TABLE OF CONTENT
Cover page……………………………………………………………………………………………………i
Title Page……………………………………………………………………………………………ii
Declaration…………………………………………………………………………………………iii
Certification……………………………………………………………………………………….iv
Dedication………………………………………………………………………………………….v
Acknowledgement………………………………………………………………………………vi
Table of Content……………………………………………………………………………….vii
List of Tables…………………………………………………………………………………….ix
Abstract……………………………………………………………………………………………..x
CHAPTER ONE
Introduction …………….……………………………………………………1
Background of Study……………………………………………………………………………1
Statement of Problem……………………………………………………………………………3
Research Objectives…………………………………………………………………………….4
Significance of Study……………………………………………………………………………5
Research Questions…………………………………………………………..6
Research Hypothesis…………………………………………………………6
Scope of Study……………………………………………………………….7
Limitation of Study…………………………………………………………..7
Operational Definition………………………………………………………………………….7
CHAPTER TWO
Literature review………………………………………………………………………………….9
Introduction ………………………………………………………………………………………..9
Signs and symptoms of Breast Cancer ………………………………………………….10
Risk Factors ………………………………………………………………………………………11
Women and Age………………………………………………………………………………..11
Family History and Genetic Factors……………………………………………………..12
Prolonged Exposure to Oestrogen…………………………………………………………13
Radiation Exposure…………………………………………………………………………….14
Other risk factors………………………………………………………………………………..14
Breast cancer in Nigeria………………………………………………………………………15
Young Women’s Perception of Breast Cancer………………………………………..16
Breast Cancer Detection Programmes ………………………………………………….18
Breast Self-examination………………………………………………………………………18
Theoretical Framework……………………………………………………………………….19
CHAPTER THREE
Research Methodology……………………………………………………………………….21
Research Design………………………………………………………………………………..21
Area of Study…………………………………………………………………………………….21
Population of Study……………………………………………………………………………21
Sampling Technique…………………………………………………………………………..21
Instrument for Data Collection …………………………………………………………..21
Validation of Instrument ……………………………………………………………………23
Ethical Consideration…………………………………………………………………………23
Method of Data Analysis ……………………………………………………………………24
CHAPTER FOUR
Data Presentation and Analysis ………………………………………………………….25
Presentation and Analysis…………………………………………………………………..25
CHAPTER FIVE
Discussions, Conclusions and Recommendations ………………………………44
Discussion………………………………………………………………………………………..44
Nursing implication……………………………………………………………………………46
Conclusion………………………………………………………………………………………..48
Recommendation……………………………………………………………………………….49
References…………………………………………………………………………………………50
Appendix…………………………………………………………………………………………..57
LIST OF TABLES
Table 1: Socio-demographics on age 26
Table 2: Socio-demographics on ethnicity 27
Table 3: Socio-demographics on marital status 27
Table 4: Socio-demographics on religion 28
Table 5: Socio-demographics on family history on breast cancer 29
Table 6: Knowledge of breast cancer and breast self-examination 30
Table 7: Is it common in this environment? 30
Table 8: Can it be detected early? 31
Table 9: Can early detection improve chances of survival? 31
Table 10: Have you heard of breast self-examination? 32
Table 11: How did you hear about it? 33
Table 12: Who should perform breast self-examination? 34
Table 13: At what age should breast self-examination begin? 35
Table 14: How often should breast self-examination be performed? 36
Table 15: How is breast self-examination done? 37
Table 16: How often do you practice breast self-examination in a year? 38
Table 17: What time do you normally practice breast self-examination 39
Table 18: why do you practice breast self-examination? 40
Table 19: Reasons for not performing breast self-examination 41
Table 20: Relationship between level of knowledge about breast
Self-examination and practice of breast self-examination 43
ABSTRACT
Screening for early detection and diagnosis of disease and health conditions is an important public health principle. Breast cancer is the most common cancer in women and its incidence is increasing in many countries. Nursing students are the future nurses who will have the opportunity to encourage and influence women to be breast aware. Breast self-examination (BSE) is a process whereby women examine their breast regularly to detect any abnormal swelling or lumps in order to seek prompt medical attention. The main aim of the study is to determine level of knowledge and awareness of breast self-examination among female Nursing students of Ambrose Alli University, Ekpoma.
This study was a non-experimental descriptive study using Ajzen and Fishbein’s Theory of Reasoned Action as the theoretical framework to describe the characteristics associated with breast self-examination performance, Using a stratified sampling technique, questionnaires were distributed to female nursing students between the age of 15 and 44 in Ambrose Alli University, Ekpoma. A well-structured questionnaire which comprised of demographic data, knowledge of breast self-examination and practices of breast self-examination was used. A pilot study was conducted. Data was analysed using the statistical package for social sciences (SPSS) version 20. The study findings showed a strongly positive linear relationship between knowledge of breast self-examination and practice of breast self-examination. The relationship indicating that as knowledge improves the practice of breast self-examination improves.
CHAPTER ONE
INTRODUCTION
BACKGROUND TO STUDY
Breast cancer is an abnormal growth of cells which begins in breast tissue and it is the second leading cause of cancer deaths among women worldwide (American Cancer Society, 2007).
Breast cancer is the top cancer in women worldwide and it is increasing particularly in developing countries where majority of the cases are diagnosed in late stages (WHO, 2010). It also comprises 16% of all female cancers and it is more common in females than in men (WHO, 2010). Breast cancer is curable if detected early (WHO, 2010). The low survival rates in less developed countries may be explained mainly by lack of early detection programmes, lack of adequate diagnosis and treatment facilities which results in high proportion of women presenting with late stage disease.
It is the second principal cause of death in the world as well as in Nigeria (Parkin et al., 2002, Adebamawo & Ajayi, 2000). The actual burden of breast cancer in Nigeria is unknown due to lack of adequate statistics (Okobia et al., 2006). However the prevalence of breast cancer in a study in Nigeria was 116 per 100,000 and 27,840 cases were expected to occur in 1999 (Okobia et al., 2006). Women can be made ‘breast-aware’ with cheap early detection measures such as breast self-examination (BSE) which may in turn lead to early diagnosis of breast cancer. The incidence of breast cancer among younger women seems to be increasing. A report in Nigeria showed that the peak age of incidence was 42.6 years and 125 of cases occurred before the age of 30years (Adebamawo & Ajayi, 2000). More young girls are being exposed to risk factors (apart from genetic or family) such as alcohol, tobacco, obesity, late age at first pregnancy (>30) due to education and late marriages. Studies in Nigeria have shown that most women have poor knowledge of breast cancer (Okobia et al., 2006, Odusanya, 2001, Aderounmu et al., 2006).
The screening methods currently used for early detection of breast cancer include breast self-examination (BSE), clinical breast examination (CBE), and mammography. Mammography is the most expensive and involves substantial financial and manpower resources and this is not very feasible for developing countries like Nigeria. However breast self-examination offers women a chance to learn what is normal for them so that they can recognize any changes immediately. Breast self examination is seen as an option for women from adolescent age especially in developing countries and the benefits and limitations should be known the earlier the better.
According to American Cancer Society (2007), finding and reporting breast changes early through breast self examination offers women the best opportunity for reducing breast cancer deaths. Teaching breast examination and issues about breast cancer as early as possible will go a long way to encourage positive behaviour towards breast self-examination, create a ‘breast awareness’ consciousness and can lead to seeking regular professional breast examinations/screenings later in life. Therefore the knowledge and awareness of breast self-examination is very important as everyone needs to know that early detection saves life.
The purpose of this study is to access the level of knowledge and awareness of breast self-examination among female nursing students in Ambrose Alli University (AAU), Ekpoma. In addition this study is also aimed at examining the factors that influence students to practice breast self-examination and to identify the barriers that hinder the practice of breast self examination.
STATEMENT OF PROBLEM
Breast cancer is now the most common cancer in women and the second leading cause of death in Nigeria (Adebamawo & Ajayi, 2000). Among women, breast cancer emerged as the condition they were most concerned about out of a list of 11 comparable conditions, and 56% cited breast cancer as one of the top conditions they feared most (Spittle & Morgan, 1999). A study of cancer awareness in Nigeria showed that only 32% knew that a breast lump was a warning sign of cancer, 58.5% were not aware of most warning signs, 9.8% knew of methods of detecting cancer and 50% did not know that cancer was curable when detected early (Uche, 1999). This low level of knowledge of warning signs and detection may be responsible for late presentation, with as many as 64% of patients presenting 6months after the onset of symptoms (Atoyebi, 1997). The disease has been reported to have a nearly onset among Nigerian women (Atoyebi, 1997, Madong, 1998). It is clear that breast cancer is not well understood by women (Uche, 1999, Atoyebi, 1997, Madong, 1998) and there is a need for information and enlightenment if patients are to present early in hospital.
RESEARCH OBJECTIVES
General Objectives:
This study aim to examine the level of knowledge, awareness and practice of breast self-examination among female nursing students in Ambrose Alli University Ekpoma.
Specific Objectives:
- To assess the level of knowledge of breast self examination among the respondents.
- To assess the level of awareness of breast self examination among the respondents.
- To examine the frequency of practice of breast self examination among the respondents.
- To examine the reasons for not performing breast self examination among the respondents.
SIGNIFICANCE OF STUDY
Findings from this research will provide data about the level of knowledge, awareness and practice of breast self examination among female nursing students. If the results found that the respondents have poor level of knowledge, awareness and practice, further re-visitation could be done to instil knowledge to improve it. If the level of knowledge, awareness and practice of breast self examination is good, health education still need to be done as learning is a continuous process and any new update of information regarding breast self examinations shall be told to the students.
Furthermore, as recommended by the American Cancer Society (2007) breast self examination should be started as early as 20’s. Young adults at this age should find out more information about breast self examination because it is one of the screening methods for breast cancer. They should practice it before they reach the age of common occurrence of the disease. It is important to emphasize to them that practicing breast self examination regularly enable them to detect any changes with their breast and seek medical advice earlier.
The results of this study are of great importance as it may assist health professionals in planning health education for female university students. Also from this research, health screening which include breast self examination could be included as one of the annual activities in Ambrose Alli University calendar. The purpose of this health education is to uncover knowledge about the importance of breast self examination and its relation with breast cancer.
RESEARCH QUESTIONS
The following research questions are addressed;
- What is the level of knowledge of breast self examination among female nursing students of Ambrose Alli university?
- What is the level of awareness of breast self examination among female nursing students of Ambrose Alli university?
- What is the frequency of practising breast self examination among female nursing students in Ambrose Alli University?
- What are the reasons for not performing breast self examination among female nursing students of Ambrose Alli University?
RESEARCH HYPOTHESIS
To test the relationship between level of knowledge about breast self examination and practice of breast self examination among female nursing students of Ambrose Alli University.
SCOPE OF STUDY
The scope of this study is limited to the knowledge, awareness and practice of breast self examination among female nursing students in Ambrose Alli University Ekpoma, Edo State.
LIMITATION OF STUDY
During the course of this study, some constraints were encountered and they are considered as limitation to the study.
- Material – it was difficult laying hands on useful books and journals for this project.
- Financial condition – financial constraint was a major problem in printing of questionnaires and transportation to school daily to share the questionnaires.
OPERATIONAL DEFINITION
Knowledge: Information, understanding or skill that you get from experience or education.
Awareness: knowledge that something exist or understanding of a situation or subject at the present time based on information or experience.
Breast self examination: According to National Cancer Institute, breast self examination is an examination done by a woman on her own breasts to check for lumps or other changes.
Knowledge on breast self-examination: According to Chioma & Asuzu (2007) knowledge of breast self examination is the fact of having information about breast self examination.
