A theory driven school based intervention to improve breast cancer preventive behaviors among adolescents in low resource school settings

Although breast cancer is rare during adolescence, early breast health awareness and preventive skills may support long-term health behavior. This study evaluated a school-based intervention integrating Orem’s Self-Care Theory and Social Cognitive Theory (SCT). A quasi-experimental pre-test–post-test control group study involved 159 adolescent girls from two Indonesian secondary schools. Schools were allocated to an intervention group ( n = 80), which received three 90-minute sessions combining self-care framing, modeling, guided practice, feedback, and educational materials, or a control group ( n = 79), which received a leaflet and a 45-minute lecture. Knowledge, attitude, BSE practice, and self-efficacy were assessed at baseline and six months later using validated instruments. Within-group changes and between-group differences in change scores were analyzed using distribution-appropriate tests. Between-group comparisons of change scores showed significantly greater improvements in the intervention group than in the control group across all outcomes (all p < 0.001). Within the intervention group, the mean increases in total scores were 6.73 points for knowledge (95% CI 6.17 to 7.28), 8.35 points for attitude (95% CI 7.48 to 9.22), 37.86 points for BSE practice (95% CI 35.14 to 40.58), and 3.60 points for self-efficacy (95% CI 2.79 to 4.41). The largest improvement occurred in BSE practice, indicating substantial gains in psychomotor competence. The theory-integrated intervention was associated with improvements in knowledge, attitudes, BSE practice, and self-efficacy. Combining self-care principles with modeling, guided practice, and feedback may bridge the gap between knowledge and preventive action in resource-limited schools.