ROJoson Breast Wellness Self-assessment Tool – Part I – For Piloting – May 25, 2012

ROJoson Breast Wellness Self-assessment Tool – Part I – For Piloting – May 25, 2012

Posted on May 25, 2012 by

I have been developing a Breast Wellness Self-assessment tool since 2 months ago.  It is NOT easy.  However, here it is.  I am sharing this now for piloting purpose.  It is not yet final.  I will continually refine it with the inputs that I will get from the female Filipinos who will do a self-assessment using the tool and who will submit to me their filled-in forms as well as their comments and feedback.  I promise to keep the filled-in forms confidential.  Thank you.

Seen below is just the Part I of the tool.  I also attached a MS Word file for those who will do a self-assessment and submit their outputs to me for purposes of piloting. I repeat, I will observe strict confidentiality.  Click on the link below for the MS Word file:

ROJ Breast Wellness Self_assess_Part1_rj_12may25

Part II will be “My Current Knowledge, Attitude and Practices on Breast Wellness” which I will share soon in another post.

Dr Rey

May 25, 2012

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ROJoson Breast Wellness Self-assessment Tool

Part I

My Current OVERALL Status on Breast Wellness (Self-assessment)

For those who have NOT been treated with breast cancer and do NOT have breast cancer at the moment (Pls. tick one answer only):

[    ] I have NO fear of breast cancer whatsoever.

[    ] I have SOME fear of breast cancer but it is NOT affecting my well-being and productivity as a citizen in my community.

[    ] I have GREAT fear of breast cancer and it is SOMEWHAT affecting my well-being and productivity as a citizen in my community.

[    ] I have EXCESSIVE fear of breast cancer and it is AFFECTING my well-being and productivity as a citizen in my community.

 

For those who have been treated with breast cancer and in remission at the moment:

[    ] I have NO fear of recurrence of my breast cancer whatsoever.

[    ] I have SOME fear of recurrence of my breast cancer but it is NOT affecting my well-being and productivity as a citizen in my community.

[    ] I have GREAT fear of recurrence of my breast cancer and it is SOMEWHAT affecting my well-being and productivity as a citizen in my community.

[    ] I have EXCESSIVE fear of recurrence of my breast cancer and it is AFFECTING my well-being and productivity as a citizen in my community.

For those who have been treated with breast cancer and with recurrence at the moment:

[    ] I have NO fear of my breast cancer recurrence whatsoever.

[    ] I have SOME fear of my breast cancer recurrence but it is NOT affecting my well-being and productivity as a citizen in my community.

[    ] I have GREAT fear of my breast cancer recurrence and it is SOMEWHAT affecting my well-being and productivity as a citizen in my community.

[    ] I have EXCESSIVE fear of my breast cancer recurrence and it is AFFECTING my well-being and productivity as a citizen in my community.

My Current BEHAVIORS with regard to Breast Wellness (Self-assessment)

Please assess the statements on the 1st column of the table below using the four optional responses on the 2nd to the 5th columns provided (tick only ONE response per statement):

Statements on BEHAVIORS with regard to breast wellness Strongly agree Agree Disagree Strongly disagree
I don’t like to HEAR anything regarding breast cancer.
I don’t like to READ anything regarding breast cancer.
I don’t like to TALK on anything regarding breast cancer.
I don’t like to palpate my own breast for fear of discovering something that may turn out to be breast cancer.
I don’t like to see a breast specialist for consultation / check-up for fear of discovering something that may turn out to be breast cancer.
I don’t like to have screening diagnostic tests such as mammography and breast ultrasound for fear of discovering something that may turn out to be breast cancer.
I am NOT as productive as before at home or at work because of fear of breast cancer.
I stopped / am planning to stop my job / work because of fear of breast cancer.
I usually have insomnia (unable to sleep) because of fear of breast cancer.
If I have breast cancer or a breast cancer recurrence, as much as possible, I don’t like anybody to know.
OTHERS (After assessing the above statements, pls. add in the rows below other current BEHAVIORS you may have with regard to breast wellness.)

 

 

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