Effect Of Breast Self Examination Programme On Women's Awareness For Early Detection Of Breast Cancer

Introduction:

Breast self-examination is one of the three tests that the American Cancer Society recommends helping detect breast cancer in its earliest stage by regularly examining how their breast normally feels and reporting any breast changes promptly to their health care providers. Breast Self-Examination is a cost-effective method of early detection of breast cancer, especially in resource developing countries. More than 90% of breast cancer cases can be detected by women themselves, stressing the importance of breast self-examination (BSE) as the key breast cancer detection mechanism (Marhaeni et al., 2017).

Breast self-examination benefits women in two ways: women become familiar with both the appearance and the feel of their breast and detect any changes in their breast as early as possible. Breast self-examination is best performed after menses (day 5 to day 7 counting the 1st day of menses as a day one) because women themselves detect many breast cancer, priority is given to teaching all women how and when to examine their breast (Febriyanti et al., 2018). Women who do breast self-examination make a significant contribution to the early identification of breast cancer and reduce cancer fatalities (Mohapatro et al., 2020).

Knowledge of BSE involves having information on signs of BC, BSE procedures, and performing BSE (Akpanekpo, 2017). Knowledge of BSE may also influence the attitude and practice of BSE (Iwuoha et al., 2021). Attitude is a settled way of thinking about BSE, which includes acceptance that BSE is necessary, all women should perform it, ready to encourage other people to get information, practice it, and seek early medical care with any abnormalities (Udoh et al., 2020).

Breast self-examination practice makes the individual become familiar with the structure of her breast and be responsible for her health since detecting any abnormality will necessitate seeking early medical care (Black and Richmond, 2019).

Nurses play a unique role in alerting the community to the early detection of breast cancer as they usually have the closest contact with female patients. Nurses can use their knowledge of the health services to educate women about breast cancer risk factors and available breast cancer screening services and practices. Nurses play an important role in educating women about the importance of breast self-examination and understanding the risk factors of breast cancer (Aynalem et al., 2019).

Significance of the study:  

Breast cancer is the most common cancer among women, comprising 23% of the female cancers. One in eight women born today will be diagnosed with breast cancer at some time in her life. The incidence rate of breast cancer is rapidly increasing in developing countries due to increased life expectancy, growing urbanization, adoption of western lifestyle, particularly in younger women (Haque et al., 2016). About half of all breast cancer (BC) cases occur in developing countries, with a 43% mortality rate compared to 30% in developed countries (Eltwansy, 2018).

However, detection of breast cancer at an early stage improves treatment options, specific opportunities for treatment, and survival. Theoretically, a 95% survival rate could be achieved if breast cancer was diagnosed early (Mohamed et al., 2016).

Aim of the study:

      To evaluate the effect of breast self-examination programme on women's  awareness for early detection of breast cancer.

Research hypotheses

H 1: There is a significant difference between the pretest and posttest knowledge, attitude, practice level regarding breast self-examination on any woman.

H 2: There is a significant association between pretest knowledge, attitude, practice level regarding breast self-examination women with selected socio-demographic variables.  

Subjects and Method

Research design

A quasi-experimental design was utilized for carrying out this study.

Setting

This study was conducted in an outpatient clinic in maternity and child Minia University Hospital. This hospital provides different services such as antenatal care services, follow-up of pregnant women during pregnancy, Laboring services, gynecological services, family planning services, pot care services, laboratory tests, and health education services. The investigator expected to receive many women searching for the effect of breast self-examination programs on women's awareness for early detection of breast cancer.

Subjects

The study subjects included all women who are all fulfilling inclusion criteria during the period of data collection.

Inclusion Criteria:

• All women at reproductive age from 18 to 49 years old.
• Women not diagnosed with breast cancer.
• Women who have a family history and genetic disease of breast cancer.

Sample size:

The sampling technique was utilized in this study. The study sample included 100 women of reproductive age in a rural area in Minia city according; the sample size was estimated according to the determination of the sample size is based upon the following sample calculation formula :

Data collection tools:

Three tools were used to collect the current data

The first tool: A structured interviewing questionnaire: it was designed by the researcher and consisted of two parts:

Part I: socio-demographic characteristics

It was used to assess socio-demographic characteristics of women such as age, level of education, occupation, income, marital status,……..etc. 

Part II: women's knowledge regarding breast self-examination questionnaire: to assess women's knowledge regarding breast self-examination, it included (10) items related to the definition of BSE, timing of its importance of BSE and abnormalities of it……...etc. (Fletcher, 2020).

Scoring system:  

For knowledge outcomes, correct response and complete were scored as (Two ), correct response and incomplete were scored as ( one ), while incorrect and '' don't know'' responses were scored as ( Zero ). The total knowledge score was 20 scores. Score ≤ 10  ( 50% ) classified as unsatisfactory level of knowledge, scores ˃10 ( 50% ) classified as a satisfactory level of knowledge.

The second tool: women's attitude Scale regarding breast self-examination: to assess women's attitude regarding breast self-examination, it included (14) questions

Scoring system:  

For attitude outcomes, responses agree taken (three) responses neutral taken (two), and responses disagree taken (one). The total attitude score was 42. Scores ≤ 21 classified as a negative attitude, scores ˃ 21 classified as a positive attitude.

The third tool: Women's practices Observational checklist

The researcher developed it to assess women's practices regarding breast self-examination. It involves (15) steps, such as (inspection, palpation, palpate of lymph node, squeezing of nipples and……etc.

Scoring system:  

For practice outcomes, correct responses scored as (one), while incorrect responses were (Zero). The total practice score was 15. Scores ≤ 7.5  classified as poor practice scores ˃ 7.6 classified as good practice.

Validity and Reliability:

To establish validity, the questionnaire was piloted on a panel of 5 experts of Obstetrics and Gynecological staff and nursing professors who reviewed the instruments for clarity, relevance, comprehensiveness, understanding, applicability, and easiness. The tools tested for internal consistency by using Cronbach’s alpha test to check the stability of the internal consistency of the women's knowledge, attitude, and practice tools were 0.791, 0.815, and 0.804, respectively, which is considered good reliability.

Pilot study

A pilot study was conducted on ten women (10 %) to ascertain the clarity and comprehensiveness of the tools as well as to estimate the appropriate time required to fill the questionnaire; results of the pilot study illustrated that no refinements and modification needed, so the subject was included to the actual sample.

Ethical consideration :

An official written approval letter clarifying the purpose of the study was obtained from the Dean of Faculty of Nursing Minia University and Head Manager of Minia University Hospital as approval for data collection.

Data collection procedure:

Written initial approval was obtained from the research committee of the Faculty of Nursing, Minia University. Tool I, II, and III were submitted to a jury of 5 experts in the field of women's health and obstetric nursing department to determine its applicability and content validity. The necessary modification was done

A group interview was done by the researcher to explain the nature and purpose of the study.  Data collection tools were introduced to women to be filled. The time required for filling the questionnaire was stimmed after making the pilot study. It was relatively thirty minutes. All study sample required handout includes knowledge related to breast self-examination such as definition, timing, technique, and signs of abnormality.

The study's data collection took three months, starting at the beginning of April at the end of June 2021. The research attended at setting; 3 days/ week starting from 9 A.m. to 2 P.m. until the end of the previous predetermined period. The researcher met women in the waiting area in the group's average number 5 to 8 women. At first, the researcher obtained oral consent after explaining the aim of the study and explaining how to fill the tools.

 The first tool structured interviewing questionnaire used to assess general characteristics obstetrical history and knowledge of breast self-examination of the women with clarifying any question. The third tool (observational cheek list) assessed women's practices and attitudes regarding breast self-examination within 25 to 30 minutes. The follow-up sessions were done after three months by the investigator to conduct this study.

Statistical analysis of data

The data obtained from the study tools were categorized, tabulated, analyzed, and data entry was performed using the SPSS software (statistical package for social sciences version (25.0). Descriptive statistics were applied (e.g., mean, standard deviation, frequency, and percentage). Tests of significance were performed to test the study hypotheses. A significant level value was considered when p<0.05.

Results

Table (1): Frequency distribution of the studied sample regarding their socio-demographic characteristics (n= 100)

Table (1): shows that the mean age of the studied sample was 32.6 ± 4.7 years, 59.0% of them not read or write, 70.0% of them were housewives, 91.0% of them was married, 80.0% of them hadn't insufficient income, and 68.0% of them lives in a rural area.

Figure (1): Percentage distribution of the studied sample regarding their sources of knowledge (n = 100)

Figure (1): illustrates that 33.0% of the studied sample their source of knowledge was television, followed by 30.0% of them was their friends and relative, 22.0% of them did not have any source of knowledge, and 15.0% of them their source was social media.

Figure (2): Percentage distribution of the studied sample regarding their total knowledge levels regarding breast self-examination pre/ post program (n = 100).

                   Figure (2):  illustrates that 3.0% of the studied sample had satisfactory knowledge regarding breast self-examination pre-program increased to 99.0% post-program with highly statistically significant differences which P-value < 0.0001.

Figure (3): Percentage distribution of the studied sample regarding their total attitude levels regarding breast self-examination pre/ post program (n = 100).

Figure (3) illustrates that 86.0% of the studied sample had a positive attitude regarding breast self-examination pre-program increased to 98.0% post program with highly statistically significant differences with P-value < 0.002.

Figure (4): Percentage distribution of the studied sample regarding their total practice levels regarding breast self-examination pre/ post program (n = 100).

                   Figure (4):  illustrates that 30.0% of the studied sample had good practice regarding breast self-examination pre-program increased to 98.0% post-program with highly statistically significant differences which P-value < 0.0001.

Table (2): Relation between the socio-demographic characteristics of the studied sample and their total knowledge levels regarding breast self-examination pre/post–program (n= 100).

The percentage did by row     *Statistically significance differences at < 0.05

Table (2): shows that 50.0% of the highly educated studied sample had unsatisfactory knowledge regarding breast self-examination pre-program with statistically significant differences which P-value < 0.05 and no statistical significance difference between residence, marital status, and occupation of the studied sample with their total knowledge levels regarding breast self-examination pre-program.

Also, 16.7% of the highly educated studied sample had satisfactory knowledge regarding breast self-examination post-program with statistically significant differences, which P-value < 0.03 and no statistically significant difference between residence, marital status, and occupation of the studied sample with their total knowledge levels regarding breast self-examination post-program.

Table (3): Relation between the socio-demographic characteristics of the studied sample and their total attitude levels regarding breast self-examination pre/post–program (n= 100).         

                Percentage done by row     *Statistically significance differences at < 0.05

**Highly statistically significance differences at < 0.01

Table (3): presents that 31.3% & 50.0 % of the urban and widow of the studied sample had negative attitudes regarding breast self-examination pre-program with statistically significant differences which P-value < 0.018, 0.0001 respectively but no statistically significant difference between educational level, and occupation of the studied sample with their total attitude levels regarding breast self-examination pre-program.

                Also, no statistically significant difference between residence, marital status, educational level, and occupation of the studied sample with their total attitude levels regarding breast self-examination post-program.

Table (4): Relation between the socio-demographic characteristics of the studied sample and their total practice levels regarding breast self-examination pre/post–program (n= 100).            

                The percentage did by row     **Highly statistically significant differences at < 0.01

Table (4): shows that 56.3% of the urban studied sample had a good practice, 83.3% of the widow studied sample had a good practice, 83.3% of the high educational studied sample had a good practice, and 56.7% of the workers studied sample had good practice regarding breast self-examination pre-program with statistically significant differences which P-value < 0.0001, 0.005, 0.0001& 0.0001 respectively.

Also, 100.0% of the urban of the studied sample had good practice regarding breast self-examination post-program with statistically significant differences, which P-value < 0.037, but no statistically significant difference between marital status, educational level, and occupation of the studied sample with their total practice levels regarding breast self-examination post-program.