Background
Breast cancer is a major public health problem in both developed and developing countries. It is the second leading cause of cancer death in women around the world [
1]. In Iran, breast cancer remains the first most common cancer among women. Research has demonstrated that Iranian females are affected by breast cancer at least one decade earlier than women in developed countries [
2]. The breast cancer incidence rate among Iranian women is 24.6% of all cancers, and most of the women (67.6%) are aged between 35 and 60 years old [
3]. Multiple risk factors may enhance the odds of developing breast cancer, but lifestyle factors seem to have a larger impact on it. Prevention has been proposed as an effective method to reduce the burden of breast cancer [
4,
5]. Furthermore, a health-promoting lifestyle has been recommended for breast cancer prevention [
6].
Health promotion is a process of enabling people to increase control over and to improve their health. Health promotion is not only the responsibility of the health sector, but it is also the duty of society members [
7]. Engaging in health-promoting lifestyles is among the principal determinants of improving health that have been identified as crucial in the prevention of diseases. Changing unhealthy lifestyle behaviors into healthy ones can prevent many diseases, like various forms of cancer [
8,
9]. Health-promoting lifestyles can be considered multidimensional in nature because they involve several aspects of a person’s daily life patterns, including nutritional habits, leisure activities, smoking frequency, regular exercise, stress management, and health [
10].
Lifestyle behaviors impact people’s health status. Therefore, a health preventive lifestyle can be considered a main approach to keeping and improving women’s health and managing breast cancer [
11]. In addition, women’s health affects the health status of other family members. Due to sociocultural factors, health-promoting lifestyles among women have been shown to be different between countries [
12]. At the individual level, personal, social, economic, and environmental factors have been found to be related to a person’s health status and health-promoting lifestyle condition. At a broader level, health-promoting lifestyles seem to be affected by social and cultural norms, mass media, national health policies, and environmental factors as well [
13‐
15].
Social support is one of the important issues associated with a health-promoting lifestyle, but the relationship between social support and women’s lifestyles, however, is complex and not extensively studied [
16]. Social support can be considered a subjective feeling of belonging; being loved, valued, and respected; and learning what is required for your personal health, not for what you can do for others [
17]. Social support also refers to the physical and emotional sources provided to people by interpersonal communication [
18]. In other words, it is an exchange of resources between two persons or more, and these resources are perceived by the provider or the receiver to improve the receiver’s health [
19,
20]. According to Toronton and colleagues (2006), social support consists of three key dimensions: an informational dimension (like advice or guidance), an emotional dimension (such as feeling loved, esteemed, and valued), and an instrumental dimension (like tangible assistance) [
21]. Most often, a positive association is found between social support and health-promoting lifestyles [
19], though some studies failed to find a significant association [
16]. However, it is generally accepted that social support is an essential aspect that influences a health-promoting lifestyle, aside from buffering the effects of stressful events on a person’s quality of life [
22].
The rates of breast cancer in Iranian women are increasing, and to the best of our knowledge, no study—either qualitatively or quantitatively—has investigated the associations between a health-promoting lifestyle, perceived social support, and breast cancer prevention. Understanding the effects of women’s health-promoting lifestyles on breast cancer prevention and the association with social support and sociodemographic factors will make it possible to design breast cancer prevention programs in this social group, which will in turn improve women’s quality of life.
The present study protocol is designed to disentangle the different aspects of someone’s healthy lifestyle to prevent breast cancer in Iranian women. This knowledge might help health experts and policy makers plan and allocate resources to priorities that facilitate the enhancement of women’s health. The majority of studies about health-promoting lifestyles have been conducted by applying a quantitative approach. To date, there is need for qualitative information about Iranian women’s experiences of social support and healthy lifestyles used to prevent breast cancer [
23]. Additionally, none of the existing studies have applied a mixed-methods approach to gain a better comprehension of health-promoting lifestyle and their association with social support experienced by Iranian women for the purpose of developing strategies for breast cancer prevention.
The aims of the study
A mixed-methods approach will be applied to determine the factors associated with a healthy lifestyle, which in turn affects breast cancer. Aside from sociodemographic characteristics and perceived social support, our study will explore women’s experiences regarding healthy lifestyle for preventing breast cancer. On the basis of the achieved data, general and cultural approaches will be suggested to promote a breast cancer prevention lifestyle for Iranian women.
The specific objectives of the study are below:
1.
To explore how Iranian women experience breast cancer prevention.
2.
To explore healthy lifestyles of women and their association with breast cancer prevention.
3.
To explore the perceived social support of Iranian women and its association with breast cancer prevention.
4.
To determine the influence of women’s sociodemographic characteristics and the perceived social support that influences a healthy lifestyle, which in turn influences breast cancer.
5.
To suggest breast cancer preventive strategies for Iranian women.
Discussion
Breast cancer is a major public health problem that affects many women. The onset of breast cancer in Iranian females occurs, on average, at least one decade earlier than in women in developed countries [
2]. The aim of the present study is to provide valuable information about a healthy lifestyle for Iranian women and breast cancer prevention through a cultural approach. To develop breast cancer preventive strategies as well as promote healthy lifestyle strategies, a qualitative and quantitative study, a literature review about related issues in a health-promoting lifestyle, and an NGT among specialists will be performed. The NGT technique has some advantages, including the instant diffusion of outcomes to the group, which promotes consent to membership, and the very structured aspect of the process, which reduces investigator bias in comparison with other techniques, such as focus groups, Delphi, or brainstorming techniques [
37].
The findings of the present study may assist health experts and policy makers to recognize the vital role of cultural and operational strategies in breast cancer prevention as well as women’s needs in this area. Furthermore, the results of this study will enhance our understanding about women’s perspectives of the factors that influence their preventive lifestyle. The study can also lead to strategies to increase Iranian women’s behaviors related to breast cancer prevention and, in turn, those of their family members.
Acknowledgments
We would like to thank for helping received from the Department of Health Education & Promotion, School of Health, Tehran University of Medical Sciences (TUMS).