Evaluation of individuals’ health beliefs and their association with testicular self-examination: adult sample from Amasya

Abstract

Background

Testicular self-examination is important for the early diagnosis and treatment of testicular cancer; the nature of the examination itself influences individuals’ health beliefs about testicular self-examination.

Methods

This descriptive research study was carried out using 152 individuals working at Amasya University between August and November 2016. A personal information form and Champion’s Health Belief Model Scale were used for the data collection stage of this research. Descriptive statistical tests, Mann–Whitney U test, Kruskal–Wallis variance analysis and Cronbach’s alpha were used in the data analysis stage.

Results

Analysis of respondents’ sociodemographic data revealed that the study participants’ mean age was 38.88 ± 9.36, and that 112 participants (73.7%) were married and 76 participants (50.0%) had a graduate degree at the time the study was conducted. Of the research participants, 134 (88.2%) had no training on testicular self-examination; a statistically significant difference (p < 0.05) was found between participants’ consciousness of their capability to perform testicular self-examination on their own and the mean factor scores of the Champion’s Health Belief Model Scale’s ‘barriers of testicular self-examination’ and ‘self-effectiveness’ items.

Conclusion

The study found that health beliefs play a part in individuals’ positive health behaviours regarding testicular self-examination.

Introduction

The concept of health, which is the basic concept of nursing, predicts ‘presentation of the individual-based and integrated health care services which protects, maintains and develops individuals’, families’ and society’s health’ (Adıbelli, 2016: 231). For secondary prevention – the second stage of healthcare services – early diagnosis and treatment of terminal illnesses, especially diseases such as cancer, is significantly important to the improvement of society’s overall health (Nahcivan, 2014). Testicular cancer is a type of cancer that can be cured if diagnosed at an early stage.

Testicular cancer is a relatively rare type of cancer; it accounts for 1% of malignant tumours among men (Kılıç, 2016; Kuzgunbay, 2014). Nevertheless, testicular cancer has attracted attention due to the fact that it is the most common type of cancer among men aged 15–35 years, and because its prevalence has increased by 50% over the past 20 years (Pınar et al., 2011). According to Turkey’s Ministry of Health Cancer Statistics 2012, testicular cancer was the most common cancer diagnosed among men aged 15–24 years (Ministry of Health, 2015). Furthermore, the document stated that the age-specific incidence rate of testicular cancer between the ages of 15 and 35 years is 30.6 per 100,000 people (Şencan and İnce, 2016). Although testicular cancer is a type of cancer that can rapidly spread to other organs, the likelihood of successful treatment is high with early diagnosis (Doğan et al., 2016; Kuzgunbay, 2014; Pınar et al., 2011; Siegel et al., 2015).

If testicular self-examination (TSE) is conducted regularly, it can help detect a possible abnormality in testicles before testicular cancer is diagnosed with further intensive medical investigation. TSE is a regular physical examination conducted by the individual in question once in a month during or after a shower in front of a mirror using inspection and palpation methods. TSE is conducted with both hands; one hand stabilises the testicle while the other examines the testicle for lumps (Kılıç, 2016; Shallwani et al., 2010). TSE is an advantageous procedure because it does not require any process-specific tools, is easy to learn and apply, is safe and economic, and is not an invasive or time-consuming act (Göçgeldi and Koçak, 2010). According to the existing literature in the field, although TSE is a simple method, it is not performed among those at risk of developing testicular cancer as often as could be hoped (Akar and Bebiş, 2014; Altınel and Aydın Avcı, 2013; Asgar Pour and Çam, 2014; Bektaş et al., 2014; Brown et al., 2012; Doğan et al., 2016; Göçgeldi and Koçak, 2010; Göçgeldi et al., 2011; Pınar et al., 2011). Some who do not perform TSE think that they have more important problems than this (Altınel and Aydın Avcı, 2013).

As a preventive health behaviour, TSE must be performed regularly for the early diagnosis of testicular cancer. Healthcare professionals could assist in helping people to understand the importance of TSE, its importance as a simple diagnosis method, and the importance of putting it into practice. Consequently, it can only help to investigate people’s health beliefs concerning TSE (Brown et al., 2012; Kuzgunbay et al., 2013). Some researchers argue that people’s health behaviours are affected by their beliefs, values and attitudes; if problematic beliefs, values and attitudes are explored and changed, then health training and treatment can be improved (Gözüm and Çapık, 2014). Some studies have investigated students’ and particular adult groups’ awareness levels regarding their knowledge level, attitude, implementation and opinions of TSE (e.g. Brown et al., 2012; Kuzgunbay et al., 2013; Onyiriuka and Imoebe, 2013; Ramim et al., 2014; Shallwani et al., 2010); however, research examining people’s health beliefs as to TSE directly is limited (Altınel and Aydın Avcı, 2013; Doğan et al., 2016; Pınar et al., 2011).

The current study focuses on TSE practices and enhancing TSE awareness by exploring individuals’ understanding, seriousness, self-efficacy and benefit perceptions regarding the procedure.

Methods

Research location, time frame and sample

In this descriptive research study, data were collected from male academic and administrative staff working at Amasya University, Amasya, Turkey, between August and November 2016. The research population was composed of people working at the university’s city centre units. The research sample was composed of 152 people, all of whom voluntarily agreed to participate in the research.

Data collection and data collection tools

Research data were collected using a personal information form and the Champion’s Health Belief Model Scale (CHBMS) by reviewing relevant and existing literature studies (Akgün Şahin and Kardaş, 2015; Asgar Pour and Çam, 2014; Göçgeldi and Koçak, 2010).

Personal information form

The personal information form used in this study was composed of 13 questions: four on participants’ demographic characteristics (age, marital status, education level, etc.) and nine on participants’ views concerning TSE such as ‘TSE may help detect a possible abnormality for early diagnosis of testicular cancer’, ‘Do you know that you can do TSE by yourself?’ and ‘Frequency of TSE that you performed during the last year’. This form was prepared by researchers in the context of the literature (Altınel and Aydın Avcı, 2013; Doğan et al., 2016; Pınar et al., 2011; Ramim et al., 2014); however, the validity and reliability of the items were not confirmed.

Champion’s Health Belief Model Scale

The CHBMS explains the role of personal beliefs and values determining the implementation of preventive health behaviour. Consequently, the scale has an important role to play in applying primary, secondary and tertiary prevention actions (Champion, 1999). Confidence and validity tests of the CHBMS were performed by Pınar et al. (2011). The CHBMS consists of 26 questions; responses regarding these questions are given according to a five-point Likert-type scale with the following responses available to participants: ‘strongly disagree’, ‘disagree’, ‘neutral’, ‘agree’ and ‘strongly agree’. The CHBMS consists of five factors (susceptibility, seriousness, benefits of TSE, barriers to TSE, and confidence/self-effectiveness). The first factor, susceptibility, is composed of five (1–5) items, ‘seriousness’ is composed of seven items (6–12), ‘benefits of TSE’ is composed of three items (13–15), ‘barriers to TSE’ is composed of five items (16–20), and ‘confidence/self-effectiveness’ is composed of six items (21–26). Averages were used to calculate the score of the relevant factors within the scale. The CHBMS confidence and validity scores are as follows: the Cronbach’s alpha coefficient was found to be 0.92 for ‘susceptibility’, 0.90 for ‘seriousness’, 0.72 for ‘benefits of TSE’, 0.64 for ‘barriers to TSE’ and 0.78 for ‘confidence/self-effectiveness’ (Pınar et al., 2011). The minimum–maximum values for the CHBMS were found to be 5–24 for ‘susceptibility’, 6–30 for ‘seriousness’, 3–15 for ‘benefits of TSE’, 5–22 for ‘barriers to TSE’ and 6–30 for ‘confidence/self-effectiveness’; the Cronbach’s alpha coefficient was found to be 0.92 for ‘susceptibility’, 0.86 for ‘seriousness’, 0.71 for ‘benefits of TSE’, 0.71 for ‘barriers to TSE’, and 0.87 for ‘confidence/self-effectiveness’ (Table 1).

Table 1.

Distribution of individuals’ average factor scores of the Champion’s Health Belief Model Scale, minimum–maximum values and Cronbach’s alpha coefficient.

Factors	X ± SD	Min.	Max.	Cronbach’s alpha	Cronbach’s alpha (Pınar et al., 2011)
Susceptibility	12.26 ± 4.02	5	24	0.915	0.92
Seriousness	17.43 ± 5.28	6	30	0.857	0.90
Benefits of TSE	10.78 ± 2.55	3	15	0.711	0.72
Barriers to TSE	11.82 ± 3.33	5	22	0.711	0.64
Self-effectiveness	17.43 ± 5.28	6	30	0.866	0.78

TSE: testicular self-examination; SD: standard deviation.

Method

Individuals who agreed to participate in this study were informed about the aim of the research and how they could complete the data collection forms by way of a pollster. The forms used to collate the research data were distributed to the participants individually and by hand; the participants were visited individually and in person to ensure that their responses were reliable, because the topic is a private one in Turkey. The respondents were asked not to write down any kind of identifying information on the forms. The survey forms were collected by survey takers to prevent any kind of bias among participants, thereby guaranteeing anonymity for each completed form. Data collection forms were delivered to the participants personally and on a date selected by the participant; this was due to the workload and the need to create an environment allowing the participant to respond in comfort and without concern. Overall, 35 participants were excluded from the study because they did not fill in the survey forms or filled them in incompletely, or because the survey forms were not delivered to the participants in time, among other reasons. Every participant reported that 10 minutes was sufficient time in which to complete the data collection forms.

Statistical analysis

The research data were evaluated by using the statistical package for the social sciences (SPSS) 20 program (IBM Corporation, New York, USA). The suitability of the data to normal distribution was determined using the Shapiro–Wilks and Kolmogorov–Smirnov tests; according to the results, the data did not show a normal distribution (p < 0.05). Descriptive statistics and Mann–Whitney U tests were applied to the data, along with Kruskal descriptive statistical tests; Wallis variance analysis and Cronbach’s alpha measurement were also used during the data analysis stage. The significance level for the data was accepted to be p < 0.05.

Generalisability and limitations of the study

The research findings could be generalised to only this study population. The biggest limitation of the study was the small number of participants from whom the data were collected and its geographical limitation to Amasya Province.

Results

The findings obtained by the research were analysed in three groups.

CHBMS’s mean factor scores, min.–max. values and Cronbach’s alpha coefficients

Mean factor scores, min.–max. values and Cronbach’s alpha coefficients for the CHBMS data are presented in Table 1. When we compared the differences between CHBMS’s Cronbach’s alpha coefficients, only ‘barriers to TSE’ and ‘self-effectiveness’ subscales were higher than those of Pınar et al. (2011) (Table 1).

Sociodemographic characteristics and knowledge applications related to TSE

By analysing the participants’ sociodemographic characteristics it was determined that the mean age of participants was 38.88 ± 9.36 years; 112 of the participants (73.7%) were married; 76 (50.0%) had a graduate degree, and 81 (53.5%) were employed as administrative staff (Table 2).

Table 2.

Distribution of data regarding individuals’ sociodemographic characteristics and knowledge and applications related to TSE.

Sociodemographic characteristics	Category	n	%
Age (years)	18–29	22	14.5
	30–41	75	49.3
	42–53	42	27.6
	54–65	13	8.6
Average age (years)	38.88 ± 9.36
Marital status	Married	112	73.7
	Single	40	26.3
Education level	Secondary education	20	13.2
	Undergraduate	56	36.8
	Graduate	76	50.0
Service unit	Academic	71	46.7
	Administrative	81	53.3
Knowledge and applications regarding TSE	Category
TSE is important for early diagnosis of testicular cancer	Agree	11	7.2
	Disagree	112	73.7
	Neutral	29	19.1
Do you know that you can do TSE on your own?	Yes	40	26.3
	No	112	73.7
Have you had any information/ training on TSE?	Yes	18	11.8
	No	134	88.2
Where did you get information?	TV/Internet	6	3.9
	Social circle	2	1.3
	Healthcare professionals	10	6.6
Have you done TSE in the last year?	Yes	18	11.8
	No	134	88.2
Your frequency of doing TSE in the last year	Once a week	2	1.3
	Once a month	3	2.0
	Once a year	4	2.6
	Whenever I remember	9	5.9
Have you had any medical issue with your testicles?	Yes	12	7.9
	No	140	92.1
Is there anyone in your family who has had testicle issues?	Yes	7	4.6
	No	145	95.4
Are you willing to be trained on TSE?	Yes	98	64.5
	No, I think it is not necessary	54	35.5
Total		152	100

TSE: testicular self-examination.

Analysis of the data concerning knowledge applications revealed that 112 of the participants (73.7%) agreed with the argument that TSE plays an important role in the early diagnosis of testicular cancer and that they did not know that they could perform TSE on their own; 134 (88.2%) had no training regarding TSE; of the 10 participants (6.6%) who had received such training (n = 18, 11.8%), all had been trained by health professionals (Table 2). The data showed that 134 (88.2%) of them had not performed TSE in the year preceding their participation in this research; of the participants who had performed TSE within this time frame, only nine (5.9%) did so on the occasion that they remembered; 98 participants (64.8%) said they were willing to be trained in how to conduct TSE (Table 2).

Comparison of individuals’ sociodemographic characteristics, knowledge and application of TSE with CHBMS’s mean factor scores

By comparing the participants’ sociodemographic characteristics and CHBMS’s mean factor scores, a statistically significant difference was found between age and the mean factor scores of ‘susceptibility’ (p = 0.015) and ‘self-effectiveness’ (p = 0.001), and between marital status and mean factor scores of ‘susceptibility’ (p = 0.046), ‘seriousness’ (p = 0.015) and ‘self-effectiveness’ (p = 0.015). A statistically significant difference was also found between educational level and ‘benefits of TSE’ (p = 0.004); the analysis revealed that higher education mean factor score levels also meant higher ‘benefits of TSE’ values (Table 3).

Table 3.

Comparison of individuals’ sociodemographic characteristics and knowledge and applications related to TSE with Champion’s Health Belief Model Scale average factor scores (n = 152).

	Susceptibility	Seriousness	Benefits of TSE	Barriers to TSE	Self-effectiveness
	$\overline{X}$ ± SD	$\overline{X}$ ± SD	$\overline{X}$ ± SD	$\overline{X}$ ± SD	$\overline{X}$ ± SD
Age (years)
18–29	9.90 ± 3.62	18.77 ± 6.20	10.40 ± 2.40	11.22 ± 2.86	16.09 ± 4.38
30–41	12.45 ± 3.59	21.32 ± 5.75	11.01 ± 2.44	12.17 ± 3.29	16.44 ± 4.70
42–53	13.26 ± 4.25	22.61 ± 5.71	10.35 ± 2.53	11.40 ± 3.62	18.85 ± 5.51
54–65	11.92 ± 5.00	21.38 ± 7.56	11.46 ± 3.35	12.15 ± 3.46	20.84 ± 6.91
	KW = 10.50 df = 3 p = 0.015	KW = 5.29 df = 3 p = 0.15	KW = 3.24 df = 3 p = 0.35	KW = 2.83 df = 3 p = 0.41	KW = 15.52 df = 3 p = 0.001
Marital status
Married	12.66 ± 4.08	18.05 ± 5.38	10.87 ± 2.48	11.77 ± 3.36	18.05 ± 5.38
Single	11.15 ± 3.67	15.70 ± 4.64	10.52 ± 2.74	11.95 ± 3.35	15.70 ± 4.64
	z = −1.99 P=0.046	z = −2.42 p = 0.015	z = −0.38 p = 0.70	z = −0.32 p = 0.74	z = −2.42 p = 0.015
Education level
Secondary	12.30 ± 4.09	19.55 ± 6.88	9.40 ± 2.56	12.40 ± 3.08	18.25 ± 4.91
Education	12.19 ± 4.39	20.55 ± 6.32	10.53 ± 2.63	11.98 ± 3.67	17.92 ± 4.85
Undergraduate	12.30 ± 3.77	22.34 ± 5.44	11.32 ± 2.34	11.55 ± 3.15	16.85 ± 5.66
Graduate	KW = 0.057 df = 2 p = 0.97	KW = 4.61 df = 2 p = 0.099	KW = 11.01 df = 2 p = 0.004	KW = 2.00 df = 2 p = 0.36	KW = 1.87 df = 2 p = 0.39
Service unit
Academic	12.14 ± 3.82	22.15 ± 5.55	11.35 ± 2.33	11.25 ± 2.89	16.97 ± 5.83
Administrative	12.37 ± 4.21	20.58 ± 6.36	10.28 ± 2.64	12.32 ± 3.62	17.83 ± 4.77
	z =−0.57 p = 0.56	z = −1.47 p = 0.14	z = −2.61 p = 0.009	z = −2.05 p = 0.04	z = −0.63 p = 0.52
TSE is important for early diagnosis of testicular cancer
Agree	12.00 ± 5.05	20.00 ± 5.01	9.90 ± 1.81	11.45 ± 3.26	15.90 ± 3.88
Disagree	12.24 ± 3.90	21.58 ± 6.15	11.05 ± 2.68	11.67 ± 3.45	18.05 ± 5.44
Neutral	12.44 ± 4.23	20.75 ± 6.00	10.06 ± 2.08	12.51 ± 2.87	15.62 ± 4.66
	KW = 0.45 df = 2 p = 0.79	KW = 1.62 df = 2 p = 0.44	KW = 9.11 df = 2 p = 0.011	KW = 1.54 df = 2 p = 0.46	KW = 5.82 df = 2 p = 0.054
Do you know that you can do TSE on your own?
Yes	11.77 ± 4.52	21.72 ± 7.52	10.92 ± 2.99	10.57 ± 3.69	19.65 ± 6.07
No	12.43 ± 3.84	21.16 ± 5.43	10.73 ± 2.38	12.26 ± 3.09	16.64 ± 4.74
	z = − 1.16 p = 0.24	z = −0.88 p = 0.37	z = −0.84 p = 0.39	z = −2.69 p = 0.007	z = −3.32 p = 0.001
Have you had any information/training on TSE?
Yes	11.61 ± 4.81	19.72 ± 7.80	10.38 ± 3.48	11.44 ± 4.27	19.11 ± 7.00
No	12.35 ± 3.92	21.52 ± 5.75	10.83 ± 241	11.87 ± 3.20	17.20 ± 5.00
	z = −1.03 p = 0.30	z = −0.87 p = 0.38	z = −0.06 p = 0.94	z = −0.71 p = 0.47	z = −1.84 p = 0.06
Have you had any health issues with your testicles?
Yes	14.00 ± 3.43	25.50 ± 4.94	12.00 ± 1.99	9.91 ± 3.94	17.58 ± 5.12
No	12.11 ± 4.05	20.95 ± 5.99	10.67 ± 2.57	11.98 ± 3.24	17.42 ± 5.31
	z = −1.71 p = 0.08	z = −2.71 p = 0.007	z = −1.62 p = 0.10	z = −1.94 p = 0.52	z = −0.55 p = 0.57
Are you willing to be trained on TSE?
Yes	12.91 ± 3.59	22.35 ± 5.80	11.07 ± 2.45	12.04 ± 3.45	16.45 ± 4.95
No, I think it is not necessary	11.07 ± 4.50	19.42 ± 6.34	10.25 ± 2.66	11.42 ± 3.11	19.20 ± 5.45
	z = −2.83 p = 0.005	z = −2.98 p = 0.003	z = −2.07 p = 0.03	z = −1.11 p = 0.26	z = −2.39 p = 0.01

TSE: testicular self-examination; KW: KruskalWallis variance. SD: standard deviation; df: degree of freedom.

By comparing individual participants’ knowledge of carrying out TSE and CHBMS’s mean factor scores it was determined that, although there is a statistically significant difference between the knowledge that TSE has an important role to play in early testicular cancer diagnosis per mean factor score of ‘benefits of TSE’ (p = 0.011), the difference between this thought and the mean factor score of ‘self-effectiveness’ was not statistically significant (p = 0.054) (Table 3). A statistically significant difference was found between the awareness of being able to perform TSE on their own and mean factor scores of ‘barriers to TSE’ and ‘self-effectiveness’ (p = 0.007; p = 0.001). It was revealed that people who know they can do TSE on their own have higher mean factor scores for ‘self-effectiveness’, and those who do not had higher mean factor scores on ‘barriers to TSE’ (Table 3).

There is a statistically significant difference between having a testicular disease and the mean factor score for ‘seriousness’ (p = 0.007). Those who have a testicular problem have a higher mean factor score of ‘seriousness’ than those who do not (Table 3). While a statistical difference was found between willingness to be trained on TSE and the mean factor scores of ‘susceptibility’, ‘seriousness’, ‘benefits of TSE’ and ‘self-effectiveness’ (p = 0.005; p = 0.003; p = 0.05; p = 0.01, respectively), the results also showed that those who think that training is unnecessary have a higher mean factor score of ‘self-effectiveness’ than those who do not (Table 3).

Discussion

As healthcare professionals, nurses have an important role to play in the development of positive health behaviours. For this reason, nurses need to be aware of individuals’ health beliefs regarding TSE when planning health prevention activities. According to the results of the current study, most people (73.7%) believe that TSE is important in order to detect a possible abnormality in the testicles before testicular cancer is diagnosed. This percentage is supported by other related studies conducted with different sample groups concerning the application and practice of TSE (Asgar Pour and Çam, 2014; Brown et al., 2012; Göçgeldi et al., 2011). The results of other studies are not consistent with the findings of this study. A study conducted by Ugboma and Aburoma (2011) showed that only a minority of individuals (1.0%) believe that TSE can help in the early detection of a possible abnormality in the testicles. Among the reasons why this research yielded a much higher percentage may be because the majority of its participants have a graduate degree (50%); as educational level increases, so does the ‘benefits of TSE’ value. The relevant literature also emphasised that benefit perception is an individual’s belief that the suggested preventive behaviour is useful for protecting that individual from disease (Gözüm and Çapık, 2014). In this study, the ratio of people who have no TSE training or who had not carried out TSE within a year was 88.2%. According to related studies, the percentage of people who have never carried out TSE in their lives was 82.3% among college students (Ugurlu et al., 2011) and 95.3% among soldiers. However, for healthcare professionals, this percentage is higher – 73.0% for military doctors (Tichler et al., 2000) and 22.0% for those individuals working in primary care health services (Khadra and Oakeshott, 2002). It is convenient to say that people working in health-related occupational groups are aware of TSE and practise it accordingly. It may raise a question in healthy people’s minds as to whether or not the application of TSE is still an object of issue in some healthcare organisations (Thornton, 2016). Nevertheless, it is a fact that TSE allows for testicular cancer to be diagnosed easily and earlier, and consequently it gives the opportunity to prevent testicular cancer from spreading to other organs. Awareness of the fact that TSE can be carried out by the individual and without the need for a healthcare professional remains very low. The researchers believe that providing theoretical and practical training to healthy people will raise awareness and utilisation of TSE among the relevant population.

The mean factor score of ‘susceptibility’ and ‘self-effectiveness’ increased as the participant age increased; ‘susceptibility’, ‘seriousness’ and ‘self-effectiveness’ mean factor scores were significantly higher among married participants. No studies could be found that compared marital status and mean subscale scores of the CHBMS; one study conducted using nursing students found that the mean subscale score of ‘self-efficacy’ increased by a statistically significant amount among senior nursing students. Individuals’ perceptions towards TSE as a positive healthcare practice regarding testicular cancer are potentially affected by sociodemographic variables such as age, marital status and educational level. According to the health-belief model, personal risk and sensitivity remains an important aspect regarding people’s perspectives of health behaviours; the more people feel at risk, the more they tend to carry out preventive procedures (Gözüm and Çapık, 2014). The findings of this study corroborate those of the existing literature regarding age as a risk factor for cancer. Furthermore, the results of the current study also show that the self-effectiveness level, which concerns both a belief in the efficacy of the procedure as well as a tendency to carry it out, also increases with age. As individuals get older they are then more likely to understand and be aware of the potential danger of testicular cancer and the threat it poses both to themselves and to the people close to them; therefore, they are more likely to be aware of the importance of TSE and carry it out in order to overcome potential issues they may face in the future (Erci, 2010). Testicular cancer can lead to the belief that it is the end of sexual life and the end of reproductivity for the man in question, hence married individuals may be more sensitive to eliminating related risk factors, gaining knowledge on general health issues and embracing preventive health practices and procedures. The researchers maintain that there is a strong relationship between this situation and the mean factor scores for ‘susceptibility’, ‘seriousness’ and ‘self-effectiveness’ among married men.

A significantly higher mean factor score revealed regarding the ‘benefits of TSE’ among those participants with graduate degrees gives rise to the thought that the span of consciousness is also expanded in these people. Healthcare professionals may train individuals on the effects regular TSE can have on lifespan and quality of life. The researchers believe that by doing so, the perception that TSE may be beneficial for the detection of a possible abnormality in the testicles in terms of testicular cancer causes health-related attitudes/behaviours and TSE can also expand the span of consciousness.

The mean factor score for ‘barriers to TSE’ was high for those individuals who were unaware that they could perform TSE on their own. In another research study conducted using nursing students, the mean factor score of ‘barriers to TSE’ was found to be significantly high among participants who had not performed TSE within a year; these results are similar to those of the current study (Doğan et al., 2016). There are numerous reasons why performing TSE for the early diagnosis of testicular cancer remains difficult (Erci, 2010). Uneasiness resulting from testicular cancer, believing that the individual in question is unable to overcome testicular cancer if and when they might detect it, a lack of knowledge, a fear of cancer, forgetfulness, insufficient free time, fear of touching one’s own testicles, a sense of shame, finding TSE ridiculous, feeling guilty, thinking that TSE is sinful and thinking that TSE is not manly, are just some of the reasons why men may avoid the practice of TSE (Altınel and Aydın Avcı, 2013; Asgar Pour and Çam, 2014; Doğan et al., 2016; Erci, 2010; Pınar et al., 2011; Thornton, 2016).

The mean factor score of ‘self-effectiveness’ was higher among participants who thought that TSE training was unnecessary compared to those who did not; this was an unexpected finding. This finding may be interpreted as evidence that individuals think they have the strength to cope with testicular cancer they may face in the future and they believe in this; and it may also be a sign showing that individuals who believe TSE to be unnecessary are unaware of the importance of both the subject and the benefits of TSE.

Conclusions and recommendations for future research

This research found that most individuals were aware of the importance of TSE in terms of the early detection of a possible abnormality in the testicles, but they did not know that TSE was something they could perform on their own. It was found that most of the participants did not have TSE training, that the rate of those who had received TSE training from healthcare providers was low, that they had not performed TSE within a year, and that those who had performed TSE did not do so as part of a routine or programme.

The research revealed a significant correlation between age, marital status, the wish to receive TSE training, and ‘susceptibility’ and ‘self-efficacy’ scores; between marital status and ‘seriousness’ scores; between educational level and ‘TSE benefits’ scores; between those who knew how to perform TSE and ‘TSE barriers’ and ‘self-efficacy’ scores; and between those who experienced health problems with their testicles and the ‘seriousness’ score. The application of TSE among men can be improved by heightened sensitivity and the creation and propagation of health beliefs related to testicular cancer. Healthcare professionals can play a crucial role in this matter. Across all healthcare services, especially primary care health services, men could be trained on TSE by video, orally, or the use of leaflets which could suggest to the appropriate demographic that they regularly undergo medical screening for testicular cancer. This training is likely to increase individuals’ self-effectiveness and seriousness regarding TSE. TSE could also be added to high school and college curricula, and social media, mass communication and non-governmental organisations could be used to raise awareness of TSE. By raising awareness through planned training, barrier perceptions about TSE can be overcome.

Key points for policy, practice and/or research

• One way to diagnose testicular cancer at an early stage is to perform testicular self-examination on a regular basis.

• The application of testicular self-examination may be expanded by increasing sensitivity and caring in creating a health belief related to testicular cancer.

• Nurses have a big role in this matter. In all healthcare services, especially in primary care health services, men may be trained on testicular cancer and testicular self-examination orally, by video or by leaflets, and it may be suggested that they undergo medical screening for testicular cancer regularly.

Biography

Kenan Gümüs is an Assistant Professor of Nursing, Amasya University, School of Health. He has a Bachelor of Science in Surgical Nursing and a PhD from the Institute of Medical Sciences, University of Atatürk. He teaches surgical nursing, wound care nursing and operating room nursing.

Banu Terzi is an Assistant Professor of Nursing, Amasya University, School of Health, Head of Physical Therapy and Rehabilitation Department. She has a Bachelor of Science degree in Fundamentals of Nursing and a PhD from the Institute of Medical Sciences, University of Istanbul. She teaches fundamentals of nursing, critical care nursing, physical examination.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethics

Written authority to conduct the study was granted by Amasya University’s Rectorate before the research began. As participation was voluntary, those individuals who agreed to take part in the research were taken. All individuals were informed that participation in the study was voluntary and all gave their consent orally.

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.