As a means for early detection of breast cancer, breast self-examination (BSE) has shown that cancer may be discovered at anytime. Most women accept the idea that breast cancer may happen to any of them, yet at the same time, some of them fear discovering the disease. Although researchers have studied the determinants of BSE, there has been relatively little understanding about the motivation of women to learn breast self-examination.
A more in-depth exploration of women's experiences in relation to BSE might provide an insight into their behavioral choices. Therefore, we have attempted to explore the reasons why women want to learn BSE skills, as well as explore and illustrate the patterns of how women make the decision to learn this technique. The research questions involved were 2-fold: (a) what are the overall approaches that women decide to enter a BSE training program? (b) what are the personal and social factors related to the motivation for making the decision? For this study, an overall approach was defined as a general way in which a person cognitively addresses a given decision-making task.
] announced that women no longer need to examine their breasts. This has influenced the policies of some medical organizations, such as the American Cancer Society (ACS). For years, the ACS recommended that BSE conducted on a monthly basis was an important means of early cancer detection. Now the ACS promotes mammography for routine cancer screening rather than BSE [2
]. Women's decision making about BSE was complicated by being provided with paradoxical advice from health professionals or other sources of information. For example, the guidelines from the Department of Health in Taiwan encouraged women to do BSE monthly, but the media and physicians only encouraged women to participate in an annual examination in the hospital with clinical palpation or mammography, and purposely told their clients that the monthly BSE might be useless. These inconsistent guidelines increased the uncertainty of women making a decision regarding BSE.
Motivation is defined as an internal state or condition that serves to activate or energize behavior [3
]. For example, seeking a sense of security often arouses the inner drive into an action of decision-making. In the healthcare field, steps involved in making a decision may be remembered using the mnemonic BRAND, which includes benefits of the action; risks in the action; alternatives to the prospective action; nothing: that is, doing nothing at all; and decision [4
]. These steps also explained how the surrounding sources or information from the media and physicians could make such an impact in women's attitude to BSE.
BSE is represented as an opportunity for having some control in the face of a potentially life-threatening disorder. Vahabi and Gastaldo [5
] noted that the logical behavior based on our current understanding of prevention is one of a philosophy of risk that incorporates a secularized approach to life where events do not simply happen without warning, but can be predicted, i.e. individuals should plan for the future and take judicious steps to ensure protection against misfortune, whilst retaining responsibility for their affairs.
Thus, the underlying assumption behind this philosophy is that women must have knowledge of their potential and covert possibility of breast cancer in order to protect themselves. According to Rothman and Kiviniemi [5
], people's knowledge about health risks and the benefits of taking protective action is the driving force in their decision making. By extension, efforts directed at appraising people's decisions consider that human beings are rational, with a fundamental goal of maintaining or enhancing their health.
There has been little research published on how women make decisions regarding BSE. Most researchers have focused on factors associated with women's behavior related to BSE rather than on the decision-making process that preceded the behavior. For example, the low ratio of women who practice BSE monthly has been attributed to several other factors, such as inadequate knowledge about the risk of breast cancer and the life-saving advantages of BSE [6
]. The concept of rationality in decision-making is prevalent in substantive theories of rationality, such as the Health Belief Model (HBM). However, the HBM does not adequately give an explanation for the low rate of BSE practice [9
]. The reason for this is partly due to the fact that many studies have found little variation in the model's independent variables, i.e. most women believe that the threat of breast cancer can be high and the benefit of BSE is great. But this knowledge itself is not enough to ensure frequent and/or competent BSE practice. The inadequacy of cognitive-behavioral models to explain women's practice of BSE and the need to consider the social context in different cultures and groups have previously been recognized [9
]. However, this research did not examine how women actually took these factors into account when they considered performing or not performing BSE.
The above literature highlights the fact that BSE is a complex issue. It is not only a medical one, but a sociological one. In summary, much of the research in the field of BSE practice has focused on factors associated with BSE frequency using standardized questionnaires. Thus, ascertaining how women make decisions regarding BSE urgently requires more empirical study.