A Pre-Experimental Study to Assess the Effectiveness of the Plan Teaching Programme regarding the Identification, Prevention and Management of Breast Cancer in Terms of Knowledge among women in selected area Mohal Kullu (H.P)

 

Shivani Sharma, Meenakshi Soni

Assistant Professor, Department of Obstetrical and Gynecological Nursing,

Chamunda Institute of Medical Science and Nursing College, Kullu.

Assistant Professor, Mental Health Nursing, Saraswati Nursing Institute, kurali, Ropar.

 

ABSTRACT:

Breast cancer arises in lining cells (epithelium) of the ducts (85%) or lobules (15%) in   the glandular tissue of the breast. Initially, the cancerous growth is confined to the duct or lobule (“in situ”) where it generally causes no symptoms and has minimal potential for spread (metastasis). Breast cancer is a malignant cell growth in the breast. If left untreated, the cancer spreads to other areas of the body. Excluding skin cancer, breast cancer is the most common type of cancer in women. Material and methods: Quantitative research approach and pre-experimental (One group pre-test and post-test research design was used. The sample size 40 women were selected by non-probability convenient sampling technique in village Mohal, Kullu. Planned Teaching Programme on knowledge regarding the identification, prevention and management of breast cancer among women and data was analysed by using descriptive and inferential statistics. The result showed that mean score and SD of pre-test and post-test of knowledge regarding the identification, prevention and management of breast cancer among women were (14.3±5.13) and (31.17±4.04) respectively, from the mean score, it was clear that women gained higher score after implementing planned teaching programme. The ‘t’ value is 20.73 which is significant at 0.05 level.  Hence it is proved that the research hypothesis is accepted. The finding of the study reveals that the knowledge of the Breast cancer and its management adolescents’ girls not satisfactory before the SIM. Conclusion: The finding of the study was indicated a planned teaching programme, VATP carried out and to improve the knowledge of women regarding breast cancer.

 

 

INTRODUCTION:

Breasts are made up of fat and breast tissue, along with nerves, veins, arteries and connective tissue that helps hold everything in place. Throughout childhood, girls have a small patch of immature breast tissue.

 

During puberty, hormones produced by the ovaries and pituitary gland (a part of the brain that controls growth and other glands in the body) cause the breasts to grow. The breast tissue then develops into a mature system of lobules and ducts¹.

 

Breast cancer is a malignant cell growth in the breast. If left untreated, the cancer spreads to other areas of the body. Excluding skin cancer, breast cancer is the most common type of cancer in women in the United States, accounting for one of every three cancer diagnoses². Every year October month is considered as the Breast Cancer Awareness Month, which is worldwide annual campaign involving thousands of organizations to highlight the importance of breast awareness, education and research³.

 

Breast cancer arises in the lining cells (epithelium) of the ducts (85%) or lobules (15%) in the glandular tissue of the breast. Initially, the cancerous growth is confined to the duct or lobule (“in situ”) where it generally causes no symptoms and has minimal potential for spread (metastasis)⁴.

 

In 2020, there were 2.3 million women diagnosed with breast cancer and 6,85,000 deaths globally. As of the end of 2020, there were 7.8 million women alive who were diagnosed with breast cancer in the past 5 years, making it the world’s most prevalent cancer. Breast cancer occurs in every country of the world in women at any age after puberty but with increasing rates in later life.

 

Survival of breast cancer for at least 5 years after diagnosis ranges from more than 90% in high-income countries, to 66% in India. Early detection and treatment have proven successful in high-income countries and should be applied in countries with limited resources where some of the standard tools are available⁵.

 

A total of 2,088,849 new cases of breast cancer and 626,679 related deaths were reported in 2018. The global age-standardized rate of its incidence was 46.3 per 100,000 population and showed an almost four-fold variation worldwide⁶. Cancer is one of the leading causes of death globally, but its burden is not uniform.

 

The cancer burden has grown over time in both developed and developing countries due to the complex reasons involved, which include aging and burgeoning population, accelerating socioeconomic development, and changes in the prevalenc9e of associated risk factors^7. Himachal Pradesh, out of all the states and Union territories, showed highest self-reported prevalence of cancer and other malignant tumours in adults aged 45 and above (2.2 per cent)⁸.

 

The cases of breast cancer are top the list at the IGMC. Every year, there are 3,000 to 3,500 cancer cases at the IGMC. Out of those, breast cancer cases are around 250-275.¹⁹ With being the most common type of cancer in women, breast cancer accounts for 14% of cancers in Indian women.

 

It is reported that with every four minutes, an Indian women is diagnosed with breast cancer. Breast cancer is on the rise, both in rural and urban India. A 2018 report of Breast Cancer statistics recorded 1,62,468 new registered cases and 87,090 reported deaths. Women can self-diagnose their condition and know of the presence of lumps or masses that suggest cancerous outgrowths.⁹

 

STATEMENT OF THE PROBLEM:

A study to Assess the Effectiveness of the Planned Teaching Programme regarding the Identification, Prevention and Management of Breast Cancer in Terms of Knowledge Among Women in Selected Area Mohal, Kullu (H.P.).

 

OBJECTIVES:

1.     To assess the pre-test knowledge score regarding early identification, prevention and management of breast cancer among woman.

2.     To develop and evaluate the effectiveness of planned teaching programme (PTP) regarding early identification, prevention and management of breast cancer among women.

3.     To assess the post-test knowledge score regarding early identification, prevention and management of breast cancer among woman.

4.     To find out the association between pre-test knowledge score of women regarding breast cancer with their selected socio demographic variables.

 

NULL HPOTHESIS

H0: The mean post test knowledge scores of community people is not significantly higher than the mean pre-test knowledge scores as evident from a structured knowledge questionnaire at 0.05 level of significance.

 

RESEARCH HYPOTHESIS:

H₁ The mean post test knowledge scores of community people is significantly higher than the mean pre-test knowledge scores as evident from a structured knowledge questionnaire at 0.05 level of significance.

 

REVIEW OF LITERATURE:

A Sunitha et.al, (2020):

A Quasi-Experimental study was conducted among female housekeeping staff in a private medical college Pondicherry to assess the effectiveness of a structured teaching programme on breast cancer awareness and practice on breast self-examination. Total 79 women were selected. Study results showed lack of awareness & practice on BSE during pre-test (20.5%). The study concluded that positive impact of the structured teaching program in post- test (83.8%) evaluation, which was statistically as well as clinically significant.¹⁰

 

Prusty K R et.al, (2020):

A cross sectional study was conducted at Prabha devi, Mumbai to assess the Knowledge of symptoms and risk factors of breast cancer among 480 women aged 18-55 year. The study showed that around half (49%) of the women were aware of breast cancer. The women who were aware of breast cancer considered lump in breast (75%), change in shape and size of breast (57%), lump under armpit (56%), pain in one breast (56%) as the important and common symptoms. Less than one-fifth of the women who were aware of breast cancer reported early menstruation (5.6%), late menopause (10%), hormone therapy (13%), late pregnancy (15%) and obesity (19%) as the risk factors for breast cancer. were about 4 times more likely to be aware of breast cancer than women who had less than 10 years of schooling. Study concluded that the knowledge of danger signs and risk factors of breast cancer were low among women in the community. This may lead to late detection of breast cancer among women in the community.¹¹

 

VARIABLES:

Independent variable: Planned teaching programme regarding breast cancer.

Dependent variable: Knowledge of women regarding breast cancer.

 

MATERIAL AND METHODS:

The research design adopted for this study was pre-experimental (one group pre- test/post- test design). The conceptual framework used for the study based on General system model (ludwing von bertalanffy). Non –Probability Convenient sampling technique was used to select the samples. The data was collected from 40 women (30-70 years) who live in selected area of Mohal, Kullu and Self - administered structured questionnaire used for study. The first day pre-test was conducted after pre-test planned teaching programme was given to all selected women. The post-test was conducted after seventh day using the same structured questionnaire to find out the effectiveness of planned teaching programme.

 

CRITERIA FOR SELECTION OF SAMPLES

Inclusion criteria:

Women in age group of 30 – 70 years.

Able to understand in English and Hindi.

Community women who are willing to participate in the study.

Residing in particular community area during the period of data collection.

 

Exclusion criteria:

Who were not available at the time of data collection.

Who were sick at the time data collection.

 

DEVELOPMENT OF TOOLS:

The tools were developed by referring books, article, journals, websites and experts.

 

Tool 1 – Socio- demographic sheet:

This tool consists of 10 items for obtaining information about socio- demographic variables such as age, marital status, religion, type of family, dietary pattern, educational status, occupation, family history of breast cancer, previous knowledge of breast cancer and source of information.

 

Tool 2 – Structured knowledge questionnaire:

This tool consists of 40 questions to assess the knowledge of women regarding breast cancer. Each correct response was assigned score 1 and incorrect response was assigned score 0.

 

SCORING:

Score Interpretation	Score	Percentage
Poor	1-13	32.5%
Average	14- 26	32.5-67.5%
Adequate	27- 40	67.5-100%

 

RESULTS:

Table 1- Frequency and percentage distribution of demographic variables of adult women.

N=40

S.No.	Demographic Variables	f	(%)
1.	Age (in years) 30-40 41-50 51-60 61-70	014 015 010 001	35% 37.5% 25% 2.5%
2.	Marital status Married Unmarried	037 003	92.5% 7.5%
3.	Religion Hindu Muslim Sikh Buddhist Christian	030 004 001 004 001	75% 10% 2.5% 10% 2.5%
4.	Type of family Nuclear Joint	029 011	72.5% 27.5%
5.	Dietary pattern Vegetarian Non- vegetarian Eggetarian	013 025 002	32.5% 62.5% 5%
6.	Educational status No formal education Primary Secondary Graduate and above	001 003 011 025	2.5% 7.5% 27.5% 62.5%
7.	Occupation Homemaker Private job Government job	017 017 006	42.5% 42.5% 15%
8.	Family history of breast cancer Yes No	006 034	15% 85%
9.	Previous knowledge of breast cancer Yes No	018 022	45% 55%
10.	Source of information Mass media Health worker Family member/relation Friends/peer	016 008 011 005	40% 20% 27.5% 12.5%

 

Table 2. Frequency and percentage distribution of subject as per pre-test knowledge score on breast cancer.                          N=40            

Sr. No.	Category	Frequency (n)	Percentage (%)
1.	Poor knowledge (1-13)	21	52.5%
2.	Average knowledge (14-26)	16	40%
3.	Adequate knowledge (27-40)	03	7.5%
	Total	40	100%

Mean score±SD=14.3±5.13

 

Figure 1 Percentage distribution of post-test knowledge regarding breast cancer and its prevention among community people

 

 

 

Table 3. Frequency and percentage distribution of women level of knowledge regarding breast cancer.                                                 N=40

S. No.	Measurement	Mean	Median	SD	Mean difference	Median difference	SD Difference	‘t’ Test
1	Pre test	14.3	13	5.13	16.87	19	1.09	20.73*
2	Post test	31.7	32	4.04

“t value df (39) level =2.023, p> 0.05 =* significant at 0.05 level of significance.

 

The above table depicts respondents on Pre test and Post test knowledge scores obtained by the women community. The mean post test knowledge score was 31.17 which are higher than the mean of pre test knowledge score of 14.3. The findings also show that the standard deviation of post test knowledge score was 4.04 whereas the standard deviation of the pre test knowledge score was 5.13.

 

The data further shows that the median for the pre test was 13 whereas the median for the post test was 32. The obtained mean difference (16.87) between the post test and pre test knowledge scores of pre-experimental groups was found to be statistically significant as evident from the ‘t’ value 20.73. for df (39) at 0.05 level. Therefore, the obtained mean difference was true difference and not by chance. Hence, the null hypothesis (H0) was rejected and the research hypothesis (H1) is accepted. This shows that the planned teaching programme on “breast cancer and its prevention” is effective in enhancing the knowledge of women of community.

 

Table 4. Association of demographic variables with pre-test knowledge of women.          N=40

S. No.	Demographic variable	Poor	Average	Good	X2	Df	Table value
1.	AGE 30-40 41-50 51-60 61-70	6 8 3 0	5 6 6 1	3 1 1 0	4.21	6	12.59ns
2.	Marital status Married Unmarried	16 1	16 2	5 0	0.81	2	5.99ns
3.	Religion Hindu Muslim Sikh Buddhist Christian	14 1 0 2 0	12 2 1 2 1	4 0 0 1 0	3.76	8	15.51ns
4.	Type of family Nuclear Joint	15 2	11 7	3 2	3.67	2	5.99ns
5.	Dietary pattern Vegetarian Non-vegetarian Eggetarian	5 12 0	8 9 1	0 4 1	6.45	4	9.49ns
6.	Educational status No formal education Primary Secondary Graduate and above	1 2 3 11	0 1 6 11	0 0 2 3	3.36	6	12.59ns
7.	Occupation Homemaker Private job Govt. job	5 9 3	7 8 3	5 0 0	8.07	4	9.49ns
8.	Family history of breast cancer Yes No	2 15	4 14	0 5	1.76	2	5.99ns
9.	Previous knowledge of breast cancer Yes No	8 9	7 11	3 2	0.76	2	5.99ns
10.	Source of information Mass media Health worker Family members/relative Friends/peers	6 6 3 2	9 1 5 3	2 1 2 0	6.07	6	12.59ns

Ns=not significant, significant at 0.05 level of significance.

 

DISCUSSION:

To assess the pre test knowledge score regarding early identification, prevention and management of breast cancer among women (30-70 years):

The present study the result showed that the maximum score 21(52.5%) women had poor knowledge, 16(40%) had average knowledge and 3(7.5%) had adequate knowledge regarding breast cancer. The findings of the present study are similar to the study conducted by Arkierupaia Shadap, Maria Pais and Anusuya Prabhuto assess the knowledge regarding breast cancer. The data was collected from 320 samples. Result shows that 46.6% with poor knowledge, 45.3% with average knowledge and 8.1% with adequate knowledge.¹²

 

To develop and evaluate the effectiveness of planned teaching programme regarding identification, prevention and management of breast cancer among women:

In the present study the result showed that the mean score of the pre-test is 14.3 and post-test is 31.17 having knowledge regarding breast cancer and mean difference is 16.87. The calculated t value was 20.73. So, it can be interpreted that planned teaching programme is effective in improving the knowledge of women.

 

The findings of the present study are similar to the study conducted by Ahmed Osman Ahmed Mohamed, the mean post test knowledge score 26.1 was higher than that of mean pre test knowledge score 11.2. So, it can be interpreted that the self- administered structure questionnaire if effective in improving the knowledge.¹³

 

To assess post test knowledge score regarding early identification, prevention and management of breast cancer among women (30-70 years):

In the present study conducted the post test knowledge score of women regarding breast cancer among 40 samples through multiple choice questionnaires is 35(87.5%) with adequate knowledge, 5(12.5%) with average knowledge and 0(0%) with poor knowledge.

 

Similar findings were observed in the study conducted by Ankit Singh, Justina Jacob, AnsguThomar and Pubs Gupta. Pre experimental study was conducted to assess the knowledge regarding breast self examination. Data was collected from 160 samples by using simple random sampling technique. The study results showed that 73.75% have adequate knowledge, 26.25% have average knowledge and 0% have poor knowledge. The study concluded that there is increase awareness regarding breast cancer.¹⁴

 

CONCLUSION:

The study findings revealed that there was a significant improvement in the knowledge of women regarding breast cancer by planned teaching programme. Based on the statistical findings it is evident that provision of such kind of teaching programme will motivate the women help them to acquire knowledge regarding breast cancer.

 

REFERENCES:

1.      https://www.komen.org/breast-cancer/facts-statistics/what-is-breast-cancer/the-breast-anatomy.

2.      National Cancer Institute SEER Training Module (2021) (https://training.seer.cancer.gov/breast/intro/)

3.      Afira S. A study to assess effectiveness of structured teaching programme regarding breast self examination. 2020; 1: 1-14 (https://www.ipinnovative.com/journal-article-file/11208)

4.      World Health Organization (2021). (https://www.who.int/news-room/fact-sheets/detail/breast-cancer)

5.      Breast Cancer-WHO. (https://www.who.int/news-room/fact-sheets/detail/breast-cancer).

6.      huangjunjie et.al, global incidence and mortality of breast cancer (2021) (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7950292/)

7.      Cao et.al, Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics (2020) (https://journals.lww.com/cmj/Fulltext/2021/04050/Changing_profiles_of_cancer_burden_worldwide_and.5.aspx)

8.      Adarsh et.al, Cancer among elderly women more prevalent than among men: LASI report 2021. (https://www.downtoearth.org.in/news/health/cancer-among-elderly-women-more-prevalent-than-among-men-lasi-report-75521.

9.      Statistics of Breast Cancer in India/ Cytec are Hospital. (https://cytecare.com/blog/statistics-of-breast-cancer/)

10.   A Sunitha et.al, to assess the effectiveness of a structured teaching programme on breast cancer awareness and practice on breast self-examination (2020). (http://journal.njrcmindia.com/index.php/njrcm/article/view/57)

11.   Prusty K R et.al, to assess the Knowledge of symptoms and risk factors of breast cancer among 480 women aged 18-55 year (2020). (https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-020-00967-x).

12.   Heena. H. et.al, A Cross sectional study to assess knowledge, attitudes, and practices related to breast cancer screening among female health care professionals. 22, Oct. (2019). (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6806575/).

13.   Mohamed A.O.A. et.al, to assess knowledge, attitude, and practice of breast cancer and breast self- examination among female detainees in Khartoum, Sudan, Oct (2020)(https://pubmed.ncbi.nlm.nih.gov/33150235/)

14.   Arifa S. et.al.  A pre–experimental study to assess the effectiveness of structured teaching programme on knowledge regarding breast self-examination among fmphw 1st year students at Ramzan institute of paramedical sciences (2020). (https://www.ipinnovative.com/journal-article-file/11208).

 

 

 

 

 

 

Received on 02.12.2023         Modified on 12.02.2024

Accepted on 24.04.2024        ©A&V Publications All right reserved