Consensus-Based Model for Adolescent Breast Cancer Prevention Education in Indonesia: A Three-Round Delphi Study Informed by Self-Care Theory and Social Cognitive Theory

Abstract

Background: The burden of breast cancer has increased among younger age groups, while literacy and preventive behaviors among adolescent girls remain low. Existing educational interventions are often unidirectional and do not explicitly integrate behavior change theories. This study aimed to develop a theory-based breast cancer prevention educational model for adolescent girls using Self-Care Theory and Social Cognitive Theory (SCT) through a Delphi consensus process. Methods: A three-round Delphi study was conducted in Majene Regency, Indonesia. Round 1 used a semi-structured questionnaire to generate candidate items. Rounds 2 and 3 evaluated item relevance using a 4-point Likert scale. Consensus was defined a priori as I-CVI ≥0.80 in Round 3, with strict consensus requiring modified kappa (k) ≥0.74*. Stability was assessed using median and interquartile range (IQR) across rounds. Results: Fifteen experts participated in Round 1, and 11 experts completed Rounds 2 and 3. Of 67 initial items, 59 achieved final consensus, indicating excellent content validity (S-CVI/Ave = 0.952; 94% of items had IQR ≤1.0). Six core themes emerged: preventive self-care behaviors; adolescent breast cancer literacy; interactive, skill-based education supported by schools and digital media; cultural and psychological barriers; SCT-based reinforcement and social support; and multi-stakeholder involvement. Conclusion: The content-validated model emphasizes skill development, self-efficacy, and social contextual support. It provides a practical framework for school and primary health care–based breast cancer prevention programs for adolescents, although effectiveness testing and cross-context validation are required.

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