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ORIGINAL ARTICLE
Year : 2020  |  Volume : 16  |  Issue : 1  |  Page : 139-143

Effectiveness of self-instructional module on awareness on screening regarding breast cancer with Intelligent Breast Examination among primary schoolteachers in Karad


1 Department of Medical Surgical Nusrsing, Krishna Institute of Nursing Sciences, Karad, Maharashtra, India
2 Department of Community Medicine, Krishna Institute of Medical Sciences, Karad, Maharashtra, India

Date of Submission22-Feb-2019
Date of Decision19-Jul-2019
Date of Acceptance21-Aug-2019
Date of Web Publication29-Apr-2020

Correspondence Address:
Shreyas Shripad Walvekar
PG Student, Department of Medical Surgical Nusrsing, Krishna Institute of Nursing Sciences, Malkapur, Karad, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrt.JCRT_132_19

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 > Abstract 


Aim: As Breast cancer is most common in developed and developing world. Despite of seriousness & importance of breast cancer the awareness is low. This Study highlights the primary screening of breast cancer with the device Intelligent Breast Examination.
Objectives: The objectives of this study are to assess the knowledge regarding awareness on screening of breast cancer with Intelligent Breast Examination (IBE), to develop a self-instructional module (SIM) on awareness on screening regarding breast cancer with IBE, and to assess its effectiveness on awareness about screening breast cancer with IBE.
Materials and Methods: Evaluative research approach was used. The study used preexperimental research design. The samples (60 primary schoolteachers) were selected by the use of two sampling techniques, i.e., random sampling (for schools) and purposive sampling (study participants). Data were collected in two phases (pre and post) using structured questionnaire followed by the administration of SIM.
Results: The results revealed a significant increase in mean knowledge scores (mean pre 11.16 standard deviation [SD] = 2.631 to mean post 21.2 SD = 1.842) regarding awareness on screening of breast cancer with IBE. The calculated paired t value (23.902) is greater than the table value ( t = 1.67) at 0.05 level of significance.
Conclusion: The study concluded that the SIM prepared proved to be effective in increasing the awareness regarding screening with IBE in breast cancer.

Keywords: Breast cancer, Intelligent Breast Examination, self-instructional module


How to cite this article:
Walvekar SS, Mohite VR, Mohite RV, Kakade SV. Effectiveness of self-instructional module on awareness on screening regarding breast cancer with Intelligent Breast Examination among primary schoolteachers in Karad. J Can Res Ther 2020;16:139-43

How to cite this URL:
Walvekar SS, Mohite VR, Mohite RV, Kakade SV. Effectiveness of self-instructional module on awareness on screening regarding breast cancer with Intelligent Breast Examination among primary schoolteachers in Karad. J Can Res Ther [serial online] 2020 [cited 2020 May 30];16:139-43. Available from: http://www.cancerjournal.net/text.asp?2020/16/1/139/283317




 > Introduction Top


Breast cancer is a common cancer in developed and developing countries in world. In India, Globocan (2012) shows that the number of new breast cancer cases is 144,937 and deaths is 70,218 (22%).[1] The incidence rates in India begin to rise in the early thirties and peak at ages 50-64 years[2] Despite seriousness of the disease, there is low awareness on breast cancer, and the previous study conducted in 1989, at primary and secondary schools of 12 European Union countries demonstrated the potential of the teachers in health education at schools, namely on cancer prevention.[3] Teachers are active social mediators, and they have an important role in cognitive and practical (behavioral) changes.

Intelligent Breast Examination (IBE) is noninvasive, handheld, fully wireless mHealth point-of-care solution for breast lesion detection. It is a standardized procedure approved by the Food and Drug Administration, WHO. Also its a primary screening technique, completely radiation free, and quick and painless accuracy to detect clinically relevant breast lesions >86%. And can be used by any health worker/doctor, the results are available instantly, at site. This study aims to create awareness among primary schoolteachers regarding screening breast cancer with IBE.

Objectives

The objectives of this study were as follows:

  • To assess the knowledge regarding awareness on screening for breast cancer with IBE among primary schoolteachers
  • To develop a self-instructional module (SIM) on awareness regarding screening for breast cancer with IBE among primary schoolteachers
  • To assess the effectiveness of SIM on awareness regarding screening for breast cancer with IBE among primary schoolteachers
  • To evaluate the outcome of SIM about referral for screening for breast cancer with IBE among primary schoolteachers.



 > Materials and Methods Top


Research approach

An evaluative research approach is used in this study. The present study aimed to assess the effectiveness of SIM on awareness on breast cancer screening with IBE among primary schoolteachers.

Research design

The research design used is preexperimental research design. This study proceeded in two phases, i.e., pretest and then administration of SIM followed by posttest on awareness regarding screening breast cancer with IBE.

Independent variable

The independent variable is SIM on awareness on screening breast cancer with IBE.

Dependent variable

The dependent variable is awareness of primary schoolteacher regarding screening of breast cancer with IBE.

Ethical clearance

The study was approved by the Institutional Ethical Committee of Krishna Institute of Medical Sciences Deemed University, Karad, Maharashtra, before the commencement of study.

Setting of the study

The study was carried out on primary schoolteachers in Zilla Parishad Primary Schools, Karad, the rural area of Satara district, western Maharashtra. The study duration was from November 25, 2017, to December 24, 2017.

Population

The study Population consisted of primary schoolteachers from Zilla Parishad Primary Schools, Karad.

Sampling technique

The study followed two sampling techniques, i.e., random sampling for selecting the study setting (primary schools) and purposive sampling technique for selecting study participants (primary schoolteachers).

Sample size

The study was conducted on 60 primary schoolteachers from selected Zilla Parishad Primary Schools in Karad.

Inclusion criteria

The investigator included primary schoolteachers from Zilla Parishad Primary Schools in Karad. Both male and female teachers above 20 years were included.

Exclusion criteria

Those who had diagnosed as breast cancer with mammography were excluded from the present study.

Data collection tool

A structured questionnaire regarding awareness on screening breast cancer with IBE was developed and used for data collection.

Development of self-instructional module and tool

Based on the objectives of the study, the following points were developed.

Section I

Sociodemographic variables (5).

  1. Age in years
  2. Gender
  3. Education
  4. Marital status
  5. Source of information.


Section II

Part A: Questions on knowledge regarding awareness on breast cancer and available screening techniques (8).

  • Do you know “breast cancer”?
  • Do you know the cause of breast cancer?
  • Is breast cancer communicable disease?
  • Do you know how breast cancer is diagnosed?
  • Do you know about various screening techniques for breast cancer?
  • Do you think screening will be helpful to cure breast cancer?
  • Is screening early for breast cancer helpful?
  • Are all screening techniques easily accessible?
  • Breast cancer once detected it cannot be treated?


Part B: Questions on IBE and its use (6).

  • Have you ever heard about IBE?
  • Is IBE helpful in diagnosing breast cancer?
  • Do you know how IBE device works?
  • Do you what can be screened with IBE device?
  • Is it more effective than other available screening techniques?
  • Is IBE is primary screening method?


Part C: Questions on screening and availability of IBE (11).

Each correct item carried score “1” and incorrect item “0”.

  • Is screening with IBE ethically right?
  • Do you know the technique of screening with IBE?
  • Does IBE require special preparation?
  • Have you ever seen the IBE?
  • Are there any side effects of screening with IBE?
  • Is this device available for screening for everyone?
  • Are there any special screening centers for screening with IBE?
  • Do you have trust in screening with IBE?
  • Do you agree to participate in awareness campaign regarding IBE?
  • Will you encourage others to get screened with IBE?


The study proceeded with the development of SIM on scientifically based review of literature including breast cancer and effectiveness of IBE in screening of breast cancer with its working policy, availability, and its use.

Data collection procedure

The study commenced by obtaining formal permissions from Chief Educational Officer and respective principals of schools. Data were collected after obtaining informed consent from participants with administration of SIM among primary schoolteachers.

Analysis

The data so collected were compiled in MS Excel and analyzed into tabular and graphical form. Data were analyzed using Graph Pad Software InStat 3.06 version. Paired t -test was applied to assess the effectiveness of SIM.


 > Results Top


Section I: It deals with analysis of demographic data of study participants.

The study showed that out of 60 participants (primary schoolteachers), majority of the participants, i.e., 24 (40%), belonged to the age group of 49 years and above. In terms of gender, 45 (75%) participants were female. Majority of the participants, i.e., 53 (88%), were married. Educational status of the participants (33, 55%) was D. Ed. The majority of source of information was television 40 (67%) in the population.


 > Discussion Top


The core aim of the present study is to assess the effectiveness of SIM on awareness on screening breast cancer with IBE among primary schoolteachers in Zilla Parishad Primary Schools in Karad. The analyzed data reveal some important aspects of this study which are categorized as per the objectives of the study.

The frequency and distribution of demographic variable of primary schoolteachers show that of 60 respondents, majority of the primary schoolteachers (24, 40%) belong to the age group of 49 years and above. About 45 (75%) were females and 53 (88%) were married. Maximum [33 (55%)] completed their D. Ed education.

This is a novel study conducted on awareness regarding new primary screening technique IBE in community, so there are no similar or contradictory studies for discussion.

However, there are many studies regarding effectiveness of IBE in screening breast cancer in community.

A study conducted by Somashekhar et al . revealed that 989 healthy women visiting Manipal Hospital, Bengaluru, for annual health check were recruited for bilateral breast examinations. All malignant lesions were identified by IBE, while one nonpalpable malignant lesion was missed by clinician Clinical Breast Examination (CBE). IBE can be a promising tool to provide clinically effective and standardized breast examinations in low-resource settings to detect breast lesions at early stages. The device can also be an effective screening tool for younger women with dense breasts.[4]

Another study conducted by Broach et al. on breast examination in India using a portable handheld breast palpation device is as effective as an expert CBE. The findings revealed that IBE is a powerful tool that can be widely used to screen for breast pathology in women who do not have access to routine preventive health care or mammography. Laypeople can be trained on the device and provide access to prescreening for women in rural and poor communities in developing nations.[5]

The above studies supported this study as the area in which it was conducted is exposed to education and medical facilities.

[Table 1], [Table 2], [Table 3] show the findings in pretest as follows: 48 (80%) participants had average, 1 (2%) had good, and 11 (18%) had poor knowledge regarding awareness on screening of breast cancer with IBE. Whereas, in posttest, no participants had poor, 59 (98%) had good, and 1 (2%) had average knowledge regarding awareness on screening of breast cancer with IBE. Furthermore, discussing about the hypothesis and when comparing pre- and post-test mean, there is a significant increase in scores (mean pre 11.16 standard deviation [SD] =2.631 to mean post 21.2 SD = 1.842). The calculated paired t value (23.902) is greater than the table value ( t = 1.67) at 0.05 level of significance. These findings proved that SIM was effective in improving awareness among primary schoolteachers.
Table 1: Distribution of participants according to knowledge regarding awareness on screening on breast cancer with Intelligent Breast Examination ( n =60)

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Table 2: Distribution of participants according to mean , median, mode, standard deviation, and range of pre- and posttest score knowledge regarding awareness on screening regarding breast cancer with Intelligent Breast Examination

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Table 3: Distribution of participants according mean, standard deviation, and paired t -test

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As per [Figure 1] at the end after administration of SIM among primary schoolteachers. From total study population (60 participants) around 15 (25%) primary school teachers approached to the researcher to get screened with Intelligent Breast Examination. This proves that the SIM was effective to create awareness regarding early screening with IBE among primary schoolteachers.
Figure 1: Pie chart showing percentage outcome of self-instructional module about referral for screening for breast cancer with Intelligent Breast Examination among primary schoolteachers

Click here to view


With this new screening technique IBE, many camps were conducted in Maharashtra, Rajasthan, and Delhi like areas for creating awareness about early detection of breast cancer with this device.

The camp report of Maharashtra revealed that program was intended to screen 12,689 women screened with IBE across 16 Government Medical Colleges in Maharashtra; 736 women found positive on IBE were asked for a follow-up targeted ultrasound. Of these 736 women, 612 were found to have benign lesions, while 80 women required fine-needle aspiration cytology/core-needle biopsy, and 31 malignancies were confirmed. Another similar camp conducted in Rajasthan showed 289 women of average age 37 years participated at the breast health camps and 4 women were identified with positive findings on the IBE test. These women were advised a follow-up consultation with the area gynecologist. Women across all districts welcomed IBE test and found the breast health check to be painless and comfortable.[6]

These studies demonstrated the need to enlighten the community with the fact of “early diagnosis.” Above mentioned camp report and discussion studies supports the present study, as it was conducted in area karad which has higher literacy rate, well versed medical & education facilities. Hence, the posttest scenario showed improvement in their awareness.

Similarly, like camps, the present study's SIM played a key role to make teachers aware about such thing and can spread it in community. So steps are needed to create awareness among women in all settings to screen for Breast cancer early with such new techniques. Thus, in Indian setting, teachers are in role of shaping community with their creative thoughts regarding culture, health, and education.

In this study the geographical area of (Karad, Western Maharashtra), the educational & Medical Facilities available here, all these factors helped to create awareness among teachers about early detection of breast cancer and screening with Intelligent Breast Examination.


 > Conclusion Top


The study emphasizes three things, i.e., awareness, education, and early detection . The finding of the study reveals that informational booklet causes a significance rise in awareness of the primary schoolteachers. The study concluded that there is a strong need to create awareness and education among primary schoolteachers regarding screening of breast cancer with primary screening method, i.e., IBE through more available health promotion option.

Financial support and sponsorship

This was a self-funded study.

Conflicts of interest

This was a self-funded study.



 
 > References Top

1.
Ferlay JF. GLOBOCAN Cancer Fact Sheets. Breast Cancer; 2018. Available from: http://globocan.iarc.fr/old/FactSheets/cancers/breast-new.asp. [Last accessed on 17 May 2018].  Back to cited text no. 1
    
2.
Mehrotra D. Statistics – India Against Cancer. India Against Cancer; 2018. Available from: http://cancerindia.org.in/statistics. [Last accessed on 2018 May 17].  Back to cited text no. 2
    
3.
Barros A, Moreira L, Santos H, Ribeiro N, Carvalho L, Santos-Silva F. “Cancer – Educate to prevent” – High-school teachers, the new promoters of cancer prevention education campaigns. PLoS One 2014;9:e96672.  Back to cited text no. 3
    
4.
Somashekhar SP, Vijay R, Ananthasivan R, Prasanna G. Noninvasive and low-cost technique for early detection of clinically relevant breast lesions using a handheld point-of-care medical device (iBreastExam): Prospective three-arm triple-blinded comparative study. Indian J Gynecol Oncol 2016;14:26.  Back to cited text no. 4
    
5.
Broach RB, Geha R, Englander BS, DeLaCruz L, Thrash H, Brooks AD. A cost-effective handheld breast scanner for use in low-resource environments: A validation study. World J Surg Oncol 2016;14:277.  Back to cited text no. 5
    
6.
iBreastExam; 2018. Available from: http://www.ibreastexam.com. [Last accessed on 2018 May 17].  Back to cited text no. 6
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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