CANCER RI SK AND PREVENTI VE BEHAVI OR: PERSUASI ON AS AN
I NTERVENTI ON STRATEGY
1Mar cela Tonani2 Em ilia Cam pos de Car v alho3
Ton an i M, Car v alh o EC. Can cer r isk an d p r ev en t iv e b eh av ior : p er su asion as an in t er v en t ion st rat eg y. Rev Lat ino- am Enfer m agem 2 0 0 8 set em br o- out ubr o; 1 6 ( 5 ) : 8 6 4 - 7 0 .
The effect iveness of int ervent ions for healt h prom ot ion, prot ect ion, and early diagnosis m ay include t he process of p er su asion em p loy ed . Th is st u d y aim s t o ev alu at e t h e r isk lev el of d ev elop in g can cer , con sid er in g t h e per t inent r isk fact or s, and t he pr esence of per suasion and char act er ist ics in com m unicat ion r egar ding cancer prevent ion and early det ect ion. I t is an observat ional st udy, conduct ed am ong 110 inhabit ant s of a neighborhood in Ribeir ao Pr et o, Sao Paulo, Br azil. I t w as confir m ed t hat t her e ar e high r isks for colon/ r ect um , cer vical, and endom et rial cancer; and m oderat e risks for t he above as well as lung and breast cancer. I n t erm s of persuasion, it was observed t hat cancer inform at ion was spread but not sust ained for long periods. Moreover, t here was no reinforcem ent . I n view of cancer risk and t he ident ified prevent ive behaviors, persuasion is considered a useful st r at egy t o r educe t hese r isk s, as w ell as t o encour age and sust ain pr ev ent iv e behav ior s, since it indicat es r out es t o be follow ed.
DESCRI PTORS: per suasiv e com m unicat ion; r isk r educt ion behav ior ; pr im ar y pr ev ent ion; secondar y pr ev ent ion
RI ESGO DE CÁNCER Y COMPORTAMI ENTOS PREVENTI VOS: LA PERSUASI ÓN COMO
UNA ESTRATEGI A DE I NTERVENCI ÓN
La efect ividad de las int ervenciones de prom oción de la salud, prot ección y diagnóst ico precoz puede depender d el p r oceso d e p er su asión em p lead o. Est e est u d io b u scó ev alu ar el g r ad o d e r iesg o p ar a la ap ar ición d e cáncer, cont em plando los fact ores de riesgo pert inent es a cada t ipo, así com o la presencia y las caract eríst icas de la persuasión en la com unicación para su prevención y det ección precoz. Se t rat a de un est udio observacional, de 110 habit ant es de un bar r io de Ribeir ao Pr et o, San Pablo. Se const at ar on alt os r iesgos par a el cáncer del colon / r ect o, de cer v ix y de en dom et r io; m oder ados r iesgos par a los y a descr it os, adem ás de pu lm ón y de m am a. En cuant o a la per suasión, se obser v ó el desencadenam ient o de las infor m aciones sobr e cáncer ; sin em bar go est as n o con sigu ier on m an t en er se por lar gos per íodos, adem ás de la in ex ist en cia de r efu er zo. Se con sid er a la p er su asión u n a est r at eg ia ú t il p ar a d ism in u ir esos r iesg os y d e in cen t iv o y m an u t en ción d e com por t am ient os pr ev ent iv os, adopt ándose en t odo su pr oceso, y a que apunt a cam inos a ser r ecor r idos.
DESCRI PTORES: com unicación per suasiv a; conduct a de r educción del r iesgo; pr ev ención pr im ar ia; pr ev ención secu n d ar ia
RI SCO DE CÂNCER E COMPORTAMENTOS PREVENTI VOS: A PERSUASÃO COMO
ESTRATÉGI A DE I NTERVENÇÃO
A ef et iv idade das in t er v en ções de pr om oção da saú de, pr ot eção e diagn óst ico pr ecoce pode con t ar com o pr ocesso de per suasão em pr egado. Est e est udo buscou av aliar o gr au de r isco par a apr esent ação de câncer , con t em p lan d o os f at or es d e r isco p er t in en t es a cad a t ip o, b em com o a p r esen ça e as car act er íst icas d a per suasão na com unicação par a a pr ev enção e det ecção pr ecoce. Tr at a- se de est udo obser v acional, de 1 1 0 h ab it an t es d e u m b air r o d e Rib eir ão Pr et o, SP. Con st at ou - se alt os r iscos p ar a cân cer es d e cólon / r et o, d e cérvice e de endom ét rio; m oderados riscos para os j á descrit os, além de pulm ão e m am a. Quant o à persuasão, con st at ou - se d esen cad eam en t o d as in f or m ações sob r e cân cer , m as essas n ão con segu ir am m an t er - se p or lon gos per íodos, além da in ex ist ên cia de r ef or ço. Con sider a- se a per su asão est r at égia ú t il par a dim in u ição desses r iscos e de incent iv o e m anut enção de com por t am ent os pr ev ent iv os, se adot ado t odo o seu pr ocesso, j á que apont a cam inhos a ser em per cor r idos.
DESCRI TORES: com unicação per suasiv a; com por t am ent o de r edução do r isco; pr ev enção pr im ár ia; pr ev enção secu n d ár ia
1 Paper ext ract ed from Mast er ’s Thesis. Research funded by Brazilian council for Scient ific and Technological Developm ent , CNPq, Brazil; 2 RN, M.Sc. in
Nursing; 3 Full Professor, Universit y of Sao Paulo at Ribeirao Pret o College of Nursing, WHO Collaborat ing Cent er for Nursing Research Developm ent , Brazil, e- m ail: ecdcava@usp.br.
I NTRODUCTI ON
C
an cer h as b een cl assi f i ed as a ch r o n ic-d e g e n e r a t i v e c-d i s e a s e , p r e s e n t i n g a l o n g a n c-d
progressive developm ent , in case it is not affect ed in
any of it s phases, and also as a com m on process of a
het erogeneous group of diseases t hat differ in et iology,
fr equency and clinical m anifest at ions( 1- 3).
I t r ep r esen t s a sev er e p r o b l em f o r p u b l i c
h eal t h i n d ev el o p ed an d d ev el o p i n g co u n t r i es. I n
Br azi l , i t i s t h e seco n d cau se o f d eat h b y k n o w n
causes( 1). I n 2006, 472,050 new cases of cancer were regist ered. The m ost incident t ypes were prost at e and
lung cancer in m en, and breast and cervical cancer in
w o m e n , w h i ch a r e i n l i n e w i t h g l o b a l m a g n i t u d e
lev els( 4). This epidem iological infor m at ion is essent ial for planning healt h prom ot ion act ions, early det ect ion
and car e at all levels.
Can cer is of t en diagn osed w h en alr eady in
advanced phases, which not only worsens it s prognosis
but also incr eases m or t alit y. Pr event ion, in t his case,
is essent ial for r educing m or bidit y and m or t alit y and
im pr ov ing pat ient s’ qualit y of life( 5). Thus, it s cont r ol m ain l y d ep en d s on act ion s in t h e ar eas of h ealt h
pr om ot ion, specific pr ot ect ion and ear ly diagnosis of
t h e disease.
I n f or m at ion r egar din g t h e con t r ibu t ion of a
risk fact or t o global rat es of t he disease in populat ions,
and not only in exposed individuals, is useful t o decide
which risk fact ors are part icularly im port ant , and which
ar e not so im por t ant for global com m unit y healt h. I t
can p r ov id e in f or m at ion t o h ealt h p olicy m ak er s on
how t o choose priorit ies for t he use of healt h resources.
A r elat iv ely w eak r isk fact or, but highly pr evalent in
t h e co m m u n i t y, ca n b e r e sp o n si b l e f o r a h i g h e r
incidence of t he disease t han a st ronger fact or of lower
pr ev alen ce lev el( 6 ).
Fu r t h er st u dies in t h is ar ea ar e n eeded, so
t hat t he populat ion can use t he infor m at ion t o adopt
h ealt h ier lif e st y les, esp ecially st u d ies t h at aim t o
assess not only a populat ion’s risk of cancer, but also
t h e ef f ect iv e per su asion of in f or m at ion abou t t h ese
r isk fact or s and t heir pr ev ent ion.
Th e p r ob ab ilit y of an u n d esir ab le ev en t t o
occur is considered a risk( 7), an associat ion t o a higher r isk of b ecom in g ill. Ev en if it d oes n ot cau se t h e
d i s e a s e , i t s p r e s e n c e a l l o w s u s t o p r e d i c t t h e
pr obabilit y t hat a cer t ain disease w ill occur( 6). Th e et iology of can cer is m u lt i- cau sal, t h at
is, it r esult s fr om t he int er act ion of sev er al fact or s,
w h ich in cr ease, t o a g r eat er or lesser ex t en t , t h e
pr obabilit y t hat an indiv idual w ill be affect ed by t he
disease, that is, the risk factors related to cancer. On the
other hand, factors that grant the body a lower probability
of acquiring a disease are called protection factors( 7). Th u s, t o r ed u ce t h e im p act of can cer, it is
first necessary t o reduce t he prevalence of behavioral
a n d e n v i r o n m e n t a l f a ct o r s t h a t i n cr e a se i t s r i sk .
Scr een in g pr ogr am s an d t r eat m en t pr ot ocols based
o n a v a i l a b l e e v i d e n c e s h o u l d b e g u a r a n t e e d ,
esp ecially t o p op u lat ion s w it h p r ecar iou s access t o
h e a l t h s e r v i c e s . Fo r t h i s p u r p o s e , p e r s u a s i v e
com m unicat ion can be used.
The word persuasion originat es from t he Lat in
w o r d p e r su a si o n e, w h i ch m e a n s a ct o r e f f e ct o f
per suading. Per suade (per suader e) is t o lead one t o
per su asion or t o con v ict ion ; is t o in du ce on e t o do
som et h in g, con sen t , believ e, adv ise, adm it as t r u e,
t r ust , conv ince( 8).
H e a l t h , a s w e l l a s o t h e r f i e l d s , n e e d s
com m u n icat ion st r at egies t h at m eet t h e goals of a
p e r su a si v e m e ssa g e , t a k i n g i n t o a cco u n t t h a t i t
depends on differ ent iat ed appr oaches and appeals in
relat ion t o it s obj ect ives, language and public receiving
t h e m essage.
Th e p r ocess of p er su asion , in t h e ad op t ed
m odel( 9 ), r efer s t o t he effect s a m essage causes on t he receiver, relevant and useful for t he achievem ent
of t he source’s desired goal. Som e crit eria are relat ed
t o t h i s d ef i n i t i o n : 1 ) r el ev a n ce o f ef f ect s f o r t h e
source’s obj ect ives; 2) persuasion inst rum ent alit y, t hat
is, t he m eans or act ions used t o reach t he goal, wit h
p o s s i b l e a c t i o n s b e i n g a d o p t i o n , p e r m a n e n c e ,
d issu asion an d d iscon t in u it y ; 3 ) t h e im p or t an ce of
m essages, w hich can be v er bal and non- v er bal or a
com bin at ion of bot h ; 4 ) t h e in v olv em en t of ch oice,
t hat is, t he illusion of choice; and 5) t he personal and
in t er p er son al n at u r e of t h e p er su asion , k eep in g in
m ind t hat t he source develops a m essage t o achieve
t he goal, inv olv ing m or e t han a r eceiv er( 10).
The persuasion process occurs in five st ages:
a m essa g e i s sen t t o a r ecei v er ; t h e m essa g e i s
p e r c e i v e d a n d i d e n t i f i e d b y t h e r e c e i v e r ; t h e
in t er p r et er ( r eceiv er ) at t r ib u t es a m ean in g t o t h e
m essage; t he m eaning, inside t he receiver, act s as a
st im ulus t o any effect s t hat m ight occur; and t he effect s
in t he receiver generat e an act ion t hat can be relat ed
t o t he per suader ’s desir ed goal. The m ain im por t ant
concept in t his m odel is t hat t he st im ulus for change
Per su asiv e com m u n icat ion , as a g en er at or
of relevant and useful effect s in t he receivers, can be
used as a st rat egy t o dim inishing t he risk of cancer in
a p o p u l a t i o n , t h a t i s, t h e u se o f t h i s p r o ce ss i n
com m unicat ing cancer prevent ion and early det ect ion
can lead t o prevent ive behaviors. St udies have shown
t h a t p u b l i ci t y ca m p a i g n s ca n b e su ccessf u l w h en
d i r e c t e d t o a t a r g e t p u b l i c u s i n g a p p r o p r i a t e
language( 11- 12).I n t his perspect ive, t his st udy used t his fram ework wit h t he following obj ect ives: evaluat e t he
r i sk o f p r e se n t i n g ca n ce r, i n cl u d i n g r e l e v a n t r i sk
fact or s, ev aluat e t he pr esence and char act er ist ics of
per su asion in com m u n icat ion f or can cer pr ev en t ion
and ear ly det ect ion.
METHOD
Th is is a cr oss- sect ion al an d ob ser v at ion al
st u d y, car r ied ou t in a d ist r ict ( Jar d im Paiv a I ) in
Ribeirao Pret o, São Paulo, Brazil, where t he Universit y
d eliv er s com m u n it y ser v ices. Th is ch oice is d u e t o
t h e f act t h at t h is st u d y can f av or t h e p lan n in g of
e f f e c t i v e s t r a t e g i e s i n t h e d i s t r i c t t h r o u g h t h e
im p lem en t at ion of a Healt h Un it . Th e p r oj ect w as
su b m i t t e d a n d a p p r o v e d b y t h e Re se a r ch Et h i cs
Com m it t ee at t he Universit y of São Paulo at Ribeirão
Pret o College of Nursing ( EERP- USP) . Only t hose who
v olu n t ar ily ag r eed t o p ar t icip at e in t h e st u d y an d
si g n ed t h e f r ee an d i n f or m ed con sen t t er m , af t er
r eceiv ing infor m at ion about t he st udy obj ect iv es and
aft er guarant eeing t heir anony m it y, w er e included in
t his st udy.
Th e st u dy popu lat ion w as com posed of t h e
dist r ict r esiden t s, w it h t h e r an dom select ion ( dr aw )
of 25% fr om a t ot al of 440 households, obt aining a
sam ple of 110 households. When t her e w as nobody
in t he household and cont act w as not possible, aft er
t w o at t em pt s, t he house on t he left or r ight , in t his
sequence, w ould r eplace t he or iginal choice. I n case
t h is st r at eg y w as n ot su ccessf u l, a n ew d r aw w as
per for m ed for t he sak e of r eplacem ent .
I n c l u s i o n c r i t e r i a : v o l u n t a r i l y a g r e e d i n
part icipat ing in t he st udy, signed t he free and inform ed
con sen t t er m af t er t h e st u d y ob j ect iv es h ad b een
inform ed; age equal t o or older t han 18 years; was a
r esident of t he dist r ict ( r egar dless of how long) , and
had cognit ive abilit ies. Exclusion crit eria: under cancer
t r eat m ent or in t he r em ission phase of t he disease.
The follow ing t w o inst r um ent s w er e used for
dat a collect ion:
1 - Can cer : assessin g y ou r r isk w as d ev elop ed b y
t he Am erican Cancer Societ y t o evaluat e t he presence
o f r i s k f a c t o r s f o r s e v e r a l t y p e s o f c a n c e r. I t s
t r an slat ion an d adapt at ion w as car r ied ou t t o m eet
t he Brazilian realit y; t he m et hod( 13) of t his procedure in clu d ed t r an slat ion , b ack t r an slat ion , com p ar ison
bet w een t hr ee v er sions by a gr oup of ex per t s, w it h
ag r eem en t b et w een 9 9 % an d 8 0 % . Th is w ay, t h e
i n st r u m e n t w a s co n si d e r e d a s h a v i n g t h e sa m e
m ea n i n g a s t h e o r i g i n a l , r esu l t i n g i n a n a d a p t ed
inst rum ent . I t s it em s were relat ed t o lung, colon and
rect um , skin, breast and cervical cancers, and include:
personal dat a ( gender, age) , life st yle, previous hist ory
o f r e s p o n d e n t a n d f a m i l y, e x a m s , s i g n s a n d
sy m p t om s.
2 - Qu e s t i o n n a i r e t o i d e n t i f y t h e e l e m e n t s o f
p e r s u a s i o n c o n t a i n e d i n t h e p e r s u a s i v e
co m m u n i ca t i o n . Th e l i t e r a t u r e( 1 4 ) p r i n ci p l e s w e r e follow ed in it s const r uct ion, including it em s t o m eet
t h e ad op t ed t h eor y of p er su asion( 9 ). Each q u est ion was evaluat ed by a group of expert s regarding clarit y,
sensibilit y t o t he psychological st at e of t he respondent ,
i m p a r t i a l i t y, l e v e l o f r e a d i n g a n d s e q u e n c e o f
quest ions. I t was applied t o 20 subj ect s from a nearby
d i st r i ct , w i t h ch a r a ct e r i st i cs si m i l a r t o t h e st u d y
subj ect s, t o v er ify t he r elev ance and achiev em ent of
t h e o b j e c t i v e s . Th e i n s t r u m e n t w a s c o n s i d e r e d
adequ at e giv en t h e r esu lt s of t h e f ace an d con t en t
v alidat ion. I t s m ain it em s included: ident ificat ion of
inform at ion on cancer prevent ion and early det ect ion,
co n t en t o f i n f o r m a t i o n , t y p e o f ca n cer, so u r ce o f
inform at ion, st im ulus for act ion, and behavior adopt ed
because of t he infor m at ion.
The dat a collect ed by t he researcher, t hrough
int erviews, were regist ered in a dat abase, using SPSS
v er sion 15.0, and analy zed w it h descr ipt iv e st at ist ics
( f r e q u e n cy a n d p e r ce n t a g e ) . To a n a l y ze r e l e v a n t
variables for persuasion, t he principles of t he adopt ed
t heor y w er e used( 9).
RESULTS
Regarding t he charact erist ics observed in t he
sam ple ( 110 subj ect s) , 81.8% were fem ale and 18.2%
m ale. Age v ar ied bet w een 18 and 75 y ear s, w it h an
av er age of 3 8 . 1 y ear s an d m edian of 3 6 y ear s. I n
f ou r r esiden t s per h ou seh old w as obt ain ed, w it h at
l e a s t o n e a n d a t m o s t e i g h t r e s i d e n t s i n e a c h
h ou seh old, w it h a v ar ian ce of 2 . 1 4 . Mar r ied people
( 5 5 . 5 % ) p r e d o m i n a t e d , a n d t h e m o s t f r e q u e n t
occupat ions w er e housew ife and m aid ( 58. 2% ) .
Th u s, t h e su b j e ct s’ p r o f i l e : f e m a l e , w i t h
av er age age of 3 8 y ear s, basic edu cat ion , m ar r ied,
h o u se w i v e s, a n d l i v i n g i n a h o u se h o l d w i t h f o u r
people. The r isk scor es in t he st udy sam ple, v ar ied
accor ding t o t he t ype of cancer ( Table 1) .
Table 1 – Dist ribut ion of cancer risk according t o t ype
of can cer
The r isk for lung cancer w as pr edom inant ly
observed in t he low or m ild risk classificat ion ( 90.9% ) ,
t hat is, w hen indiv iduals pr esent ed low r isk or w er e considered m ild sm okers wit h good chances of quit t ing.
Those w it h m oder at e r isk , w it h incr eased chances of
l u n g a n d r e sp i r a t o r y t r a ct ca n ce r, w e r e n o t v e r y p r ed o m i n a n t ( 9 . 1 % ) ; f o r t h em , q u i t t i n g sm o k i n g
becom es r eally im por t an t .
Fo r co l o n a n d r e ct u m ca n ce r, 2 . 7 % w e r e i d e n t i f i e d a t h i g h r i s k , w h o s e i m p a c t o f f a c t o r
con sider ed w as f am ily h ist or y w it h can cer or colon
polyps. I n t his case, periodical evaluat ion is indicat ed for follow up. Moderat e risk, considered for 43.6% of
su bj ect s, is du e t o t h eir age, older t h an 4 0 y ear s,
which by it self put s t he subj ect at m oderat e risk. The m aj or it y, t hough, pr esent ed low r isk for t his t y pe of
can cer.
I n r elat ion t o b r east can cer, 1 4 . 4 % of t h e subj ect s present ed m oderat e risk; for 87.5% of t hese,
t he m ain im pact fact or was age, older t han 50 years,
and for t he rem ainder, bet ween 40 and 49 years old, t h e a b se n ce o f m a m m o g r a p h y o r b r e a st cl i n i ca l
e x a m s. I t i s st r e sse d t h a t t h e m a j o r i t y ( 6 6 . 7 % )
pr esent ed low r isk .
The r isk of cer v ical cancer w as ident ified as
high in 3.6% of t he int erviewees and as m oderat e in
1 0 % . Th e m a i n d e t e r m i n a n t f a ct o r s w e r e : a g e , bet w een 4 0 and 5 4 y ear s old, ear ly sex ual act iv it y,
and no realizat ion of t he Pap sm ear. The lat t er was a
fact or pr esen t in all par t icipan t s con sider ed at h igh
r isk . This indicat or w as also det er m inant of r isk for
e n d o m e t r i u m ca n ce r, si n ce i t w a s p r e se n t i n t h e
subj ect s at high and m oderat e risk; for t his risk level,
a g e o l d e r t h a n 5 0 y e a r s a n d o b e si t y w e r e a l so
p r ed om in an t .
Th e r isk for sk in can cer is m easu r ed based
on posit iv e or n egat iv e an sw er s pr ov ided r egar din g
t he risk fact ors. Thus, t he average observed was 1.58
risk fact or in t he subj ect s int erviewed, wit h a m inim um
of no fact or and a m ax im um of fiv e fact or s. Am ong
t he fact ors considered, when t he subj ect provided only
on e p osit iv e an sw er, t h is w as r elat ed t o: f air sk in ,
excessive solar exposure before 18 years old, current
solar ex posu r e, f am ily h ist or y, an d t h e pr esen ce of
sk in m odificat ion s.
To evaluat e t he charact er ist ics and pr esence
of per su asion inv olv ed in can cer, t h e su bj ect s w er e
ask ed abou t t h e ex ist en ce of in for m at ion on k n ow n
prevent ion and early det ect ion, in order t o get t o know
t heir capacit y t o ident ify t he m essage sent , t hat is, if
it w as p er ceiv ed b y t h e su b j ect s. I t w as id en t if ied
t h a t 8 0 % o f t h e m w e r e a b l e t o a ck n o w l e d g e i t s
ex ist en ce, an d 5 5 . 5 % of t h em r elat ed it t o b r east
cancer, 37.3% t o cervical cancer, 21.8% t o skin cancer,
20. 9% t o pr ost at e, 3. 6% t o colon, 0. 9% t o r ect um ,
2.7% t o lung and 1.8% t o m out h cancer, w her eas it
could be relat ed t o m ore t han one t ype of cancer.
All su b j ect s w h o id en t if ied t h e p r esen ce of
in for m at ion w er e also able t o iden t ify w h er e it w as
t ransm it t ed: TV ( 58.2% ) , post ers ( 13.6% ) , healt h unit
( 1 0 . 9 % ) , b o o k l e t s ( 8 . 2 % ) , h e a l t h p r o f e s s i o n a l s
( 7. 3% ) , m agazines ( 3. 6% ) , new spaper s ( 2. 7% ) and
r elat iv es ( 1 . 8 % ) . Wh en t h ey w er e ask ed abou t t h e
cont ent of m essages, 61% m anaged t o rem em ber it .
Am on g t h em , 5 3 . 7 % r epor t ed bein g en cou r aged t o
p r a c t i c e a n a c t i v i t y r e l a t e d t o t h e i n f o r m a t i o n
p r esen t ed .
Th e c o n t e n t o f i n f o r m a t i o n o n c a n c e r
p r e v e n t i o n a n d e a r l y d e t e ct i o n , r e p o r t e d b y t h e
i n t e r v i e w e e s, i s t h e sa m e a s t h e a ct i v i t i e s t h e y
per for m . For inst ance, a per son ident ifies t he br east
self- exam as a piece of inform at ion, which m ay have
persuaded her, encouraging her t o pract ice t his act ivit y
( 8 4 . 2 % ) . How ev er, ev en w h en on e w as n ot able t o
i d e n t i f y t h e c o n t e n t , t h e a c t i v i t y c o u l d s t i l l b e
per for m ed. For inst ance, in t his st udy, t he per iodical
m a m m o g r a p h y e x a m r e p o r t e d b y o n e o f t h e
part icipant s in t he sam ple ( Table 2) was t aken wit hout
t h e p e r su a si v e st i m u l u s. Th e r e f o r e , t h e su b j e ct s
e p y T
k s i r r e c n a C
l a t o T r
o w o L
d l i
m Moderate High
N % N % N % N %
g n u
L 100 90.9 10 9.1 - - 110 100 m
u t c e r / n o l o
C 59 53.6 48 43.6 3 2.7 110 100 t
s a e r
B 74 66.7 16 14.4 - - 90 100 l
a c i v r e
C 75 68.2 11 10.0 4 3.6 90 100 m
u i r t e m o d n
per for m som e act iv it ies t hat ar e not dir ect ly r elat ed
t o t he st im ulus t hey ident ified.
Ta b l e 2 - Li st o f i n f o r m a t i o n co n t e n t o n ca n ce r
pr ev ent ion and ear ly det ect ion and t he ex ist ence of
st im ulus giv en t his infor m at ion
n o i t a m r o f n I f o t n e t n o
C Existenceofstimulus Total e c n e s e r
P Absence
m a x e -fl e s t s a e r
B 16 84.2% 3 15.8% 19 100% r a e m s p a p e n it u o
R 8 61.5% 5 38.5% 13 100% y h p a r g o m m a m l a c i d o i r e P m a x
e 0 0% 1 100% 1 100% s n o it a c if i d o m f o n o it p e c r e P y d o b e h t n
o 7 77.7% 2 22.3% 9 100% s l a n o i s s e f o r p r o f h c r a e S d n u o f e r a s e g n a h c n e h
w 6 60% 4 40% 10 100% n o it n e v e r p f o e c n a t r o p m
I 3 50% 3 50% 6 100% s i s o n g a i d y l r a e f o e c n a t r o p m
I 0 0% 1 100% 1 100% s n a e m n e e r c s n u s f o e s
U 2 100% 0 0% 2 100%
Th e su bj ect s’ m ot iv at ion t o per f or m can cer
pr ev ent ion and ear ly det ect ion act iv it ies w as due t o
t he im por t ance of infor m at ion for 16. 4% ; t o fear of
being affect ed by t he disease for 9.1% , t o t he effect s
pr om ot ed by pr ev ent iv e act ions and ear ly det ect ion
for 8.2% , and t o own decision for 3.6% .
A m o n g t h e s u b j e c t s i d e n t i f i e d a s b e i n g
encouraged t o perform a cancer prevent ion and early
d et ect i o n act i v i t i es t h r o u g h i n f o r m at i o n p r o v i d ed ,
58. 6% k ept up t his act iv it y for up t o a m ont h, and
2 7 . 5 % f r o m o n e t o s i x m o n t h s . I t s h o w s t h e
discont inuit y t he source does not desire in t he pract ice
of t h ese act ion s. Also, n on e of t h em ack n ow ledged
t h e ex ist en ce of st im u lu s an d r ein f or cem en t in t h e
cont inuit y of t he adopt ed pr act ices.
DI SCUSSI ON
The classificat ion of lung cancer risk, according
t o t h e q u est ion n air e, in clu d es it em s r ecom m en d ed
by t h e I NCA/ MS ( Br azilian Can cer I n st it u t e/ Min ist r y
of Healt h) , such as gender, age, exposure t o agent s,
carcinogens inhaled, m ainly sm oking, relat ing several
aspect s inv olv ed, lengt h, t y pe and quant it y( 15). Sm oking is t he prim ary avoidable risk fact or,
not only for lung cancer, but also for car diovascular
and r espirat or y diseases( 7). I n t his st udy, all subj ect s wit h m oderat e risk were sm okers, wit h a long hist ory
of sm oking; half of t hem had sm ok ed for m or e t han
25 years, and t he ot her half bet ween 15 and 25 years.
Alt hough all subj ect s at m oder at e r isk w er e
sm ok er s, 1 5 sm ok er s w er e con sider ed at m ild r isk .
That is because t he m ain fact or in t his classificat ion w a s c o n s i d e r e d t h e s h o r t e r t i m e o f s m o k i n g .
Addit ion ally, 4 0 % of t h e 2 5 sm ok er s w er e y ou n ger t han 30, t hat is, young adult s who can eit her increase
t heir risk over t im e or undergo int ervent ions t hat can dim inish t heir r isk fact or.
Th e m ar k er s f o r r i sk g r o u p s o f co l o n an d rect um cancer are( 15): older t han 50 years; hist ory of adenom as or colon and rect um cancer in first - degree r e l a t i v e s ; p r e v i o u s p e r s o n a l h i s t o r y o f o v a r i a n ,
en dom et r iu m , or br east can cer ; affect ed by ch r on ic u lcer at iv e colit is or Cr oh n ’s disease, an d also som e
congenit al condit ions, such as fam ilial adenom at ous
p o l y p o si s an d h er ed i t ar y n o n - p o l y p o si s co l o r ect al can cer, w h ich is r elat ed t o t h e fact or s addr essed in
t h i s s t u d y. Th e I N CA / M S( 1 5 ) c o n s e n s u s f o r t h e prevent ion and cont rol of t his t ype of cancer includes:
an n u al ( p r ef er ab ly ) or b ien n ial scr een in g b y f ecal occult blood t est ing for t he populat ion aged 50 years
or old er ; colon oscop y f or t h ose w it h p osit iv e f ecal
occult blood t est result ; endoscopy m et hods m ust have p r ior it y an d b e p er f or m ed an n u ally in r isk g r ou p s;
pr im ar y pr ev ent ion should be based on t he adopt ion of a healt hy diet , rich in fibers, fruit s and veget ables,
and poor in anim al fat .
The im pact fact or s r elat ed t o br east cancer,
appoint ed by t he st udy, corroborat e wit h t he m arkers est ablish ed in r isk gr ou ps( 1 5 ): age, m ain r isk gr ou p m ar k er, sin ce in ciden ce lev els r apidly in cr ease w it h age; fam ily hist ory of breast cancer in pre- m enopause
( m ot her or sist er ) ; r epr oduct ive fact or s, such as lat e
m e n o p a u s e , e a r l y m e n a r c h , f i r s t p r e g n a n c y a t a d v a n ced a g e o r n u l l i p a r i t y ; o b esi t y, a l co h o l a n d
ex posur e t o ion r adiat ion.
These m ar k er s ar e m ult i- fact or ial and, t hus,
har dly suscept ible t o pr im ar y pr ev ent ion. Scr eening,
in t h is case, is t h e m ain st r at egy pu blic h ealt h can u s e t o c o n t r o l b r e a s t c a n c e r. Ma m m o g r a p h y i s
r ecom m ended for w om en bet w een 5 0 and 6 9 y ear s
old on a y ear ly basis, and clinical br east ex am fr om
t he age of 40. The self- exam should not be an isolat ed st rat egy, which is why it does not replace t he clinical
exam( 15). The int erviewees wit h increased risk did not com ply w it h t his r ecom m endat ion.
Rem ar kably, am ong t he int er view ees, 76.6%
perform ed t he breast self- exam , and 42.2% t he clinical
ex am or m am m ogr am . All par t icipant s older t han 50 y ear s and 68.1% of t hose bet w een 40 and 49 y ear s
old underwent clinical breast exam or m am m ography.
Am ong t he m arkers of risk groups for cervical
HPV; ear ly sex ual act iv it y ; m ult iple sex ual par t ner s;
low socioeconom ic lev el; HI V and sm ok ing. The Pap
sm ear is a scr een in g st r at egy, t h ou gh t h er e ar e n o
precise dat a on it s sensit ivit y and specificit y, est im at ed
ar ound 6 0 % and 9 0 - 9 9 % , r espect iv ely( 15). How ev er, t his is st ill t he m ost used and recom m ended m et hod
for wom en aged 18 or older or st art ing sexual act ivit y.
The observat ion of risk fact ors for skin cancer
con f ir m s t h e m ain m ar k er s t o iden t if y r isk gr ou ps:
f air sk in , ex cessiv e solar ex p osu r e; ad v an ced ag e;
fam ily h ist or y of sk in can cer ; ex posu r e t o ch em ical
agen t s. Th e pr im ar y pr ev en t ion f act or s, am on g t h e
in t er v iew ees, w er e: 5 7 % ex am in e t h e sk in look in g
f or ch an g es, 1 9 . 7 % u se su n p r ot ect ion lot ion , an d
18. 3% use ex t er nal pr ot ect ion, for inst ance, hat s t o
pr ot ect fr om solar ex posur e, w hich r educe t he r isk s
f or t h is t y p e of can cer. Sp ecif ically, t h e est im at ed
reduct ion of m ort alit y wit h t he skin self- exam is 63% .
I n g e n e r a l , a p o p u l a t i o n w i t h d i m i n i sh e d
cancer risks was found, because t he higher risk levels
of som e subj ect s result ed from inherent fact ors, such
as ad v an ced ag e. Also, som e p r ev en t iv e m easu r es
h ad alr eady been adopt ed, w h ich m igh t h av e been
influenced by pr ior infor m at ion on r isk s obt ained by
t h e su b j ect s. I n t h i s p er sp ect i v e, d at a r el at ed t o
per suasion w ill cor r obor at e w it h t his analy sis.
Th e p r e s e n c e a n d c h a r a c t e r i s t i c s o f
p er su asi o n t h r o u g h i n f o r m at i o n r el at ed t o can cer
pr ev en t ion an d ear ly det ect ion w er e iden t if ied. Th e
m aj orit y of t he int erviewees ( 80% ) acknowledged t he
ex ist ence of infor m at ion r egar ding cancer pr ev ent ion
an d ear ly d et ect ion , in ag r eem en t w it h a p r ev iou s
st udy( 16), in w hich nur ses, w or k ing in t his sam e cit y,
r epor t ed par t icipat in g in can cer pr ev en t ion act ion s,
eit her as part of program s and cam paigns or on t heir
o w n i n i t i a t i v e . Re g a r d i n g ca n ce r p r e v e n t i o n a n d
cont r ol in t heir place of w or k , t he m aj or it y ( 86. 4% )
r epor t ed pr ogr am s r elat ed t o cer v ical, br east , sk in ,
m ou t h an d pr ost at e can cer. Th er efor e, t h e t y pes of
can cer m en t ion ed b y t h e p ar t icip an t s in t h is st u d y
b u t n o t a ck n o w l e d g e d b y t h e p r o f e ssi o n a l s a r e :
cer v ical, colon and r ect um , and lung cancer.
TV w a s o b se r v e d a s t h e m a i n m e a n s o f
in f or m at ion d issem in at ion on p r ev en t ion an d ear ly
d e t e c t i o n . Th e p e r s u a s i v e m e s s a g e s u s e d a
com binat ion of verbal and non- verbal( 9) elem ent s and r eached t he r espondent s m or e per suasively, show ing
it self as an im port ant and efficient m eans t o reach a
goal in a cam paign, for inst ance.
Nevert heless, it is im port ant t o st ress t he role
of healt h pr ofessionals, especially nur ses, as one of
t he healt h educat ion agent s in t he m ult i- pr ofessional
t e a m . N u r s e s ’ a c t i o n s s h o u l d b e i n t e g r a l a n d
p ar t i ci p at i v e; sh o u l d n o t w ast e o p p o r t u n i t i es an d
a l w a y s b e d i r ect ed t o t h e d ev el o p m en t o f h ea l t h
act ion s an d ed u cat iv e p r act ices aim in g t o p r ev en t
diseases, including cancer.
Th er efor e, t h e obser v ed per su asion pr ocess
ap p oin t s t h at t h e m essag e ( can cer p r ev en t ion an d
e a r l y d e t e c t i o n ) w a s s e n t , t h a t t h e r e c e i v e r s
( int erviewees) at t ribut ed a m eaning t o it and t hat t he
m essage act ed as a st im ulus t o pr oduce an effect in
t h e r e ce i v e r s ( 5 3 . 7 % o f t h e r e sp o n d e n t s) . I t i s
im por t ant t o st r ess t hat t he st im ulus for change, in
t his case, t he behavioral act ions of cancer prevent ion
an d ear ly d et ect ion , d esir ed b y t h e sou r ce, is t h e
m eaning ar oused in t he r eceiver.
Th u s, a cco r d i n g t o t h e t h e o r y u se d , t h e
a r o u s e d e f f e c t s w e r e : a f f e c t i v e ( f e e l i n g l e v e l ) ,
cognit ive ( knowledge, opinion, beliefs) and m anifest ed
beh av ior al ef f ect s, w h ich ar e t h ose plan n ed by t h e
so u r ce , i n t h i s ca se t h e p e r so n s r e sp o n si b l e f o r
sen d in g p r ev en t iv e m essag es. Th e d ecision of t h e
i n d i v i d u a l h i m ( e r ) s e l f c a n b e a t t r i b u t e d t o t h e
per suasion cr it er ion, in w hich t he indiv idual has t he
illusion of m ak ing choices, t hat is, ( s) he believ es t o
per for m an act iv it y w it hout ex t er nal int er fer ence.
Th e ev al u at i o n o f t h e r i sk an d p r o t ect i o n
fact or s in v olv ed in can cer is an act iv it y in con st an t
t r a n sf o r m a t i o n i n t h e r e se a r ch e r s’ f i e l d , d u e t o
scien t if ic ad v an cem en t s an d b eh av ior al ch an g es in
h u m an bein gs. Th er efor e, t h e v er ificat ion of can cer
r isk s and pr ev ent iv e behav ior s inv olv ed is subm it t ed
t o t hese inher ent t r ansfor m at ions.
CONCLUSI ON
Th i s s t u d y s o u g h t t o v e r i f y t h e r e a l i t y
pr esent ed by t he st udied populat ion, ident ify ing t he
presence of det erm inant risk fact ors for different t ypes
o f ca n cer, a i m i n g t o w o r k o n t h ese f a ct o r s w h en
appr opr iat e act ions ar e possible.
The process of inform at ion persuasion relat ed
t o cancer pr ev ent ion and ear ly det ect ion is not v er y
effect iv e y et , since t her e is dissem inat ion, r ecept ion
an d u n der st an din g of in f or m at ion , bu t adopt ion f or
Th e r e f o r e , g i v e n t h e r i s k o f c a n c e r a n d i d e n t i f i e d p r e v e n t i v e b e h a v i o r s , p e r s u a s i o n i s con sid er ed a u sef u l st r at eg y f or d im in ish in g t h ese r i sk s a n d a l so f o r e n co u r a g i n g a n d m a i n t a i n i n g p r e v e n t i v e b e h a v i o r s , s i n c e i t a l r e a d y a p p o i n t s st r at eg ies t o b e u sed in or d er t o ach iev e su ccess. How ev er, all st ages of t his per suasive pr ocess need t o b e u s e d , e s p e c i a l l y s t r a t e g i e s t h a t p e r m i t m aint aining behav ior for longer per iods.
This st udy is ex pect ed t o fav or t he pr ogr ess of m easu r es inv olv ed in can cer an d , m or eov er, t o
f a v o r t h e n u r ses w h o p a r t i ci p a t e i n t h i s p r o cess,
g r a n t i n g t h e m a b a s e f o r m e a s u r e s a i m e d a t
dim inishing m or bidit y and m or t alit y and incr ease t he
populat ion’s qualit y of life.
Even t hough t his st udy w as car r ied out w it h
a specific populat ion, w hich lim it s it s gener alizat ion,
it con t r ib u t es t o t h e an aly sis of t h e d ist r ict st at u s
regarding st rat egies t o be adopt ed for cancer cont rol,
a per spect iv e t h at h as n ot been m u ch ex plor ed. I t
can also be a st im ulus t o t est t he efficiency of t he use
of p er su asion , in all it s st ag es, w h ich can b e lat er
ex panded t o ot her com m unit ies.
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