EFFECTS OF TWO TRAINING APPROACHES ON BREAST SELF EXAMINATION FOR CANCER DETECTION AMONG WOMEN IN SELECTED LOCAL GOVERNMENT AREAS IN IBADAN

Abstract

Breast Cancer (BC) is a leading cause of cancer-related deaths among women especially in developing countries. Late detection and presentation of BC result in poor treatment outcomes. Breast Self-examination (BSE) is a cost-effective screening method recommended for early BC detection in developing countries. Currently, the effects of trained Role-Model Mothers (RMMs) and Community Health Extension Workers (CHEWs) in educating Community Women (CW) on BSE is rarely documented. Therefore, this study was designed to assess the effects of training approaches by RMMs and CHEWs on knowledge, attitude and practice of BSE among CW in three semi-urban Local Government Areas (LGAs) in Ibadan, Nigeria. A quasi-experimental design and multi-stage sampling technique were adopted in this study. Three semi-urban LGAs were randomly selected out of the six in Ibadan and allocated by balloting into Experimental Group I (EGI): Ido LGA, Experimental Group II (EGII): Akinyele LGA and Control Group (CG): Egbeda LGA. One hundred CW were randomly recruited from each LGA. Ten Focus Group Discussions (FGDs) were conducted among the CW in each study LGA. Quantitative data were collected using a pre-tested interviewer-administered semi structured questionnaire which included 29-point knowledge, 14-point attitude and 12-point practice scales. Knowledge scores of ≤14 and >14 were categorised as poor and good, respectively. Attitude scores of ≤7 were categorized as negative and >7 as positive. Practice scores ≤6 were considered wrong and >6 as correct. Baseline results were used in designing interventions for CW. Ten RMMs in EGI and 10 CHEWs in EGII conducted a weekly training for CW on BSE for six months in form of lectures, step-wise demonstration and return demonstration using breast models. Post-intervention evaluation was conducted on the CW in the three study groups using the same instrument. Qualitative data was analysed using a thematic approach while quantitative data was analysed with ANOVA, paired t-test and independent sample t-test at α0.05. Respondents‘ mean ages across the three groups were 40.3±9.7, 39.4±9.2 and 31.8±7.7 years in EGI, EGII and CG, respectively. A significantly higher proportion of respondents had tertiary education in CG (46.0%) compared to EGI (34.0%) and EGII (12.0%) (p<0.001). The FGD revealed misconceptions about BC and BSE including being caused by spiritual forces, putting money in braziers and wearing fairly-used braziers. Mean scores of knowledge (EGI:11.4±4.2; EGII:11.7±4.2; CG:13.0±4.8; p=0.067), attitude (EGI:5.2±1.8; EGII:5.1±1.80; CG:4.5±1.1; p=0.125) and practice (EGI:3.3±1.7; EGII:3.8±1.8; CG:3.9±1.9; p=0.467); were obtained at baseline. At endline, these scores significantly improved across the three study groups (p<0.05) with higher improvement in EGI and EGII [Mean scores of knowledge (EGI:19.8±3.7; EGII:18.5±3.4; CG:14.3±2.4; p=0.018), attitude (EGI:11.7±1.8; EGII:11.3±1.5; CG:7.4±1.2; p=0.027), and practice (EGI:10.0±2.7; EGII:8.8±2.6; CG: 6.09±1.64; p=0.018)]. There were no significant differences in knowledge and attitude between CW in the two experimental groups but CW in EGI demonstrated a significant difference in practice (p<0.001). Role-Model Mothers improved Breast Self-examination practice among community women. They should be formally engaged as trainers for Breast Self-examination practice at community level to promote early detection of Breast Cancer.