r e l a t i o n s 1979.  ( ERIC Document R e p r o d u c t i o n  Service  No.  195873) G.  The  Company, Feinstein,  A.  Skilled  Helper.  Monterey: Brooks/Cole  Publishing  1975. R.  Compliance  bias  and  the  interpretation  of  187  therapeutic  trials.  D. L. Sackett  In  R. B. Haynes,  (Eds.),  D. W. T a y l o r  &  Compliance i n Health Care.  B a l t i m o r e : Johns Hopkins U n i v e r s i t y Press, 1979. Fiore,  N.  Fighting  cancer:  one  England J o u r n a l of Medicine, F l y n n , K. T.  G a s t r i n , G.  Given,  processes  Geyman,  1980, 29 (2), 12-15. breast  B r i t i s h Medical J o u r n a l , 1980, 281, 193.  B.,  1979,  Occupational  Programme to encourage s e l f - e x a m i n a t i o n f o r  cancer.  New  1979, 300 (6), 284-9.  On teaching breast s e l f - e x a m i n a t i o n .  Health Nursing,  Given,  patient's perspective.  C. W.,  &  Simoni,  of care to p a t i e n t  L. E.  outcomes.  R e l a t i o n s h i p of Nursing  Research,  28 (2), 85-93.  J . P.  Family G o r d i s , L.  How e f f e c t i v e  i s p a t i e n t education?  J o u r n a l of  P r a c t i c e , 1980, j_0 ( 6 ) , 973-4. Conceptual  patient  and methodologic  compliance.  D. L. Sackett  In  problems  R. B. Haynes,  (Eds.),  in  measuring  D. W. T a y l o r  &  Compliance i n Health Care.  B a l t i m o r e : Johns Hopkins U n i v e r s i t y Press, 1979. Green,  L. W.  E d u c a t i o n a l s t r a t e g i e s to improve compliance  t h e r a p e u t i c and p r e v e n t i v e regimens: the recent In  R. B. Haynes,  D. W. T a y l o r  Compliance i n Health Care.  &  evidence.  D. L. Sackett  Baltimore:  Johns  with  (Eds.), Hopkins  U n i v e r s i t y Press, 1979. Hall,  D. C ,  Adams,  C. K.,  Stein,  G. H., Stephenson, H. S.,  G o l d s t e i n , M. K., & Pennypacker, H. S. of  human  Improved  breast l e s i o n s f o l l o w i n g experimental  Cancer, 1980, 46^ 408-414.  detection training.  188  Hall,  D. C , breast  Hand,  G o l d s t e i n , M. K., S t e i n , G. H. examination.  S. E . ,  &  Cancer,  Puder,  of A d u l t  Tallahassee: Florida  R. B.'  D. L.  Sackett  Baltimore: Haynes,  Basis  State  S e r v i c e No.  In R. B.  (Eds.),  Education  University,  D e t e r m i n a n t s of c o m p l i a n c e :  mechanics of treatment.  1967.  ED 016 161) the disease  H a y n e s , D. W. Compliance  and t h e  Taylor  i n Health  &  Care.  J o h n s H o p k i n s U n i v e r s i t y P r e s s , 1979.  R. B.  Strategies  for  R. B.  (Eds.), Compliance With T h e r a p e u t i c  Baltimore:  review.  compliance:  analysis  Haynes  and  improving  methodologic  In  D. L .  a  Sackett  &  Regimens.  J o h n s H o p k i n s U n i v e r s i t y P r e s s , 1967.  Haynes, R. B., T a y l o r , D. W., Health  manual  P e r s o n a l i t y F a c t o r s Which May  (ERIC Document R e p r o d u c t i o n Haynes,  in  1977, 40, 364-370.  W. H.  I n t e r f e r e With the Learning Students.  Progress  Care.  &  Baltimore:  Sackett, Johns  D. S.  Compliance i n  Hopkins U n i v e r s i t y Press,  1979. Howe, H. L .  Enhancing  promoting Reports, Howe,  H. L .  regular  Social  Hogue,  Health,  C. C.  Joe,  self-examination.  media  messages  Public  Health  high  associated risk  women.  with  breast  American  self-  J o u r n a l of  1981, 7J_ ( 3 ) , 251-255.  Nursing  D. W. T a y l o r  of  134-142.  factors  among  effectiveness  breast  1981, 96 ( 2 ) ,  examination Public  the  &  and  compliance.  D. L. S a c k e t t  In  R. B. Haynes,  (Ed.), Compliance  In H e a l t h  Care.  Baltimore:  J o h n s H o p k i n s U n i v e r s i t y P r e s s , 1979.  V. C.  Review o f t h e i n t e r n a l - e x t e r n a l c o n t r o l c o n s t r u c t a s  189  a personality  variable.  Psychological  Reports,  1971,  28,  619-640. Kilmann,  P.  R.,  & Sortile,  unstructured Journal Kinder,  of  B.  &  external 32, Kirch,  P.  R.  structure  on  structured  i n t e r n a l group 1976,  32,  The the  group p a r t i c i p a n t s .  L.,  & K l e i n , M.  breast  examination  44  728-736.  (2), R.  E.  148-156.  impact  Journal  and  participants.  of  outcome of  Kivett,  V.  programs:  Company,  R.,  of  differential internal  Psychology,  and 1976,  locus  of  of  D.,  physical,  1977  of  i n t e r v a l cases.  Statistics.  J . A.,  control  Gerontology,  evaluation  periodic  Cancer,  Monterey:  1978  Brook/Cole  1978.  Watson,  importance  Krech,  Prospective  Introductory  Publishing  to  on  e f f e c t s of  857-863.  R.  Kirk,  The  Psychology,  Kilman,  in leader  M.  roles  Clinical  N.,  shifts  leader  W.  &  Busch,  psychological,  orientation  32,  and  The  relative  social  variables  i n m i d d l e age.  Journal  of  203-210.  Crutchfield,  Psychology: A Basic  J . C.  R.  S.,  Course.  Livson, New  N.,  York:  &  Krech,  Alfred  A.  H.  Knoff,  1 976. Lai,  C. the  University Social  D.  S.,  patient Care,  Columbia  Vancouver:  Statistical University  Package of  for  British  1983. &  Evans,  education  1979,  British  Sciences.  Columbia, Lane,  of  J_7  D.  M e a s u r e s and  programs  (1),  30-42.  for  methods  chronic  in  illness.  evaluating Medical  190  Lao,  C.  Is i n t e r n a l - e x t e r n a l c o n t r o l an a g e - r e l a t e d v a r i a b l e ?  J o u r n a l of Psychology, L e f c o u r t , H. M. freedon. Linde,  1976, 92, 3-7.  The f u n c t i o n of the i l l u s i o n s American P s y c h o l o g i s t ,  B. J . ,  &  Janz,  knowledge and  N. M.  compliance  of  control  and  1973, 28, 417-425.  E f f e c t of a teaching program on of  cardiac  patients.  Nursing  self-examination.  Canadian  Research, 1979, 28 ( 5 ) , 282-6. Mahoney,  L.,  Medical Mager,  &  Csima,  A.  Breast  Association Journal,  R. F.,  &  Pipe,  P.  1983, 129 ( 8 ) , 801.  Analyzing  Performance Problems.  Belmont: Fearon P u b l i s h e r s , 1970. Marston,  M.  Compliance with medical  literature. Mink,  Nursing  0. G. internal  Research, 1970, j_9 ( 4 ) , 312-323.  A composite c o u n s e l i n g  M o r r i s , L. A.,  &  information  Halperin, on  literature  Newsom,  S e r v i c e No.  J . A.  patient  review.  expectancy,  1975.  ED 120589)  Effects  knowledge  of  and  written  drug  compliance:  a  American J o u r n a l of P u b l i c H e a l t h ,  69 ( 1 ) , 47-52. R.,  completion  &  Foxworth,  L.  Locus of c o n t r o l and c l a s s  among a d u l t b a s i c education  (ERIC Document Reproduction Norris,  s t r a t e g y f o r developing  locus o r i e n t a t i o n and success  (ERIC Document Reproduction  1979,  regimens: a review of the  R. G.  ED 150 442)  S e r v i c e No.  1979.  ED 176057)  C h a r a c t e r i s t i c s of A d u l t s That F a c i l i t a t e and/or  I n t e r f e r e with L e a r n i n g . University,  clients,  1977.  Tallahassee:  Florida  (ERIC Document Reproduction  State  S e r v i c e No.  191  Oppenheim, A. N.  Q u e s t i o n n a i r e Design  New Y o r k : B a s i c Books, Powel,  A.,  &  V e g a , M.  Psychological  I n c . , 1966.  C o r r e l a t e s of a d u l t l o c u s of c o n t r o l .  Reports,  1972, 30, 455-460.  R e e d e r , L . G., Ramacher, L . , and  and A t t i t u d e Measurement.  Gorelnik,  S.  I n d i c e s of H e a l t h B e h a v i o r .  California: Rokeach, M.  Goodyear  Handbook o f S c a l e s  Pacific  Palisades,  P u b l i s h i n g Co., I n c . , 1976.  The N a t u r e o f Human V a l u e s .  New  York:  The  Free  P r e s s , 1973. Rotter,  J . B.  Generalized  external  control  Monographs, Rotter,  expectancies  of  reinforcement.  of  internal  versus  reinforcement. Psychology,  S e r v i c e No.  1975.  (ERIC Document  Discussion-paper  practitioner.  Vuxenutbilkning.  Gothoburgensis,  Participation  D. L.  Sackett  of  Toward p e r s o n h o o d d e v e l o p m e n t i n  Rekrytering t i l l  Developments Sackett,  control  Reproduction  ED 114137)  Universitatis  Review.  external  t o the  1975, 43_j_ 56-67.  t h e community c o l l e g e ,  K.  related  J o u r n a l o f C o n s u l t i n g and C l i n i c a l  Roueche, J . E . , & Mink, 0. G.  Rubenson,  versus  Psychological  Some p r o b l e m s and m i s c o n c e p t i o n s  construct  internal  1966, 8 0 ^ 1-28.  J . B.  Rubenson, K.  for  i n Recurrent A  (Eds.),  Acta  1975.  i n Recurrent presented  Education: A research  t o CERI  Conference  on  E d u c a t i o n , 1977.  compliance  I n R. B.  Varberg:  practicum  Haynes,  Compliance  D. W.  for Taylor  i n Health Care.  the &  busy  D. L .  Baltimore:  1 92  Johns Hopkins U n i v e r s i t y P r e s s , Sackett,  D.  L.,  &  Regimens. Sackett,  D.  Haynes,  Baltimore:  L.,  B.  In R.  (Eds.),  Compliance With  B.  The  Haynes, D.  Compliance  in  C,  W r i g h t s m a n , L.  Social  Relations.  York: H o l t , Rinehart Seltzer,  A.,  Roncari,  education  on  Psychiatry, Smith,  D.  H.  time. in  and I.,  1980,  25  H.  and  Taylor  &  Care.  and  D.  L.  Baltimore:  1979.  & Cooke, S. Edition,  W.  L. H.  Research Kidder,  Methods  Ed.  New  1976.  & G a r f i n k e l , P. compliance.  (8),  Effect  of p a t i e n t  Canadian J o u r n a l  of  d i s c r e t i o n a r y use  of  638-45. individuals'  Smith & J .  Political  W.  in Health  Winston,  D e t e r m i n a n t s of  Social  Stillman,  4th  medication  In D.  Bass,  S.,  1976.  m a g n i t u d e of c o m p l i a n c e  Johns Hopkins U n i v e r s i t y P r e s s , Selltiz,  Therapeutic  Johns Hopkins U n i v e r s i t y P r e s s ,  & Snow, J . C.  noncompliance. Sackett  R.  1979.  Macaulay  Activities.  (Eds.), Part i c ipat ion San  Francisco;  Jossey-  1980. M.  breast  J.  Women's h e a l t h b e l i e f s  self-examination.  about  Nursing  breast  Research,  cancer  and  26.  (2),  1977,  121-127. Tagliacozzo,  D.  M.,  predicator Disease, Tseng,  M.  & of  1970,  S.  vocational Psychology,  K.  Knowledge  patient 22,  Locus  proficiency,  Ima,  behavior.  illness  Journal  of  as  a  Chronic  765-775. of  control  employabi1ity,  rehabilitation 1970,  of  as and  clients.  487-491.  a  determinant  training  of  satisfaction  Journal  of  job of  Counseling  193  Turnbull,  E . M.  mass  media  Nursing Vincent,  Effect on  the  Research,  P.  of b a s i c p r e v e n t i v e  theoretical  p r a c t i c e of b r e a s t  1978, 27  Factors  h e a l t h p r a c t i c e s and  ( 2 ) , 98-102.  influencing  approach.  self-examination.  Nursing  patient  noncompliance:  Research,  1971, 20  a  ( 6 ) , 509-  516. Wallston,  K. A.,  seeking  health  1976,  W_  a  review  value.  of t h e 1978,  Development (HLC)  locus  of R e s e a r c h  information of  control  in Personality,  L o c u s o f c o n t r o l and h e a l t h : Health  Education  Monographs,  107-117. K. A., K a p l a n , G. D.,  validation  Scale. 1976,  of t h e H e a l t h  Journal 44,  & M a i d e s , S. A. Locus of C o n t r o l  of C o n s u l t i n g  and  Clinical  580-585.  E f f e c t i v e n e s s of p a t i e n t e d u c a t i o n  counseling  in  hypertensive  patients.  promoting  compliance  Journal  and  of Family  and  psychosocial  control  among  Practice,  1980,  ( 6 ) , 1047-55.  Williams,  K.  Nursing  Breast Times,  maintenance  pulmonary 1980, 33  self-examination:  1979, O c t o b e r  W i n d s o r , R. A., G r e e n , and  K. A.  literature.  and  Psychology,  10  Health-related  Journal  & Wallston,  W a l l s t o n . B . S., W a l l s t o n ,  Webb, P. A.  S.  215-222.  B. S.,  Spring,  Maides,  as a f u n c t i o n of h e a l t h - r e l a t e d  and  Wallston,  &  L. W., for  disease: ( 1 ) , 5-12.  the  personal  touch.  11, 311-319.  & Roseman,  patients  a review.  J . M.  with Journal  Health  chronic  promotion  obstructive  of C h r o n i c  Disease,  194  Wise,  P.  S.  Barriers  education. 1979, Zahn, J . Adult  (or  enhancers)  J o u r n a l of C o n t i n u i n g  to  adult  Education  patient  f o r Nurses,  j_0 (6) , 1 1-16. Burnout Years,  in  adult  1980,  4  educators.  (4),  4-6.  Lifelong  Learning;  The  Appendix Letter  of  A:  Initial  Contact  196 THE UNTVERSITY OF BRITISH COLUMBIA ADULT EDUCATION DIVISION DEPARTMENT OF ADMINISTRATIVE, ADULT AND HIGHER EDUCATION 5769 TORONTO ROAD  Dear You are a female student i n an Adult Education c l a s s . This makes you of v i t a l i n t e r e s t t o a study I am c u r r e n t l y c a r r y i n g out as part of my Masters Thesis-under the supervision of Dr. K j e l l Rubenson and Dr. Thomas Sork. Your cooperation i n j o i n i n g the p r o j e c t w i l l provide u s e f u l information t o help me i n my study of breast self-examination p r a c t i c e s . This i s a t o p i c of i n t e r e s t t o me not only i n terms of completing a degree requirement but a l s o i n terms of improving my effectiveness as a nurseeducator teaching about preventive h e a l t h measures. My aim i s to use i n d i v i d u a l opinions and experiences t o help Improve program planning. Your personal experiences and a t t i t u d e s would be invaluable i n such a search. Don't f e e l that you have t o be an expert on the t o p i c of the study, breast self-examination, to p a r t i c i p a t e . The concern of the study i s personal experiences, a t t i t u d e s and values and you are the expert on these issues as they concern you. You can expect t o see me speaking about my p r o j e c t a f t e r one of your regular Adult Education classes sometime i n the near future. I w i l l be handing out my data c o l l e c t i o n forms at that time. I hope t o use the r e s u l t s to suggest b e t t e r ways of s e t t i n g up health.teaching programs concerned w i t h breast self-examination. I f you are i n t e r e s t e d i n a summary of the r e s u l t s they w i l l be a v a i l a b l e on request.You are not required t o j o i n i n t h i s p r o j e c t and your p a r t i c i p a t i o n w i l l be on a s t r i c t l y volunteer b a s i s . When you f i l l out the data c o l l e c t i o n form, however, you w i l l be providing valuable help i n my research e f f o r t s and, i n . a d d i t i o n , you w i l l be t a k i n g an opportunity t o explore your own f e e l i n g s and a t t i t u d e s toward t h i s important area of preventive h e a l t h . The issue involves not only women o f a l l ages, i t involves a l l women. I hope that you w i l l p a r t i c i p a t e and share your unique experiences. S i n c e r e l y yours,  I n g r i d Armstrong, R.N.,  B.S.N.  Appendix  B:  Quest i o n n a i re  PERFORMANCE DISCREPANCIES IN BREAST SELF-EXAMINATION PRACTICES OF FEMALE UNIVERSITY STUDENTS  FEMALE UNIVERSITY STUDENT  QUESTIONNAIRE  ADULT EDUCATION MASTERS THESIS P r e p a r e d By INGRID ARMSTRONG Thesis Advisors: Dr. K j e l l Rubenson Dr. Thomas Sork  199  THE  UNIVERSITY OF BRITISH COLUMBIA ADULT EDUCATION DIVISION DEPARTMENT OF ADMINISTRATIVE, ADULT AND HIGHER EDUCATION 5760 TORONTO ROAD  Hi! T h i s form i s a data c o l l e c t i o n t o o l designed to e x p l o r e your stance on h e a l t h and, i n p a r t i c u l a r , your stance on b r e a s t s e l f - e x a m i n a t i o n . The aim of t h i s study i s to suggest more e f f e c t i v e p l a n n i n g s t r a t e g i e s f o r b r e a s t s e l f - e x a m i n a t i o n teaching programs. Do not f e e l that you must be an " e x p e r t " to answer the q u e s t i o n s . I t i s your unique experiences and thoughts on the s u b j e c t i n which we are most i n t e r e s t e d . You w i l l n o t i c e that your name i s not requested anywhere on the form. Your answers w i l l be anonymous and r e p o r t e d only as p a r t of a sample. The numbers on each page do not i d e n t i f y you i n any way but are only there to h e l p keep together forms when pages become s e p a r a t e d . Any i n f o r m a t i o n that you p r o v i d e i s s t r i c t l y v o l u n t a r y but an e f f o r t has been made to ask f o r only the i n f o r m a t i o n that i s r e l e v a n t to the t o p i c and whose l i n k with our concerns i s supported by the l i t e r a t u r e . D e t a i l s asked about your job e x p e r i e n c e s are aimed at a s s i s t i n g i n s e p a r a t i n g people i n t o h e a l t h and non-health o r i e n t e d job c l a s s i f i c a t i o n s . No s e p a r a t e consent form i s i n c l u d e d so that anonymity can be p r o t e c t e d . A completed q u e s t i o n n a i r e w i l l be assumed to i n d i c a t e consent to p a r t i c i p a t e i n t h i s p r o j e c t as a volunteer. T h i s form u s u a l l y takes l e s s than h a l f an hour to c o m p l e t e I f you m i s p l a c e i t you can get another copy from the a d u l t e d u c a t i o n s e c r e t a r y . When you have completed your form p l e a s e r e t u r n i t i n the envelope p r o v i d e d to the a d u l t education b u i l d i n g on Toronto Road. Please complete and r e t u r n the form AS SOON AS POSSIBLE. I f you want a copy of the r e s u l t s you may c o n t a c t I n g r i d Armstrong through the A d u l t E d u c a t i o n D i v i s i o n . v  Thank you  f o r your h e l p i n t h i s p r o j e c t .  200  J.  VALUES L i s t e d below i n a l p h a b e t i c a l order a r e 19 v a l u e s . Your task i s to p i c k out the f i v e (5) v a l u e s which a r e most important t o YOU as g u i d i n g p r i n c i p l e s i n YOUR l i f e . F e e l f r e e to make any marks o r checks t h a t you wish on the paper as you study the l i s t and begin t o choose only f i v e o f the items. U n d e r l i n e your f i n a l choices.. Do not be concerned by the o r d e r i n which the items which you u n d e r l i n e appear. They a r e l i s t e d a l p h a b e t i c a l l y and are not intended to g i v e any g r e a t e r importance to any p a r t i c u l a r v a l u e . A COMFORTABLE LIFE (a prosperous l i f e )  INNER HARMONY (freedom from inner  AN EXCITING LIFE (a s t i m u l a t i n g , a c t i v e  life)  conflict)  MATURE LOVE (sexual and s p i r i t u a l  intimacy)  A SENSE OF ACCOMPLISHMENT (lasting contibution)  NATIONAL SECURITY' ( p r o t e c t i o n from a t t a c k )  A WORLD AT PEACE ( f r e e of war and c o n f l i c t )  PLEASURE (an e n j o y a b l e , l e i s u r e l y  A WORLD.OF BEAUTY (beauty of nature and the a r t s )  SALVATION (saved, e t e r n a l l i f e )  EQUALITY (brotherhood, opportunity f o r a l l ) .  SELF-RESPECT • (self-esteem)  equal  FAMILY SECURITY ( t a k i n g care o f l o v e d ones)  SOCIAL RECOGNITION ( r e s p e c t , admiration)  FREEDOM (independence,  TRUE FRIENDSHIP ( c l o s e companionship)  free  choice)  HAPPINESS (contentedness)  WISDOM (a mature understanding  life)  of l i f e )  HEALTH (optimal p h y s i c a l and mental f u n c t i o n i n g )  WAIT! Have you u n d e r l i n e d o n l y f i v e (5) items? Go over t h i s p e r s o n a l l i s t of f i v e and. put a number one (1) b e s i d e the value which i s the MOST important to you. Put a number two (2) b e s i d e the v a l u e which i s SECOND MOST important t o you. Put a number three (3) b e s i d e the v a l u e which i s THIRD MOST important t o you.  PLEASE TURN OVER  201 2.  HEALTH BELIEFS  The  f o l l o w i n g items  t r y to determine the way  people view c e r t a i n important b e l i e f statement statement  i n which  health-related issues.  w i t h which you may  Each item i s a  agree or d i s a g r e e .  i s a s c a l e which ranges from s t r o n g l y d i s a g r e e  s t r o n g l y agree  (6).  For each item you are to c i r c l e  Below each (1) to  the number t h a t _  r e p r e s e n t s the e x t e n t  to which you d i s a g r e e or agree w i t h the  The more s t r o n g l y you  agree with a statement,  the number you  circle.  the lower w i l l be  different  the h i g h e r w i l l  statement. be  The more s t r o n g l y you d i s a g r e e w i t h a  the number you  circle.  Please c i r c l e  statement,  o n l y one  T h i s i s a measure of your p e r s o n a l b e l i e f s ; o b v i o u s l y t h e r e are  number. no  r i g h t or wrong answers. P l e a s e answer these items on any  one  item.  c a r e f u l l y but do not spend too much time  Be sure to answer every item.  A l s o , t r y to respond  to  each item i n d e p e n d e n t l y  when making your c h o i c e ; do not be i n f l u e n c e d by  your p r e v i o u s c h o i c e s .  I t i s important  that you respond  your a c t u a l b e l i e f s and not a c c o r d i n g to how  you  feel  a c c o r d i n g to  you s h o u l d b e l i e v e .  202  HEALTH BELIEFS  QUESTIONNAIRE  0 ©  Strongly Disagree Moderately D i s a g r e e S l i g h t l y Disagree S l i g h t l y Agree Moderately Agree I S t r o n g l y Agree  1.  I F I TAKE CARE OF MYSELF, I CAN AVOID ILLNESS  QS  2  3  4  5  6  2  3  4  5  6  3. . GODD.-.HEALTH: IS. LARGELY ..A MATTER OF FORTUNE,  2  3  4  5  6  4. NO MATTER WHAT I DO, IF I AM GOING TO GET SICK I WILL GET SICK  2  3  4  5  6  5. MOST PEOPLE DO NOT REALIZE THE EXTENT TO WHICH THEIR ILLNESSES ARE CONTROLLED BY ACCIDENTAL HAPPENINGS  2  3  4  5  6  6. I CAN ONLY DO WHAT MY DOCTOR TELLS ME TO DO  2  3  4  5  6  7. THERE ARE SO MANY STRANGE DISEASES AROUND THAT YOU CAN NEVER KNOW HOW OR WHEN YOU MIGHT PICK ONE UP  2  3  4  5  6  8. WHEN I" FEEL I L L , I KNOW IT IS BECAUSE I HAVE NOT BEEN GETTING THE PROPER EXERCISE OR EATING RIGHT  2  3  4  5  6  9. PEOPLE WHO NEVER GET SICK ARE JUST PLAIN LUCKY  2  3  4  5  6  10. PEOPLE'S I L L HEALTH RESULTS FROM THEIR OWN CARELESSNESS  5  6  11. I AM DIRECTLY RESPONSIBLE FOR MY OWN HEALTH  5  6  2. WHENEVER I GET SICK IT IS BECAUSE OF SOMETHING I'VE DONE OR NOT DONE  ,  PLEASE TURN OVER  © (b  203  BREAST SELF-EXAMINATION Breast self-examination i s an a c t i v i t y recommended for women by health professionals whereby they examine their own breasts to detect changes i n breast tissue. The questions which follow are concerned with your personal experiences, attitudes and understanding. Please read each question carefully and choose the answer(s) which BEST APPLY TO YOU. 1. Have you ever heard of the need to regularly examine your own breasts to detect changes i n breast tissue? No Yes If you answered No, you have never heard of this preventive health measure, only three more questions on this questionnaire w i l l apply to you. Please go on to questions #17, #18 and #19. I f you have heard of this preventive health practice, please go on to question #2. 2. People often hear about breast self-examination from a variety of sources. Please check ( ) a l l of the sources that have given you information about breast self-examination'. Underline the one(s) that you f e e l were most useful. a doctor a nurse a pamphlet a magazine a r t i c l e a TV advertisement a radio advertisement a family member a friend a work associate other (please l i s t any other information sources that you have encountered.)  WAIT! In question #2, have you underlined the sources that you f e e l were most useful?  204 5. 3. Information can be presented i n a number of ways. Which of. the following have you experienced when learning about breast self-examination? Please check ( ) a l l of the different approaches that you can remember experiencing. Underline the one(s) that you f e e l were most useful. spoken information written information pictures or sketches two-way discussion with you demonstration with a mechanical model demonstration with another person demonstration with the teacher using themselves as a model demonstration on you guided practice with you examining a mechanical model guided practice with you examining another person guided practice with you examining yourself other (Please l i s t any other presentation methods that you have encountered)  WAIT! In question #3, have you underlined the approaches that you f e e l were most useful? 4. Did any of the breast self-examination information sources with which you have had contact provide a follow-up learning session ( i e . was there an opportunity at a l a t e r date f o r discussion, questions, supervised practice, return demonstration, etc.)? No Yes Please describe your follow-up experience or the circumstances or issues which may have interfered with your p a r t i c i p a t i o n i n such an a c t i v i t y .  PLEASE TURN OVER  205 6. The recommended method of breast self-examination includes a variety of a c t i v i t i e s . Please l i s t a l l of the things a person should do to carry out a complete breast self-examination. Do not be concerned about your l e v e l of expertise i n answering this question. Answer i t at WHATEVER l e v e l of understanding that you have. Try to give a l l of the d e t a i l s that you can remember were recommended to you including when the examination should be done.  Which of the following categories most accurately describes YOUR breast self-examination habits? No breast self-examination Breast self-examination less than once a year ( i e . once a year or less) Breast self-examination at least once a year ( i e . 1 to 3 times a year) Breast self-examination at least once every three months ( i e . A to 11 times per year) Monthly breast self-examination ( i e . 12 or more times per year and at least once every month)  206 7. IF YOU DO NOT CARRY OUT BREAST SELF-EXAMINATION SKIP ITEMS ill TO #9. 7. For a variety of reasons, women frequently do not carry out breast s e l f examination exactly as i t has been recommended to them. When you examine your breasts do you follow the procedure exactly as you have described i t i n question //5? No Yes If you modify your examination i n any way please describe what you do.  8. Do you remember when and under what circumstances you f i r s t started examining your breasts? No Yes. I f you answered Yes: a) At what age did you start examining your breasts? b) What influenced you to s t a r t examining your breasts?  9. Sometimes p a r t i c u l a r things help remind women to carry out their breast self-examination. Is this true f o r you? No Yes, I remember to examine my breasts when  10. Sometimes breast self-examination habits change. Have your habits ever varied or changed? No Yes Being as s p e c i f i c as you can and including any influences that you f e e l are or were involved, explain how your habits are or were different.  PLEASE TURN OVER  207  11. Many f a c t o r s can i n f l u e n c e how o f t e n women examine t h e i r b r e a s t s . Circle the number which r e f l e c t s the degree of i n f l u e n c e each o f these f a c t o r s have on how o f t e n you examine your b r e a s t s . Never i n f l u e n c e s me H a r d l y ever i n f l u e n c e s me O c c a s i o n a l l y i n f l u e n c e s me F r e q u e n t l y i n f l u e n c e s me Almost always i n f l u e n c e s me A l w a y s l i r i f l u e n c e s me  0® (3)0 a. LACK OF TIME  2  3  4  5  6 •  b. LACK OF ENERGY  2  3  4  5  6  c. FEAR OF WHAT I'LL FIND.  2  3  4  5  6  d. NOT KNOWING EXACTLY HOW MY BREASTS  TO EXAMINE  e. FEELING PERSONALLY SUSCEPTIBLE TO BREAST DISEASE  3  5  6  f. SIMPLY FORGETTING.  3  5  6  12.  Can you t h i n k o f any other f a c t o r s b e s i d e s the ones mentioned i n q u e s t i o n e l e v e n (above) that i n f l u e n c e how o f t e n you examine your b r e a s t s ? No Yes, they a r e :  13. Have any o f the f o l l o w i n g people e x p e r i e n c e d b r e a s t d i s e a s e ? you p e r s o n a l l y a member o f your b i o l o g i c a l f a m i l y a c l o s e f r i e n d o f yours anyone you know none o f t h e above P l e a s e e x p l a i n the e x p e r i e n c e ( s ) b r i e f l y . When d i d i t happen? What was the outcome? I f the person i n v o l v e d was a member o f your b i o l o g i c a l f a m i l y or j u s t someone you know p l e a s e i n c l u d e your s p e c i f i c r e l a t i o n s h i p .  208  14. How would you r a t e your s u s c e p t i b i l i t y v e r y low low  to breast  disease?  ayerage high very high 15. B e s i d e each o f the statements t h a t f o l l o w i s a s c a l e which ranges from s t r o n g l y d i s a g r e e (1) to s t r o n g l y agree (6). F o r each item c i r c l e the number t h a t r e p r e s e n t s the extent t o which you agree o r d i s a g r e e w i t h the statement. The more s t r o n g l y you d i s a g r e e the lower w i l l be the number t h a t you c i r c l e . Please c i r c l e ONLY ONE NUMBER. Strongly Disagree Moderately Disagree S l i g h t l y Disagree S l i g h t l y Agree Moderately Agree J S t r o n g l y Agree  0@d)0©(i) a. I FEEL CONFIDENT WITH MY PRESENT LEVEL OF KNOWLEDGE ABOUT CARRYING OUT BREAST SELF-EXAMINATION b. I FEEL CONFIDENT THAT I COULD DETECT CHANGES IN MY BREAST TISSUE c. I FEEL SATISFIED WITH MY PRESENT BREAST SELF-EXAMINATION HABITS d. I FIND BREAST SELF-EXAMINATION TO BE AN UNCOMFORTABLE EXPERIENCE  3  4  5  6  e. THE MOST VALUABLE PREVENTIVE HEALTH PRACTICE FOR WOMEN IS BREAST SELF-EXAMINATION  3  4  5  6  f . I AM PERSONALLY RESPONSIBLE FOR MAINTAINING MY OWN HEALTH  3  4  5  6  PLEASE TURN OVER  209  10. 16. Beside each of the following statements i s a scale which ranges from never (1) to always (6). For each Item c i r c l e the number which r e f l e c t s how often you f e e l the s i t u a t i o n described i n the statement occurs. Never Hardly Ever Oc :asionally Frequently Almost Always j Always  Q0(900(i) CARRY OUT BREAST  SELF-EXAMINATION  BREAST  SELF-EXAMINATION  BREAST  3  4  3  4  SELF-EXAMINATION  3  4  d. I USE THE PADS OF MY FINGERS WHEN EXAMINING MY BREASTS  3  4  e. BREAST CHANGES FOUND DURING BREAST SELF-EXAMINATION LEAD1 TO DISFIGURING SURGURY  3  4  f . BREAST SELF-EXAMINATION INCREASES. MY FEAR OF BREAST DISEASE  3  4  CARRY OUT  CARRY OUT  g. . BECAUSE IT RESULTS IN EARLIER DETECTION OF BREAST CHANGES, REGULAR BREAST SELFEXAMINATION GREATLY IMPROVES THE OUTCOME OF BREAST DISEASE...  2  3  4  5  6  h. BREAST LUMPS ARE CAUSED BY CANCER  2  3  4  5  6  210 11. Now t h a t the t o p i c o f b r e a s t s e l f - e x a m i n a t i o n has been e x p l o r e d could you p r o v i d e some p e r s o n a l - d a t a to help i n the s t a t i s t i c a l a n a l y s i s of t h i s study. 17. What i s (are) your c u r r e n t o c c u p a t i o n ( s ) ?  eg. t e a c h e r , n u r s e , homemaker, f u l l o r p a r t time s t u d e n t .  18. Do you now o r have you ever worked i n the h e a l t h care f i e l d ? No Yes. What i s (was) the name o f your job? eg. n u r s e , p h y s i o - t h e r a p i s t , etc.  19. How o l d were you a t your l a s t b i r t h d a y ? 19 o r younger 20-29 30-39 40-49 50-59 60 o r o l d e r  THANK YOU!  Your h e l p i n f i l l i n g  out t h i s form i s i n v a l u a b l e .  P l e a s e r e t u r n your completed form c/o I n g r i d Armstrong t o the A d u l t Education b u i l d i n g a t 5760 Toronto Road i n the envelope p r o v i d e d AS^SODN AS POSSIBLE. A l l forms s h o u l d b e . r e t u r n e d by MARCH 18, 1983.  

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