The Influence Of Social Media On Breast Self-Examination (BSE) Knowledge In Adolescent: Scoping Review

Background: The leading cause of death for women is breast cancer because they realize too late that they have cancer. This situation is usually only realized after cancer has entered an advanced stage, so there is no early detection process that slows down or even cures cancer from an early age. Purpose: This scoping review aimed to examine the evidence on the impact of social media on adolescents' understanding of BSE. Inclusion criteria: Articles published in Indonesia and English within the last ten years meet the requirements for this review(2014-2023). These articles focus on social media's influence on adolescent Breast self-examination (BSE) knowledge. Method: According to Arksey and O'Malley, the written format of this scoping review follows the PRISMA-ScR Checklist, which has five stages.. An article search was conducted on January 20, 2023, using several databases, including PubMed, the Wiley Online Library, ScienceDirect, and Proquest. Results: Of the 706 articles obtained, 31 were possibly relevant, and 6 articles met the inclusion criteria, presented with two themes: the influence of adolescents on breast cancer and social media as a means of increasing adolescent knowledge about BSE. Conclusion: Based on the six articles discovered during the search, it is known that social media affects adolescents' knowledge, but not all social media are widely used. WhatsApp and Instagram are often used, and there are many variations of other social media, namely: TikTok, Youtube, Snapchat, line, Facebook, Twitter, zoom meeting, etc.


INTRODUCTION
Breast cancer is the second greatest cause of death in women.This situation is usually only realized after the cancer has entered an advanced stage.Thus the treatment given is too late (Dewi dkk, 2021).
Based on data obtained from the World Cancer Research Fund International (2020) that number of new breast cancer cases among women in the world has increased by 25.8%.Based on the projections of the Global Cancer Registry (Globocan), in 2020, there will be 396,914 new cancer cases in Indonesia, of which 68,858 are breast cancer.At the same time, the death toll surpassed 22,000.Yogyakarta has the largest incidence (4.86 cases per 1000 population), followed by West Sumatra Province (2.47 cases) and Gorontalo Province (2.44 cases).Due to the country's alarming prevalence of breast cancer, the Indonesian government has prioritized implementing promotion and prevention campaigns.
Breast self-examination (BSE) is advised for early breast cancer detection (Indonesian Cancer Foundation, 2012).According to research by Sinaga & Ardayani (2016), Breast self-examination (BSE) can begin as early as 15 years old.Due to the cancer patients incidence at Hope Clinic Medan, out of 76 cases, 6 cases (7.8%) were experienced by people aged 15-25 years.The 7-10 th day after menstruation is the right time to do monthly BSE.According to Etwiory (2013), mortality from breast cancer can be reduced by 20% if BSE is carried out every month.
Adolescence is a transition from infancy to adulthood characterized by some significant developmental phases in her life.Teenagers have unique challenges when trying to adopt a cancerprevention lifestyle.Lack of awareness among adolescents about breast cancer and its symptoms contributes to its prevalence (Irawan et al., 2017).
According to Fatmawati (2010), the Internet can be a persuasive communication tool to encourage early detection of breast cancer and prevent its spread.In 2022, 191 million people in Indonesia actively use social media compared to 2021, as many as 170 million.We Are Social (2022) reports that the social media frequently used in Indonesia is WhatsApp at 88.7%, Instagram at 84.8%, Facebook at 81.3%, TikTok at 63.1%, and Telegram at 62.2%.Most of today's youth rely on social media to share and get information quickly.Commonly used forms of social media include Whatsapp, Instagram, TikTok, Facebook, and others.This scoping review aims to analyze the social media influence on adolescents' understanding of BSE by reviewing and mapping scientific data from published papers.

METHOD
The research method was scoping review.Scoping reviews taken are international and national journals about the influence of social media on BSE knowledge in adolescents.Data was collected by electronically searching international and national journals in the PubMed, Whiley Online Library, ScienceDirect, and Proquest databases.This scoping review used the PICO framework.The keywords used were Adolescent AND Education OR Knowledge OR Science AND Breast Self-Examination OR BSE AND Social Media.Articles selected as research material are those that meet the inclusion criteria.Inclusion criteria were all types of research methods, original articles, full text, and open access, articles in English and Indonesian, articles that were relevant and discussed the influence of social media on BSE knowledge in teenage girls, as well as articles published in the last 10 years 2014-2023.The exclusion criteria were review articles, commentary articles, report documents, books, and proceedings.
In selecting articles, the authors used Mendeley software which made it possible to check for duplicates, and used Rayyan software to select titles and abstracts according to the inclusion criteria and read the full text.6 articles met the review's inclusion criteria.Reporting of article reviews carried out using the PRISMA Flowchart is as follows: Full-text articles that meet the inclusion criteria

Include
Checklist is utilized for implementation and analysisCritical Appraisal applied a quantitative research design to six articles.The following are the findings of the researcher's critical appraisal After receiving health education, respondents' knowledge increased, with audiovisual (80%) in the good category, compared to the previous one only (13.3%) and the sufficient category (40%), and the category was not bad.

Selection of Evidence Sources
Rayyan screens based on the keyword searches results in 4 databases using the PICO framework.The phases of article screening are described using the AlUr Prisma diagram.6 articles fulfilled the inclusion criteria and were considered suitable after undergoing a Critical Appraisal using The Joanna Briggs Institute (JBI).(Peters et al., 2015).

Characteristics of Evidence Sources
The characteristics derived from the six selected articles are primarily based on country groups and research methodology.

Individual Evidence Sources' Result
In this review, the articles reviewed were classified into 2 main themes, namely the influence of adolescents on breast cancer and social media to increase adolescent knowledge about BSE.The theme of adolescents' influence on breast cancer is found in the articles (A1, A2, A4, A5, A6).While the theme of social media as a means of increasing adolescents' knowledge about BSE is found in articles (A1, A2, A3, A4, A5, A6).

Summary of Evidence
It is known that the article is pertinent to the scoping review purpose based on the 6 selected articles, which is to discuss the influence of adolescent knowledge about breast cancer social media to increase adolescent knowledge about BSE.

Theme 1: The Effect of Adolescent Knowledge About Breast Cancer (A1, A2, A4, A5, A6)
Breast cancer is a severe health issue with an increasing frequency, including in Indonesia (Alfalah, 2022).More and more people with cancer are young women, around 14 years old.It begins with the slow growth of breast tumors that develop into breast cancer.Therefore it is necessary to have breast cancer early detection.Adolescence is a period of individual transition from childhood to adulthood.Usually, this transitional period occurs at the age of 13-20 years, and there are 3 phases in adolescence, namely early adolescents, aged 11-14 years, mid-teens aged 15-17 years and the last is late adolescence, aged 17-20 years (Permana Indra, 2012).During this teenage period, female hormones begin to function properly.These hormones in some women are associated with the breast cancer incidence.
Adolescents' limited understanding of breast cancer is a barrier to early detection and treatment.Many women with breast cancer realize late that they have breast cancer after experiencing severe symptoms.Therefore, recognizing breast cancer earlier is very important in preventing this disease from developing to a more dangerous stage (article 1).People are less likely to be aware of their breast cancer risk if they do not know to do a breast self-examination.As the world's number one killer of women, people need to have an adequate understanding of breast cancer (Rachmasari, 2018).
The level of one's knowledge strongly influences a person's behavior.Notoadmodjo (2012) identified six stages (or "levels") of knowledge, namely: knowing, understanding, applying, analyzing, synthesizing, and evaluating.According to Maier (2007), knowledge can be seen as many things people experience and learn through observation.Introspective to demonstrate knowledge, a person must be able to mentally identify items or events that were previously unseen or made no sense.Knowledge can reduce the effects of experience, activity, and environment regarding health behavior.In (article 4) health promotion is also used extensively for breast cancer prevention.
Activities or to convey health messages to individuals or groups of adolescents are inseparable from health promotion.The message is addressed to adolescents and youth groups in the hope that they will learn more about health issues, including breast cancer and BSE (article 2).(Article 5) outlines a set of criteria for assessing a person's level of knowledge about breast cancer in the areas of the definition, types, risk factors, symptoms, treatments, prevention, early detection, and diagnosis of breast cancer.Knowledge about BSE is in the form of BSE concepts, benefits, goals, and the right time for BSE.
From the interviews with five female students, four often complained of breast pain during menstruation and did not know about BSE examinations.One female student felt a hard and small lump on top of her breast and never went to a health worker (article 6).It can be said that adolescents' knowledge about health is very influential with the mindset of adolescents, especially about health so that their present and future lives remain healthy.This knowledge makes it necessary to socialize BSE for young women.
Theme 2: Social Media as a Means of Increasing Adoloscent Knowledge About BSE (A1, A2, A3, A4, A5, A6) Education level, exposure to mass media/social media, economic status, experience, and social status can influence an individual's degree of knowledge on a subject.In this era, it is easy to get and find information using a smartphone, and most teenagers have it.Adolescents tend to have a greater curiosity about new things than adults (Widyahapsari dkk., 2021).
Marketing strategies that use social media are popular because they are considered lowcost and easy to implement.Forty teenagers were surveyed about their use of social media in Kudus District, and the results indicated that all of them use at least one platform, with Facebook usage of 7.5% and Instagram usage of 92.5% (article 2).For Whatsapp, it reaches 88.7%, TikTok 63.1%, and Telegram 62.8% (we are Social, 2022).The results of the review found that most teenagers most often use social media in the form of Instagram (article 2) and WhatsApp (articles 1, 3, 4, 5, and 6).
Based on research conducted in (article 3) says that students with FFTG (face-to-face) 26.4% and WBTG students (by WhatsApp) 37.7% have a cancer family history.6.9% of FFTG students and 13.1% of WBTG students have have breast cancer family history.This phenomenon further strengthens that counseling regarding BSE based on the Whatsapp application effectively increases BSE knowledge and practice in adolescents during the Covid-19 pandemic (article 1).According to (article 6), there was an improvement in respondents' understanding in the experimental group before and after receiving health education with audiovisuals in the good category (60%) which previously had not been given intervention only (13.3%), the sufficient category after being given intervention (40%) and the less category after being given the intervention became (0%) which was before (6.7%).The audiovisual media used is sent using the WhatsApp application line with (article 4) in which the WhatsApp application can help and facilitate the dissemination of knowledge about breast cancer and its prevention, followed by (article 5) which says that the WhatsApp application reminder message has a significant effect on increasing adolescents' knowledge of BSE.There is a significant difference between adolescent students' knowledge before and after receiving a WhatsApp application reminder message about BSE.In (article 2), there is a significant effect before and after being given BSE knowledge interventions to adolescents using the Instagram application with the Instagram AISAS method in providing BSE knowledge information to adolescents.
Increased participant knowledge about preventing non-communicable diseases, one of which is breast cancer, after being given health education using application-based social media, there has been an increase in understanding and positive behavior in society (E.Y. Mulyani, et al, 2020).The social media used is the WhatsApp application group media because this media is very effectively used in discussions and interactions between resource persons and other participants in obtaining more comprehensive information about the prevention of non-communicable diseases.Whatsapp is a smartphone instant messaging program that is functionally very similar to an SMS application; the main difference is that instead of using credit, Whatsapp uses the user's available Internet or wifi data plan.
Women of Reproductive Age between the ages of 15 to 49 showed a statistically significant increase in their knowledge of breast cancer after receiving social media-based information education interventions in the form of the Instagram application (Anggraini et al., 2021).Instagram is a more efficient way to provide information because it relies heavily on visual assets such as photos and videos.Previous studies (Ayudia Fardila Sari, 2019) found that non-health students at Andalas University showed different changes in knowledge, attitudes, and perspectives on health promotion on Instagram before and after BSE.Instagram is one of the most popular social networking sites.As part of a campaign to raise awareness and prevent breast cancer in Indonesia, it can spread important information about BSE.

LIMITATIONS OF THE STUDY
The limitation of this assessment is that data collection was not carried out directly because the authors were involved in analyzing other research articles, and the search for articles was limited to between 2014-2023, so searches could not be widespread.The researchers, in this case, the scoping review was only concerned with addressing research goals.and analyzing the influence of social media on adolescents' understanding of BSE.

Figure 1 .
Figure 1.PRISMA Flow ChartAfter data filtering, a Critical Appraisal was conducted to evaluate the quality of the articles in terms of methodology and the extent to which the studies addressed potential design bias.The JBI a. Characteristics of articles based on country groups Articles derived from the country group-based selection results included article from the developed country group, namely Turkey (A3), and 5 from the developing country group, namely Phipiphina (A4), Egypt (A5), and Indonesia (A1, A2, A6) which shown in diagram 1.

Diagram 1
article characteristics by country group b.Article Characteristic based on research methodology Judging from the research method, found 4 research methods, namely the Quasy Experimental research method (A2, A3, A5, A6), Cross-Sectional (A1), and Randomized Control Trial (A4), shown in diagram 2.