Breast cancer is the first most and common gynecologic cancer among Somali women [33]. When breast cancer is detected early, patients live longer, require less extensive treatment, and the death rate decreases [34]. Therefore, early diagnosis programs are important and BSE is one of the best methods for detecting breast problems [35]. Somalia where health-related resources are limited, and there are never cancer centers, or cancer control programs, so it is important to teach women 20 and older to do BSE [36]. This study aimed to explore which BC and BSE knowledge, beliefs, and practices of young women in Somalia Mogadishu.
The findings of the present study show that Somalian women have poor knowledge of BC. In the studies conducted with women in Saudi Arabia and Ethiopia, similar results were obtained with this study, showing that women’s knowledge of BC is not sufficient [14, 18]. Mamdouh et al. (2014) indicated that Egyptian women also had poor knowledge of BC [37]. Our finding is consistent with previous studies’ results. These results suggest that women in developing countries need education about breast cancer.
Although BSE is a simple method that does not require any invasive intervention, or any tools and can be performed in a short time, and is inexpensive, studies have shown that women do not perform breast examinations at a high rate [8, 38, 39]. It was determined in this study that more than half of the participants had never heard of BSE. Negussie et al. (2015) shows that only %16.5 of women, who are from Ethiopia, heard about BSE [40]. Contrary to these studies, the study conducted in Kenya showed that almost all of the young women had heard of Bse [41]. These results may suggest that demographic differences contribute to the inconsistent findings regarding the age and education level of the participants.
Women’s BSE knowledge was found to be poor in this study. 74.8% of women did not know BSE. Many studies conducted in regions such as Asia, Turkey, Africa, and the Arab peninsula, applications have achieved similar results to our study findings and have shown a very low knowledge of BSE (average 20%) [8, 14, 39, 42,43,44]. However, in a study conducted with female university students in Ethiopia, the rate of having good BSE knowledge was found to be 49.9% [45]. These results suggest that BSE is a less well-known practice and requires the broad participation of women to improve this situation. In addition, low living standards, lack of health awareness, and less attention to BSE due to socioeconomic disparities in access to health education may contribute to their misunderstanding of BC risk factors and BSE.
In this study, only 17.2% of women performed BSE. Similar to our study result, in a study conducted in India, the rate of female students’ BSE practice was found to be 17% [46]. In line with this result, 31.7% of women in Iraq [47]. 34.9% of women in Ethiopia performed BSE [48]. However, Kratzke et al. conducted a study with women of college age in the United States, obtained slightly better results in contrast to these studies, and stated that the rate of BSE application was 55% [49]. These results consider that low-performance rates can be associated with regional and cultural differences, and women of college age feel healthy and therefore do not need to perform BSE.
According to HBM, women who sense themselves to be susceptible to BC (perceived susceptibility) and who also think that BC is a serious disease (perceived seriousness) are most likely to practice regular BSE. The effect of health beliefs on breast cancer screening of women is important and has been analyzed with this aspect in many studies [20, 50]. The socio-demographic characteristics of individuals can affect their health-related behaviors and attitudes [14]. When sociodemographic characteristics and CHBMS sub-dimensions were compared, our finding showed that a significant difference was found between the sensitivity perception and health motivation sub-dimensions of CHBMS with an economic income. Kirag and Kızılkaya stated in their studies that there is a relationship between economic income and BSE benefits, barriers, and self-efficacy sub-dimensions [51]. These results suggest that economic income is not only effective in receiving healthcare services but also in applying health screenings. In our study, it was determined that there was a significant relationship between marital status and the perception of benefits sub-dimensions of CHBMS. However, in another study, they stated that there was a significant difference in the perception of sensitivity as well as the perception of benefits sub-dimensions of CHBMS [52]. According to these results, married participants think that BSE can be beneficial for early diagnosis. However, in the present study, age, working, and education status was not significant with sub-dimensions of CHBMS. This was also the situation for having children and the number of children.
The literature states that women’s knowledge of BC has a favorable impact on BSE practice. Most women apply to health institutions in the advanced stages of the disease because of their insufficient knowledge about BC and their unawareness of screening methods [14]. In this study, a significant difference was found between women’s knowledge about BC and the CHBMS sub-dimensions of health motivation, barriers, and perception of self-efficacy. In the present study, participants who know BC have high health motivation and confidence perception, and low barrier perception. Erbil and Bölükbaş found that scores of benefits, barriers, confidence, and health motivation sub-dimensions of women who knew BC were statistically significant. In another study conducted in Turkey, unlike these studies, they stated that the participants’ knowledge about BC was only related to their health motivation subscale. These results support the literature and suggest that women’s BC knowledge affects women’s health beliefs, increasing their self-confidence and health motivation in doing BSE.
In our study, a significant difference was found between the participants’ status of hearing BSE before and the subscales of health motivation, BSE benefits, self-efficacy, and total means of scoring CHBMS. In the study conducted with female teachers in Ethiopia, the rate of hearing about BSE was found to be only 16.5%, but no comparison was made with the total means of score CHBMS [40]. These findings suggest that hearing BSE raises awareness about BSE in women and affects health beliefs in doing BSE.
In our study, it was determined that the mean total scores of CHBMS of the participants who knew BSE were high, and a significant difference was found between them. Furthermore, there was no difference between the CHBMS sub-dimensions mean scores of the participants and their knowledge about BSE. Fry and Dunn (2006) showed that the total scores of CHBMS of women who knew BSE were higher than for women who had not acknowledged it [53]. This result is similar to this study. Contrary to these studies, Erbil and Bölükbaş found a significant relationship between women’s knowledge about BSE and the benefits, barriers, confidence, and health motivation sub-dimensions of CHBMS [54].
HBM, there is a positive correlation between practice BSE and health motivation, sensitivity, seriousness, and benefits perceptions, and negative correlations with barriers perceptions [55]. In this study, perceived severity, health motivation, and barriers were not significantly related to BSE practice. However, increased perceived sensitivity, benefits, and self-efficacy were significantly associated with them. Similarly, some studies have shown that women’s higher levels of perceived sensitivity are associated with higher BSE performance [14, 26]. Gözum and Aydın [26] found in their study that perceived benefits as an important determining factor for Turkish women in performing BSE. In contrast, Foxall et al. [56] didn’t find a relation between BSE practice and perceived susceptibility or benefits. These findings propose that women should apply BSE if they are susceptible to breast cancer and might have information about the severity of the disease. In this study, the fact that the participants had insufficient knowledge about BSE and that those who practiced BSE were negligible may suggest that they had low perceptions of sensitivity and seriousness, and high perceptions of BSE barriers. There is a need to increase the sensitivity perceptions and decrease the barriers perceptions of Somali women and to determine the factors affecting their sensitivity through different studies.
Knowing how to do BSE and performing it correctly is important for the effectiveness of the examination. In addition, knowing how to do it affects the situation of performing BSE [14]. Only 16% of the women participating in our study know how to do BSE. The sensitivity, BSE benefits, and BSE self-efficacy of women who knew how BSE was performed were found to be significant and high. The fact that women know how to do BSE affects BSE benefits perception and BSE self-efficacy. Abolfotouh et all. In their study with Saudi women, they determined that among the noticed causes for not performing BSE was not knowing how to examine their breasts or not trusting that they could do it [14]. It is thought that it will be effective to explain how breast examination will be done in the BSE training to be given, by showing it on the practical or training materials. Because knowing how to do BSE is an important condition as it will increase the number of women who do it. At the same time, it is thought that knowing how to do BSE will increase women’s confidence and self-efficacy in their health beliefs.
It is very important for women to know about the early diagnosis and treatment of BC and to have information regarding the hazards and advantages of early diagnosis in terms of BC prognosis. Knowing the early diagnosis has a positive effect on the implementation of BSE. At the same time, it has been determined that women’s knowledge of early diagnosis of BC affects women’s health beliefs, attitudes, and behaviors positively [14, 54]. In our study, although the number of women who knew about the early diagnosis of breast cancer was quite low, it was seen that those who knew had a positive effect on BSE benefits perception and BSE self-efficacy. It is thought that providing breast health programs for women by health professionals and including early diagnosis and diagnosis of breast cancer in these programs will help women gain good health behaviors and maintain their health. It is thought that there is a lack of health education, especially in these societies for breast cancer, which is common in African women, and that health programs should be increased.
WHO has declared that women should have CBE once a year, but more frequently in risky situations [57] In our study, the number of women who had CBE was very low. However, it was determined that the mean CHBMS score of women who had clinical breast examination was high and significant, no significant difference was found with the scale sub-dimensions. Like our study, Darvishpour et all. ın their study with Iranian women, no significant difference was found between the scale sub-dimensions of women who had clinical breast examinations. It was determined that none of the health belief model subscales were effective in increasing CBE performance. [58]. However, in the study of Hajian-Tilaki and Auladi with Iranian women, the perception of benefits, trust, and health motivation sub-dimensions of those who had CBE were found to be significant. They determined that the perception of benefits, confidence, e, and high health motivation affect BCEperformancee [51]. In the study of Kırağı and Kızılkaya with Turkish academic women, it was determined that female academician women who had clinical breast examinations had higher self-efficacy than women who did not [28]. It is thought that women’s clinical breast examination affects their health beliefs.