{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T07:21:45Z","timestamp":1771053705640,"version":"3.50.1"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T00:00:00Z","timestamp":1679616000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Key Projects of Science Research in Colleges in Anhui Province, China","award":["SK2018A1074 and SK2020A0348"],"award-info":[{"award-number":["SK2018A1074 and SK2020A0348"]}]},{"name":"Anhui Provincial Colleges and Universities Ideological and Political Work Ability Improvement Project","award":["sztsjh2019-7-14"],"award-info":[{"award-number":["sztsjh2019-7-14"]}]},{"name":"the Key Projects of Teaching Research for Colleges and Universities in Anhui Province, China","award":["2020jyxm1174"],"award-info":[{"award-number":["2020jyxm1174"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>This study aimed to establish a structural equation model to determine the associations among knowledge of breast cancer, beliefs about breast self-examination (BSE), BSE practice, socio-economic status (SES), and barriers to BSE among Eastern Chinese women.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>An online cross-sectional correlational survey of 2026 women from Eastern China was undertaken by a self-administered questionnaire in 2020. Structural equation modeling was utilized for examining the interrelationships between BSE barriers and other variables.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Our results suggested that BSE barriers were significantly and negatively related to SES, BSE beliefs, and BSE practices (<jats:italic>\u03b2 =<\/jats:italic> -0.176, <jats:italic>p<\/jats:italic> &lt; 0.001 and <jats:italic>\u03b2 =<\/jats:italic> -0.118, <jats:italic>p<\/jats:italic> &lt; 0.001 and <jats:italic>\u03b2 =<\/jats:italic> -0.435, <jats:italic>p<\/jats:italic> &lt; 0.001, respectively). Among them, participants\u2019 BSE practices had the strongest effects on BSE barriers, while the effect of breast cancer knowledge on BSE barriers was in an opposite direction (<jats:italic>\u03b2 =<\/jats:italic> 0.177, <jats:italic>p &lt;<\/jats:italic> 0.001).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>BSE barriers were influenced by SES, breast cancer knowledge, BSE beliefs and BSE practices. Our results warn that breast cancer prevention education should strengthen knowledge of practical methods rather than general knowledge. Therefore, intervention strategies designed to develop BSE and breast cancer prevention should take into account multiple factors, in particular finding more effective ways for the public to turn knowledge into a motivator rather than a barrier.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0283525","type":"journal-article","created":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T17:32:37Z","timestamp":1679679157000},"page":"e0283525","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Structural equation modeling analysis of determinants of barriers to breast self-examination among Eastern Chinese women"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6117-021X","authenticated-orcid":true,"given":"Jianwei","family":"Yu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yizheng","family":"Gao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hairuo","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Binghao","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3221-3628","authenticated-orcid":true,"given":"Shunhua","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,3,24]]},"reference":[{"issue":"3","key":"pone.0283525.ref001","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"H Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"issue":"2","key":"pone.0283525.ref002","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1007\/s10549-008-0303-z","article-title":"Breast cancer in a transitional society over 18 years: trends and present status in Shanghai, China","volume":"117","author":"L Fan","year":"2009","journal-title":"Breast Cancer Res Treat"},{"issue":"2","key":"pone.0283525.ref003","doi-asserted-by":"crossref","first-page":"115","DOI":"10.3322\/caac.21338","article-title":"Cancer statistics in China, 2015","volume":"66","author":"W Chen","year":"2016","journal-title":"CA Cancer J Clin"},{"issue":"5","key":"pone.0283525.ref004","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1089\/jwh.2006.15.520","article-title":"Health beliefs and rates of breast cancer screening among Arab women","volume":"15","author":"F Azaiza","year":"2006","journal-title":"J Womens Health"},{"issue":"1","key":"pone.0283525.ref005","doi-asserted-by":"crossref","first-page":"e139","DOI":"10.1016\/j.whi.2013.11.005","article-title":"Longitudinal patterns of breast cancer screening: mammography, clinical, and breast self-examinations in a rural and urban setting","volume":"24","author":"J Leung","year":"2014","journal-title":"Womens Health Issues"},{"key":"pone.0283525.ref006","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s13104-015-1004-4","article-title":"Knowledge, attitude and practice of breast self-examination among female undergraduate students in the University of Buea","volume":"8","author":"FP Nde","year":"2015","journal-title":"BMC Res Notes"},{"issue":"4","key":"pone.0283525.ref007","doi-asserted-by":"crossref","first-page":"244","DOI":"10.6061\/clinics\/2017(04)09","article-title":"Breast cancer screening in developing countries","volume":"72","author":"RA da Costa Vieira","year":"2017","journal-title":"Clinics"},{"issue":"1","key":"pone.0283525.ref008","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1186\/s12889-019-7951-2","article-title":"Determinants of breast self-examination practice among women in Surabaya, Indonesia: an application of the health belief model","volume":"19","author":"TK Dewi","year":"2019","journal-title":"BMC Public Health"},{"issue":"9","key":"pone.0283525.ref009","first-page":"1205","article-title":"Effect of breast self-examination techniques on the risk of death from breast cancer","volume":"157","author":"BJ Harvey","year":"1997","journal-title":"CMAJ"},{"issue":"4","key":"pone.0283525.ref010","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1093\/jnci\/83.4.260","article-title":"Breast self-examination in relation to the occurrence of advanced breast cancer","volume":"83","author":"PA Newcomb","year":"1991","journal-title":"J Natl Cancer Inst"},{"issue":"7","key":"pone.0283525.ref011","doi-asserted-by":"crossref","first-page":"e279","DOI":"10.1016\/S1470-2045(13)70567-9","article-title":"Breast cancer in China","volume":"15","author":"L Fan","year":"2014","journal-title":"Lancet Oncol"},{"issue":"2","key":"pone.0283525.ref012","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1111\/jog.14550","article-title":"Structural equation modeling to detect predictors of breast self-examination behavior: Implications for intervention planning","volume":"47","author":"N Ju","year":"2021","journal-title":"J Obstet Gynaecol Res"},{"issue":"3","key":"pone.0283525.ref013","doi-asserted-by":"crossref","first-page":"185","DOI":"10.4103\/0300-1652.160362","article-title":"Predictors of breast self-examination as cancer prevention practice among women of reproductive age-group in a rural town in Nigeria","volume":"56","author":"OE Amoran","year":"2015","journal-title":"Niger Med J"},{"issue":"3","key":"pone.0283525.ref014","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.7314\/APJCP.2016.17.3.1463","article-title":"Breast Cancer Knowledge, Perception and Breast Self- Examination Practices among Yemeni Women: an Application of the Health Belief Model","volume":"17","author":"KA Al-Sakkaf","year":"2016","journal-title":"Asian Pac J Cancer Prev"},{"issue":"1","key":"pone.0283525.ref015","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1186\/s13104-018-3731-9","article-title":"Breast self-examination practice and associated factors among women aged 20\u201370 years attending public health institutions of Adwa town, North Ethiopia","volume":"11","author":"M Abay","year":"2018","journal-title":"BMC Res Notes"},{"issue":"8","key":"pone.0283525.ref016","doi-asserted-by":"crossref","first-page":"e0221356","DOI":"10.1371\/journal.pone.0221356","article-title":"Assessment of breast self- examination practice and associated factors among female workers in Debre Tabor Town public health facilities, North West Ethiopia, 2018: Cross- sectional study","volume":"14","author":"AH Dagne","year":"2019","journal-title":"PLoS One"},{"key":"pone.0283525.ref017","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1186\/s40064-015-1491-8","article-title":"Barriers to breast self examination practice among Malaysian female students: a cross sectional study","volume":"4","author":"M Akhtari-Zavare","year":"2015","journal-title":"Springerplus"},{"issue":"4","key":"pone.0283525.ref018","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1046\/j.1524-4741.2000.99016.x","article-title":"Socioeconomic Factors, not Ethnicity, Predict Breast Self-Examination","volume":"6","author":"AK Madan","year":"2000","journal-title":"Breast J"},{"issue":"4","key":"pone.0283525.ref019","first-page":"618","article-title":"Socioeconomic factors association with knowledge and practice of breast self-examination among Iranian women","volume":"8","author":"P Yavari","year":"2007","journal-title":"Asian Pac J Cancer Prev"},{"issue":"11","key":"pone.0283525.ref020","doi-asserted-by":"crossref","first-page":"e012753","DOI":"10.1136\/bmjopen-2016-012753","article-title":"Life-course socioeconomic status and breast and cervical cancer screening: analysis of the WHO\u2019s Study on Global Ageing and Adult Health (SAGE)","volume":"6","author":"T Akinyemiju","year":"2016","journal-title":"BMJ Open"},{"issue":"5","key":"pone.0283525.ref021","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/0091-7435(86)90025-3","article-title":"Health promotion and the knowledge-attitude-behavior continuum","volume":"15","author":"EP Bettinghaus","year":"1986","journal-title":"Prev Med"},{"issue":"9","key":"pone.0283525.ref022","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1177\/0022034510372896","article-title":"Behavioral pathways explaining oral health disparity in children","volume":"89","author":"XL Gao","year":"2010","journal-title":"J Dent Res"},{"issue":"1","key":"pone.0283525.ref023","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1186\/s12903-019-0787-4","article-title":"Structural equation modelling for associated factors with dental caries among 3-5-year-old children: a cross-sectional study","volume":"19","author":"Y Qin","year":"2019","journal-title":"BMC Oral Health"},{"key":"pone.0283525.ref024","doi-asserted-by":"crossref","first-page":"1936","DOI":"10.3389\/fpsyg.2018.01936","article-title":"Editorial: Recent Advancements in Structural Equation Modeling (SEM): From Both Methodological and Application Perspectives","volume":"9","author":"OM Kwok","year":"2018","journal-title":"Front Psychol"},{"issue":"1","key":"pone.0283525.ref025","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1186\/s12903-021-01419-0","article-title":"Relationship between oral health-related knowledge, attitudes, practice, self-rated oral health and oral health-related quality of life among Chinese college students: a structural equation modeling approach","volume":"21","author":"S Zheng","year":"2021","journal-title":"BMC Oral Health"},{"issue":"4","key":"pone.0283525.ref026","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1111\/nhs.12533","article-title":"Breast cancer screening behaviors among Chinese women in Mainland China","volume":"20","author":"Y Bao","year":"2018","journal-title":"Nurs Health Sci"},{"issue":"1","key":"pone.0283525.ref027","doi-asserted-by":"crossref","first-page":"e0245856","DOI":"10.1371\/journal.pone.0245856","article-title":"Factors associated with breast cancer screening intention in Kathmandu Valley, Nepal","volume":"16","author":"D Bhandari","year":"2021","journal-title":"PLoS One"},{"issue":"6","key":"pone.0283525.ref028","doi-asserted-by":"crossref","first-page":"e0253373","DOI":"10.1371\/journal.pone.0253373","article-title":"Breast cancer awareness, risk factors and screening practices among future health professionals in Ghana: A cross-sectional study","volume":"16","author":"S Osei-Afriyie","year":"2021","journal-title":"PLoS One"},{"issue":"1","key":"pone.0283525.ref029","doi-asserted-by":"crossref","first-page":"1073274819862788","DOI":"10.1177\/1073274819862788","article-title":"Breast Self-Examination: Knowledge and Practice Among Female Textile Workers in Vietnam","volume":"26","author":"DQ Tuyen","year":"2019","journal-title":"Cancer Control"},{"issue":"1","key":"pone.0283525.ref030","doi-asserted-by":"crossref","first-page":"e0262030","DOI":"10.1371\/journal.pone.0262030","article-title":"A national survey to assess breast cancer awareness among the female university students of Pakistan","volume":"17","author":"I Hussain","year":"2022","journal-title":"PLoS One"},{"issue":"15","key":"pone.0283525.ref031","doi-asserted-by":"crossref","first-page":"6697","DOI":"10.7314\/APJCP.2015.16.15.6697","article-title":"Differences in Breast and Cervical Cancer Screening Rates in Jordan among Women from Different Socioeconomic Strata: Analysis of the 2012 Population-Based Household Survey","volume":"16","author":"R Al Rifai","year":"2015","journal-title":"Asian Pac J Cancer Prev"},{"issue":"11","key":"pone.0283525.ref032","doi-asserted-by":"crossref","first-page":"e0225667","DOI":"10.1371\/journal.pone.0225667","article-title":"Socioeconomic determinants of cancer screening utilisation in Latin America: A systematic review","volume":"14","author":"B Nuche-Berenguer","year":"2019","journal-title":"PLoS One"},{"issue":"1","key":"pone.0283525.ref033","doi-asserted-by":"crossref","first-page":"e005596","DOI":"10.1136\/bmjopen-2014-005596","article-title":"Do socioeconomic factors influence breast cancer screening practices among Arab women in Qatar?","volume":"5","author":"TT Donnelly","year":"2015","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0283525.ref034","first-page":"121","article-title":"Beliefs and Behavior of Saudi Women in the University of Tabuk Toward Breast Self Examination Practice","volume":"19","author":"A Gonzales","year":"2018","journal-title":"Asian Pac J Cancer Prev"},{"issue":"1","key":"pone.0283525.ref035","doi-asserted-by":"crossref","first-page":"155","DOI":"10.7314\/APJCP.2014.15.1.155","article-title":"Turkish female academician self-esteem and health beliefs for breast cancer screening","volume":"15","author":"IA Avci","year":"2014","journal-title":"Asian Pac J Cancer Prev"},{"issue":"2","key":"pone.0283525.ref036","doi-asserted-by":"crossref","first-page":"268","DOI":"10.4103\/0973-1482.188433","article-title":"Breast cancer screening practices amongst female tertiary health worker","volume":"13","author":"CI Madubogwu","year":"2017","journal-title":"Nnewi. J Cancer Res Ther"},{"issue":"2","key":"pone.0283525.ref037","doi-asserted-by":"crossref","first-page":"108","DOI":"10.4103\/ijnmr.IJNMR_94_18","article-title":"Barriers to Breast Self-examination among Iranian Women","volume":"24","author":"F Taleghani","year":"2019","journal-title":"Iran J Nurs Midwifery Res"},{"key":"pone.0283525.ref038","doi-asserted-by":"crossref","first-page":"2928901","DOI":"10.1155\/2019\/2928901","article-title":"A Community-Based Assessment of Knowledge and Practice of Breast Self-Examination and Prevalence of Breast Disease in Southwest Cameroon","volume":"2019","author":"K Azemfac","year":"2019","journal-title":"J Cancer Epidemiol"},{"key":"pone.0283525.ref039","first-page":"6490156","article-title":"Knowledge, Attitudes, and Behaviors about Breast Self-Examination and Mammography among Female Primary Healthcare Workers in Diyarbakir","volume":"2016","author":"O Erdem","year":"2016","journal-title":"Turkey. Biomed Res Int"},{"issue":"12","key":"pone.0283525.ref040","doi-asserted-by":"crossref","first-page":"1982","DOI":"10.1111\/jog.12819","article-title":"Predictors affecting breast self-examination practice among undergraduate female students in Klang Valley, Malaysia","volume":"41","author":"M Akhtari-Zavare","year":"2015","journal-title":"J Obstet Gynaecol Res"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0283525","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T17:33:23Z","timestamp":1679679203000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0283525"}},"subtitle":[],"editor":[{"given":"Sun Kyung","family":"Kim","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2023,3,24]]},"references-count":40,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,3,24]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0283525","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,24]]}}}