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Table of Contents
Year : 2020  |  Volume : 21  |  Issue : 2  |  Page : 155-158

Impact of an educational programme on knowledge on breast cancer and practice of breast self examination among women

Professor, NIMS Nursing College, NIMS University, Jaipur, Rajasthan, India

Date of Submission25-Jan-2020
Date of Decision14-May-2020
Date of Acceptance04-Sep-2020
Date of Web Publication19-Feb-2021

Correspondence Address:
Dr. Nema Ram Gurjar
NIMS Nursing College, NIMS University, Jaipur, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJCN.IJCN_18_19

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Breast self-examination (BSE) is important for early detection of breast cancer. Women need to have appropriate knowledge and practice regarding BSE. Irrespective of many awareness programme for prevention of breast cancer, the knowledge and practice regarding BSE among women are still poor. This study aimed to assess the effectiveness of health education programme on knowledge on breast cancer and practice of BSE among women. A pre-experimental research design was used. A total of 40 women were recruited by convenient sampling technique. Data were collected using an instrument with 20 knowledge and 7 practice questions before and after the Health Education programme on BSE. The findings revealed that the knowledge on breast cancer and practice scores on BSE were poor at pre-test and improved significantly after an educational intervention. Findings concluded that the educational programme was helpful in increasing knowledge and practice of BSE among women. Education programme is important to create awareness among women regarding BSE and needs to be continued to help women in prevention and early detection of breast cancer.

Keywords: Breast self-examination, educational programme, knowledge, practice

How to cite this article:
Gurjar NR. Impact of an educational programme on knowledge on breast cancer and practice of breast self examination among women. Indian J Cont Nsg Edn 2020;21:155-8

How to cite this URL:
Gurjar NR. Impact of an educational programme on knowledge on breast cancer and practice of breast self examination among women. Indian J Cont Nsg Edn [serial online] 2020 [cited 2021 Sep 25];21:155-8. Available from: https://www.ijcne.org/text.asp?2020/21/2/155/309854

  Introduction Top

Breast cancer is the third most common cancer in the world.[1] The burden of cancer is increasing every day. The major risk factors for breast cancer are family history of breast cancer and changes in Breast Cancer genes, BRCA1 and BRCA2. Other risk factors for breast cancer include older age, genetic mutation, early onset of menstrual cycle before the age of 12 years, late menopause after the age of 55 years, dense breast and exposure to radiation for any treatment. Some of the modifiable risk factors of breast cancer are physical inactivity, drinking alcohol, obesity, not breastfeeding and taking hormonal therapy.[2] Breast cancer is the most common cancer in women and accounts for 25%–31% of all cancer in women in India. Mortality is high due to a lack of awareness of early detection and treatment.[3] Singh et al.[4] reported in their study that knowledge regarding risk factors and diagnostic tests such as mammography and biopsy was poor among women. Some women had knowledge regarding breast self-examination (BSE), but very few were actively performing it regularly. A study conducted by Fletcher-Brown et al.[5] reported that around 70,218 Indian women died due to breast cancer in 2012 and further predicted an increase to 76,000 in 2020. Singh et al.[6] in a study conducted in Chhattisgarh, India, reported that there were wide knowledge gap for breast cancer symptoms, risk factor and screening methods in women and this caused a delay in the diagnosis of breast cancer. General observation indicates that in India even if abnormalities are suspected in the breast, it is not immediately reported, neither to their family nor to the health team members. Not taking things seriously, work commitments or financial implications were the general reasons given by affected individuals when history was taken. The delay in seeking diagnosis or treatment leads to cancer being diagnosed in an advanced stage. The aim of this study was to improve awareness of BSE and empower women to overcome any barriers in seeking help when needed.

  Methods Top

One-group pre-test post-test pre-experimental research design was used to provide the benefit of educational programme to all participants. A total of 40 women from the age of 18–60 years were included by the convenient sampling technique. Sample size calculation was done based on previous studies. The study was conducted in a village with a population of 5000 in North India.


The research instrument was prepared by the researcher and consisted of three sections:

  • Section I - Sociodemographic variables which included age, education, marital status, residence area, family income and source of information for the women
  • Section II included a knowledge questionnaire on breast cancer and BSE which consisted of 20 multiple-choice questions. The correct answer was given a score of 1. Knowledge score was categorised as poor, average and good
  • Section III included an observational checklist on the practice of BSE which consisted 7 items. Female faculty helped with demonstration and assessment (pre-test and post-test) of BSE in privacy at the participants' homes and observed how the women performed BSE. Correct performance for each item was given a score of 1 and incorrect performance with a score of 0. If the subject performed correctly all 7 steps of BSE, then it was considered satisfactory, otherwise unsatisfactory. Content validity of the data collection tools and educational programme were established by submitting the prepared draft along with checklist to five experts from nursing. Modification of the tool was done as per the suggestion of experts. Finally, the tool was translated into Hindi language and appropriateness of the language was checked by language experts. The content validity index for the tool and educational programme were found to be 0.88 and 0.92, respectively. After pilot study, reliability of the knowledge questionnaires on breast cancer was assessed and found good with r = 0.78 for knowledge questionnaire and r = 0.83 for practice checklist.

Data collection

The educational programme was developed after a review of the literature. Modifications or changes were made based on the guidance or opinion of experts. It was a nurse-led educational programme which provided for 30-min duration by lecture and general discussion method on breast cancer types, sign/symptoms, early detection and screening and management of cancer followed by 30-min BSE practice demonstration. Then, every woman was asked to re-demonstrate BSE. It was assured that all women learnt the practice of 7 steps of BSE correctly and performing it appropriately. The researcher approached the women in their homes and explained about the study objectives and procedure. Study participants were also explained that confidentiality and anonymity will be maintained for the given information. Women who consented to participate were given pre-test and were told the date and venue of health education programme and requested to attend the educational programme. In this way, the pre-test was administered to a total of 50 women. Then, on a scheduled date, the health education programme was conducted for 1-h duration and 46 women attended the programme. Then, the investigator went back to their homes for conducting a post-test by approaching women in their homes. Post-test was conducted only for 40 women after 7 days of intervention. The remaining 6 women were not available at the time of post-test.

Data analysis

Data were analysed using descriptive and inferential statistics. Distribution of participants with respect to demographic variables was presented using frequencies and percentages. Mean standard deviation and mean percentage was used to describe the knowledge and practice of the women on BSE. Further statistical significance of the effectiveness of the health educational programme was analysed using paired “t” test.

Ethical consideration

Ethical clearance was obtained from Medical Officer, Primary Health Centre, for conducting the study at the village. Similarly, written informed consent was obtained from each study participant.

  Results Top

The study findings revealed that majority (37.5%) of the participants were from the age group of 31 to 40 years and between 51 and 60 years (25%). More than half the proportion of women (55%) were illiterate or had less than primary education and 12.5% were graduates. Majority of the women were married (87.5%), 5 % unmarried, 2.5% divorced and 5% were widows. Most of them (72.5%) were housewives and 45% of them had monthly family income of <Rs. 10,000. One third of them (30%) were aware of BSE from other sources and 20% were aware of BSE from friends and family and 17.5% had gained some knowledge from newspaper, 12.5%, from books 2.5% from internet and television respectively.

[Table 1] depicts that in pre-test, out of 40 participants, majority (77.5%) of the women had poor knowledge and 9 (22.5%) women had average knowledge on BSE. In the post-test, around half (45%) of the women had good knowledge, 16 (40%) had poor knowledge and 6 (15%) had average knowledge.
Table 1: Frequency and percentage distribution of women as per their pre-test and post-test level of knowledge regarding breast self-examination

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Domain-wise improvement in knowledge score regarding breast self-examination among women

All women had significant knowledge improvement in all domains of breast cancer after education, but major improvement was seen in the domain of breast cancer in general with a mean gain score of 1.10, followed by the domain of signs and symptoms of breast cancer with a total mean gain score of 0.75. In the other two domains including early detection, screening and management of cancer, the increase in mean score was 0.75 and 0.20 respectively.

[Table 2] depicts that in pre-test, out of 40 participants, majority 32 (80%) of the women had unsatisfactory practice and 8 (20%) women had satisfactory practice of BSE. In the post-test, 15 (37.5%) women had unsatisfactory practice and 25 (62.5%) had satisfactory practice of BSE.
Table 2: Comparison of the pre-test and post-test levels of practice regarding breast self-examination among women

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Domain-wise pre-test post-test assessment of practice score regarding breast self-examination among women

The findings revealed a significant improvement in the practice of all domains or steps of BSE after educational programme and the overall total gain in practice was 42.5% with a maximum gain in 7th steps of BSE, lie flat on the back, right arm overhead and a pillow under left shoulder (80%) and minimum gain in the 1st step of BSE, stand before a mirror (20%).

[Table 3] depicts that the mean post-test knowledge score was 10.20 with a standard deviation 5.95 which was higher than the mean pre-test knowledge score of 4.90 with a standard deviation of 2.18. The mean post-test knowledge score was found to be significantly higher at P < 0.001 level of significance. The mean post-test practice score was significantly higher than the mean pre-test practice score at P < 0.01 level of significance.
Table 3: Comparison of the mean pre-test and post-test mean scores of knowledge and practice regarding breast self-examination among women

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  Discussion Top

Women's knowledge of breast cancer and practice of BSE are important factors in the prevention and early diagnosis of breast cancer. Early diagnosis has advantages for the patient as well as the family members. Early detection and treatment improves health outcomes significantly in women diagnosed with breast cancer. On the contrary, it is well established that metastatic disease which is diagnosed late is associated with increased mortality. Improving knowledge on breast cancer and breast examination can reduce the threat to life as well as minimise economic and social burden associated with cancer treatment. In this study, 37.5% of participants were in the age group of 31–40 years that constitute an important group for this educational programme.

The study findings established that the knowledge at pre-test was poor for most (77.5%) indicating a lack of knowledge which can be detrimental to their health with regard to breast cancer. Although the proportion of women with good knowledge increased after educational intervention, it is important to note that a large proportion (40%) continued to have poor knowledge. This finding is in contrast to another study from India which reported that 96.1% were aware of breast cancer. However, this descriptive study included dichotomous questions (Yes/No) rather than questions on aspects of breast cancer which was studied in the present study.[6] The reason for the lack of improvement may be attributed to many (55%) of women having not attended or had obtained only primary education and may not have understood what was taught. This relationship can be only assumed as the association was not assessed in this study. However, previous studies have established the relationship between educational status and knowledge of women on BSE.[7] It is also vital to select educational materials and methods that are appropriate to the population of the study.

With regard to levels of women's knowledge about BSE, the study results revealed that there was a significant improvement in women's knowledge on BSE. Although there was a difference, the mean score remained as average. It showed that 1-time education may not be adequate and continuous reinforcement is needed to improve knowledge and retention. The finding of this study is supported by Zain et al.[8] study which reported that educational programme on BSE increased the knowledge by 33.4% from pre-intervention scores (P < 0.001) in schoolchildren.[6]

The study results revealed that there was a statistically significant improvement among women's practice on BSE after educational programme. These findings were in accordance with a study by Moustafa et al.[9] who reported that the educational intervention was effective in improving university female students' knowledge, perceptions, attitudes and practice.[7] The practice and frequency of BSE were reported to increase significantly in Turkish women in another study who were provided health education using different teaching aids. Motivational teaching methods need to be used to bring about behaviour change. There is also a need to note that the step of standing in front of a mirror and examining the breast was least performed in the post-test also. This could be related to cultural factors of not exposing self in a mirror or lack of privacy for performing this step or even not having a large size mirror at home. Therefore, this study introduces the need for addressing factors related to the knowledge and practice of BSE in the Indian population.

  Conclusion Top

Although many awareness programmes are conducted on breast cancer and BSE, women's knowledge and the practice of BSE remain inadequate. The importance of educational programme in increasing knowledge and practice has yet again been shown by this study. The study also points to the need for addressing factors related to BSE and the need for ongoing structured education that is tailored to the population.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Kommula AL, Borra S, Kommula VM. Awareness and practice of breast self examination among women in South India. Int J Curr Microbiol Appl Sci 2014;3:391-4.  Back to cited text no. 1
Centers for Disease Control and Prevention. What Are the Risk Factors for Breast Cancer? Available from: https://www.cdc.gov/cancer/breast/basic_info/risk_factors. [Last accessed on 2020 Jul 03].  Back to cited text no. 2
Oncostem. Alarming Facts about Breast Cancer in India Onco Stem Blog. Available from: http://www.oncostem.com/blog/alarming-facts-about-breast-cancer-in-india. [Last accessed on 2020 Jul 03].  Back to cited text no. 3
Singh R, Shetty N, Rai P, Yadav G, Gandhi M, Naveed M, Ronghe AM. Breast cancer awareness among women in an urban setup in Western India. Indian J Med Paediatr Oncol 2018;39:215.  Back to cited text no. 4
  [Full text]  
Fletcher-Brown J, Pereira V, Nyadzayo MW. Health marketing in an emerging market: The critical role of signaling theory in breast cancer awareness. J Bus Res 2018;86:416-34.  Back to cited text no. 5
Singh S, Pal A, Srivastava NK. Level of awareness and practices of women regarding breast cancer in Chhattisgarh, India: An institution based survey. Int J Med Public Health 2018;8:145-151.  Back to cited text no. 6
Obaji NC, Elom HA, Agwu UM. Awareness and practice of breast self examination among market women in Abakaliki South East Nigeria. Ann Med Health Sci Res 2013;3:7-12.  Back to cited text no. 7
[PUBMED]  [Full text]  
Zain NM, Mut NA, Bakar NH, Kamal I, Suhaimi SA, Mohammad NM, et al. The effectiveness of educational intervention program on knowledge of BSE among secondary school girls in Seremban, Negeri Sembilan. J Sains Kesihatan Malays (Malays J Health Sci) 2019;17:73-79.  Back to cited text no. 8
Moustafa DG, Abd-Allah ES, Taha NM. Effect of a breast-self examination (BSE) educational intervention among female university students. Am J Nurs 2015;4:159-65.  Back to cited text no. 9


  [Table 1], [Table 2], [Table 3]


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