The impact of an education program on increasing early detection tests, knowledge, and beliefs related to breast cancer among Yemeni female school teachers in Klang Valley, Malaysia.

1. Brief name: An educational program on breast cancer screening 2. The rationale of the educational program: Many educational programs that were grounded based on the health belief model have shown improvement in the practice of breast cancer early detection behaviors among participants. 3. Materials used in the educational program: The intervention group received a behavior change educational program developed based on American Cancer Society (2015), American Congress of Obstetricians and Gynecologists (2015), and International Agency for Research on Cancer (IARC) (2008). The educational program package includes 90 minutes, which composed of: i) The power-point presentation last for 60 minutes, presented along with: five minutes short film about breast self-examination (BSE) performance, and another five minutes short film testimony for one of the breast cancer survivor. ii) The training session was performed within thirty minutes that includes the practice of BSE on a silicon breast model with multiple implanted lumps. iii) A dissemination of a booklet, a CD copy of the five minutes short film about BSE performance, and a breast cancer logo sticker. iv) All participants in the intervention group will continue to receive short reminder text messages for 6 months. 4. Describe procedure: i) 60 minutes Power-point presentation was implemented by the researcher, and presented along with five minutes short film about BSE performance, and another five minutes short film testimony for one of the breast cancer survivor. That addressed general information of anatomy and physiology of a normal breast, breast cancer knowledge, learning about the different methods of breast cancer screening, and the importance of breast health awareness. ii) A training session that was performed within thirty minutes, which included the practice of BSE on a silicon breast model with multiple implanted lumps. During this section, teachers learned search strategy, palpation technique and signs of breast cancer that should be used when examining the breasts. Following this, the participants were asked to practice on the model and look for any lumps and abnormalities. iii) At the end of the educational program, there was a dissemination of a booklet containing all the information that was delivered in the education program, a CD copy of the five minutes short film about BSE performance, and a breast cancer logo sticker to be hanged in the participants mirrors to remind them of the importance of breast cancer screening practices, monthly BSE performance, and to reinforce the messages. iv) All participants in the intervention group will continue to receive short reminder text messages for 6 months. The key messages addressed recommendations about breast cancer screening behaviors to encourage participants of practicing breast cancer screening behaviors. 5. Who provided: Only the study researcher delivered the educational program. Selection criteria for the researcher include receiving and supervision one day of training on BSE performance skills specific to the trial from an experienced medical doctor, and a master certificate of community health science. For the training session, the procedure is simple, the researcher taught the participants BSE performance skills on a silicon breast model with multiple implanted lumps, then all participants involved in the study completed the training session by independently practice the procedure on the model. 6. How: Describe the modes of delivery: Study researcher visited each of the study sites, then the education program was delivered through power point presentation and training sessions that held one time in each of the study clusters, and facilitated in groups of 18, then participants have been receiving short reminder text messages for 6 months aimed at reminding and giving them motivation to practice of early detection of breast cancer. 7. Where: Describe the type(s) of location(s) Teachers were recruited from each school where the educational program was delivered. 8. When and how much: Describe the number of times the intervention was delivered and over what period of time. The power point presentation of the educational program was delivered over 60 min, followed by the training session that was delivered over 30 min. Then, teachers have been receiving short reminder text message once a month for six months. 9. How well (planned): If intervention adherence or fidelity was assessed The educational program package session was delivered independently in each of study cluster; the researcher was adhered to a single educational program protocol to ensure standardized delivery across schools. Researcher in the study sites was trained initially on BSE performance skills. BSE training delivery was planned by the researcher and rehearsed using role-play with the participants. In addition, the researcher acted as an observer during the training sessions in each school and provided feedback to participants. Adherence to the educational program was assessed by means of the self-reported questionnaire and the BSE proficiency rating skill collected during follow-up meetings to ensure rigorous adherence to the educational program throughout the duration of the trial. Data were categorized as no practice performed or yes practice performed, and check marks were given for BSE skills performed. Skills not performed or performed incorrectly are left blank. A possible means of adhering fidelity is the monthly short reminder text messages to encourage them and to answer any inquiries, and the using of the breast cancer logo sticker to be hanged in the participants' mirrors can remind them of the importance of breast cancer screening practices, monthly BSE performance, and to reinforce the messages.