Evaluate The effectiveness of Awareness programme with health Education on breast cancer and skill Training on breast self-Examination among rural women in chittoor Dist Andhra Pradesh-A Collaborative Research
Dr. Padmaja
A1, Mohanasundari S K4, Dr Munuswamy3,
Murali2, K. Sesha Kumar5
1Professor Cum Vice Principal, College of Nursing,
SVIMS, Tirupati.
2Faculty College of Nursing,
AIIMS Jodhpur, Rajasthan
3CMO, Emergency Department,
SVIMS, Tirupathi. AP
4District Rural development
authority Officer, Chittoor Dist, A, P.
5Lecturer, Viswa Bharathi College
of Nursing, Mysore Karnataka
*Corresponding Author Email: raajinaidu@rocketmail.com
ABSTRACT:
Introduction: There is an increased burden of breast cancer in both developed and developing countries including India. Globally, over one million breast cancer cases are diagnosed annually. Inadequate knowledge about breast cancer is documented as an important factor in preventing women visiting screening facilities, engaging in BSE, and delayed treatment, and thus contributes to the high morbidity and mortality rates. Method: Evaluation study was conducted to assess the effectiveness of the awareness programme on knowledge regarding breast cancer and practice on breast self-examination (BSE) among 3015 rural women in Chittoor dist, Andhra Pradesh though providing health education on breast cancer and skill training on BSE. Result: Women had adequate knowledge on breast cancer (Mean ± SD=8.04 ± 1.62) and very good practice on BSE (Mean ± SD= 15.21±1.98). Conclusion: Conducting awareness programme for women will help rural women to go for screen and that could prevent increasing incident of mortality and morbidity rate.
KEYWORDS: Breast cancer, Breast self-examination, awareness programme, and rural women.
INTRODUCTION:
Breast cancer is one of the 2nd leading diseases for death among all cancer in women.it is one of the global focused concern1. There is an increased burden of breast cancer in both developed and developing countries including India. Globally, over one million breast cancer cases are diagnosed annually. This amount to a total 411,000 deaths from breast cancer accounting for 14% of female cancer deaths worldwide. It is estimated that about half (60%) of breast cancer deaths occur in economically developing countries.
Genetics factors, poverty and inaccessibility for quality treatment, inadequate awareness and knowledge of the disease is leading cause for the increased incident of the breast cancer. Breast cancer is invasive and aggressive disease associated with poor prognosis. Inadequate knowledge about breast cancer is documented as an important factor in preventing women visiting screening facilities, engaging in BSE, and delayed treatment, and thus contributes to the high morbidity and mortality rates1.
Breast cancer accounted for almost 25% of all cancers in women globally in 2012. Although breast cancer is the most prevalent cancer in India, there is no organized national breast cancer screening programme.2 A recent study of breast cancer risk in India revealed that 1 in 28 women develop breast cancer during their lifetime.1 An increasing trend in incidence is reported from various registries of national cancer registry project and now India is a country with largest estimated number of breast cancer deaths worldwide. In India the incidence/mortality ratio is 0.48 compared with 0.25 in North America.3
Breast cancer patients do not tend to survive for a longer time if the cancer is detected at a late stage because the tumor size at the time of diagnosis has a significant impact on survival rate even with effective treatment. The reasons for late detection of breast cancer includes low awareness, presence of stigma, fear about pain during screening and fear about the disease, gender inequity, lack of screening test and infrastructure, low literacy, low-income level and cultural taboos that make Indian women embarrassed to talk about their bodily problems leads to late detection of disease and death.. One potentially important strategy in reducing breast cancer mortality is the use of screening methods such as BSE, clinical breast examination, and mammography for early detection. Early detection helps in the treatment before metastasis and associated with excellent prognosis. Breast cancer screening was found to reduce the risk of mortality by 20%. Despite the presence of various screening methods, majority of breast cancer cases are detected by women themselves, stressing the importance of BSE. 4
Regular practice of breast self- examination is the corner stone of the fight against breast cancer.3. BSE is considered to be a simple, inexpensive, quick, noninvasive, nonhazardous intervention. This could be a useful measure for early identification of breast cancer in resource-poor countries where accessibility to better screening methods is less. The sensitivity of the test was found to be 78%.5
Furthermore, many studies have shown that most breast tumours are self- discovered and that the majority of the early self-discoveries were by women who regularly practice BSE. BSE is still recommended as a general approach to increasing breast health awareness and thus potentially allow for early detection of any anomalies. Therefore, BSE become particularly important and appropriate. Reaching out to the rural women at the grassroots levels will help in early detection of breast changes.5 Raising awareness may also empower women to follow healthy behaviors and health promotion activities. Health motivation and improving confidence are two important factors which improve preventive health behaviors. 6 Keeping this background as reason the present study was undertaken to empower rural women with informational booklet on breast cancer and skill training on breast self-examination and to evaluate the effectiveness of the empowerment programme.
AIM:
“To evaluate the effectiveness of awareness programme with health education on breast cancer and skill training on breast self-examination among rural women in Chittoor Dist Andhra Pradesh.
ASSUMPTIONS:
· Health education on breast cancer will improve the level of knowledge among rural women regarding breast cancer.
· Breast self-examination skill training (demonstration and re-demonstration) will improve skill of rural women on BSE.
MATERIAL AND METHODS:
Study was conducted by collaborating with district rural development authority of Chittoor Dist. to evaluate the effectiveness of awareness programme on knowledge of breast cancer and skill training on breast self-examination (BSE) among rural women though providing health education booklet on breast cancer and skill training on BSE. A total of 3015 rural women were selected for the study as participant through two stage cluster sampling method. On lottery method Chittoor district were chosen (As per 2011 census total population of Chittoor Dist were 4,174,064 of which male and female were 2,090,204 and 2,083,860 respectively) from Rayalaseema region and from that district 54 villages were chosen randomly. All women aged <30 to >50 years in those villages were included in this study. Women who were diagnosed with breast cancer were excluded for the study.
The tool contains 3 sessions. Session-1 was socio demographic variables which contains 14 questions with 3 extended form questions. (Age in years, educational status, occupation, marital status, number of children delivered, age at delivery of first child, have you had any abortions, family history of breast cancer, age at menarche, age of your menopause, are you taking hormones to reduce menopausal symptoms, do you have habit of consuming alcohol, have you had been diagnosed as breast cancer, previous knowledge on breast cancer, source of information, have you ever heard about BSE and have you performed BSE). Session-2 was Self-structured knowledge questioner which contains 10 MCQ to assess knowledge regarding breast cancer. Score >70% indicates adequate knowledge, 50-70% was average knowledge and <50% was considered as inadequate knowledge. Session 3 was observational check list (18 steps procedure on BSE) used to assess the skill on BSE after the intervention and score >50% was considered as good practice and <50% was considered as poor practice.
Before collecting the data ethical permission was obtained from IEC of SVIMS University, formal permission was obtained from DRDA Officer Chittooe dist, and verbal and written informed consent was obtained after explaining the purpose and objectives of the study from the participants and assured for privacy and confidentiality of the information.
The pilot study was conducted among rural women at Tirupati, after obtaining formal permission from DRDA Officer, Chittoor. The study was conducted with the sample size of 20. Reliability of the tool was assessed through split half method (KR -20) r = 0.8. Content validity of the questionnaire was done by the experts from the Department of Obstetrics & Gynecology, Department of Oncology from different colleges. Necessary corrections were made in relation to the content for the final tool.
Actual data collection was done over a period of 4 months (September 2019 to December 2019) through self-report method with closed end questioner technique (for knowledge level) and non-participant observational method with check list (for BSE skill). The interventions were awareness programme on breast cancer; awareness was created in 54 villages for women’s though health education on breast cancer and skill training on BSE. Individual attention was given to each woman or educating and providing skill training.
Before intervention the socio demographic variables were collected. With help of dummy the breast examination steps were demonstrated by the trained health care professionals for each women’s. Individual attention was given to each woman for re-demonstrating procedure. Every women participated with same enthusiasm even though they are from different demographics. The BSE observational check list was filled by the investigator by observing the procedural skill. After the de skill training, health education on breast cancer was given to the women through AV Aids. The AV Aids contains information on definition, risk factors, causes, clinical manifestation types of breast cancer, pathophysiology, diagnostic measure including self-breast examination technique, management and prevention etc. After a week the women’s were contacted from their homes and assessed for level of knowledge on breast cancer with help of structured questioner. For the women who don’t know to read was assisted for filling the questioner.
Data obtained was coded in excel and entered in SPSS version 16 for analysis. Descriptive statistics such as frequency, percentage, mean and standard deviation were used for analyzing the demographic variables and knowledge score of breast cancer, and effect of BSE practice. Inferential statistics such as chi- square test were used to find out association between level of knowledge and selected demographic variables.
RESULTS:
Table-1: Frequency distribution of demographic variables and association of selected demographic variables with level of knowledge. N=3015
|
Demographic variables |
Frequency (%) |
X2 |
P value (<0.05) |
|
1. Age in Years a) <30 b) 30-40 c) 40-50 d) >50 |
672 (22.3) 966(32) 747(24.8 630 (20.9) |
7.63 |
0.032 (S) |
|
2. Educational status a) Illiterate b) Primary education c) Secondary education d) Intermediate and above |
1208(40.1) 543(18) 754(25) 510(16.9) |
6.19 |
0.324 (NS) |
|
3. Occupation: a) Home maker b) Government employee c) Private employee d) Self – employee |
2239(74.3) 77(2.6) 110(3.6) 589(19.5) |
4.456 |
0.767 (NS) |
|
4. Marital status: a) Married b) Unmarried c) Divorced d) Widow |
2823(93.6) 69(2.3) 66(2.2) 57(1.9) |
2.092 |
0.42 (NS) |
|
5. Number of children delivered? a) Nil b) One c) Two d) Three |
150(4.9) 547(18.1) 1671(55.4) 647(21.5) |
7.52 |
0.067 (NS) |
|
5a. If one or more children delivered, age at which delivered first child? (N=2865). a) < 35 years b) 35-44 years c) >44 years |
43(1.5) 2738(95.6) 84(2.9) |
3.897
|
0.68 (NS) |
|
6. Have you had any abortions? a) Yes b) No |
549(18.2) 2466(81.8) |
2.738 |
0.76 (NS) |
|
7. Family history of breast cancer? a) Yes b) No |
53(1.8) 2962(98.2) |
1.09 |
1.00 (NS) |
|
8. Age at menarche? a) Less than 12 years b) 13-15 years c) >15 years |
612 (20.3) 1274 (42.3) 1129 (37.5) |
28.924 |
0.00* (S) |
|
9. What is the age of your menopause? a) < 40 years b)> 40 d) Not attained |
646 (21.4) 917(30.4) 1452(48.2) |
6.283 |
0.216 (NS) |
|
10. Are you taking hormones to reduce menopausal symptoms? a) Yes b) No |
57 (1.9) 2858 (98.1) |
No association is possible |
|
|
11. Do you have habit of consuming alcohol? a) Yes b) No |
7(0.2) 3008 (99.8) |
No association is possible |
|
|
12. Have you had been diagnosed as breast cancer? a) Yes b) No |
18(0.6) 2997 (99.4) |
No association is possible |
|
|
13. Previous knowledge on breast cancer? a) Yes b) No |
1182(39.2) 1833(60.8) |
5.674 |
0.192 (NS) |
|
13a. If yes, what is the source of information? (N=1182) a) Family members or friends b) Mass media c) Health professionals d) Others |
610(51.6) 50(4.2) 77(6.5) 445(37.7) |
1.418 |
0.841 (NS) |
|
14 Have you ever heard about Breast Self - Examination? a) Yes b) No |
1021(33.9) 1994(66.1) |
7.96 |
0.024* (S) |
|
14a. If yes, did you have performed Breast Self - Examination? (N=1021) a) Yes b) No |
193 (18.9) 828(81.1) |
3.246 |
0.076 (NS) |
Note: * =Significant at P<0.05 NS=No significant, S= Significant
It was interpreted from table-1 that previous knowledge about breast self-examination, age and age at menarche has significant association with level of knowledge on breast cancer and other demographic variables were not had significant association. Majority of the women were married, illiterate, aged between 30-40 years, home makers and also who given birth to minimum children. Majority of the women had no history of abortion, no family history of breast cancer and not taking hormonal medication to control menopausal syndrome. Many were attained menopause; most of them were non-alcoholic, and also attained menarche between 13-15 years of age. Few were aware about breast cancer and for them the major source of information was family and neighbors. Also most of them were not aware about self-breast examination and very few know to perform it.
Table-2: Frequency and mean of level of knowledge on breast cancer N=3015.
|
Level of knowledge |
Score |
Frequency |
Mean ±SD |
|
Inadequate knowledge |
<5 |
90 |
8.04±1.62 |
|
Moderately adequate knowledge |
5-7 |
825 |
|
|
Adequate knowledge |
>7 |
2100 |
Table-2 showed there was adequate knowledge on breast cancer among rural women as mean score was 8.04±1.62. So the health education was effective in improving the knowledge level of the rural women regarding breast cancer.
Table-3: Frequency and mean of level of practice on breast self-examination N=3015
|
Level of knowledge |
Score |
Frequency |
Mean ±SD |
|
Poor skill on BSE |
≤9 |
0 |
15.21±1.98 |
|
Good skill on BSE |
>9 |
3015 |
Table-3 showed there was good skill on practicing self-breast examination among rural women as mean score was 15.21±1.98. So the skill training was effective in improving the procedural skill on BSE among rural women’s.
On breast self-examination it was found that around 90 women felt pain with tenderness and 65 women had lump over the breast. They were referred for mammography to rule out breast cancer.
DISCUSSION:
The study showed that women who participated in skill training programme on BSE was able to perform BSE very well irrespective of their demographic variables and also women who exposed to health education on breast cancer showed improved level of knowledge on breast cancer as indicated by the mean score 15.21±1.98 and 8.04±1.62 respectively. This study finding was supported by the flowing studies such as study conducted by Safiya K et,al. (2017)7 to investigate any difference between females in medical and non‑medical colleges for knowledge, attitude and practice of breast self‑examination and the percentage of medical students who perform BSE was higher than that of non‑medical students and 49.7 % of medical student were had adequate knowledge on breast cancer than non-medical students, study conducted by Anantha Lakshmi et.al, (2014)8 on awareness and practice of breast self examination among the women in KIMS, AP and 96.1% knows about breast cancer, 16.5% are aware of BSE, 2.4% are practicing BSE, study conducted by Hiwot A et al (2017)9 on effectiveness of planned teaching program on knowledge and practice of breast self-examination among first year female midwifery students in Hawassa health Sciences College showed highly significant increment on both the knowledge and practical competency scores after the intervention, study of Swapna M K (2016)10 assessed the effectiveness of video assisted teaching programme on Breast Self-examination among women and the result shown for the Knowledge score regarding Breast Self-Examination was improved after education and study conducted by Kanika R (2015)11 to evaluate the effectiveness of planned teaching program on knowledge regarding B.S.E. among the nursing students and the result showed there was a significant difference between the mean post-test and pre-test knowledge scores.
This study findings was not supported by study of Rao S et al (2016) 12 who conducted study to evaluate the current status of knowledge and practices related to BC and breast self‑examination in the female rural population attending a teaching hospital and found that women are not skillful in performing BSE and not knowledgeable on breast cancer. But these studied were cross sectional descriptive studies without intervention and our present study was evaluation study after the awareness programme through health education and skill training on BSE.
CONCLUSION:
It was concluded that awareness through health education on breast cancer will improve their knowledge level and that could prevent the increasing incident of morbidity and mortality rate. As well as empowering women through skill training programme about BSE could help rural women who show very less interest to visit Gynecologist to screen for breast cancer. It is recommended that conducting such programme very frequently in rural and urban area will empower women adequately with good knowledge, attitude and practice on BSE that ultimately aid in detecting new cases in the early stage itself.
ACKNOWLEDGEMENT:
District rural development authority officer, Chittoor Dist and participants.
CONFLICT OF INTEREST:
No.
FUNDING:
District Rural Development Authority, Chittoor Dist. And SVIMS University.
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Received on 23.12.2019 Modified on 30.12.2019
Accepted on 05.01.2020 ©A&V Publications All right reserved
Asian J. Nursing Education and Research. 2020; 10(1):97-102.
DOI: 10.5958/2349-2996.2020.00022.1