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Breast cancer is one of the most prevalent malignancies worldwide. This study aimed to compare the level of knowledge and attitude of females regarding Breast cancer and to determine the role of knowledge, attitude and barriers in performing regular self-examination.

Non-physician females aged 18 years old or above were enrolled in this cross-sectional study in two groups of usual clients and healthcare staff from January 2018 to January 2019 from a healthcare center in Sari, a major city in the northern district of Iran. A questionnaire was used to score the participants’ knowledge and attitude levels using questions about the participants' knowledge and attitude towards Breast cancer along with their status on Breast self-examination and barriers. Mean scores were used for statistical analysis using SPSS V25. p < 0.05 was considered significant.

A final dataset of 279 females were collected. A significant difference in the knowledge and attitude regarding breast cancer was found between the two study groups (p < 0.001). The practice of BSE was significantly lower in the usual clients compared to non-physician healthcare staff (p < 0.001). The most frequent barriers for not performing a regular BSE were fear of finding a mass in usual clients (17.8%) and lack of confidence in healthcare staff (3.8%).

Limitations include single-centered sample selection.

Given the importance of early detection in breast cancer prevention and the general taboo regarding breast cancer screening methods in certain parts of the world, leading to poor results in early detection and prevention, the authors believe that it is of superior importance to address and promote positive attitudes in general population towards breast self-examination.

Given the importance of early detection in breast cancer prevention, and the general taboo regarding breast cancer screening methods in certain parts of the world, leading to poor results in early detection and prevention, the authors believe that it is of superior importance to address and promote positive attitudes in general population toward breast self-examination. The authors of this study believe that the manuscript represents honest and original work.

This study aims to identify the most important factors affecting the usability of Learning Management Systems (LMSs) and present these factors in the form of a comprehensive and practical framework and validate the framework.

In this research, a mixed research method and sequential exploratory research design were used. In the qualitative section, the qualitative meta-synthesis method was utilized to extract usability factors from the research literature and formulate the framework of factors, and in the quantitative section, the survey method was employed to validate the framework. In the qualitative section, the research field included the research available in the Scopus and Web of Science databases, and the data collection tool included electronic and printed documents on the usability factors of LMSs. To validate the findings, in addition to citing research literature and theoretical foundations, the audit trail, consensual validity and expert peer review methods were used. Also, to analyze the data, the thematic analysis method and thematic network via MAXQDA 2020 software were used. In the quantitative section, the statistical population was students of the Faculty of Psychology and Educational Sciences at Allameh Tabatabai University in Iran, and the sample included undergraduate students of this faculty with a volume of 200 people. The tool for collecting information was a researcher-made questionnaire that was provided to students in the first half of the academic year 2022–2023. To validate the findings, content-related validity through Content Validity Ratio (CVR) and Content Validity Index (CVI) and construct validity through Confirmatory Factor Analysis (CFA) and Convergent Validity were examined. Cronbach’s alpha coefficient and Composite Reliability (CR) were also used to check reliability. To analyze the data one-sample T-test via SPSS 27 software was used, and the PLS-SEM was utilized via SmartPLS 4 software to validate the framework proposed by the researcher.

The findings from the qualitative part of this research include basic themes and organizing themes related to the global theme of usability. Based on the findings from the qualitative part, it can be concluded that the factors in terms of frequency in the research literature have the following ranks: interaction (first rank), ease of use and usefulness (second rank), learnability (third rank), navigation (fourth rank), satisfaction and enjoyment, visual design and accessibility (fifth rank), help and assessment and feedback (sixth rank) and content, errors correction and privacy and security (seventh rank). The findings of the quantitative part include the external fit indexes of the framework and the internal fit index of the framework; based on the obtained values, it can be concluded that the framework of LMS usability factors has a good fit.

This research is the first comprehensive study of all theories on the usability of LMSs, in which a framework is proposed that combines the important factors mentioned in the relevant theories and models for the first time. Additionally, practical and applicable suggestions are provided in this study to enhance each of the usability factors of LMS.

To the best of the authors’ knowledge, this research presents a framework for the first time in which all important factors of usability theories and models are combined and prioritizes these factors based on their importance in relevant research. It also provides practical recommendations for enhancing these factors in LMSs for system developers and instructional designers.