Study setting, design and population
Arbaminch zuria Districtis is found in Southern Nation Nationalities and People Region Gamo Zone, around Arbaminch Town located 505 km southwest from the capital city, Addis Ababa and 275km far from Hawassa city of SNNPR. Based on the 2007 census conducted by the Central statistical Agency of Ethiopia and population projection for 2017, the total population of Arbaminch zuria District is 195,858; of whom 50.01% are women(21).
All Women who are Age between 20-64 Years old
All Women who are Age between 20-64 Years old during the study period
A community based cross-sectional study design was conducted
Sample size determination
In this study, sample size was determined by using single population proportion formula by considering the level of breast self-examination 50%, margin of error of 5%, and confidence level 95%, design effect 1.5 and adding non-response rate of 10%. So, the sample size for this study was 634.
A multi-stage sampling technique was employed to select the study participants. Arba Minch Zuria district has 29 kebeles (the smallest administrative unit in Ethiopia) from which nine kebeles were selected by lottery method. First, eligible households were identified from family folder belongs to health post in each kebeles. If there are two and more than two participants in the house one of them would be taken by lottery methods. Three visits were conducted during data collection in case when the data collectors didn’t get the study participants. Then, eligible households were coded in to computer, finally, computer generated random numbers were used to select households with eligible study participants.
Data Collection tools and techniques
The tool was adapted from the champion’s breast self-examination questionnaire and from different literature reviews (53, 54). The questionnaire was first prepared in English and, it was translated to Gamoegna language and back to English by language expert. The data were collected by nine data collectors and two supervisors using face-to-face interviewer administered pre-tested questionnaires.
Data quality control
The questionnaire was pre-tested on 5 % (32) of the total sample size of non-study subjects in Mirab Abaya woreda Delibo Kebele before the actual data collection. Training was given for data collectors & supervisors for 2 days by the investigators on the purpose of the study, method of interviewing; keeping confidentiality of information and other essential principles. The overall activities of data collection were supervised and coordinated by the investigators. The completeness of the questionnaire was checked by supervisor at the end of each day and double checked by investigators.
Data processing and analysis
Collected questionnaire were checked manually for its completeness, coded entered in to EPI INFO version 3.5.1and exported to SPSS version 22 for data cleaning and analysis. Each of the 3 breast self-examination questions were summed and the result with mean and higher score denoting good practice. The Hosmer-Lemeshow test was used to check the goodness of fit of the model. Bivariate analysis was done to identify associations between dependent and independent variables, with crude and adjusted odd ratios, 95% CI and p-values were used to assess the strength of associations and statistical significance. Variables with a p-value of <0.25 in bivariate analysis were considered as candidate for multivariable analysis; and variables with a p-value of <0.05 level in the multivariable analysis were considered as significant factors of breast self-examination practice in the final logistic regression analysis.
Breast self-examination practice: If the woman has performed breast self- examination monthly during menses (regular) or ever performed breast self -examination (irregular) we considered as practiced BSE.
Knowledge towards breast self- examination: -was assessed through 7 items on breast Self-examination. Respondents who score less than or equal to the mean value was considered as Poor knowledge (23).
Attitude towards breast self-examination: - was assessed through 3 questions and Respondents who scored above the mean value, was considered as having “favorable” attitude while those who scored below or equal to the mean value was considered as having “unfavorable” attitude towards breast self-examination (23).
Perceived susceptibility towards breast self-examination: - participants who scored mean and above the mean values regarding their risk of breast cancer from the provided 3 close-ended questions were considered as having good perceived susceptibility (54).
Perceived severity towards breast self-examination: - participants who scored mean and above the mean values regarding their consequence of breast cancer from the provided 4 close-ended questions were considered as having good perceived seriousness (54).
Perceived benefits toward breast self -examination: - participants who scored mean and above values regarding the benefit of BSE from the provided 4 close ended questions were considered as having good perceived benefits (53)
Perceived barriers towards breast self-examination: - participants whose answered to barrier related questions to do BSE measured by 3 questions, and scored mean above values was considered as having a perceived barrier to do BSE (53)