Breast Cancer Self-concept at Prof. Dr. W. Z. Johannes Hospital Kupang

Breast cancer is the disease that many women fear the most. Breast cancer signifi cantly affects the psychological states of the patients, including self-concept. Patients with breast cancer commonly experience a negative self-concept due to the disease and side effects of the treatment. However, problems of self-concept among patients with breast cancer are rarely investigated by nurses. Furthermore, no measurement tool specifi cally measures the self-concept of breast cancer patients. The purpose of this study was to examine the validity and reliability of the self-concept questionnaire. This study used a case study research design to measure the self-concept of breast cancer patients using a newly developed questionnaire, namely the Merlin Breast Cancer Self-Concept Questionnaire. This questionnaire will be tested on breast cancer patients undergoing treatment in the hospital. The result showed a Cronbach’s alpha value of 0.909 for the validity and 0.500-0.790 for the reliability of the instrument. Merlin Breast Cancer Self-Concept Questionnaire was evident to be a valid and reliable instrument to measure self-concept among breast cancer patients. This questionnaire is feasible for use to measure self-concept among breast cancer patients. Implication for practice: This questionnaire will greatly help the clinic nurse in measuring the patient’s self concept. Psychological problems especially self-concept can be examined to improve the quality of life.


INTRODUCTION
The number of patients with breast cancer is increasing every year. In Indonesia, breast cancer becomes the most commonly diagnosed cancer in females with 40% of the total number of cancer patients. (1). Breast cancer has negative impacts on patients (2). Chronic illness that a patient experiences can cause some changes in body image and self-identity that affect the patient's self-concept (3)(4)(5). Self-concept describes a self-assessment or self-attitude in the conscious and subconscious states (6).
According to Drummond, self-concept is an impression of an individual towards himself as a whole (7). Many patients experience a negative self-concept. However, there are no valid and reliable measurement tools for use to measure it. Self-concept consists of four components, including self-identity, body image, self-esteem, and roles.
Self-concept is divided into two types: positive self-concept and negative self-concept. A positive self-concept is a positive self-assessment of an individual who is willing to accept and understand himself (8). Meanwhile, people with a negative self-concept are usually unstable and tend to be intolerant with one's mistakes (9) An individual with a negative self-concept tends to have negative behaviors (10,11).
Self-concept affects the confidence of breast cancer patients, coping processes and social inability (15). Breast cancer patients who have a negative self-concept will affect their social welfare and even patients can experience depression (16), some of the patients will choose not to continue the chemotherapy or radiation treatment that is being undertaken due to negative self-concept.
S e l f -c o n c e p t h a s f o u r u n d e r l y i n g components: body image, self-esteem, roles, and self-identity (12). Body image is the perception of oneself, which can be influenced by the judgment of others (6,12). A study by Faten et al. reported that body image disturbances could interfere with women in their relationship and sex life changes as much as 45% to 47%.
Body image disturbances and sexual relations have a relationship with one another (13). Body image or self-image disturbances can occur due to the effects of the disease that the patients experience, which will affect self-identity, selfesteem, and self-roles (14). The aim of this study was to see the validity and reliability of the Merlin breasct cancer self-concept questionnaire.

MATERIALS AND METHODS
This research was a case study that

Discussion
Based on the result of the validity and reliability tests, it was evident that the questionnaire is feasible to use. This questionnaire is developed for assessing the self-concept in breast cancer patients. Self-concept is how a person views himself (17). According to the researchers, respondents with negative self-concept will see themselves in a negative way. Self-concept has four infl uencing components: self-identity, self-role, body image, and self-esteem. These components have been explained as the basis which affects one's self-concept (6). These  she has lost her role as a woman, that she thinks she cannot care for her family well due to the disease, and that the disease has caused the husband not to touch her at all.

Self-identity component in this questionnaire
consists of four statements that explore whether the patient thinks that the disease has made her weak or not, the disease has caused the patient not to be seen as a woman, and the limitations experienced by the patient due to the disease.

CONCLUSION AND RECOMMENDATIONS
The result of the reliability test in this study Based on these results, it could be concluded that the Merlin Breast Cancer Self-Concept Questionnaire is feasible for use to measure selfconcept among breast cancer patients.