Journal of Health Literacy

Journal of Health Literacy

Breast Cancer Screening Behaviors and the Role of Specific Health Literacy: How Much and How?

Articles in Press

Document Type : Original Article

Authors
Zohreh Rahaei 1
Reyhane Sefidkar 2
Hajar Hoshyar 3
Tahere Soltani 4
1 Associate Professor of Health Education & Promotion, School of Public Health. Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
2 Assistant Professor of Center for Healthcare Data Modeling, Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
3 Master's student in Health Education and Promotion. Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
4 Assistant Professor of Health Education & Promotion, School of Public Health, Social Determinants of Health Research Center, Non-Communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
10.22038/jhl.2026.94128.1931
Abstract
Background and Objectives: Breast cancer is highly prevalent among Iranian women, yet screening participation remains suboptimal. Drawing upon integrated health literacy frameworks, this study investigated breast cancer-specific health literacy and its association with screening behaviors among women aged 30–59 years in Pasargad city, Iran.

Materials and Methods: This descriptive-analytical cross-sectional study surveyed 194 women selected via randomized stratified sampling. Data were gathered using validated demographic, mHealth Literacy (8- item), and breast cancer-specific health literacy (26-item) scales, alongside a screening behavior checklist (4-item) (BSE, CBE, and mammography). Multiple linear regression model was applied to assess relation between cancer-specific health literacy and screening behaviors.

Results: Participants' mean breast cancer-specific health literacy and mHealth literacy scores were 85 ±7.88 and 19.09 ±4.60. Breast cancer-specific health literacy scores positively correlated with education, employment, and prior health training (p<0.05). Conversely, age and number of children were inversely correlated with information evaluation and decision-making dimensions (p<0.05). breast cancer-specific health literacy remained a significant factor for screening behaviors after controlling for confounders (p=0.05). mHealth literacy showed no significant association.

Conclusion: Digital literacy alone is insufficient to drive preventive actions, highlighting the importance of mHealth literacy as a critical component of health literacy. Disease-specific health literacy acts as a critical cognitive antecedent that shapes screening behaviors by altering cognitive appraisal, modifying health knowledge, attitudes, and practice, and reducing barriers, thereby strengthening the behavioral intention required for actual screening compliance, including breast self-examination (BSE), clinical breast examination (CBE), and mammography. Health promotion programs must shift from basic information delivery toward cognitive and attitudinal restructuring to successfully bridge the gap between literacy and action and improve patient acceptance of health care.
Keywords
Breast Neoplasms
Health Literacy
mHealth Literacy
Breast Self-Examination
Mammography
Patient Acceptance of Health Care
Screening Behaviors

Acknowledgments: This study is based on an MSc thesis in Health Education and Promotion, which was approved by the Research and Technology Deputy of Shahid Sadoughi University of Medical Sciences. The authors wish to extend their appreciation to the Deputy of Research and Technology at Yazd Shahid Sadoughi University of Medical Sciences for providing financial support for the project. Additionally, the author acknowledges the research subjects for their participation, whose provision of information and time made this study possible.


Availability of Data and Materials: The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.


Conflicts of interest: The authors declare that they have no competing interests.


Consent for publication: Not applicable.


Ethical Approval and consent to participate: This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of Shahid Sadoughi University of Medical Sciences, Yazd, Iran. (IR.SSU.SPH.REC.1402.200). The study objectives were verbally explained, and the confidentiality of the collected information was assured. 


Funding: This research was carried out without external financial support.


Authors’ Contributions: T.S, Z.R, H.H, and R.S contributed to the study conception and design, data analysis, and drafting of the manuscript. H.H contributed to data collection. Z.R, and R.S contributed to statistical analysis. T.S supervised the project and All authors reviewed and approved the final version.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

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Journal of Health Literacy

Articles in Press, Accepted Manuscript
Available Online from 28 July 2026