Visual Breast Self-Examination Education in Illiterate Women

The Effect of Breast Self-Examination Education Using Visual Materials on Breast Cancer Awareness and Health Motivation Among Illiterate Women of Reproductive Age: A Study in Diyarbakır, Türkiye

Breast cancer is the most common malignancy among women and remains a major public health concern despite being largely preventable through early detection and regular screening practices. Increasing early detection rates depends on women's ability to recognize the signs and symptoms of breast cancer, perform regular breast self-examination (BSE), and maintain adequate health motivation. However, women who are illiterate and reside in rural areas generally have low levels of breast cancer awareness, which adversely affects early detection behaviors. This situation is associated with insufficient knowledge, misconceptions, limited access to healthcare services, and low health literacy. Previous studies have demonstrated that educational interventions supported by visual materials are effective in improving health awareness among individuals with low educational attainment. Therefore, this study aims to contribute to the limited literature by evaluating an intervention designed to improve breast cancer awareness among women with low literacy levels.

The study is designed for illiterate women of reproductive age (15-49 years) living in rural areas. Participants will receive breast self-examination (BSE) education using visual materials. The educational content will include breast anatomy, signs and symptoms of breast cancer, the importance of early detection, and the correct steps for performing breast self-examination. Pictures, breast models, videos, and hands-on demonstration techniques will be used throughout the educational sessions. The effectiveness of the intervention will be evaluated using a pretest-posttest design by comparing changes in breast cancer awareness and health motivation before and after the educational program. The research process will include a literature review, development of educational materials, implementation of the intervention, data collection, and statistical analysis, with the principal investigator actively involved in all phases of the study.

The study is expected to improve participants' ability to recognize the signs and symptoms of breast cancer, increase the frequency of breast self-examination, and enhance their health motivation. Furthermore, the findings are expected to support the development of community-based health education skills among midwifery students, encourage their active participation in preventive healthcare services, and strengthen their involvement in scientific research. The results may also provide evidence for planning educational programs targeting women with low educational attainment and contribute to the development of visual material-based educational strategies. Ultimately, the study is anticipated to increase women's awareness of their own health responsibilities, promote early detection behaviors, improve quality of life, and indirectly contribute to reducing breast cancer-related mortality.

Study Overview

• Status: Active, not recruiting
• Conditions: Breast Cancer; Breast Self-Examination
• Intervention / Treatment: Behavioral: Visual-based Breast Self-Examination (BSE) Education

Detailed Description

Breast cancer remains the most common cancer among women worldwide, and early detection is one of the most effective strategies for reducing mortality. However, women with limited literacy often have lower awareness of breast cancer, inadequate knowledge of breast self-examination (BSE), and reduced motivation to engage in preventive health behaviors. Traditional educational approaches that rely heavily on written information may be insufficient for this population.

This randomized controlled trial has been designed to evaluate the effectiveness of a visual educational intervention developed specifically for illiterate women of reproductive age living in rural areas. The intervention incorporates culturally appropriate visual materials, including illustrated educational brochures, demonstration videos, and a handmade amigurumi breast model to facilitate practical learning of breast self-examination techniques.

Participants allocated to the intervention group will receive structured face-to-face education delivered in three educational sessions. The sessions include information on breast anatomy, warning signs of breast cancer, the importance of early detection, recommended breast cancer screening practices, and step-by-step demonstration of breast self-examination using visual teaching materials. Interactive practice and reinforcement activities are incorporated to improve knowledge retention and skill acquisition.

Participants in the control group will receive routine health services without the structured educational intervention during the study period.

The effectiveness of the intervention will be evaluated by comparing changes in breast cancer awareness and health motivation before and after the intervention using validated measurement instruments. The findings are expected to provide evidence regarding the effectiveness of visual education strategies for improving preventive health behaviors among women with low literacy and may contribute to the development of community-based breast cancer education programs for disadvantaged populations.

• Study Type: Interventional
• Enrollment (Actual): 156
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Malatya, Turkey (Türkiye)
    • İnönü University Faculty of Health Sciences
  • Malatya, Turkey (Türkiye), 44
    • İnönü University Faculty of Health Sciences

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Able to communicate verbally No visual or hearing impairment Aged between 15 and 49 years No previously diagnosed chronic diseases (e.g., cardiovascular diseases, asthma, epilepsy, etc.) No history of breast cancer education or breast self-examination (BSE/KKMM) training within the last 21 days Female participants

Exclusion Criteria:

• Currently pregnant or planning pregnancy in the near future Presence of a family history of breast cancer Having any health condition that would prevent participation in the educational intervention

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention Group; Participants will receive a structured visual breast self-examination education program using illustrated educational materials and an amigurumi breast model, in addition to routine care.	Behavioral: Visual-based Breast Self-Examination (BSE) Education; A structured behavioral education program designed for illiterate women aged 15-49 years to improve breast cancer awareness and breast self-examination (BSE) skills. The intervention is delivered face-to-face using visual educational materials, pictorial brochures, an amigurumi breast model, and guided hands-on demonstrations. The program includes repeated teaching sessions and practical applications to reinforce learning and support behavioral change in breast health practices.; Other Names: Breast Self-Examination (BSE) Education; Visual breast cancer education program; KKMM training program
No Intervention: Control Group; Participants will receive routine care without the visual breast self-examination education during the study period.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Breast Cancer Awareness Level	Breast cancer awareness will be assessed using a validated Breast Cancer Awareness Scale. The scale evaluates participants' knowledge regarding breast cancer symptoms, early detection practices, and screening behaviors. Higher scores reflect greater levels of breast cancer awareness and knowledge.	Baseline and immediately after the 15-minute intervention session

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Health Motivation Level	Health motivation will be assessed using the Health Motivation subscale of the Champion Health Belief Model Scale. This subscale evaluates participants' motivation to engage in preventive health behaviors. Higher scores indicate greater health motivation.	Baseline and immediately after the 10-15-minute educational intervention session

Collaborators and Investigators

• Sponsor: Inonu University

Publications and helpful links

General Publications

• Al-Naggar RA, Al-Naggar DH, Bobryshev YV, Chen R, Assabri A. Practice and barriers toward breast self-examination among young Malaysian women. Asian Pac J Cancer Prev. 2011;12(5):1173-8.

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2026
• Primary Completion (Actual): June 1, 2026
• Study Completion (Estimated): January 1, 2027

Study Registration Dates

• First Submitted: July 2, 2026
• First Submitted That Met QC Criteria: July 2, 2026
• First Posted (Actual): July 9, 2026

Study Record Updates

• Last Update Posted (Actual): July 9, 2026
• Last Update Submitted That Met QC Criteria: July 2, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Breast Cancer; Midwifery; Breast Cancer Awareness; Health Motivation
• Additional Relevant MeSH Terms: Neoplasms by Site; Neoplasms; Skin Diseases; Breast Diseases; Behavior; Skin and Connective Tissue Diseases; Health Behavior; Self-Examination; Breast Neoplasms; Breast Self-Examination; Socioeconomic Factors; Population Characteristics; Educational Status
• Other Study ID Numbers: 8970

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared. The dataset generated in this study will remain confidential and will only be used for scientific reporting and publication purposes.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No