Researchers from Covenant University and Caleb University in Nigeria surveyed 519 women of reproductive age, between 18 and 49 years old, in selected urban and rural communities across Niger and Yobe States. The study sites included Bosso and Bida in Niger State and Damaturu and Machina in Yobe State, chosen to capture a range of communication environments. The sample size was calculated using the Taro Yamane formula at a 95 percent confidence level with a 5 percent margin of error, then inflated by 30 percent to guard against non-response. Participants completed a structured questionnaire translated into Hausa and independently back-translated to ensure semantic equivalence, administered face-to-face by trained bilingual field assistants.

The theoretical backbone of the study was the Health Belief Model, developed in the early 1950s by social psychologists Godfrey Hochbaum, Irwin Rosenstock, and Stephen Kegels. The model holds that health behaviour depends on perceptions of susceptibility, severity, benefits, and barriers, along with cues to action and self-efficacy. The Nigerian team extended this framework in a communication-centred direction, proposing what they call the Communication Extended Health Belief Model, in which health beliefs are treated not as purely individual cognitive processes but as socially mediated constructions shaped by family networks, religious spaces, media exposure, and healthcare encounters.

To test whether information sources actually predict postpartum depression knowledge, the researchers employed partial least squares structural equation modelling, a statistical technique well suited to prediction-oriented research with complex relationships among constructs and non-normally distributed data. They assessed reliability and validity using composite reliability, average variance extracted, and Cronbach’s alpha, applying thresholds of 0.80, 0.50, and 0.70 respectively. Factor loadings ranged from 0.747 to 0.952, and variance inflation factors stayed well below the conservative benchmark of 5.0, indicating minimal collinearity and no significant common method bias. Bootstrapping with 5,000 subsamples tested the significance of the pathways in the model.

The model fit statistics were strong across the board. The standardised root mean square residual came in at 0.078, below the 0.08 threshold for acceptable fit, while the goodness-of-fit index reached 0.929, exceeding the 0.90 benchmark. The normed fit index of 0.950 indicated a highly appropriate model, the parsimony comparative fit index of 0.647 surpassed the recommended minimum of 0.50, and the chi-square divided by degrees of freedom stood at 2.228, well under the upper limit of 3.0. The Q-squared value for postpartum depression knowledge was 0.659, well above zero, confirming the model’s predictive relevance.

The results paint a striking picture of where Northern Nigerian women actually learn about maternal mental health. Family and friends emerged as the most powerful predictor, with a path coefficient of 0.617 and an R-squared value of 0.381, both statistically significant at p equals 0.000. Medical personnel followed closely with a path coefficient of 0.688 and an R-squared of 0.473, confirming their role as expert health educators. Radio broadcasting proved significant with a coefficient of 0.331, as did religious leaders at 0.310, social media at 0.217, and websites at 0.227. Effect sizes, measured by the f-squared statistic, were large across the significant predictors, with medical personnel at 0.643 and social media at 0.672.

Just as revealing were the channels that failed to move the needle. Newspapers produced a path coefficient of only 0.033 with a p-value of 0.188, magazines managed 0.017 with a p-value of 0.452, television registered 0.088 with a p-value of 0.251, indigenous media reached 0.085 with a p-value of 0.110, and opinion leaders came in at 0.099 with a p-value of 0.078. None of these achieved statistical significance. The pattern held even though government and non-governmental organisation messages were highly recalled by respondents, with mean recall scores of 4.20 and 3.88 respectively, exposing a systemic disconnect between message dissemination and meaningful integration into women’s belief systems.

The demographic profile of the sample helps explain why. A majority of participants, 71.3 percent, came from Niger State, 88.2 percent were married, and 57.4 percent fell in the 18 to 33 year bracket, the prime reproductive years. Only 2.5 percent held a postgraduate degree, and 53.9 percent earned less than 50,000 naira per month, with 44.5 percent listing the Senior School Certificate Examination as their highest educational attainment. In such a context, family structures function more as mechanisms of survival than pathways for socioeconomic mobility, and kinship and faith-based networks become the primary decoders of maternal health experiences. The researchers note that the near-absence of divorce alongside accepted polygyny may create a socially stable but emotionally strained marital landscape that shapes how women interpret postpartum distress.

The findings carry direct implications for health policy. The authors argue that general awareness campaigns relying on formal mass media are insufficient in settings like Northern Nigeria. Instead, maternal mental health education should be embedded within the channels women already trust, pairing healthcare providers with religious leaders and community-based interpersonal networks. Training programmes should equip health workers and faith leaders with culturally sensitive communication strategies that present postpartum depression as a valid and treatable condition. Messaging delivered through antenatal and postnatal care, religious gatherings, and community meetings, calibrated to the literacy levels of the target population, could raise knowledge acquisition and reduce the stigma that keeps women from seeking professional help.

The study is not without limitations. Its cross-sectional design prevents causal inference, self-reported data may be vulnerable to recall or social desirability bias, and purposive sampling restricts generalisation beyond Niger and Yobe States. The researchers measured knowledge rather than actual help-seeking behaviour, and they recommend longitudinal or mixed-method designs to trace how communication exposure translates into behavioural change over time. Still, the core message stands: in culturally complex maternal health settings, combating postpartum depression is less a problem of information scarcity than one of communication congruency. The path forward lies in weaving biomedical knowledge into the trusted systems of family, faith, and community leadership that already shape how women understand their own minds after childbirth.

Subject of Research: The influence of information sources on postpartum depression knowledge among women in Northern Nigeria

Article Title: Information sources and postpartum depression knowledge in Northern Nigeria: extending the health belief model

Article References: Omale, G. E., Oyesomi, K. O., Oladosun, M., & Msughter Aondover, E. (2026). Information sources and postpartum depression knowledge in Northern Nigeria: extending the health belief model. Frontiers in Communication, 11, 1812199. https://doi.org/10.3389/fcomm.2026.1812199

Image Credits: AI Generated

DOI: 10.3389/fcomm.2026.1812199

Keywords: postpartum depression, maternal mental health, health communication, Health Belief Model, Northern Nigeria, information sources, PLS-SEM, religious leaders, radio, social media, help-seeking behaviour, risk communication

The study, published in Discover Education, is notable for how it defines its target. Rather than treating cybersecurity awareness as a single quality a person either has or lacks, the researchers grounded their survey in two behavioral models widely used in information security research: Protection Motivation Theory and the Health Belief Model. Protection Motivation Theory holds that people perform two appraisals before acting on a warning: a threat appraisal, weighing how serious and likely a danger is, and a coping appraisal, weighing whether the recommended behavior actually works and whether they can perform it. The Health Belief Model, originally developed to explain preventive health behavior, adds that people act when they believe they are susceptible, that the consequences are serious, that a behavior is beneficial, that barriers can be overcome, and that an external trigger, a cue to action, sets the process in motion. A structured training session, in this framing, is a deliberate cue to action aimed at shifting specific beliefs rather than raising one undifferentiated awareness level.

To measure those beliefs, the team administered a five-point Likert-type survey online to pilot high schools drawn from four school types: an Anatolian High School, a Girls’ Anatolian Imam Hatip High School, a Vocational and Technical Anatolian High School, and a Science High School. The first survey ran between November and December 2024. Instructors from the Department of Management Information Systems at Gebze Technical University, including research assistants and associate professors with expertise in information systems and cybersecurity, then delivered the same one-hour session in each school’s conference hall between February and March 2025. The training assumed no prior knowledge and covered basic cybersecurity concepts and terminology, personal security measures, and practical guidance on identifying fraudulent websites and misleading content, supported by examples, visual demonstrations and selected videos. The same survey was sent again in April 2025.

Of 1029 student responses before the training and 870 after, only students who completed both surveys and could be matched by school and student number were kept, producing a final paired sample of 601. The researchers acknowledge that this attrition was not random: chi-square comparisons between matched and unmatched students showed differences on gender, school and grade, and matching rates ranged from 15.6 percent to 86.7 percent across the four schools. The findings therefore describe the matched participants rather than the full baseline population.

The survey’s structure emerged from a principal component analysis on the pre-training responses, which produced a five-dimensional scale with acceptable overall internal consistency, Cronbach’s alpha of 0.86. The Kaiser-Meyer-Olkin measure of 0.905 and a significant Bartlett sphericity test confirmed the data were suitable for factor analysis, and the five factors, with initial eigenvalues of 6.24, 2.07, 1.30, 1.15 and 1.08, accounted for 56.42 percent of the total variance. The dimensions were conceptual awareness of cybersecurity, covering knowledge of malware, firewalls and social engineering; action-oriented behaviors, covering device authentication, email checking and password security; awareness of advanced protection mechanisms such as VPNs and two-factor authentication; security in online interactions and transactions, combining cyberbullying and card-security items; and digital risk tendency and privacy management, covering unsecured networks and credential sharing in gaming or streaming. Two-item subscales showed lower internal consistency and were interpreted with caution.

Paired-samples t-tests on the 601 matched students revealed a pattern the authors describe as mixed. Scores on action-oriented protective behaviors rose significantly, which the researchers interpret as a strengthening of coping appraisal in Protection Motivation Theory terms: students increasingly believed that protective measures were useful and within their reach. In contrast, self-reported scores on the conceptual-knowledge dimensions declined significantly, with a similar and more pronounced decrease on the advanced protection mechanisms factor. One plausible reading, the authors suggest, draws on the Dunning-Kruger effect: students who had overestimated their familiarity with cybersecurity terminology may have judged themselves more realistically after the training. Because the study measured only self-assessment and not actual knowledge, the same decline could equally reflect response-shift bias, the instability of a short self-report measure, or a real drop in reported confidence, so the interpretation is offered tentatively rather than as proven fact.

The most concrete evidence came from a practical task embedded at the end of the survey. Participants judged ten website screenshots, eight fraudulent and two genuine, designed from real-world attack cases and deliberately containing cues such as urgent requests, mismatches between displayed URLs and embedded hyperlinks, grammatical errors and abnormal visual design. McNemar tests showed that correct identification improved significantly on four of the fraudulent screens, for example rising from 50.4 percent to 63.9 percent on one item. The improvement was not uniform: no significant change appeared on two fraudulent screens, one of which 87.2 percent of students already identified correctly before the training, and correct identification decreased on two fraudulent screens that already had high pre-training rates. For the two genuine screens, accuracy did not improve and declined significantly on one, from 94.0 percent to 89.7 percent, meaning students became somewhat more likely to label legitimate pages as fraudulent. The authors suggest future training should give more attention to distinguishing fraudulent from genuine pages rather than treating every page as suspicious.

Demographic comparisons revealed differences that shifted in complex ways. Before the training, male students scored significantly higher on the knowledge-oriented dimensions, with the largest gap on conceptual awareness, where male students averaged 3.46 against 2.87 for female students, an effect size of d = 0.68. Female students scored higher on the online interaction and privacy dimensions. After the training, the gap on conceptual awareness disappeared, with female students averaging 2.47 and male students 2.39, while the difference on advanced protection mechanisms reversed in direction, reflecting a larger decline among male students rather than a gain among female students. Across schools, the Girls’ Anatolian Imam Hatip High School scored significantly lower than the other three schools on conceptual awareness before the training, yet after the training the school means converged, ranging from 2.29 to 2.47, and the between-school difference was no longer statistically significant. The authors caution that because the study included no control group and no time-by-school or time-by-gender interaction was tested, these are described as observed differences at each time point rather than as evidence that the training equalized the groups. Grade level, from 9th through 12th, was not a meaningful source of variation on any dimension.

The authors are careful about what the design can and cannot show. Because the same students were measured before and after without a comparison group, the results are interpreted as changes associated with the training rather than definitive proof of cause, and part of the measured change may reflect growing familiarity with the questions. The four pilot schools were purposively selected from a single district, each school type was represented by a single institution, and one all-girls school means the gender findings are partly confounded with school composition. Many statistical tests were conducted without correction for multiple comparisons, so individual significant results, especially the smaller between-group differences and the item-level screen comparisons, are treated as tentative, with more weight placed on the overall pattern.

Within those limits, the study supports integrating standardized cybersecurity training into secondary education. The training appears to have worked mainly as a cue to action in Health Belief Model terms, prompting students to apply protective measures, while strengthening the coping appraisal described by Protection Motivation Theory. The authors suggest that a single program spanning all high school grades may be a practical approach, given that grade-level means were similar before and after the training, and that standardized school-wide training may be more practical than curricula tailored to individual schools. They propose extending the research to pilot schools from different districts to examine the influence of school location, and to middle schools, since children are starting to use the internet at increasingly younger ages and the benefits of introducing cybersecurity education earlier remain to be examined.

Subject of Research: Cybersecurity

Article Title: Evaluation of cybersecurity awareness among high school students in Turkey before and after training

Article References: Cubukcu Cerasi, C., Erat, S., Huseynov, F., Kilic, A., Ozdenizci Kose, B., & Saritoprak, B. (2026). Evaluation of cybersecurity awareness among high school students in Turkey before and after training. Discover Education, 5(1), Article 1194. https://doi.org/10.1007/s44217-026-02338-4

Image Credits: AI Generated

DOI: 10.1007/s44217-026-02338-4

Keywords: cybersecurity awareness, high school students, Turkey, phishing, cybersecurity education, Protection Motivation Theory, Health Belief Model, digital literacy, Evaluation, cybersecurity, awareness, high

The research team, led by Kirsten Paulus and Sarah Bauerle Bass of Temple University College of Public Health, applied the Health Belief Model, a long-standing behavioral framework, to understand pandemic decision-making among people who use drugs. The model proposes that a person’s belief in the threat of a disease, together with their belief in the effectiveness of a proposed protective behavior, predicts the likelihood that they will actually perform that behavior. It rests on six constructs: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. Public health professionals have used the model for decades to design interventions that increase uptake of behaviors like disease screening, and during the COVID-19 pandemic it was successfully applied to predict vaccine intention and adherence to prevention practices across many population groups. What it had never been used for, until now, was understanding pandemic behavior among people who use drugs.

To fill that gap, the researchers conducted a cross-sectional survey between September and December 2021 with 75 clients of a large harm reduction organization in Philadelphia, an agency that serves more than 25,000 unique clients with services including medication for opioid use disorder, behavioral health care, infectious disease prevention, syringe exchange, medical treatment, and housing support. Research staff approached clients while they were receiving services, obtained informed consent in a private area, and administered the survey verbally on an iPad, entering responses into REDCap. Participants received a paper survey and a laminated scale sheet to improve visibility and comprehensibility, and each session took roughly 15 minutes under strict COVID-19 protocols. The instrument combined validated measures with study-specific items derived from earlier qualitative interviews, covering 18 sociodemographic questions and 22 thematic sections on COVID-19, vaccination, harm reduction, sex work, drug use, and basic needs. Five sections mapped directly onto Health Belief Model constructs, with respondents rating statements from zero for highly disagree to ten for highly agree.

The analytic centerpiece was a k-means cluster analysis, a non-hierarchical statistical method that discerns latent subgroups within a sample by assigning individual cases to clusters according to their proximity to the nearest centroid of constituent items, iterating until the desired cluster solution is achieved. Classification was based on four items capturing each participant’s relationship with COVID-19: whether they had ever tested positive, whether they knew someone who had the disease, whether they believed they were susceptible to getting it in the future, and a sum score of their perceived resiliency against difficult things. After accounting for missing data on 15 cases, the final analytic sample was 60 participants. Convergence was achieved after eight iterations, and a two-cluster solution emerged that was independent of every demographic variable measured.

The first cluster, 28 participants or 47 percent of the sample, was more likely to believe they had not been significantly affected by COVID-19 and that it posed no potential future threat, scoring a mean of 2 on the perceived impact item, and showed high overall resiliency with a mean score of 21. The researchers labeled this group Less COVID impact/High resilience, or NoCOV/HR. The second cluster, 32 participants or 53 percent, believed they had been significantly affected by COVID-19 or would be in the future, with a mean of 5, and had lower resiliency, with a mean of 13. This group was labeled High COVID impact/Low resilience, or COV/LR. Strikingly, the two clusters did not differ on age, gender, race, education, employment, income, housing status, vaccination status, or COVID-19 knowledge. Instead, the segmentation was defined by what the authors call psychographic characteristics, meaning perceptions and attitudes rather than demographic descriptors, a novel approach to understanding populations in COVID-19 research.

When the researchers compared the clusters on Health Belief Model constructs using Student’s t-tests and chi-square tests at a 0.05 significance level, meaningful differences appeared across four of the five construct sections. The COV/LR cluster more strongly agreed that people they know had gotten COVID-19, scoring a mean of 8.09 versus 5.61 for the NoCOV/HR group, indicating higher perceived susceptibility. The low-resilience cluster was also far more likely to agree that it is difficult to follow prevention instructions such as mask wearing and social distancing, with a mean of 3.94 versus 0.63, and more likely to report lacking things to keep them safe, such as masks or hand sanitizer, at 2.16 versus 0.67. On the severity side, 58.1 percent of the COV/LR cluster agreed they had to continue working in close contact with people who might be infected, compared with 26.9 percent of the high-resilience cluster, and 71.9 percent reported an increase in mental health problems or symptoms such as mood, anxiety, or stress, versus 46.4 percent.

The high-resilience cluster showed its advantages on the self-efficacy and cues-to-action constructs. Those participants agreed more strongly that they know what is safe and not safe to protect themselves from COVID-19, scoring a mean of 9.29 versus 8.38, and that messages about how to protect themselves and others are easy to understand, at 9.71 versus 8.81. In other words, the psychologically resilient group not only felt less personally impacted by the pandemic but also felt confident in its ability to act on protective information, while the low-resilience group, despite clearly fearing COVID-19’s impact, was less confident in its ability to adhere to preventative behaviors. The authors note that respondents in both clusters often fell on the same end of the agree-disagree scale, diverging mainly in magnitude, which suggests that messaging or interventions aimed at improving resiliency for everyone should yield improvement across both groups.

The findings also illuminate the connection between resilience and mental wellbeing during the pandemic. Those with lower resilience reported an increase in mental health problems, an association consistent with prior work showing that the experience of a high perceived threat can itself erode resilience. COVID-19 restrictions may have exacerbated these negative outcomes, the authors write, because government-enforced curfews and decreased capacity of community agencies reduced access to life-protecting harm reduction services, leading to increased drug use, feelings of isolation, and diminished resilience. Notably, the clusters did not differ on any non-HBM topic blocks, including knowledge of COVID-19, trust of information sources, coping, vaccine beliefs, and neighborhood and community needs, which the authors say highlights how important the Health Belief Model constructs and resiliency are to consider, and illustrates the stability of the two-cluster solution.

Practically, the results suggest concrete tools for harm reduction practitioners. The authors propose that easy screeners could be incorporated to assess overall resilience or beliefs in disease severity and susceptibility, enabling staff to quickly gauge where a client is in their thinking and tailor communication or intervention accordingly. Increasing perceived threat of COVID-19 so that people who use drugs can act upon it is one piece of the puzzle, they write, but increasing resiliency and perceived self-efficacy to use preventative behaviors is key. This may include targeting the susceptibility and severity constructs by ensuring messages are catered to the way this population does or does not believe it is susceptible to an infectious disease, then boosting self-efficacy through cues to action or increased access to protective supplies, alongside community-building techniques to create a resilient community at large.

The study carries important limitations. Because the data are cross-sectional, temporality cannot be inferred, and the reliance on self-reported data means social desirability bias should be considered. Results may not generalize to the broader population of people who use drugs, since the study was conducted only in Philadelphia among clients of a large social services agency that adapted its operations during the pandemic, likely leaving the sample feeling resourced and knowledgeable about staying safe, which may not hold for people without such access. The relatively small sample size limited the use of alternate statistical models and covariate controls, and the clustering variables overlapped conceptually with the perceived susceptibility construct. Still, the core message stands: resilience appears central to protecting this vulnerable population from future infectious disease outbreaks, and interventions aimed at increasing it may improve preventative behavior uptake and decrease disease burden when the next pandemic arrives.

Subject of Research: Health Belief Model constructs and resilience in COVID-19 prevention behavior among people who use drugs

Article Title: Using health belief model constructs to understand the role of perceived disease threat and resilience in responding to COVID-19 among people who use drugs: a cluster analysis

Article References: Paulus, K., Bass, S. B., Kelly, P. J. A., Pilla, J., Otor, A., Scialanca, M., Arroyo, A., & Faison, N. (2024). Using health belief model constructs to understand the role of perceived disease threat and resilience in responding to COVID-19 among people who use drugs: a cluster analysis. Advances in Drug and Alcohol Research, 4, Article 12197. https://doi.org/10.3389/adar.2024.12197

Image Credits: AI Generated

DOI: 10.3389/adar.2024.12197

Keywords: people who use drugs, Health Belief Model, COVID-19, resilience, cluster analysis, harm reduction, perceived susceptibility, self-efficacy, pandemic preparedness, mental health, vulnerable populations, infectious disease

Breast cancer has become the most diagnosed malignancy in the world, with 2.3 million new cases and 670,000 deaths recorded in 2022, and projections suggest annual incidence could climb to 3.2 million cases by 2050. In sub-Saharan Africa, the burden is particularly punishing: late-stage presentation is common in Rwanda, Nigeria, Uganda, and Ethiopia, where limited treatment options and reliance on traditional medicine often delay diagnosis until the disease is advanced. Somaliland is no exception. The first cancer burden report from Hargeisa’s Needle Hospital identified breast cancer as the most common malignancy in the region, accounting for 15.9 percent of cases, with the majority of patients presenting at stage III or IV when survival odds are worst.

In settings where mammography machines are scarce and clinical breast examination infrastructure is thin, breast self-examination has long been championed as a cost-effective, non-invasive tool that empowers women to detect early pathological changes themselves. The technique is operationally defined as a three-step process: visual inspection of the breasts, palpation while lying down, and palpation while bathing, performed ideally three to five days after menstruation begins. The research team, led by Nafisa Abdihamid Mohamed of Amoud University, framed their investigation around the Health Belief Model, a psychological framework holding that people adopt preventive behaviors when they perceive a meaningful health threat and believe a specific action will effectively reduce it. Notably, the World Health Organization does not currently endorse self-examination as a population-based screening strategy, citing the absence of demonstrated mortality benefit and the risk of false positives and unnecessary biopsies, but the method remains influential in awareness campaigns across low-resource settings.

To quantify the drivers of practice in Borama, the researchers administered a structured, self-administered questionnaire between April and May 2024, using convenience sampling with proportional quotas to ensure representation from both institutions. The instrument was piloted among health science students, achieved a content validity index of 0.86 and a Cronbach’s alpha of 0.850, indicating solid validity and internal consistency. Of 217 students approached, 202 provided complete data, a response rate of 93.1 percent. The sample skewed young, with 82.7 percent of respondents aged 20 to 24, and predominantly single at 90.6 percent. Institutional quotas reflected enrollment figures, with 66.3 percent from Amoud University and 33.7 percent from Adal University, and participation was heaviest among third- and fourth-year students, who collectively made up more than half the cohort.

The descriptive results painted a picture of an exceptionally well-informed population. Fully 97 percent of respondents had received prior information about breast cancer or self-examination, drawn mainly from university instruction at 54.5 percent and social media at 24.3 percent. Some 63.4 percent correctly identified the recommended starting age of 20 to 25 years, 98.5 percent agreed that early detection improves survival, and 70.8 percent could name all the major risk factors, including family history, aging, unhealthy lifestyle, and hormonal therapy. Attitudinal measures were equally strong: every single respondent agreed that regular self-examination is important for women’s health, 99.5 percent believed the practice gives women control over their health, and 80.7 percent strongly agreed they felt confident encouraging other women to perform it.

Yet behavior lagged far behind belief. Only 94 of the 202 students, or 46.5 percent, had ever performed the examination. The 108 who had not cited the absence of symptoms rather than lack of awareness. Among those who did practice, timing adherence was encouraging, with 87.2 percent correctly examining themselves a few days after menstruation, but frequency was weaker, and intriguingly, 30.8 percent reported weekly examinations, exceeding the recommended monthly cadence, a pattern the authors suggest may reflect either proactive vigilance or misunderstanding of guidelines that warrants further investigation. Motivations for practice also revealed anxiety-driven triggers: 7.9 percent had previous breast problems, and 8.9 percent began the practice out of fear of breast cancer because of a family history.

The inferential analysis, conducted with binary logistic regression in SPSS while controlling for multicollinearity using variance inflation factors with a mean of 1.64, isolated the factors that truly predicted behavior. Age emerged as a powerful determinant: students in older age categories were more than five times as likely to perform self-examination as their 20-to-24-year-old peers, with an odds ratio of 5.012 and a confidence interval of 1.978 to 12.705. The authors attribute this to academic maturity and cumulative clinical exposure, which may heighten perceived severity as students witness late-stage cancer cases during their rotations. Knowledge, measured as a continuous score, contributed incrementally, with each additional point raising the odds of practice by 16.1 percent. Family monthly income, by contrast, showed no statistically significant association whatsoever, an odds ratio of 1.011 that diverges sharply from general population studies where economic status often dictates screening access.

Attitude proved to be the strongest predictor of all. Students with positive attitudes were 3.25 times more likely to perform the examination than those with poor or neutral attitudes, an odds ratio of 3.251 with a confidence interval of 2.214 to 4.774 and a p-value below 0.001. The finding carries a crucial caveat about psychological barriers: 18.3 percent of respondents reported feeling uncomfortable during the examination, and the authors interpret this discomfort, rooted in cultural modesty or fear of finding a lump, as a perceived barrier that can outweigh knowledge of personal susceptibility. In Health Belief Model terms, knowing you are at risk is not enough if the emotional cost of the action feels prohibitive. The authors caution that their framework was exploratory, since they measured only perceived benefits and barriers rather than deploying fully validated psychometric scales covering susceptibility, severity, and cues to action.

The study’s limitations are acknowledged candidly. The cross-sectional design precludes causal inference, self-reported practice was not clinically verified, and social desirability bias may have inflated prevalence figures among students aware of professional expectations. Convenience sampling from two urban universities also limits generalizability to remote and non-academic populations. Still, the pattern mirrors regional data from Ethiopia and Nigeria, and comparisons with a Mogadishu knowledge-attitude-practice study, in which 89 percent of healthcare professionals knew about breast cancer but awareness of preventive tools was strikingly limited, suggest the gap is systemic rather than local. The policy prescription is clear: Somaliland’s medical faculties should institutionalize hands-on simulations using breast models, mandate training for first- and second-year students before clinical pressures mount, and build peer-led advocacy programs that normalize the conversation around breast health, while the Ministry of Health reframes self-examination as an act of empowerment rather than a response to disease.

The deepest lesson of the Borama study may resonate far beyond Somaliland. Knowledge dissemination through lectures, posters, and social media campaigns is merely a precursor to behavior, not behavior itself. When 77.7 percent of a cohort knows and 46.5 percent act, the bottleneck is psychological, not informational. Bridging that divide demands interventions that build self-efficacy, desensitize discomfort through clinical practice, and transform abstract awareness into a sustained monthly habit. For the future physicians of Somaliland, who will be expected to lead their communities in early detection, the difference between knowing and doing could ultimately shape survival outcomes across an entire region where late-stage diagnosis remains the deadliest obstacle.

Subject of Research: Determinants of breast self-examination practice among female medical students in Somaliland

Article Title: Factors associated with breast self-examination practice among female medical students in selected universities in Borama, Somaliland

Article References: Mohamed, N. A., Abdi, K. M., Odero, V. O., & Abdikarim, H. (2026). Factors associated with breast self-examination practice among female medical students in selected universities in Borama, Somaliland. Frontiers in Cancer Control and Society, 4, Article 1850142. https://doi.org/10.3389/fcacs.2026.1850142

Image Credits: AI Generated

DOI: 10.3389/fcacs.2026.1850142

Keywords: breast cancer, breast self-examination, Somaliland, medical students, Health Belief Model, early detection, cancer screening, knowledge-practice gap, cross-sectional study, health behavior, Amoud University, low-resource settings

The research team, led by Shasha Liu and Fuping Li of the hospital’s Human Sperm Bank together with colleagues in pediatric hematology-oncology nursing, surveyed parents of boys aged zero to twelve years who were being treated for cancer. The study followed the STROBE guidelines for cross-sectional research and divided participants into two distinct groups: those whose sons had not yet started cancer treatment and those whose sons had already undergone therapy. This pre- and post-treatment stratification is more than a methodological nicety. It captures two fundamentally different decision windows. Before treatment, parents face an urgent, often overwhelming choice with a hard deadline, because many fertility preservation options must be pursued before gonadotoxic therapy starts. After treatment, the window has largely closed, and the decision landscape changes entirely.

In total, 134 patients were enrolled, with a mean age of just 6.0 years and a standard deviation of 2.9—meaning most of the boys were far too young to make or even understand reproductive decisions themselves. The responsibility fell entirely on their parents. When asked, 64.9 percent of parents—87 of the 134—expressed willingness to pursue fertility preservation for their sons. That roughly two-thirds figure is notable in itself, but the study’s real analytical power comes from its multivariable logistic regression models, which were run separately for each treatment group to identify which factors independently predicted parental willingness.

The results split cleanly along the treatment timeline. Among parents whose sons had not yet begun cancer therapy, the single significant predictor was a democratic parenting style. Parents who reported involving their children in decisions, listening to their views, and sharing authority were more than three and a half times as likely to be willing to pursue fertility preservation, with an odds ratio of 3.557 and a 95 percent confidence interval running from 1.094 to 11.567. The authors suggest that this parenting orientation reflects a broader openness to considering the child’s future personhood—including his eventual capacity to have his own family—even when that future cannot be discussed with the child directly.

In the post-treatment group, the picture changed. Here, two factors emerged as significant. The first was parental education: parents with higher educational attainment were roughly four times as willing to pursue fertility preservation (odds ratio 4.054, 95 percent confidence interval 1.021 to 16.094). The second was health belief: for each unit increase in parents’ scores on the health belief measures used in the study, willingness rose by 17 percent (odds ratio 1.170, 95 percent confidence interval 1.045 to 1.309). In other words, once treatment was underway or complete, what mattered was no longer how parents parented, but how much they knew and how strongly they believed that cancer treatment threatens fertility and that preservation offers a genuine benefit.

That second finding aligns with the Health Belief Model, the theoretical framework the researchers used to structure their inquiry. Developed in the 1950s to explain why people fail to use preventive health services, the model proposes that health behavior depends on perceived susceptibility to a threat, perceived severity of its consequences, perceived benefits of taking action, perceived barriers to doing so, and internal cues that prompt action. Applied to fertility preservation, the model predicts that a parent who understands that gonadotoxic therapy can cause infertility, who views that infertility as a serious harm to their child’s future quality of life, and who believes preservation is effective and feasible, will be far more likely to act. The post-treatment data bear this out: parents who had lived through the treatment experience, and who had absorbed its implications for reproduction, showed willingness that tracked closely with the strength of those beliefs.

The biology underlying the whole enterprise deserves attention. The germ cells in prepubertal testes—spermatogonial stem cells—are exquisitely vulnerable to alkylating chemotherapy agents and to radiation, both of which deplete the stem cell pool that would otherwise drive spermatogenesis after puberty. For adolescent boys who have already begun producing sperm, the standard of care is straightforward: semen cryopreservation before treatment. For prepubertal boys, however, there is no sperm to freeze, and the field relies on experimental approaches, most notably testicular tissue cryopreservation, in which a small biopsy containing spermatogonial stem cells is frozen with the hope of future reimplantation or in vitro maturation. These techniques remain investigational, but the stakes are high, and the decision to bank tissue must be made in the narrow interval between diagnosis and the first chemotherapy cycle—a window that can be measured in days.

This is why the study’s central conclusion is so pointed: parents’ recognition of cancer treatment’s impact on fertility, and their understanding of what fertility preservation can actually offer, are the key drivers of decision-making. Before treatment, when families are reeling from a new cancer diagnosis, those understandings are often incomplete, and the decision may hinge on temperament and family dynamics—hence the prominence of democratic parenting in the pre-treatment model. After treatment, when the emotional fog has partially lifted and parents have had time to learn, knowledge and belief take over. The asymmetry between the two models is itself the finding: the pre-treatment window, the one that matters most biologically, is the one in which parents are least equipped cognitively to make an informed reproductive choice.

The clinical implications follow directly. The authors argue that healthcare providers should initiate timely, clear communication about fertility preservation options before treatment begins, not after. This means that oncologists, nurses, and reproductive medicine specialists need protocols that bring fertility counseling into the earliest moments of pediatric cancer care, alongside consent discussions for chemotherapy itself. In China, where sperm banks exist in major cities but pediatric fertility preservation services remain unevenly distributed, the logistics are formidable. Testicular tissue cryopreservation is available at only a handful of centers, and many families live far from any facility equipped to perform and store such biopsies. Distance, cost, and the simple scarcity of counseling time during a medical crisis all act as barriers that the Health Belief Model would predict will suppress uptake.

At the policy level, the study’s recommendations are equally concrete: integrate fertility preservation counseling into standard oncology care and provide accessible educational resources for parents. In practice, that could mean decision aids in local languages, standardized counseling scripts for pediatric oncology teams, and formal referral pathways from oncology units to reproductive medicine services. The study was supported by the Sichuan Science and Technology Program, and its authors span the sperm bank, pediatric nursing, and pediatrics departments of the same hospital—an institutional arrangement that itself models the kind of collaboration the recommendations require. For the roughly two-thirds of Chinese parents who already say yes to fertility preservation, and for the third who hesitate, the message from Chengdu is clear: the conversation about a child’s future family should start on the day of diagnosis, not when the treatment is over and the options have narrowed to memory.

Subject of Research: Parental decision-making about fertility preservation for male children and adolescents undergoing cancer treatment in China

Article Title: Fertility preservation in young male adolescents and children before and after treatment with cancer in China: factors influencing the decision of parents

Article References: Liu, S., Ma, J., Yuan, J., Zhou, J., Luo, B., Lu, X., & Li, F. (2026). Fertility preservation in young male adolescents and children before and after treatment with cancer in China: factors influencing the decision of parents. BMC Cancer. https://doi.org/10.1186/s12885-026-17108-6

Image Credits: AI Generated

DOI: 10.1186/s12885-026-17108-6

Keywords: fertility preservation, pediatric oncology, parental decision-making, China, spermatogonial stem cells, testicular tissue cryopreservation, Health Belief Model, chemotherapy-induced infertility, hematologic malignancies, health communication, reproductive medicine, childhood cancer survivors

The research team, led by pharmacist and PhD researcher Beatriz Santos, interviewed 30 ambulatory patients in Geneva, Switzerland, between July and December 2022, ultimately analyzing the accounts of 24 adults living with chronic conditions such as diabetes, hypertension, and respiratory disease. To be included, participants had to have been on a prescribed medication for at least six months and to have modified their intake at least once in the previous year without consulting a healthcare professional first. The interviews, conducted in French and lasting an average of 35 minutes, were transcribed, verified, and analyzed using a low-inference qualitative descriptive approach with MAXQDA software, a method chosen to stay as close as possible to participants’ own words rather than imposing heavy theoretical interpretation. Recruitment deliberately avoided stigmatizing language such as “non-adherent,” a choice the researchers say was essential for getting people to open up about behavior they often keep hidden.

What emerged was a wide repertoire of adjustment techniques. Participants reported skipping or reducing doses, temporarily interrupting treatment, splitting a single daily dose across the day, altering the timing of intake, and replacing pharmaceutical products with non-pharmacological alternatives. The medications involved ranged from preventive therapies such as antihypertensives, metformin, calcium, and vitamin supplements to insulin and other diabetes treatments. Notably, the researchers encouraged participants to discuss all of their medications, not just those for the conditions they were recruited through, reflecting the multimorbid reality of most chronic patients, who in this study carried an average of 2.3 chronic conditions each.

Perhaps the most striking finding is what the researchers call using the body as a compass. Many participants described relying on physical sensations, symptoms, or intuition as their primary guide for deciding when and how much medication to take, sometimes explicitly prioritizing these bodily signals over medical advice. One participant explained how leg pain served as a rough glucose meter, allowing him to estimate his blood sugar from where the pain stopped in his leg. Another insisted on the right to test things personally, saying that even if the diabetologist had insisted on a dose, he wanted first to see what was happening inside his own body, because, as he put it, it is his body and it belongs to him. The researchers interpret this as a form of experiential knowledge: rather than passively following prescriptions, these patients engage in dynamic self-monitoring, tailoring treatment to perceived needs through observation, trial, and error.

Interestingly, this bodily compass can be partly displaced by technology. Several participants described how monitoring devices, such as continuous glucose sensors or home blood pressure monitors, shifted their adjustment decisions from subjective feelings toward objective numbers. One participant reported interrupting insulin for the exact number of days her glucose sensor was removed, since without the device she could not measure her blood sugar at all. Another began checking her blood pressure at home and skipping her telmisartan whenever the reading was low, replacing a vague sense of fatigue-driven guessing with a numeric threshold. The authors note a double edge here: as patients delegate self-monitoring to devices, they may become less attuned to their own symptoms, creating a potential vulnerability whenever access to the technology is interrupted.

Why do patients do this? The dominant driver, the study found, is a perceived lack of need or benefit. Consistent with the Health Belief Model, a well-established psychological framework linking health behavior to perceived susceptibility, severity, benefits, and barriers, participants who felt no symptoms, particularly those on preventive treatments for osteoporosis or hypertension, struggled to see the point of daily pills. Some substituted what they considered natural equivalents: eating more Parmesan cheese for iron, drinking orange juice for vitamin D, or relying on dairy products instead of calcium supplements, occasionally with visible confusion between vitamins. Others adjusted to cope with medication overload, with one participant joking that the pile of pills she took daily could almost be spread on toast. Practical barriers mattered too: injections that hurt, pills too large to swallow discreetly in restaurants, side effects that ruined holidays, demanding work weeks in which a hypoglycemic episode felt unmanageable, and even insurance reimbursement limits that pushed one patient to plan dose reductions toward the end of the year.

Beneath these practical calculations lies a hidden hierarchy. Participants consistently ranked their medications, treating some as untouchable and others as negotiable. Long-standing treatments, woven into habit and routine, were considered more important and less likely to be adjusted, while newer additions, supplements, and preventive therapies sat lower on the ladder. The clinical context of prescription also weighed heavily: medications initiated after frightening events, such as a minor stroke, were regarded as essential, with one participant singling out her aspirin as non-negotiable for precisely that reason. The researchers argue that recognizing this patient-constructed frame of reference, which may diverge sharply from clinical priorities, is essential for any realistic conversation about adherence.

The emotional texture of self-adjustment is ambivalent. Participants described feelings of freedom, control, and empowerment, a sense of being the true experts on their own conditions, with one declaring that the patient is their best doctor. Yet the same decisions frequently produced guilt, anxiety, and an internal conflict that made medication management painful. One participant described the liberation of deciding not to take a pill, immediately followed by the recognition that she was not really free, because she knew she was doing something not right for her health. Fear of judgment kept many from disclosing these behaviors to prescribers, with some preferring to let six-monthly blood tests reveal the truth rather than face a lecture. Where physicians responded rigidly, patients described feeling like scolded schoolchildren and reluctantly resuming treatment; where physicians validated their reasoning, patients reported strengthened autonomy and a more honest relationship.

The study’s authors, whose protocol was approved by the Geneva Regional Research Ethics Committee and whose recruitment spanned pharmacies, hospital outpatient clinics, primary care centers, and patient associations, are careful about the limits of their work. Participants were highly educated, all came from a single French-speaking canton, and those willing to discuss such sensitive behavior may differ from those who are not. Still, the team reached thematic saturation, with later interviews generating no new insights, and they argue the descriptive foundation now justifies quantitative research into how common specific adjustment behaviors are and how they affect clinical outcomes. Their prescription for change is clear: patients need safer, more informed pathways to do what many are already doing anyway. That means patient education programs on medication adjustment, collaborative care frameworks, and above all a shift from directive, one-size-fits-all prescribing toward genuine dialogue in which patients feel heard, respected, and able to experiment openly with their clinicians rather than in secret. As the authors conclude, acknowledging both the clinician’s expertise and the patient’s agency may be the only way to close the gap between what is prescribed and what is actually taken.

Subject of Research: Patient self-adjustment of long-term medication regimens without consulting healthcare providers

Article Title: Self-Adjusting Long-Term Medications: A Qualitative Descriptive Study of Patients’ Practices

Article References: Santos, B., Arnoux, S., Pechère-Bertschi, A., Empeyta, S., Hudelson, P., & Schneider, M. (2026). Self-Adjusting Long-Term Medications: A Qualitative Descriptive Study of Patients’ Practices. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10842-4

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10842-4

Keywords: medication adherence, self-adjustment, chronic disease, qualitative research, patient-provider communication, diabetes, hypertension, Health Belief Model, self-management, patient education, shared decision-making, prescription drugs

The study, led by Huan Zheng and colleagues at the First Affiliated Hospital of Zhejiang University School of Medicine and published in Supportive Care in Cancer, surveyed 196 postoperative breast cancer patients between December 2024 and January 2025. Using a convenience sampling approach, the team approached 230 potentially eligible patients and achieved an 85.2 percent response rate, with 112 participants completing paper questionnaires and 84 responding electronically through the Questionnaire Star platform. The researchers measured lymphedema-related health information-seeking behavior, or HISB, using a 43-item scale covering four dimensions: attitudes toward information-seeking, information needs, information sources, and barriers to accessing health information. They also administered a validated knowledge, attitude, and practice scale for upper extremity lymphedema prevention.

The headline numbers are revealing. The mean lymphedema-related HISB score was 178.21 with a standard deviation of 25.02, on a scale where the possible range spans 43 to 215. Because no validated interpretative threshold exists for this instrument, the authors deliberately refrained from labeling the score as low, moderate, or high, presenting it descriptively instead. Within the individual dimensions, information needs scored highest relative to their structure at 63.18, followed by information sources at 56.87, barriers at 32.13, and attitudes at 26.03. This pattern suggests that patients genuinely want to know about lymphedema, including warning signs, self-care behaviors, treatment options, and coping strategies for anxiety, but that the channels and supports available to them may not fully match that demand.

When the researchers moved from description to explanation, two factors emerged as independently associated with information-seeking in a multiple linear regression model. The first was the total KAP score: for every one-point increase in lymphedema-related knowledge, attitude, and practice, the HISB score rose by 0.850 points on average, with a standardized coefficient of 0.621 and a p-value below 0.001. The correlation between the two instruments was strong overall at r = 0.871, and when the researchers decomposed it by dimension, the practice component showed the strongest association at r = 0.837, followed by attitude at 0.785 and knowledge at 0.742. The final regression model explained 40.2 percent of the variance in HISB, a substantial share for a behavioral outcome measured at a single point in time.

The second independent predictor is the one that has captured the most attention. Patients who reported that they did not know their axillary lymph node dissection status, meaning they could not say how many nodes had been removed, scored significantly lower on information-seeking than those who reported zero nodes removed, with a regression coefficient of −15.467 and a p-value of 0.019. The authors are careful to note that this comparison pits the unknown group against a specific reference category rather than contrasting patients who were aware of their surgical history with those who were not, and that the cross-sectional design forbids any causal interpretation. Still, the signal is provocative: uncertainty about a concrete, personally relevant surgical detail travels together with reduced engagement in health information.

Why might this be? The researchers turn to the Health Belief Model, a foundational framework in health psychology that holds that people are motivated to act when they perceive a disease threat and believe in their own capacity to respond. A patient who cannot report her nodal status may lack a clear picture of her personal risk factors, and that ambiguity could paradoxically dampen her motivation to seek information, since perceived susceptibility is one of the engine blocks of proactive behavior. The authors also raise the possibility of reverse directionality: patients who are less engaged with their health in general may simply be less likely to recall or report surgical details. Unknown status, in other words, may be less a cause of disengagement than a marker of it, reflecting limited health literacy, poor recall, or insufficient communication between clinicians and patients.

One of the study’s most instructive findings is what did not survive statistical adjustment. In univariate analyses, educational level, household size, radiotherapy site, discharge instructions, axillary web syndrome, and awareness of lymphedema clinics were all associated with HISB scores, and younger patients and those from larger households tended to score higher. Yet once the KAP score entered the model, none of these sociodemographic or clinical variables retained significance. The authors interpret this attenuation cautiously, suggesting that factors like education and household support may influence information-seeking indirectly, through their effects on disease-specific knowledge and self-management practice, rather than exerting independent effects. They did not conduct formal mediation analysis, and they emphasize that longitudinal work is needed to test whether knowledge truly sits on the causal pathway. An intriguing unadjusted pattern, in which patients who received no structured discharge instructions showed higher information-seeking, hints at possible compensatory behavior, though the authors label this interpretation speculative.

The study also paints a sobering picture of the barriers patients face. Common obstacles included complex medical information, technological challenges such as unfamiliarity with the internet, and financial constraints, with 34.69 percent of participants reporting a monthly household income below 5,000 RMB and 22.96 percent living in rural townships. Inadequate family support hindered some patients’ ability to manage these obstacles, and several reported insufficient time and energy to focus on lymphedema care. Meanwhile, information provided by healthcare providers often fails to satisfy patient needs, prompting many to turn to social networks and other informal channels, where the material they find is frequently fragmented and insufficient to support sound decisions. The broader context underscores the stakes: GLOBOCAN 2024 estimates attribute approximately 2.43 million new female breast cancer cases and 694,000 deaths worldwide to the disease in 2024, and Google Trends analyses show rising public search interest in lymphedema and arm swelling after mastectomy.

The authors are candid about their limitations. The single-center design and Hangzhou-based tertiary hospital sample raise concerns about selection bias and generalizability, and the near-total female composition of the cohort, 99.49 percent, reflects breast cancer epidemiology but limits extrapolation to the small population of male patients. The cross-sectional snapshot cannot establish temporal order, and the strong correlation between the HISB scale and the practice dimension of the KAP instrument suggests some conceptual overlap that may have modestly inflated their observed association, although the substantial correlations with knowledge and attitude dimensions indicate the relationship extends beyond shared behavioral content. The study was retrospectively registered with the Chinese Clinical Trial Registry as the quantitative component of a mixed-methods investigation, and the authors report following the STROBE checklist for observational research.

Even with those caveats, the practical implications are concrete. The authors suggest that healthcare providers routinely assess whether patients can report their axillary lymph node dissection status, treating an answer of unknown not as a trivial gap in recall but as a potential flag for patients who need tailored informational support and a check on their comprehension of postoperative care. They caution, however, that simply providing more information may not suffice, since the underlying issue may be engagement rather than supply. More broadly, the findings argue for structured education that builds lymphedema knowledge as a lever for activating information-seeking, and for refining communication models so that the gap between what clinicians deliver and what patients demand finally closes. In an era when patients must assume lifelong responsibility for monitoring their own lymphedema risk after leaving the hospital, knowing what a patient does not know may prove to be one of the most powerful diagnostic tools a care team possesses.

Subject of Research: Health information-seeking behavior related to breast cancer-related lymphedema among postoperative breast cancer patients

Article Title: Current status of lymphedema-related health information-seeking behavior and its associated factors among postoperative breast cancer patients: a cross-sectional study

Article References: Zheng, H., Chen, F., Wang, L., Cao, K., Zhao, X., & Shao, L. (2026). Current status of lymphedema-related health information-seeking behavior and its associated factors among postoperative breast cancer patients: a cross-sectional study. Supportive Care in Cancer, 34(11), Article 1091. https://doi.org/10.1007/s00520-026-11322-5

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11322-5

Keywords: breast cancer, lymphedema, health information-seeking behavior, axillary lymph node dissection, health literacy, patient education, health belief model, self-management, cross-sectional study, supportive care, nursing, cancer survivorship

The study, published in Supportive Care in Cancer by a research team led by Jinting Sun and colleagues at the First Affiliated Hospital of Soochow University in Suzhou, set out to understand why early screening behavior for BCRL varies so widely among survivors. Rather than measuring screening rates numerically, the researchers took a qualitative descriptive approach, conducting semi-structured interviews with 20 postoperative breast cancer patients recruited from a tertiary hospital. They used purposive sampling with maximum variation to ensure the participants reflected a range of ages, treatment experiences, and backgrounds, and they analyzed the transcripts using the six-phase thematic analysis procedure developed by Braun and Clarke, with reporting that followed the COREQ guidelines for qualitative research. The goal was not to count barriers but to understand them from the inside, through the words and reasoning of the patients themselves.

To organize their inquiry, the team anchored the study in the health belief model, a classic framework in health psychology first articulated in the 1950s and later refined by Janz and Becker. The model proposes that whether a person adopts a preventive health behavior depends on several cognitive appraisals: their perceived susceptibility to the condition, their perception of its severity, their belief in the benefits of taking action, their assessment of the barriers to action, and the internal cues and self-efficacy that drive them to act. Applied to BCRL, the model asks a deceptively simple question: if screening can prevent a debilitating complication, why do so many survivors not show up for it? The answers that emerged from the Suzhou interviews were layered and, in places, unexpected.

The first major theme the researchers identified was limited understanding and misinterpretation of BCRL risk. Many participants simply did not know what lymphedema was, had never heard the term before their surgery, or confused it with ordinary postoperative swelling that resolves on its own. Some underestimated their personal risk, assuming that lymphedema was something that happened to other people, or that their own treatment had been mild enough to spare them. This pattern of unrealistic optimism is well documented in the screening literature; earlier work on Israeli women’s screening intentions by Barnoy and colleagues showed how perceived control and optimism can suppress preventive behavior. In the Suzhou cohort, limited awareness of the long-term consequences of lymphedema—including its chronicity, its cosmetic and functional impact, and its links to psychological distress and even sleep problems—further weakened any sense of urgency. When a threat feels vague and distant, the cognitive machinery that motivates prevention rarely engages.

The second theme captured the motivations and barriers to screening behavior themselves. Participants who did attend screening often did so because they perceived concrete benefits: the possibility of catching swelling early, receiving timely guidance on arm care, and avoiding the heavier costs of late-stage treatment. But these perceived benefits competed against a formidable array of barriers. Some patients expressed skepticism about whether screening actually worked or whether early detection changed outcomes at all. Others described logistical hurdles—travel time, appointment scheduling, out-of-pocket costs, and the sheer fatigue of recovering from cancer treatment while juggling family and work obligations. The health belief model predicts exactly this tension: behavior emerges only when perceived benefits outweigh perceived barriers, and for many survivors in this study, the balance tipped away from screening.

The third theme broadened the lens from individual cognition to social and systemic constraints. Screening behavior, the interviews made clear, does not happen in a vacuum. Participants described family dynamics that shaped whether they could prioritize their own follow-up care, with some women deprioritizing their health in favor of caregiving responsibilities. They also pointed to gaps in the healthcare system itself: limited survivorship follow-up structures, inconsistent communication from clinicians about lymphedema risk, and scarce access to specialized screening services such as bioimpedance spectroscopy, which clinical practice guidelines, including the 2024 MASCC international Delphi consensus recommendations, identify as a valuable tool for detecting subclinical lymphedema. This systemic dimension echoes broader findings in the literature; a 2025 systematic review by Mattia and colleagues documented persistent inequities and barriers in lymphedema care, and a 2024 study in a safety-net hospital by Young and colleagues found substantial screening and treatment gaps even within well-resourced health systems.

The fourth and perhaps most hopeful theme concerned self-efficacy and health responsibility. Even among patients facing real obstacles, some had internalized a sense of ownership over their long-term health. These participants described screening not as an imposition but as an expression of responsibility to themselves and their families, and they reported confidence in their ability to carry out the recommended behaviors. This aligns with cross-sectional evidence from Chinese women showing that self-efficacy mediates the relationship between social support and cancer screening behavior, as reported by Tu and colleagues in 2024. In the health belief model’s terms, self-efficacy functions as the engine that converts awareness into action; without it, even well-informed patients may stall. The Suzhou findings suggest that cultivating this internalized health responsibility may be as important as delivering information.

Taken together, the four themes paint a picture of screening behavior as an interaction between cognitive appraisal, contextual constraints, and health system factors. No single lever—patient education alone, or clinic access alone—will move the needle. The authors conclude that interventions should focus on strengthening survivorship follow-up, improving clinician communication about lymphedema risk, and expanding access to screening services. In practical terms, this could mean embedding lymphedema education into routine postoperative consultations, providing clear risk information tailored to each patient’s treatment profile, and building screening into standard follow-up pathways rather than leaving it as an optional extra that patients must seek out on their own initiative.

The stakes are considerable. Breast cancer remains the most commonly diagnosed cancer among women globally, with GLOBOCAN 2022 estimates documenting its enormous and growing burden. As survival improves, the population living with treatment sequelae expands in parallel, and the cumulative economic burden of lymphedema treatment—documented in a systematic review by De Vrieze and colleagues—is substantial for both patients and health systems. Risk prediction models for BCRL, reviewed by Lin and colleagues, are becoming more sophisticated, and diagnostic tools such as bioimpedance spectroscopy now have dedicated clinical practice guidelines. The science of detection is advancing; the science of getting patients through the door is lagging behind, and this study helps explain why.

What makes the Suzhou study valuable is precisely its refusal to treat non-screening as simple negligence. The interviews reveal rational patients making decisions within constrained circumstances, shaped by incomplete information, competing priorities, skepticism, and system-level friction. For clinicians, the message is that communication must do more than inform; it must build perceived susceptibility without inducing fatalism, demonstrate the tangible benefits of early detection, and lower the practical barriers that stand between intention and action. For policymakers, the message is that survivorship care pathways need structural reinforcement so that screening becomes the default rather than the exception. And for survivors themselves, the study is a reminder that a feeling of well-being in the months after surgery is not a guarantee of freedom from lymphedema, and that a simple, early check may be one of the most consequential health decisions of the survivorship journey.

Subject of Research: Factors influencing early screening behavior for breast cancer–related lymphedema among postoperative breast cancer patients, analyzed through the health belief model

Article Title: Based on the health belief model: a qualitative exploration of factors influencing early screening behavior for breast cancer–related lymphedema

Article References: Sun, J., Chen, Y., Xu, J., Jiang, Y., & Ji, J. (2026). Based on the health belief model: a qualitative exploration of factors influencing early screening behavior for breast cancer–related lymphedema. Supportive Care in Cancer, 34(10), Article 974. https://doi.org/10.1007/s00520-026-11219-3

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11219-3

Keywords: breast cancer-related lymphedema, screening behavior, health belief model, qualitative research, self-efficacy, cancer survivors, perceived susceptibility, health barriers, survivorship care, bioimpedance spectroscopy, patient education, China

Neural tube defects, which include spina bifida and anencephaly, arise when the embryonic structure that becomes the brain and spinal cord fails to close properly during the first four weeks of development, often before a woman even realizes she is pregnant. Decades of evidence have established that adequate folic acid intake around the time of conception can prevent a large proportion of these defects, which remain a major preventable cause of congenital disability worldwide. Because the window for protection closes so early, public health authorities recommend that women begin taking a daily folic acid supplement before conception and continue through at least the first trimester. The new research set out to determine whether women of childbearing age in mainland China are translating that general message into precise, correctly timed behavior.

The investigation took a mixed-methods approach conducted between June and September 2024. In the quantitative phase, the researchers administered a study-specific questionnaire online to 5,741 women aged 18 to 49 years recruited from different regions of mainland China through a convenience sample. The survey assessed folic acid-related knowledge and supplementation behaviors, and the team used univariable and multivariable logistic regression analyses to examine the association between knowledge scores and correct supplementation. In the qualitative phase, the researchers conducted semi-structured interviews with 18 pregnant women, guided by the Health Belief Model, a well-established psychological framework that explains health behavior through perceptions of susceptibility, severity, benefits, obstacles, and cues to action. Qualitative data were analyzed using directed content analysis, and the quantitative and qualitative findings were integrated through a joint display to reveal where numbers and lived experience converged or diverged.

The headline numbers from the survey reveal a knowledge pyramid that narrows sharply as it descends from general awareness to actionable detail. Among the 5,741 survey participants, 5,490 women, or 95.6 percent, knew that folic acid prevents neural tube defects. But only 3,594, or 62.6 percent, knew the correct timing for supplementation, and just 2,949, or 51.4 percent, knew the recommended daily dose. In other words, while nearly all women had absorbed the core public health message, roughly half were missing the operational specifics that determine whether supplementation actually protects an embryo during the window of neural tube closure.

Behavioral data told an even more sobering story. Among the 4,470 women with pregnancy or pregnancy-planning experience, 3,858, or 86.3 percent, had obtained folic acid, and 3,708, or 83.0 percent, had actually taken it. Yet only 1,281 women, or 28.7 percent, adhered to the full regimen. The steep drop-off between obtaining the supplement and completing the recommended course indicates that the challenge is not access or initial motivation but sustained, correctly timed adherence. A bottle of folic acid purchased after a positive pregnancy test, or abandoned partway through the preconception period, offers far less protection than one taken daily from before conception onward.

The statistical analysis confirmed that knowledge is not merely correlated with good practice by chance. After adjusting for other variables, the researchers found that knowledge scores were significantly associated with adherence to correct supplementation, with an adjusted odds ratio of 1.493 and a 95 percent confidence interval of 1.43 to 1.56. Each increment in knowledge corresponded to meaningfully higher odds of taking folic acid correctly. This dose-response-like relationship between understanding and behavior strengthens the case that the knowledge gaps in timing and dosage are not benign oversights but active contributors to suboptimal supplementation practices.

The qualitative interviews added psychological texture to these statistics. Using the Health Belief Model as an analytical lens, the researchers identified barriers spanning all five of the framework’s core constructs. Women’s decisions were shaped by how susceptible they perceived themselves to be to having an affected pregnancy, how severe they believed the consequences would be, how beneficial they judged supplementation to be, what obstacles they encountered in obtaining and taking the supplement, and what cues prompted them to act. These perceived factors help explain why a woman who knows that folic acid prevents birth defects in the abstract might still fail to start early, take the right dose, or persist through the recommended duration.

When the quantitative and qualitative strands were integrated through the joint display, a coherent picture of the knowledge-practice gap emerged. The researchers concluded that limited knowledge of the recommended timing and dosage, health information that was insufficiently individualized, and brief counseling from healthcare providers may all contribute to suboptimal supplementation practices. Generic advice delivered in passing during a busy prenatal visit appears inadequate to convey the operational precision that folic acid prevention demands. Women need to hear not just that the vitamin matters, but exactly when to begin, how much to take each day, and how long to continue, with that guidance tailored to their circumstances.

The study, which received no external funding and was approved by the Institutional Review Board of the Peking University Biomedical Ethics Committee, carries clear implications for preconception health education in China and beyond. The authors call for preconception health education that provides specific, individualized, and theory-informed guidance on when, how much, and how long folic acid should be taken. Grounding educational interventions in behavioral frameworks such as the Health Belief Model could help address the perceived barriers that interviews uncovered, while longer and more structured provider counseling could close the timing and dosage knowledge gaps that the survey documented.

For a preventable cause of congenital disability, the distance between 95.6 percent awareness and 28.7 percent full adherence represents an enormous unrealized opportunity. The neural tube closes within the first four weeks of embryonic development, meaning that every month of delayed initiation or interrupted adherence translates into real risk. This research demonstrates that closing the gap requires moving beyond slogans about folic acid’s importance and toward communication that equips women with the concrete, actionable details of the regimen. As the authors’ findings make plain, knowing that a supplement prevents birth defects is only the first step; knowing precisely how to take it is what turns knowledge into protection.

Subject of Research: Folic acid supplementation knowledge and adherence for neural tube defect prevention among women of childbearing age in China

Article Title: Discrepancy between knowledge and practice in folic acid supplementation for NTD prevention: a mixed-methods study of Chinese women

Article References: Li, J., Peng, X., He, H., Liu, N., Dong, W., Lv, D., Li, S., & Zhu, X. (2026). Discrepancy between knowledge and practice in folic acid supplementation for NTD prevention: a mixed-methods study of Chinese women. BMC Public Health. https://doi.org/10.1186/s12889-026-29848-y

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29848-y

Keywords: folic acid, neural tube defects, women of childbearing age, medication adherence, health belief model, mixed-methods research, preconception health, public health, China, nutritional supplements, health education, pregnancy planning

The psychological weight of a cancer diagnosis creates conditions that researchers have long recognised as fertile ground for misinformation to take root. When patients and their families receive life-altering news, their cognitive resources are often stretched to breaking point. The study under discussion, conducted at King Fahad Specialist Hospital in Dammam, Saudi Arabia, captures this dynamic in striking detail through semi-structured interviews with nineteen cancer patients and six caregivers. By grounding their analysis in two well-established psychological frameworks, the theory of planned behaviour and the health belief model, the researchers moved beyond simply cataloguing what participants searched for online and instead examined the underlying beliefs that shaped how they searched, what they trusted, and why they sometimes fell prey to false or misleading claims.

The theory of planned behaviour posits that human actions are guided by three kinds of beliefs: behavioural beliefs about the consequences of an action, normative beliefs about the expectations of others, and control beliefs about one’s own capacity to perform the behaviour. Applied to information seeking, this framework helps explain why a patient might type symptoms into a search engine late at night despite knowing that clinicians discourage it. If the patient believes that searching will bring relief from uncertainty, senses that family members expect them to be proactive, and feels confident in their ability to navigate the web, the intention to search online becomes powerful, regardless of the quality of what they find.

The health belief model adds another layer by focusing on perceptions of threat and benefit. A patient who perceives their cancer as severe and themselves as highly susceptible to progression may be more motivated to seek information aggressively, but that same heightened perception of threat can make dramatic, unverified claims about miracle cures or hidden causes feel plausible. Perceived barriers and self-efficacy, two further constructs of the model, determine whether patients verify what they read or accept it at face value. The interview study suggests that many participants possessed low self-efficacy when it came to evaluating sources, and this deficit became a critical vulnerability.

One of the most consequential findings is that participants relied on superficial methods to search for and evaluate online cancer information, largely to reduce cognitive effort. This behaviour has a rational core. Information search is fundamentally a problem-solving task involving inference and decision-making, and these are precisely the cognitive processes that cancer and its treatments can impair. Chemotherapy-related cognitive changes, often described by patients as difficulty concentrating or remembering, compound the challenge of parsing dense, technical, and sometimes contradictory web content. Under such conditions, shortcuts become attractive: judging a website by its professional appearance, trusting the first result a search engine returns, or accepting information because it appears repeatedly across multiple pages.

These heuristics, while efficient, are unreliable proxies for accuracy. Search engine rankings reflect popularity and optimisation rather than medical validity, and polished design is no guarantee of sound science. The study’s participants were not careless; they were conserving limited mental energy during an exhausting period of their lives. Recognising this distinction matters for anyone designing interventions, because simply urging patients to be more careful ignores the cognitive realities that make carefulness difficult. Practical tools that lower the effort required for evaluation, such as checklists that prompt a few key questions about a source, may succeed where exhortations to vigilance fail.

Equally revealing is the finding that peer experiences were regarded as a trustworthy source of cancer information. This trust is not irrational. Fellow patients offer lived experience, emotional resonance, and practical advice that clinical materials often lack. Hearing that another person tolerated a treatment regimen or managed a side effect can provide hope and a sense of community that no pamphlet can replicate. The difficulty arises when anecdotal experience is generalised into medical truth. A single patient’s response to an unproven remedy says nothing about its efficacy or safety for others, yet within online communities such stories circulate with persuasive force, particularly when they align with what an anxious reader hopes to hear.

The consequences of misinformation documented in the study extended beyond confusion. Participants reported impacts on both psychological and physical health outcomes. Psychologically, exposure to false or alarming claims fuelled anxiety, eroded hope, and sometimes created conflict between what patients read and what their clinicians told them. Physically, misinformation could lead to delayed treatment decisions, abandonment of prescribed therapies, or adoption of unverified interventions with real risks. These outcomes echo broader findings in the literature: systematic reviews of social media health information quality have identified cancer as one of the topics generating the most quality concerns, and reviews of misinformation prevalence report moderate rates of false content for noncommunicable diseases including cancer.

Against these risks, participants described mitigation strategies centred on trustworthy healthcare communication. Some verified online findings by bringing them to their physicians or nurses; others defaulted to information sources recommended by their care teams. These strategies transformed the clinical encounter into a verification checkpoint, a role that many clinicians already perform informally. The study suggests that this function could be made explicit and systematic. Directing patients to well-known national and international cancer information repositories, and introducing simple evaluation checklists during consultations, would give patients reliable starting points and reduce their dependence on whatever a general search engine surfaces first.

Yet the study also uncovered significant barriers to this kind of open dialogue. Fear of confronting physicians and reluctance to interfere with the consultation process prevented many participants from raising what they had read online. This hesitancy is understandable in contexts where medical authority carries substantial cultural weight and consultation time is limited. Patients may worry that questioning a doctor’s guidance with internet-sourced material will appear disrespectful, or that doing so will consume time needed for pressing clinical matters. The result is a silent gap: misinformation circulates unchallenged in patients’ lives while clinicians remain unaware of it, losing opportunities to correct false beliefs before they influence decisions.

Closing this gap requires deliberate effort on both sides. Clinicians can normalise the conversation by asking patients what they have read online, framing the question as routine rather than accusatory. Health systems can train staff to respond to online findings with curiosity rather than dismissal, since a dismissive reaction may push patients toward secrecy and further reliance on unreliable sources. Patients and caregivers, for their part, benefit from explicit permission and encouragement to bring questions arising from internet searches into their appointments. The study’s participants themselves recommended guidance on searching and evaluating credible information, indicating appetite for exactly this kind of support.

The unmet information needs documented in the study sit within a larger pattern. Integrative reviews of supportive care needs have found that cancer patients and caregivers are frequently dissatisfied with existing options for acquiring information, a finding consistent with international research on unmet information needs across cancer populations. Digital health tools have been proposed as a complement to conventional care precisely to address gaps such as coping support and cancer education, and surveys have identified information and education as the most needed digital health function for this group. The internet’s appeal is amplified for stigmatised conditions, where barriers to traditional information sources make anonymous online searching especially attractive.

The scale of the underlying challenge is considerable. Global cancer incidence is projected to reach 27.5 million new cases by 2040, with deaths rising to 16.3 million, which means the population of information-seeking patients and caregivers will grow substantially in the coming decades. A recent systematic review of information-seeking behaviour among cancer patients identified twenty quantitative studies but only four qualitative ones since 2002, and none of the qualitative work had applied a behavioural theory. The present study fills that methodological gap, and its theoretical grounding offers a template for future research seeking to understand not just what patients do online but why.

For caregivers, the findings carry particular weight. Family members often conduct searches on behalf of patients, filter information before sharing it, and shoulder the emotional labour of translating frightening content into reassurance. Because caregivers were interviewed separately in this study, their perspectives emerge distinctly, underscoring that safeguarding against misinformation is a family-level concern rather than an individual one. Interventions that equip caregivers with evaluation skills may therefore yield benefits that ripple outward to the patients they support.

Ultimately, the study reframes susceptibility to misinformation not as a failure of intelligence or diligence but as a predictable consequence of cognitive strain, emotional urgency, and unmet informational needs converging on a digital environment where credible and false content appear side by side. Solutions that acknowledge this reality, by lowering the effort of verification, strengthening the clinical relationship as a trusted channel, and providing authoritative repositories as default destinations, offer a realistic path forward. As digital health continues to expand its role in cancer care, ensuring that patients and caregivers can navigate it safely becomes not an optional enhancement but a core component of supportive care itself.

Subject of Research: Susceptibility of cancer patients and caregivers to online cancer misinformation

Article Title: Susceptibility of cancer patients and caregivers to online cancer misinformation: a qualitative interview study

Article References: Mohamed, H., Salsberg, J., Alanzi, T., Mohamed, M., & Kelly, D. (2026). Susceptibility of cancer patients and caregivers to online cancer misinformation: a qualitative interview study. Supportive Care in Cancer, 34(10), Article 987. https://doi.org/10.1007/s00520-026-11236-2

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11236-2

Keywords: cancer, misinformation, caregivers, digital health literacy, health belief model, theory of planned behaviour, information-seeking, health communication, oncology, qualitative research, social media, patient safety