This study undertakes an evaluation of the effects of six BSE instruction techniques on subsequent frequency and proficiency of BSE practice. Women attending the AMC Cancer Research Center BreastScreen Clinic for mammographic screening will be randomly assigned to one of six treatment conditions; 1) BSE video with a celebrity narrator; 2) instruction with the CANGUARD Breast Self-examination kit; 3) BSE video with a celebrity narrator paired with demonstration of the BSE technique on the women's own breasts; 4) BSE video with celebrity narrator and a take-home ShowerCard to remind women of the BSE steps; 5) BSE video with a celebrity narrator. ShowerCard, and take- home monthly reminder cue to action for BSE; and 6) demonstrations of the BSE technique on the women's own breasts supplemented by the CANGUARD Breast Self-examination kit. Frequency and proficiency of BSE technique will be evaluated prior to the instructional interventions through a multiple item self-report questionnaire. The questionnaire will also include questions assessing dimensions of three theoretical models of health behavior: 1) Resenstock's Health Belief Model; 2) Fishbein and Ajzen's Theory of Reasoned Action; and 3) the Main Effect Social Support model. The ability of these theoretical models of involvement in preventive health behaviors to predict BSE behavior will be evaluated. Demographic variables and questions on personal and family health history for breast problems will also be examined as predictors of BSE frequency and proficiency. Post-intervention assessment of BSE behavior will take place at 12 and 18 months. Multiple self-report items will be used to assess post-intervention frequency as well as proficiency. The self-report measures of proficiency will be verified by third-party observation of BSE technique for a 10% random sample of women drawn from the total group of study participants. The analysis plan for this investigation includes repeated measures analysis of variance to evaluate changes in frequency and proficiency over time within a particular group, analysis of variance to compare differences in frequency and proficiency of BSE practice between each of the treatment groups, and multiple regression and discriminant analysis to identify those variables that differentiate between performers and non-performers of BSE as well as between proficient and non-proficient performers of BSE.
