Exploring the Influencing Factors on Breast Self-Examination among Ethiopian Women, 2022: A Qualitative Study

doi:10.21203/rs.3.rs-2635645/v1

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Exploring the Influencing Factors on Breast Self-Examination among Ethiopian Women, 2022: A Qualitative Study

https://doi.org/10.21203/rs.3.rs-2635645/v1

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Background: Breast cancer (BC) is the leading cause of cancer death worldwide and the second most common cancer overall. Breast self-examination (BSE) is one of the cheapest methods used for the early detection of breast cancer in asymptomatic women. However, in Ethiopia, most of thebreast self-examination studies were not conducted among women in the general population. Therefore, this study aimed to assess breast self-examination practice and associated factors among women of reproductive age in the North Shewa Zone, Oromia.

Method: A community-based cross-sectional qualitative study design was conducted from May 1, 2022 to June 30, 2022. Five focus group discussions (FGDs) were conducted with 46 women from four selected districts in North Shewa Zone, Oromia. A Purposive sampling technique was used to select participants for FGD

Results: Four themes emerged as the results of the in- focus group discussions, namely knowledge of breast cancer, knowledge regarding breast self-examination, Perceived benefits of treatment, barriers to performing regular BSE and enablers of BSE practice.

Conclusion: The study identified and described the factors influencing BSE practice which are inadequate knowledge regarding BSE practice and BC and also, misconceptions of BC and BSE practice. So, BSE shall be encouraged by improving knowledge of BSE practice and perception of BSE practice and BC through providing special health education for women at all levels. To overcome this problem, effort is needed from health system management like, North Shewa zonal Health Office, and the regional health bureau, Health care providers, cancer associations at the regional health bureau.

Breast self-examination

women

Ethiopia

Breast self-examination (BSE) is one of the screening methods, which involves the woman looking at herself and feeling each breast for possible lumps, distortions, or swelling (1). More than 90% of cases of breast cancer (BC) can be detected by women themselves. This reality stresses the importance of BSE as the key BC detection mechanism (2). Nowadays, BC is a major women's health problem globally. Meanwhile, primary prevention for BC is still not available(3). New cases of BC worldwide are estimated at 252,710 with almost 459,000 related deaths. (4). According to the American cancer society (ACS), 1 out of 8 United States women experiences BC in their lifetime. ACS has predicted the incidence of BC in women around the world to reach around 3.2 mil new cases per year in 2050 (1).

According to the reports of Global Burden of Cancer(GLOBOCAN) in 2020, of the 19.3 million new cases of cancer globally, BC accounted for 24.5% of which 16.8% occurred in Sub-Saharan Africa (SSA) and also accounted for 15% of the 9.9 million mortality due to cancer worldwide, while in SSA accounting for 12.1% (5,6). In Ethiopia, in 2020 the number of new cases of cancer among females of all age were 50,598 while, BC accounts for 31.9% and also, cancer accounts for about 5.8% of total national mortality while, BC accounts for 17.5%(7). In Ethiopia, BC incidence is rising and becoming the foremost common cancer, causing high rates of morbidity and mortality. (7) The incidence of BC accounts for 15,244 (22.6%) of all cases of cancer and 8,159 (17.5%) cancer mortality annually(8).

WHO recommends cancer prevention as an essential component of all cancer control plans because about 40% of all cancer deaths can be prevented (9). BSE has been promoted for many years as a screening method for BC at an early stage, to decrease the risk of dying from BC (9).

BSE practice has been appreciated to enable women to take concern their health and it is a suitable and cheap means that can be implemented regularly (10). A country with inadequate resource facilities and poor health systems has to promote early diagnosis programs based on BSE, awareness of early signs and symptoms, and prompt referral to diagnosis and treatment (11)

The practice of BSE has been reported in different countries. 12.5% in Indonesia (12), 11% in Yemen (13), 4.0% in Saudi Arabia (14), 37.6% in Ghana (15), 15% in Cameroonian. (16), 13.2% in Bale zone (17), 15% in Jimma (18), 51.4% in Adama (2), 45.8% in Gondar (19), and 6.25% in Adawa (20) town women had performed BSE on regular basis (monthly).

Factors affecting the practice of BSE were reported from different countries. These are age, family history of BC, knowledge of BSE, level of education, and women's perception towards BSE practice and BC (12,14,15,20–24). BSE is the only feasible approach that is cheap and easily applied method across wide population. Its ultimate purpose is early detection and treatment. Despite, its importance as an early detection strategy, poor practice of women has been a major obstacle. So, increasing women’s practice of BSE through creating BC awareness campaign (2,12–14,17,18)

In Ethiopia, most of the BSE studies were not conducted among women in the general population and have been conducted on university students (25,26), health care providers (27–30), and urban populations (2,19) and also not added qualitative approaches which is more important to understand health-seeking behaviour or why people not utilizing health service (2,17,31). Due to this, many women miss early detection, as well as treatment opportunities Thus, this study aimed to explore factors influencing BSE among women in north shewa zone.

Study Area, Design, and Period

The study was conducted in the North Shewa zone, Oromia region, Ethiopia. North Shewa is one zone of Oromia state, which is found in the central part of Ethiopia. A North Shewa zone has 13 districts with one town administration, 267 rural kebeles and 36 urban kebeles. Fitche is the capital town of the zone which is 112 km away from Addis Ababa. Based on the information obtained from the zonal health office, Population Projection of Oromia Region by Zone, Wereda, Urban and Rural as of July 1, 2020 indicates, that the population of the North Shewa zone is about 1.7 million of whom 49.9% are female and 44.2% are reproductive age women(32)

Additionally, the zone has 64 health centers and five public hospitals that provide health care services to the community. A community-based qualitative study design was conducted from May 1, 2022 to June 30, 2022.

Population

Purposely selected reproductive-age women (15-49) living in the selected districts of the North Shewa zone.

Sample size determination

A total of 46 women were involved in five FGDs. FGDs were conducted in four districts of the North Shewa zone namely: Kuyu, Degam, Girar Jarso, and Jidda. Which included 6 to 10 members in each group.

Sampling procedures

A Purposive sampling technique was used to select participants for FGD. From each selected district, one groups of reproductive-age women, being that study population and not included in the quantitative study have participated in the FGD.

Data Collection Tools, Personnel, and Procedures

Data were collected in the local language (Afan Oromo) by using semi-structured FGD guides. The guides were prepared in English by the principal investigator (PI), translated into Afan Oromo, and checked by experts for more clarity. The FGDs guides had a list of a few discussion points such as knowledge about BC and BSE, barriers to BSE practice and enablers of BSE with several follow-up probes used to capture beneath of the issue. The FGDs were moderated by an experienced health professional and note-taker. During the discussion, notes were taken and their voices were recorded using a tape recorder. And each discussion was 60–90 min at each selected site.

Data quality assurance

To ensure the quality of data, the PI Considered trustworthiness which is the fundamental criterion for qualitative reports as follow: -

Credibility (related to internal validity)

Credibility depends upon how closely the collection, presentation and interpretation of data match the underpinning philosophy of the research methodology chosen to address the research question. So, to maintain the credibility, of the research findings FGD guidelines were evaluated by the professionals, before the data collection. For the two individuals who participated in the FGD, orientation about the purpose of the FGD and responsibility was given before the FGD takes place to avoid unnecessary interruption and keep the rights of the participants. Triangulations were made by using multiple data sources and diversifying the study participants in terms of age, residence, and educational level for a deeper understanding of the BSE practice.

Transferability (related to generalizability)

Transferability is about providing enough information in accessible language to enable another to answer the question to transfer in another setting. To maintain the transferability of the finding, appropriate probes were used to obtain detailed information on responses. Detailed field notes and digital audio recordings were done for all FGD before and during analysis (thick description).

Dependability (related to reliability)

Dependability can be described as making sure research questions were clear and appropriate to the study design, ensuring transparency of the researcher`s role and the use of appropriate data collection. So, to maintain the dependability of the finding the research process member checking was made by returning the preliminary findings to the participants to correct errors and challenge what was perceived as wrong interpretations. The prolonged meeting was made to address individuals with different ideas acceptance was built with participants. Furthermore, the interpretations of the researcher were challenged through discussion of the preliminary analysis in group meetings with groups of data collectors and the researcher`s supervisors.

Conformability (related to objectivity)

To ensure Conformability of the finding the FGD guidelines were followed to make them homogeny in terms of age, educational level and residence and the discussion process were conducted by bilingual individuals (two female) to make the participant freely react to the issue under discussion. Detailed field notes and digital audio recordings were done for all FGD and data analysis in each sub-study was crossed checked and the results were reviewed about themes and subthemes with which their original data were linked by the investigator and at least one other researcher.

Data process and Analysis

Data, during FGD was audio-taped, transcribed, translated and coded qualitative data was organized in categories forms after being checked for similarities and differences and analyzed under selected themes based on the question guide and summarized manually.

Ethical considerations

The study was approved by the Ethical Review Board of Salale University. It was presented to the North Shewa zonal health office to grant official permission to undertake research activities in the selected districts. Written informed consent was obtained from every study subject before the discussion was started and Minor assent or parental permission for the study subject less than 18 years old. The entire information collected from the study participants was handled confidentially by omitting their identifiers.

Description of Participants

A total of 46 women were involved in five FGDs, which were considered participants with and without cancer. Participants’ ages ranged from fifteen to forty-nine. Accordingly, most of the participants were between the age of 25-34 years, educational background varies among them and ranges from primary (n= 18) to secondary (n= 22) to tertiary level (n= 6). Each participant showed good interest in the topic and gave enthusiastic answers to the questions.

Findings

Generally, confirmed from the discussion as there is a lack of BSE practice. The majority of the participants reported that they did not know how to do BSE correctly. Some women performed BSE sometimes when they felt something or had pain in the breast. They responded, "I don't have a history of breast disease. “I don't have a history of breast disease” “. I do not feel pain in my breast. I think that I do not need to do a breast examination”. (women16, Group 1-4) “… Because I do not know how to do it, and I have no extra time to do it”. (women16, Group 1-4)

“I rarely perform it because I have no problem with breast and usually visit health facilities and HCWs to get a child. Nevertheless, I have never asked about BC, and also, they do not suggest me to perform BSE” (women10, Group 1-4)

Codes were compared for similarity and differences, merged, and categorize. Finally, themes emerged and the emerged themes with the categories that came together for the data analysis. The findings are presented in four thematic groups.Table 1.

Table 1: Codes, categories and themes emerged from FGD on factors influencing BSE among study participants, 2022

Codes	Categories	Themes
Definition of BC	Knowledge about BC	BC and BSE-related knowledge.
Source of information
Sign and symptoms
Risk for BC
Its screening methods
Hearing about BSE practice	Knowledge and experience of BSE practice
Who should perform BSE
The best time to perform BSE
The right technique
The right position to perform BSE
Believe performing BSE is important
Consult traditional healers	Alternative use of treatment	Perceived benefits of treatment
Holy water (Tsebel)
Consult Health professionals
Unable to seek treatment if the disease is not severed
I don’t know how to do it	Low knowledge of BSE practice	Barriers to BSE practice
I don’t know the right technique
I don’t know the right position
I don’t know the best time to be performed
I don’t have any symptoms	The misconception about BC and BSE
I don’t feel it is necessary
BSE is embarrassing to me
Adequate information on BSE practice	Good knowledge of BSE practice	Enablers of BSE practice
I know how to do it
I worry about my body image
I believe it important
I know screening methods
breast enlargement in the childhood period	Perceived susceptibility
I am at risk for BC
Having a family history of BC

Theme 1: BC and BSE-related knowledge

Category 1: Knowledge about BC

Generally confirmed from all FGD as low awareness about BC. The participants raised that even if they had heard about BC from media (Television and Radio) and BC patients but they did not know exactly what it was., especially its sign and symptoms, risk factors, screening methods and management.

The majority of the women agreed that BC was a painful lump. Some of their responses were:

“It is the lump in the breast that can disseminate to other parts of the body. If the lump has no pain, there is no need to worry. There is no problem. It is not BC” (women 40, Group 1-5)

“....it is a painful ulcer or lump, but I do not know well” (women16, Group 1-5)

“I do not know the symptoms…It is a lump and painful” (women13, Group 1-3)

Some participants associated the early symptoms of BC with breast-feeding:

"I believed that to be usual. It's always been that way for women, but when the baby stinks, it goes away. So, I assumed that it would too”. (Women 8, Group 1-4)

Another participant stated the following to show the lack of understanding regarding the symptoms of BC: "I initially felt a lump in my breast, quite hard like a stone and large, but it was not uncomfortable therefore I disregarded it. At the moment, I never gave it any thought. Even when it got quite heavy, there was no actual pain present; only hardness and weight. Later, I visited the hospital”. (Women 4, Group 1-5)

One participant's comment that reveals ignorance about BC symptoms is as follows: "This form of sickness is particularly hazardous since it does not cause pain. I believed the lump was gone for a while when I could not even feel it. It was eating me up in the meanwhile. There was no discomfort for a long time. Then it started again all of a sudden, and this time I knew I needed to see a doctor”. (Women 1, Group 4)

Regarding risk factors and causes, many different aspects appeared. They assumed that menopausal or unmarried women can suffer more BC. Some of the women believed they had no chance to experience BC. Some of their opinions were:

“It is common in women after menopause and in spinsters. I don't think I could …. I am not old age and already married” (women 6, Group 1-3)

“…if a woman gives birth and goes out from her house within ten days, fifteen days, one month or forty days starting from the birthday, cold can be the cause of breast disease. On some other women the disease arises without any known reason, it swells and becomes painful, people say the problem is engorgement, some say again it is because of another thing, in reality, we do not know the cause.” (Women 5, Group 2)

“I thought it was menopause because my friend told me that you can experience many things when that time comes. I really that I have reached that age”. (women5, Group 1-5)

Other groups also reported, “…God (Rabbi) sends disease to a human being; I think no one can know what God brings to a human being. What God brings to human beings arises from the body of the person itself. Usually, a woman can get breast disease when she marries and gives birth to a baby. Milk fills the breast, when it remains inside the breast for a long time, it becomes curdle, then changed to pus. If she doesn’t get treatment either from a traditional healer or health facility, the problem becomes worst and changed to severe breast disease.” (Women 5, Group 1-3)

In addition, one group also stated, “…what is said in our tradition, if child eat delicious food and suck the breast, it can be diseased as the result of ‘Michi’ and the belching of a child on it.” (Women 5 Group 3-5)

Cancer patients were asked about their knowledge of ‘cancer’ and ‘BC before they were diagnosed with the illness. Most of the women were unfamiliar with the subject of cancer. They expressed a lack of knowledge of cancer as a disease and its symptoms. Although the patient heard about cancer before their diagnosis, she never knew that she could suffer from BC as well. She was shocked when told of the diagnosis and had difficulty telling his family and others about her illness.

Expressions such as “never knew anything about cancer before.” “We never knew.” “We didn’t know what is cancer” were common. Lack of knowledge of cancer could have contributed to the absence of personal experience of cancer: none of the patients in the present study knew someone personally who had cancer.

Many women in the present study recognised a lump in the breast or under the arm as a sign of ‘illness, but they did not know that this could signify BC.

“I had a little lump in my breast …for a while. I used cream to rub it, thought it will go away. (I) thought nothing of it. Then after 3 or 4 days, I had a lot of pain and I was awake all night” “I was perfectly all right, except I had a lump that was not causing any problem.” (Women 3, Group 4)

“In our setting, there has not been any awareness creating activities or education by doctors on breast matter (presence of the disease, its consequences, its symptoms and its option of treatment).” We have heard some information on television and radio. Some of us are hearing even the presence of its screening methods and methods for early detection of breast cancer today from this discussion.” (women16, Group 1-5)

Category 2: Knowledge and experience of BSE practice

The level of understanding of BSE was inadequate among participants. Although the women had already heard of and accepted BSE as a way to detect BC, but did not know the method accurately, especially the best time to perform, the right technique and the position to perform. Their uncertainty was seen in the following responses:

“. Just we heard about BSE as one method of BC screening. But it is not sure how to do it and doesn’t know the right time to perform it” (women 26, Group 1-4)

“I heard about BSE. But not know the way to do” (women 14, Group 1-5)

“I heard about BSE and accepted as it important for early detection of BC but I did not know the right time to perform as well as its technique” (women 24, Group 1-4)

“We have never had any opportunity to examine ourselves because we do not know how to do it and we don’t know when to examine our breast” (Women 13, Group 1-4)

"I heard that breast cancer might be found through lumps in advance. When I touched my breasts, I felt the mass in them. The mass is still there but there have not been any changes up to now. I think that techniques of BSE can be of help for self-examination." (P10)

FGD confirmed a lack of BSE practice; the majority of women do not need to touch their breasts if they do not doubt there their problems and also the majority of them did not believe performing BSE is important for early detection of any breast diseases. Most of the women stated that BSE is unknown among us. “…we won’t need to touch and examine our breast if we don’t doubt the problem. If it develops a problem, symptoms enforce us to touch and examine the breast.” (Women 19, Group 1-5)

“It is must see some internally felt discomfort or externally observed sign and symptoms of the disease.” (Women 12, Group 3-4)

“I heard about BSE But it is not sure how to do it so, don’t believe as it important for early detection of breast disease.” (Women 15, Group 1-4)

“We don’t know the right technique to perform BSE and the right position to perform it. Therefore, we don’t believe performing BSE is important for us If we have a problem, we check the improvement of that problem from time to time if no improvement we consult HCWs or a traditional healer” (Women 16, Group 1-4)

Theme 2: Perceived benefits of treatment

Category 1: Alternative use of treatment

In five FGD majority of the participants said that women preferred traditional medicine than a modern one.

“...women prefer traditional healer to get fast relief and recovery from their problem and for the time being it gives some relief but it does not cure.” (Women 24, Group 1-5)

“… Women who trusted in God and spray the “prayed water” Yetetseleyebet wuha by prophets healed the women who developed such a disease.” (Women 14, Group 1-5)

“…. In fact, this is true in our church Orthodox, those women who believed in God with their full heart go to ‘Tsebel’ Holy water and then healed after drinking and spraying it by church holy person.” (Women 24, Group 1-4)

“…women know their breasts or their bodies, especially during a change. Breast pain is not simple, its pain is more severe than other diseases; therefore, it is easy to know about breast problems on ourselves. However, women have seen this problem traditionally and some of them mostly seek traditional treatment because they will not permit to expose their breasts to health professionals if the disease is not severe. This makes the disease too fatal among our community...” (Women 10, Group 1-4)

“God (Rabbi) sends diseases to a human being; we think no one can know what God brings to a human being. So, women who develop such diseases go to ‘Tsebel’-meaning holy water.” (Women 11 Group 1-4) In addition, FGD from Jidda stated also stated, “…as our tradition what is being said, if child eat delicious food and suck breast can be infected as the result of “Michi”. This time we feel breast itching and tubing pain. For this we apply some leave that we know traditionally as medicine for “michi which is called demakese” (Women 4, Group 2)

Theme 3: Barriers to BSE practice

Category 1: Low knowledge of BSE practice

Generally, confirmed from the discussion as there is a lack of BSE practice. The women who had never performed BSE answered that they did not know how to do it correctly, they didn't know what to find and they didn't understand if the mass they detected was normal or not. Their responses were as follows:

“. Just we heard about BSE as one method of BC screening. But it is not sure how to do it and doesn’t know the right time to perform it” (women 26, Group 1-4)

“I heard about BSE. But not know the way to do” (women 14, Group 1-2)

“I heard about BSE and accepted as it important for early detection of BC but I did not know the right time to perform as well as its technique” (women 24, Group 1-3)

“BSE is squeezing of the breast thoroughly with hand in sitting position at the time of bathing, but not the axilla because of BC” (women 4, Group 1-2)

“Because I do not know how to do it, and I have no extra time to do it”. (Women 5, Group 1, 3)

Category 2: Misconception about BC and BSE practice

Generally, confirmed from the discussion as there is a misconception about BC and BSE practice. The women who had never performed BSE answered that, have no history of a breast lump, and have no symptoms, they did not believe it important and fear made them afraid to talk about the practice of BSE. Their responses were as follows:

“I have no history of breast disease. I do not feel pain in my breast. I think that I do not need to do a breast examination”. (Women 12, Group 1-3)

, “I heard about BSE But it is not sure how to do it so, don’t believe as it important for early detection of breast disease.” (Women 15, Group 1-4)

“BSE practice, I feel it is not necessary to me (laugh). As you saw I am an adult, I am married and have given birth to children and fed breast to all of my children so, through all this time I do not feel any changes or problems with discharge, and no pain and if this was needed, it should be done by a healthcare professional.” (Women 9, Group 1-3)

“I did BSE but I couldn´t find anything, I mean I couldn´t figure it out. Then, I asked myself why I am breaking me down and I gave up practicing these self-examinations.” (Women 19, Group 1-4)

“We don’t want to talk about BC because when you talk about a disease, the spirit of that disease can inflict or make it happen to you. It is a disease that makes them remove your breast? It is scaring” (Women 5, Group 1-4)

“Frequent breast examination will make one detect a growth. The breast is a private area that should be kept as such. (Women 5, Group 2-4)

Theme 4: Enablers of BSE practice.

Category 1: Good knowledge of BSE practice.

Generally, confirmed from the discussion out of 46 participants in this discussion, 22 women had practiced BSE at least once during the past 6 months. Those women who had performed BSE answered that “we worry for our body image”, “we know how to do it”, “we know screening methods” and “we believe it important for early diagnosis and treatment”.

“I heard about BSE and I know the way to do it” (women 14, Group 1-5)

“I heard about BSE and accepted as it important for early detection of BC and I know the right time to perform as well as its technique” (women 8, Group 1-5)

“BSE is squeezing of the breast thoroughly with hand in standing In front of the mirror” (women 14, Group 1-5)

“I heard from Health professionals as early detection of BC improves the chance of survival, do to that I do it every month” (women 14, Group 1-5)

“We are high school students and young enough at this time we carry for our physical appearance and to be healthier than older aged women us you know (laugh) we have many plans in the future for that matter we perform BSE” (Women 11, Group 1-2)

“We like to have a husband, child and to be a good mother to the children. We don’t like having cancer ...so we check our breast every time.” (Women 7, Group 3-4)

“I don’t like getting cancer, I don’t like getting chemotherapy treatment, losing hair” (Women 3, Group 1-4)

“If we get BC, we will be immersed in suffering … we’ll face the outcome of breast defect … we’ll suffer physical defect. If a member of the body is lost, we won’t know what is happening to us. If a physical crisis happens to us, the people around us look at us with pity ... we won’t feel defective, non-existence and helpless if we soon notice BC, we do not actually cause physical or psychological crises among family members. I wish I had the knowledge to do so. “(Women 6, Group 1-4)

Regarding believing it is important for early diagnosis and treatment, most participants in this discussion know well that BSE can help find the breast problem because their relatives and friends found the BC by self-examination.

"My friend discovered her BC by touching her own body. Unfortunately, her tumour been growing. If it had been found earlier, everything could be different. I think that every woman should do BSE." (Women 13, Group 1-4)

“BSE is useful to understand the normal look and feel of your breast so, by doing it you can identify any problems in your breast early”. (Women 12, Group 1-5)

"I want to say I did BSE just for health, not intending to argue with the size of my breasts. The incentive of health is still strong (laughs). By the way, I have recommended the skills to my friends. For example, I told my boy-boyfriends I could teach his sister; as we are all women, we have to protect ourselves..." (Women 2, Group 4)

"The Kuyu General Hospital caregiver found the lump in my mother's breast when she examined my mother. She did my mother a great favour. ...This is a good chance for me to learn these skills. I think that I can do it more often with my fingers so that it might keep my mind at ease." (Women 2, Group 1)

Category 2: Perceived susceptibility.

The majority of participants perceived that the cause of BC is hereditary, supernatural power and a few associated it with breast enlargement in the childhood period. Those women who had performed BSE answered that they have a family history of BC, perceived they are susceptible to the disease and perceived the severity of the disease. In this discussion, the majority of the women expressed that they perceived the risk of BC. However, the participants varied in assessing their risk of BC. The majority of them believed that their risks were connected with having a family history of BC. Their responses are as follows:

"My mother was diagnosed with a BC last five years starting from that time. I was nervous about having BC due to that I checked my breast every month." (Women 5, Group 1-4)

"I was nervous about having BC because my mother had BC, and had a mastectomy for one of her breasts last year. Also, I have sometimes felt the pain that is why I want to examine my breast every month." (Women 3, Group 1-4)

“Sometimes those women who were not breastfeeding their child at early stage…. their breast becomes very large and develop breast mass and later develops

BC” (Women 3, Group 1-4)

This community-based qualitative study attempted to explore BSE among women of in the North Shewa zone. The community is a crucial resource for encouraging improvements in early BC preventive methods. Women must know how their breasts normally look and feel. Early detection which remains the unquestionable means of BC prevention can be achieved through BSE. The value of BSE practice in the early diagnosis of BC has been emphasized by several authors (2,25,35,36). The current finding implies that clinical usage of BSE is very poor, because of this the majority of the women did not benefit from BSE to detect abnormality before reaching an advancing stage of BC.

Regarding the factors, influencing BSE the authors identified four main themes emerged, namely, knowledge of BC and knowledge regarding BSE, perceived benefits of treatment, barriers to performing regular BSE, and enablers of BSE practice.

The study results showed that low understanding about BC and BSE were the main reason of why they do not performed BSE. As confirmed from the discussions, most of the women who do not practise BSE acknowledged poor knowledge about BC, BSE and understanding of the technique. It is consistent with the studies conducted in Ethiopia, Modjo town, Iran, and Ruanda among women (31,37,38). This gives the clue that when individuals have adequate knowledge about some disease problem and its consequence probability of to practice the preventive behaviour is high. Because of that knowledgeable respondents’ motivation to practice BSE.

Traditional and spiritual beliefs and related treatments identified in the findings as the factors that influencing to perform BSE. As confirmed from the discussions, most of the women said that women preferred traditional medicine than a modern one.

In this study, we identified some misconception about BC and BSE practice. The women who had never performed BSE answered that, have no history of a breast lump, and have no symptoms, they did not believe it important and fear made them afraid to talk about the practice of BSE.

The findings identified from the discussions as women who perceived they are susceptible to developing the disease have a higher degree of performing BSE and also, the majority of them believed that their risks are connected with having a family history of BC, breast enlargement in childhood period and supernatural power. .Those women who believed BSE is important for early diagnosis and treatment are more tendency to perform it. Because their relatives and friends get the opportunity of early detection of BC (any breast problems) through self-examination. This finding was in agreement with the study conducted in Ethiopia, Hosanna town and UAE, in Ajman (24,25) The possible justification, that women with a better understanding of the benefits of BSE, such as doing it regularly(monthly) are helping them to detect any changes (like lumps) before the health professionals are more willing to perform BSE.

The findings confirmed from the discussion the self-efficacy of the women for breast screening is very low, especially among those failing to do BSE practice because they do not know how to perform it and are unable to find the lump and also, didn't understand if the mass they detected is normal or not. This finding was consistent with the study conducted in the North Ethiopia, Adawa, and other countries like Indonesia and Yemen. (12,13,20). It showed that one's ability to act successfully has an impact on their behaviour. As a result, educating women will enhance the practice.

Strengths

The fact that this study used qualitative research methods to gather its data was one of its major strengths. Additionally, the study is conducted among a general population that may be representative of Ethiopia's woman rural or urban communities.

The study identified and described the factors influencing BSE practice which are inadequate knowledge regarding BSE practice and BC and also, misconceptions of BC and BSE practice. So, BSE shall be encouraged by improving knowledge of BSE practice and perception of BSE practice and BC through providing special health education for women at all levels. To overcome this problem, effort is needed from health system management like, North Shewa zonal Health Office, and the regional health bureau, Health care providers, cancer associations at the regional health bureau, and Further research that looks into a comprehensive community-based study at a national level on BC screening practices to plan an awareness creation program and a longitudinal study for a better outcome in all dimensions of breast screening practices.

Acknowledgments

First and for most, we would like to thank all FGD participants for providing all the important information. Second, we would also like to acknowledge Salale University College of health science for the approval of the Ethical clearance for this study. Finally, we also thanks North Shewa zonal Health office for providing baseline

Information.

Ethical approval

The studies involving human participants were reviewed and approved by Salale University Ethical Review Committee. Written informed consent to participate in this study was provided by the participants and their legal guardian/next of kin for the study subject less than 18 years old.

Competing interests

The authors declare that they have no competing interests.

Author contributions

D.H. carried out the conception and designing the study, performed manual analysis and wrote the manuscript. D.G. and T.A.G. performed manual analysis. L.A.G, K.G., and B.T. O. critically evaluated and made progressive suggestions throughout the study. All of the authors read and approved the final draft of the manuscript.

Funding

The authors received no funding for this research.

Data availability statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.

ACS. Breast Cancer Screening Guidelines for Women. Int Agency Res Cancer. 2020;2–4.
Kebede L, Abdo M, Megerso A. Breast Self-examination Practice and Associated Factors Among Women of Reproductive Age in Adama Town , Oromia Regional State , Ethiopia. Cent African J Public Heal. 2021;7(4):227–35.
Liu H, Shi W, Jin Z, Zhuo R, Dong J, Lao Q, et al. Global , regional , and national mortality trends of female breast cancer by risk. BMC Cancer. 2021;21(459):1–10.
WHO. Latest global cancer data : in 2020. IARC. 2020;13–5.
World Globocan 2020. Population, Incidence , Mortality and Prevalence of Cancer. IARC. 2021;419:2020–1.
International Agency for Research on Cancer WHO. Africa Cancer Fact sheets. Globocan [Internet]. 2020;598:1–2. Available from: https://gco.iarc.fr/today/data/factsheets/populations/903-africa-fact-sheets.pdf
Globocan 2020 Ethiopia. population mortality ,Incidence and prevelence of Cancer. Vol. 133, IARC. 2021. 2020–2021 p.
EFMOH. EFMOH. National Cancer Control Plan 2016-2020. Natl Cancer Control Plan Ethiop. 2020; Natl CANCER Control PLAN Ethiop. 2020;
WHO. Key prevention and control interventions for reducing cancer burden in the African region. 2020. 49 p.
CEWG. Recommendations on Prevention and Screening for Breast Cancer For Developing country. Cent Heal Prot. 2019;
WHO. Breast Self-Awareness ( BSA ). BMC Womens Health. 2017;
Dewi TK, Massar K, Ruiter RAC, Leonardi T. Determinants of breast self-examination practice among women in Surabaya , Indonesia : an application of the health belief model. 2019;1–8.
Al-sakkaf KA, Basaleem HO. Breast Cancer Knowledge , Perception and Breast Self- Examination Practices among Yemeni Women : an Application of the Health Belief Model. Asian Pac J Cancer Prev. 2019;17(3):1463–7.
Abolfotouh MA, Banimustafa AA, Mahfouz AA, Al-assiri MH. Using the health belief model to predict breast self examination among Saudi women. BMC Public Health [Internet]. 2019;1–12. Available from: http://dx.doi.org/10.1186/s12889-015-2510-y
Dadzi R, Id AA. Assessment of knowledge and practice of breast self-examination among reproductive age women in Akatsi South district of Volta region of Ghana. PLoS One [Internet]. 2019;94(14):1–12. Available from: http://dx.doi.org/10.1371/journal.pone.0226925
Azemfac K, Christie SA, Carvalho MM, Nana T, Fonje AN, Halle-ekane G, et al. A Community-Based Assessment of Knowledge and Practice of Breast Self-Examination and Prevalence of Breast Disease in Southwest Cameroon. J ofCancer Epidemiol. 2019;2019.
Mohammed AH. Breast self-examination practice and associated factors among women of reproductive age in southeast Ethiopia. BMC. 2018;1–15.
Terfa YB, Kebede EB, Akuma AO. Breast Cancer : Targets and Therapy Breast Self-Examination Practice Among Women in Jimma , Southwest Ethiopia : A Community-Based Cross-Sectional Study. Breast Cancer Targets Ther. 2020;12:181–8.
Asmare K, Birhanu Y, Wako Z. Knowledge , attitude , practice towards breast self ‑ examination and associated factors among women in Gondar town , Northwest Ethiopia , 2021 : a community ‑ based study. BMC Womens Health [Internet]. 2022;22(174):1–14. Available from: https://doi.org/10.1186/s12905-022-01764-4
Abay M, Tuke G, Zewdie E, Abraha TH, Grum T. Breast self ‑ examination practice and associated factors among women aged 20 – 70 years in Adwa town , North Ethiopia. BMC Res Notes [Internet]. 2018;11(622):1–7. Available from: https://doi.org/10.1186/s13104-018-3731-9
Igiraneza C, Omondi LA, Nikuze B, Uwayezu MG, Fitch M, Niyonsenga G. Factors influencing breast cancer screening practices among women of reproductive age in Rwanda. BMJ. 2021;31(3):251–7.
Sani AM. Relationship between knowledge and practice of breast self-examination among female Reproductive age in Sokoto , Nigeria Relationship between knowledge and practice of breast self-examination among female workers in. Obstet Gynecol Int Journa. 2018;9(3).
Gonzales A, Alzaatreh M, Mari M, Saleh A, Alloubani A. Beliefs and Behavior of Saudi Women in Tabuk Toward Breast Self Examination Practice. Asian Pac J Cancer Prev. 2018;19(1):121–6.
Al-sharbatti SS, Shaikh RB, Mathew E, Al-biate MAS. Breast Self Examination Practice and Breast Cancer Risk Perception among Female in Ajman. Asian Pac J Cancer Prev. 2020;14(8):4919–23.
Woiloro LA, Lubego BE, Arficho TT, Diramo TS. Predictor of Breast Self-Examination and Breast Cancer Risk Perception among Female Students of WCU , Using Health Belief Model. J Women’s Heal Care. 2021;10(2):1–8.
Taklual W, Tesfaw A, Mekie M. Breast Self-Examination Practice among Female Undergraduate Students in Debre Tabor University , Northcentral Ethiopia : Based on Health Belief Model. Middle East J Cancer. 2021;12(4):9.
Degefu D. Breast Self-Examination Practice And Associated Factor Among Female Health Workers At Gambella Public Health Facilities In Gambella Town, South West Ethiopia: A Cross Sectional Study. 2020;(February).
Degu A, Assefa EM. Assessment of breast self- examination practice and associated factors among female workers in Debre Tabor Town public health facilities , North West Ethiopia , 2018 : Cross- sectional study. 2019;64:1–11.
Dagne I, Tesfaye F, Abdurashid N, Yimer RM. Breast self-examination Practice and Associated factors among female Healthcare professionals at Dire Dawa administration, eastern Ethiopia. Eur J Biomed Pharmatical Sci. 2019;6(1).
Jemebere W. Practice of Breast Self-Examination and Associated Factors among Female Nurses of Hawassa University Comprehensive Specialized Hospital, South Ethiopia in 2018. Int J Caring Sci. 2019;12(3):1457–66.
Workineh MU. Breast Cancer : Targets and Therapy Breast Self-Examination Practice and Associated Factors Among Women Attending Family Planning Service in Modjo Public Health Facilities Southwest Ethiopia. 2021;(June).
Adugna A. OROMIYA: Population projection. 2021;32.
Champion VL. The health belief model. 2017. 21 p.
Kirag N. Application of the Champion Health Belief Model to determine beliefs and behaviors of Turkish women academicians regarding breast cancer screening : A cross sectional descriptive study. BMC Womens Health. 2019;9(132):1–10.
Tesfaw A, Berihun H, Molla E, Mihret G, Feleke DG, Chanie ES, et al. Level of knowledge and practice of female healthcare providers about early detection methods of breast cancer at Debre Tabor Comprehensive Specialised Hospital : a cross-sectional study. 2021;1–14.
Ullah Z, Khan MN, Din ZU, Afaq S. Breast Cancer Awareness and Associated Factors Amongst Women in Peshawar , Pakistan : A Cross- Sectional Study. 2021;
Tahergorabi Z, Mohammadifard M, Salmani F, Moodi M. Breast cancer screening behavior and its associated factors among women of reproductive age in South Khorasan. J Educ Health Promot. 2021;1–6.
Akhtari-zavare M, Ghanbari-baghestan A, Latiff LA. Knowledge of Breast Cancer and Breast Self-Examination Practice among Iranian Women in Hamedan, Iran. 2019;6531–4.
Ismail GM, Abd AA, Hamid E, Elnaby AGA. Assessment of Factors that Hinder Early Detection of Breast Cancer among Females at Cairo University Hospital. World Appl Sci J. 2020;23(1):99–108.
Bourdeanu L, Alatrash M, Ketchedjian N, Pate B. Perceived Fears , Barriers , and Bene fi ts Regarding Breast Cancer Screening : A Comparison of Lebanese and Lebanese-American Women original reports abstract. JCO Glob Oncol. 2020;

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Exploring the Influencing Factors on Breast Self-Examination among Ethiopian Women, 2022: A Qualitative Study

Status:

Version 1

Abstract

Introduction

Methods

Study Area, Design, and Period

Population

Sample size determination

Sampling procedures

Data Collection Tools, Personnel, and Procedures

Data quality assurance

Data process and Analysis

Ethical considerations

Results

Findings

Category 1: Knowledge about BC

Category 2: Knowledge and experience of BSE practice

Theme 2: Perceived benefits of treatment

Category 1: Alternative use of treatment

Theme 3: Barriers to BSE practice

Category 1: Low knowledge of BSE practice

Category 2: Misconception about BC and BSE practice

Theme 4: Enablers of BSE practice.

Category 1: Good knowledge of BSE practice.

Category 2: Perceived susceptibility.

Discussion

Strengths

Conclusion

Declarations

References

Additional Declarations

Supplementary Files

Status:

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