Knowledge, Attitude and Practice of Breast self-examination among the Nursing students, UAE

doi:10.21203/rs.3.rs-4477871/v1

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Knowledge, Attitude and Practice of Breast self-examination among the Nursing students, UAE

https://doi.org/10.21203/rs.3.rs-4477871/v1

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Introduction

Breast cancer (BC) is one of the most common cancers and is the main cause of cancer-related deaths in women globally. Breast cancer awareness and early detection depend heavily on breast self- examination (BSE). It is an easy and economical procedure that enables people to keep track of their own breast health and possibly detect unhealthy changes in the breast tissue.

Objectives of the study

· To assess the knowledge on breast self-examination

· To determine the attitude towards breast self-examination.

· To assess the practice of breast self-examination

· To Correlate Knowledge, Attitude and Practice of breast self-examination

· To associate selected demographic variables with the knowledge and attitude of breast self-examination

Methods

A quantitative research approach with a descriptive cross-sectional research design was used to assess the knowledge, attitude and practice of breast self-examination among 100 nursing students studying in Gulf Medical Univerisity who were selected using the total enumeration technique.

Results

Sixty-seven percent of participants were found to have good knowledge of BSE, while the other 33% had poor knowledge. Fifty-four percent of participants had a positive attitude towards BSE. Only thirty-nine percent of them had practiced breast self-examination. The correlation analysis revealed a weak negative correlation with a Pearson correlation coefficient of -0.189, although the relationship was not statistically significant (p > .05).

Conclusion

This study revealed good knowledge and positive attitudes but poor practices of breast self-examination among the Nursing students. The necessity is to develop training programs that enhance awareness about the significance of practicing Breast self-examination (BSE).

Cancer Biology

Breast cancer. Breast self-examination

Nursing students

Knowledge

Attitude

Practice

With a continually rising global annual incidence, breast cancer (BC) is one of the most common cancers and the main cause of cancer-related deaths in women globally. The purpose of this study was to assess women's knowledge, attitudes, and practices on breast cancer and Breast self-examination in the seven Emirates. The key factors that increase the risk of breast cancer in females are specific hereditary genetic mutations, a personal or family history of the disease, and biopsy-confirmed hyperplasia ¹. A history of menstrual (early or late onset of periods), obesity near menopause, current oral contraceptive use, postmenopausal hormone therapy, having one's first child after turning 30 or never having children, ethnic characteristics, radiation exposure, or daily alcohol consumption are additional risk factors for breast cancer.

The lack of knowledge of breast cancer among females in the UAE is alarming since it results in poor screening and early detection methods, which in turn will contribute to higher rates of morbidity, death, and treatment expenses. Additional steps should be taken to improve breast cancer early detection and screening practices, understanding, and awareness in the UAE community ².

Breast cancer awareness and early detection depend heavily on breast self- examination (BSE).It is an easy and economical procedure that enables people to keep track of their own breast health and maybe detect unhealthy changes in the breast tissue. The odds of a successful therapy and long-term survival after breast cancer are greatly increased when the disease discovered early. Early use of the BSE is a screening method for identifying breast cancer early in life, and thus, this tool can be used at home. This easy, affordable, quick, and simple approach can be used to check women’s breast tissue for any physical or visible changes. BSE enhances the likelihood that women will receive treatment, increasing the likelihood that they will survive ³.

Aim of the study

This study aimed to explore the level of knowlede, attitude and practice of Breast self-examination among nursing students, UAE.

Objectives of the study

To assess the knowledge on breast self-examination
To determine the attitude towards breast self-examination.
To assess the practice of breast self-examination
To Correlate Knowledge, Attitude and Practice of breast self-examination
To associate selected demographic variables with the knowledge and attitude of breast self-examination

A quantitative research approach with a descriptive cross-sectional research design was used to assess the knowledge, attitude and practice of breast self-examination among the nursing students. The study was conducted at Gulf Medical University, Ajman, UAE.

This study sample included all the female nursing students enrolled at Gulf Medical University, UAE. The inclusion criteria were all the female students who were enrolled in the nursing program, and were above 18 years of age who are willing to participate. However, exclusion criteria were students who had undergone breast implants, surgeries or students with previously diagnosed breast cancer. The total enumeration sampling technique was used with a consideration of 100 female nursing students.

The study was explained to the students and an informed consent was obtained. Pretested Structured Questionnaire was used to elicit the socio demographic data of the students and practice of BSE. Pretested Structured Questionnaire was used to assess the knowledge on BSE. An opinionnaire was used to assess the attitude towards BSE. Content validity of the above tools was obtained from nursing experts. Reliability of the tool was ascertained using Cronbach’s alpha in the pilot study, where r = 0.719.

Table 4.1

Distribution of the socio-demographic profile of nursing students (n = 100)
Demographic Variables	Characteristics	Frequency	Percentage
Religion	Muslim	80	80.8
	Christian	18	18.2
	Buddhism	1	1.0
Year of Study	Year 1	38	38.0
	Year 2	18	18.0
	Year 3	21	21.0
	Year 4	23	23.0
Personal History of breast cancer	No	97	97.0
Personal History of breast cancer	Yes	3	3.0
Family History of breast cancer	No	84	84.0
Family History of breast cancer	Yes	16	16.0
Exposure to education on breast self-examination	No	38	38.0
Exposure to education on breast self-examination	Yes	62	62.0
Exposure to training on breast self-examination	No	50	50.0
Exposure to training on breast self-examination	Yes	50	50.0
Practice breast self-examination	No	61	61.0
Practice breast self-examination	Yes	39	39.0
Frequency of breast self-examination	Monthly	7	7.0
	Occasionally	21	21.0
	Only once	37	37.0
	None	35	35.0

Table 4.2

The relationships between selected demographic variables and poor knowledge of breast self-examination n = 100
Independent Variables		Number and % poor breast self-examination knowledge
Religion	Muslim	23 (23.70%)^a
Religion	Christian	8 (8.20%)^a
Year of study	Year 1	11 (11.20%)^a
	Year 2	8 (8.20)^a
	Year 3	8 (8.20%)^a
	Year 4	5 (5.10)^a
Personal history of breast cancer	No	31 (31.66%)
Personal history of breast cancer	Yes	1
Family history of breast cancer	No	25 (25.50%)^a
Family history of breast cancer	Yes	7 (7.10%)^a
Exposure to education on breast self-examination	No	10 (10.20%)^a
Exposure to education on breast self-examination	Yes	22 (22.40%)^a
Exposure to training on breast self-examination	No	10 (10.20%)^a
Exposure to training on breast self-examination	Yes	22 (22.40%)^b

Table 4.7

Correlations between Knowledge, Attitudes and Practices towards Breast Self-Examination according to Pearson Correlations
		Knowledge	Attitude	Practice
Knowledge	Pearson Correlation	1
	Sig. (2-tailed)
	N	98
Attitude	Pearson Correlation	− .189	1
	Sig. (2-tailed)	.063
	N	98	100
Practice	Pearson Correlation	.003	.028	1
	Sig. (2-tailed)	.979	.825
	N	65	65

Table 4.3

Association of selected demographic variables with knowledge of breast self-examination (Regression Analysis)
Variables	Knowledge of breast self-examination		COR with 95% CI	P-value	Adjusted OR with 95% CI	P-value
Variables	Poor	Good	COR with 95% CI	P-value	Adjusted OR with 95% CI	P-value
Age			0.93 (.81, 1.07)	.300	0.93 (0.78, 1.10)	.407
Year of study
Year 1	11	26	Ref
Year 2	8	10	.53 (.17, 1.70)	.285	0.63 (0.18, 2.20)	.466
Year 3	8	12	.64 (.20, 1.98)	.434	1.60 (0.37, 6.92)	.532
Year 4	5	18	1.52 (.45, 5.14)	.498	2.78 (0.68, 11.41)	.155
Personal history of breast cancer
No	31	64	Ref
Yes	1	2	.969 (.09, 11.10)	.980	2.15 (0.17, 27.48)	.556
Family history of breast cancer
No	25	57	Ref
Yes	7	9	.564 (.19, 1.68)	.305	.55 (0.17, 1.79)	.317
Exposure to education on breast self-examination
No	10	26	Ref
Yes	22	40	0.70 (.29, 1.71)	.434	1.14 (.36, 3.59)	.818
Exposure to training on breast self-examination
No	10	39	Ref
Yes	22	27	.32 (.13, .77)	.011	.26 (.08, .80)	.018*
*p-value < 0.05

Table 4.4

Association of selected demographic variables with the attitudes towards breast self-examination (Regression Analysis)
Variables	Attitude of breast self-examination		COR with 95% CI	P-value	Adjusted OR with 95% CI	P-value
Variables	Poor	Good	COR with 95% CI	P-value	Adjusted OR with 95% CI	P-value
Age			1.06(.92, 1.23)		1.04 (.87, 1.23)	.694
Year of study
Year 1	22	16	Ref		Ref
Year 2	5	13	3.58 (1.06 12.06)	.040	3.73 (1.06, 13.10)	.040*
Year 3	8	13	2.23 (.75, 6.65)	.149	2.28 (.60, 8.70)	.228
Year 4	11	12	1.50 (.53, 4.25)	.445	1.43 (.44, 4.64)	.549
Personal history of breast cancer
No	45	52	Ref
Yes	1	2	1.73 (.15, 19.73)	.659	1.92 (.15, 24.90)	.619
Family history of breast cancer
No	40	44	Ref
Yes	6	10	1.52 (.51, 4.55)	.459	1.51 (.48, 4.76)	.317
Exposure to education on breast self-examination
No	19	19	Ref
Yes	27	35	1.30 (.58, 2.91)	.530	1.14 (.36, 3.59)	.818
Exposure to training on breast self-examination
No	23	27	Ref
Yes	23	27	1.00(.46, 2.20)	1.000	.60(.22, 1.67)	.327
*p-value < 0.05

Overall, (62%) of the nursing students were strongly awaren of breast self-examination and breast cancer, while only a few students (38%) were uninformed of the risk factors for breast cancer. However, there is a lack of understanding of the early indicators of breast cancer, such as warm breasts, flat or inverted nipples, or breast itching. Our study investigated whether nursing students had a personal history of breast cancer, with the vast majority reporting no history (97.0%) and only a tiny fraction saying yes (3.0%).

Similar findings were found in another study that was conducted at a public university in Malaysia which revealed that (79.3%) of the participating nursing students had a strong understanding of breast cancer in general, (86.7%) were familiar with breast self-examination, and (33%) had undergone BSE ⁴.

Assessing the attitude revealed the presence or absence of a family history of breast cancer which did not significantly affect their attitudes toward breast self-examination, as depicted by both the COR and adjusted OR. Out of a sample of 100 nursing students, (54%) students had a positive attitude toward BSE while the remaining (46%) students had poor attitude. A significant association was found between students in their second year who were found to be 3.58 times more likely to have a positive attitude than first-year students (p < 0.05). Moreover, a student’s personal history of breast cancer did not significantly impact their attitude toward breast self-examination.

On the same line, in another study among 700 nonmedical female students at Diyala University in Iraq, (18.1%) of the students were found to have a negative attitude, (40.4%) students were found to have an average attitude, and (41.4%) students were found to have positive attitude. A neutral attitude was found for single females and married females with one child, mothers with more than secondary education, and mothers with a personal history of breast cancer, however, there was no significant association (p > 0.05) ⁵.

Our study revealed a modest negative association between knowledge, attitude and practice (Pearson correlation coefficient = -0.189), although this association not found to be statistically significant.

In contrast to earlier conclusions, a different study involving 356 female IT professionals, ranging from 18 to 55 years of age in India, explored the correlation among knowledge, attitudes, and practices in the context of breast self-examination (BSE). The findings from this alternative study did not establish significant correlation between knowledge and attitudes or between attitudes and practices; however, a positive correlation did appear between knowledge and practices. This emphasized the significance of one’s understanding of self-examination techniques and one’s likelihood of executing the practice effectively ⁶.

This study revealed good knowledge and positive attitude but poor practices of breast self-examination among the Nursing students. It is necessary is to develop training programs that enhance awareness about the significance of practicing breast self-examination (BSE).

Ethical considerations

The study was conducted after obtaining Institutional Ethical Clearance was obtained from the IRB Committee of the Gulf Medical University and informed consent was obtained from the nursing students prior to data collection . Anonymity and confidentiality were maintained.

Conflict of interest

There are no conflicts of interest.

Availibility of Data

All the data are available upon request to the corresponding author.

Contribution to Authors

The first three authors contributed to the development of the proposal and carried out the data collection. The fourth and fifth authors supervised the entire research activity .

Funding Statement

No funds were needed for the research.

Acknowledgment

The authors acknowledge the contributions of the statistician and the nursing students who helped in the successful conduct of the study.

Feng, Yixiao, et al. Breast Cancer Development and Progression: Risk Factors, Cancer Stem Cells, Signaling Pathways, Genomics, and Molecular Pathogenesis. In Genes & Diseases June 2018 (Vol. 5, No. 2, pp. 77–106)
Radwan H, Hasan H, Ballout RA, Rizk R. The epidemiology of cancer in the United Arab Emirates: A systematic review. Medicine. 2018 Dec 1;97(50):e13618
Erbil, Nulufer, and Nurgul Bolukbas. Health Beliefs and Breast Self-Examination among Female University Nursing Students in Turkey. In Asian Pacific Journal of Cancer Prevention 30 Aug. 2014 (Vol. 15, No. 16, pp. 6525–6529)
Khalip N, Isa KA, Masri N, Rahman HA, Jalil N, Hussein SZ, Bakar SH. Knowledge and Attitude Toward Breast Self-Examination Among Young Adult Nursing Students in a Public University in Malaysia. The Malaysian Journal of Nursing (MJN). 2021 Oct 1;13(2):16-21.
Saleh NQ, Habib HA. Knowledge and attitude of breast self-examination toward breast cancer among nonmedical female students at Diyala University. Education.;700(452):64
Kalliguddi S, Sharma S, Gore CA. Knowledge, attitude, and practice of breast self-examination among female IT professionals in Silicon Valley of India. Journal of family medicine and primary care. 2019 Feb 1;8(2):568-72.

The authors declare no competing interests.

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Knowledge, Attitude and Practice of Breast self-examination among the Nursing students, UAE

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