FACTORS THAT INFLUENCE THE UPTAKE OF BREAST

CANCER SCREENING AMONG MACHAKOS UNIVERSITY

FEMALE STUDENTS IN MACHAKOS COUNTY

BY
JOHN IMENDE ZAKAYO
D/NURS/16013/124

A RESEARCH PROJECT PRESENTED TO THE KENYA

MEDICAL TRAINING COLLEGE IN PARTIAL
FULLFILLMENTFOR THE AWARD OF DIPLOMA IN KENYA
REGISTERED COMMUNITY HEALTH NURSING
i
 DECLARATION
This is my original work and has never been presented for Diploma in any other institution.

Signature…………………………………… Date ………………………………………

JOHN IMENDE ZAKAYO
D/NURS/16013/124

ii
 SUPERVISOR’S APPROVAL
This Research has been submitted for review with our approval as College supervisors.

Signature…………………………………………Date…………………………………………..
VICTORIA MBOYA
NURSING DEPARTMENT

iii
 DEDICATION
I dedicate this research project to my Dad and Mum for their support all through the research period both
financially and morally.

iv
 ACKNOWLEDGEMENT
I would like to thank the Almighty God for enabling by giving me patience strength and good health to be
able to begin and complete my research. I also thank the Kenya Medical Training College for giving me
this opportunity. I also would like to thank Machakos University for allowing me to carry out my research
in the University. Finally I would like to acknowledge my lecturer Madam Victoria Mboya for her
guidance throughout my research project. Blessings from God to you all

v
 ABSTRACT
Breast cancer kills about 519,000 people annually across the globe.Globally, there is a rise in the
incidences of breast cancer most of these cases are reported in developing countries. In Africa
breast cancer is characterized by presentation with the advanced disease, inadequate information
about breast cancer’s incidence and inaccessibility of facilities significant for screening purposes.
In Kenya, most cases of breast cancer are presented with stage 3 and 4 of the disease. It is
important to examine the establishment of breast health education in the curriculum and school
setting, the level of breast screening awareness, accessibility of screening facilities and the role
of socio-economic, demographic and cultural beliefs, students’ attitude and fear of the uptake of
breast cancer screening. The aim of this study was to analyze the factors that affect the uptake of
breast cancer screening among Machakos University female students in MachakosCounty.
Health belief model formed the basis for this study and data was collected using interviews
administered through questionnaires. The study used cross-sectional survey research design. The
study targeted University students aged 16-30 years. The sample size was 147 university students
picked randomly and proportionally from the University. Sample data was analyzed using
fisher’s et al formula whereby the sample size 44 was selected to represent the study population.
The researcher found out significant association between SECD’s, psychological factors,
institutional factors and students level of knowledge about breast cancer screening uptake.

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 TABLE OF CONTENT
DECLARATION......................................................................................................................i
SUPERVISOR’S APPROVAL................................................................................................ii
DEDICATION.......................................................................................................................iii
ACKNOWLEDGEMENT.......................................................................................................iv
ABSTRACT............................................................................................................................v
TABLE OF CONTENT..........................................................................................................vi
APPENDICES.......................................................................................................................ix
LIST OF ABBREVIATIONS..................................................................................................x
OPPERATIONAL DEFINATION OF TERMS......................................................................xi
LIST OF FIGURES..............................................................................................................xii
LIST OF TABLES...............................................................................................................xiii
CHAPTER ONE.....................................................................................................................1
INTRODUCTION...................................................................................................................1
BACKGROUND.....................................................................................................................1
PROBLEM STATEMENT...............................................................................................................2
JUSTIFICATION.............................................................................................................................3
OBJECTIVES OF THE STUDY......................................................................................................3
1.4.1 BROAD OBJECTIVES..........................................................................................................3
1.4.2 SPECIFIC OBJECTIVES........................................................................................................3
RESEARCH QUESTIONS...............................................................................................................3
SIGNIFICANCE AND ANTICIPATED OUTPUT..........................................................................3
DELIMITATIONS............................................................................................................................4
LIMITATIONS.................................................................................................................................4

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SCOPE..............................................................................................................................................4
CHAPTER TWO..............................................................................................................................5
LITERATURE REVIEW.................................................................................................................5
2.1 BREAST HEALTH PROMOTION EDUCATION....................................................................5
2.2 Socio- Economic, Cultural and Demographic Factors................................................................6
2.3 Fear and Embarrassment............................................................................................................7
2.4. Challenges of Breast Cancer Control in Africa.........................................................................7
2.5 Educational issues.......................................................................................................................8
2.6 Health Belief Models (H.B.M).....................................................................................................8
CHAPTER THREE........................................................................................................................10
3.0 RESERCH METHODOLOGY.................................................................................................10
3.1 INTRODUCTION.....................................................................................................................10
3.2 Study Area.................................................................................................................................10
3.3 Research Design.........................................................................................................................10
3.4 Study Population.......................................................................................................................10
3.5 VARIABLE...............................................................................................................................11
3.5.1 Dependent variable.................................................................................................................11
3.5.2 Independent variable..............................................................................................................11
3.6 INCLUSSION AND EXCLUSSION CRETERIA....................................................................11
3.6.1 Inclusion Criteria....................................................................................................................11
3.6.2 Exclusion Criteria...................................................................................................................11
3.7 SAMPLING PROCEEDURE...................................................................................................11
3.8 SAMPLE SIZE..........................................................................................................................11
3.9 DATA COLLECTION TOOLS................................................................................................13
3.9.1 Construction of Research Instruments..................................................................................13
3.9.2 Pilot Study...............................................................................................................................13
3.9.3 Data Collection.......................................................................................................................13
3.9.4 Data Analysis..........................................................................................................................14
CHAPTER FOUR...........................................................................................................................15
4.1 RESULTS AND DISCUSSION.................................................................................................15

viii
 4.2 INTRODUCTION.....................................................................................................................15
4.3 RESULTS..................................................................................................................................15
4.3.1 Socio-demographic Characteristics of Respondents..............................................................15

CHAPTER FIVE..................................................................................................................23
SUMMARY, CONCLUSION AND RECOMMENDATIONS................................................23
5.1 INTRODUCTION.....................................................................................................................23
5.1.1 Students level of awareness about Breast Cancer, Breast Self Examination and Breast......23
5.1.2 Institutional characteristics in Breast Screening Uptake among students............................23
5.1.3 Psychosocial factors in Breast Cancer Screening uptake.......................................................23
5.1.5 Socio-Economic and Culture factors in Breast Cancer Screening uptake............................24
5.1.6 Demographic Factors.............................................................................................................24
5.2 Implication of the study findings...............................................................................................24

CHAPTER SIX.....................................................................................................................26
CONCLUSION AND RECOMMENDATION.......................................................................26
6.1 CONCLUSION..........................................................................................................................26
6.2 Recommendation.......................................................................................................................26
REFERENCES................................................................................................................................28

ix
 APPENDICES
APPENDIX I : Questionnaire
APPENDIX II : Authorization Letter
APPENDIX III : Research Budget
APPENDIX IV : Research Timeframe

x
 LIST OF ABBREVIATIONS

WHO : World Health Organization

CBE : Clinical Breast Examinations
MOH : Ministry Of Health
MOE : Ministry of Education
BCE : Breast Screening Examination
BSE : Breast Self-Examination

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 OPPERATIONAL DEFINATION OF TERMS
Breast cancer
This is a malicious development that occurs in the breast tissues and is characterized by uncontrolled and
abnormal cell multiplication.
Breast self-examination
This is a technique in diagnosis that is commonly done on her breast in order to ascertain for presence of
lumps or other abnormal occurrences.
Clinical breast-examination
This is the substantial assessment of the breast that is carried out by health care providers in order to
check for lumps or other changes.
Diagnosis
This involves the imaging, hormone status, pathology and staging when confirming the occurrence of
breast cancer in a patient.
Health promotion
This is the integration of both educational and environmental sustenance for action and condition of living
conducive health
Incidence
This refers to the regularity of breast cancer case appearances within the selected individual group in a
given population at a specific place and time.
Screening
This is the type of examination that involves the technique in diagnosis or a physical analysis to become
aware of the presence of breast cancer.
Stigma
An attitude or feeling of disgrace test by those affected or infected with breast cancer.
Surveillance
Careful observation of a group of people in the presence of breast cancer.

xii
 LIST OF FIGURES
Figure 4.3 Information about Breast cancer screening...............................................................................................15
Figure 4.4 Sources of information media.....................................................................................................................16
Figure 4.5 Uptake of Self Breast examination.............................................................................................................17
Figure 4.6 Test for clinical breast examinations..........................................................................................................17
Figure 4.7 Educational Information sessions..............................................................................................................18
Figure 4.9 Self Breast Examination.............................................................................................................................19
Figure 5.1 Educational pamphlets and video programmes.........................................................................................19
Figure 5.2 Academic equipping schools with Breast Health materials.......................................................................20
Figure 5.3 Cultural Beliefs.........................................................................................................................................21
Figure 5.5 Cost of breast cancer screening.................................................................................................................21

xiii
 LIST OF TABLES

Table 4.1 Respondents Gender....................................................................................................................................15

Table 4.2 Respondents Age.........................................................................................................................................15
Table 4.8 Ability to learn about self breast examination in their institution curriculum.........................................18
Table 5.0 Roles of self breast examination.................................................................................................................19
Table 5.4 Stigmatization and social pressure influence.............................................................................................21

xiv
 CHAPTER ONE

INTRODUCTION

BACKGROUND
Breast cancer kills about 519,000 people annually across the globe (WHO, 2014) OVER 1.2
million people are diagnosed withbreast cancer on annual basis, globally (1bid, 2014).There are
varying role within international with a range of between 3.9 individuals against 100,000 in
Mozambiqueand 1011 in the United States.(American cancer society, 2012) 16.6.29.9 casesper
100,000 person (1bid, 2012). There low rates have been attributed to low screening rate and
incomplete reporting. Breastcancer incidence, and inaccessibility of facilities significant for
screening purposes (McGrath et al, 2010). Between 2010 and 2012, there was a diagnosed form
of cancer amongst Kenyan with about 80% - 90% of per the pretended care with stage 3 and 4 of
ailment, when treatment cost is high with low survival chances (Apffelstaedt, 2012). Out of
every nine Kenyan tested positive with breast cancer is incurable necessitates delays as options
that are culturally acceptable are excavated in tandem with the edifying characterization of the
decease (Muchiri, 2011). Theemergence of breast disease and the subsequent development of
cancer tent to be more aggressive in young compared to breast progression in older population
(Anders et al, 2015). Young woman aged 15-29 years with breast cancer experienced mortality
rate among young woman mainly due to lack of breast cancer awareness (Aneders et al, 2012).
Early detection of breast cancer playedan important role in reducing its mortality and mortality.
Clinical Breast examinations(CBE)are considered as screening methods for early detection of
breast cancer (AVCI, 2008)
Overall, practicing BSE could provide an opportunity for people to know now their breasts
normally feel and able to notice any changes in their breast tissue (American cancer society,
2012). This complemented the breast health awareness education and supplements people with
knowledge on what to do when a lump in detected.

Despite the relative benefits of BSE, its applications remains low (Conbulat,2015). Studies
conducted among the women in Bushehr, a city in South of Iran, showed only 41.9% had
performed BSE in the past and 7.6% of them performed it regularly (Noroozi,2011). In some,
1
lack of awareness regarding the necessity of regular BSE had an impact on enlargement of the
screening practice (AVCI, 2008). Therefore, understanding the student’s beliefs regarding BSE
can be used to design appropriate educational interventions to promote the screening behavior
(Yarbrough et al, 2011).
A research report by the Kenya Medical Research Institute (KEMRI) in the year 2006, barely 3
out of 87 facilitates in Nyanza provided specialized Breast cancer screening suggested
inaccessibility, especially to the rural population. Based on a report by (UNAIDS, 2014) schools
are excellent points of contact for young people to acquire knowledge and attitudes. Moreover,
they are receptive to information in schools compared to any other environment.
(WHO, 2015). Proposed that, schools health promotion should provide circular to empower
teenagers with competency in taking reproductive health actions that screening be undertaken by
qualified health personnel. The Ministry of Health (MOH, 2015), gave recommendations on
establishment of youth friendly services in the existing education facilities to promote their
reproductive health (MOH, 2005).
Many factors are however bound to affect breast health awareness, Breast Self-Examination
(BSE) and screening among the university students. It, therefore becomes necessary to acquire
information on different factors that discourage screening among students of the university
attending, their allocations and now significant they in the decision making process making
process in participation of breast cancer screening.

PROBLEM STATEMENT
Globally, there is a rise in the incidences of breast cancer and this more prominent in developing
nations. The rising breast cancer incidences rate in Kenya is a major concern to the health sector,
yet little research has been done to reduce the rate rise (Kenya National Cancer, 2014)
Breast Self examination and screening among youths in the Machakos County and Sub-county,
considering that Breast self examination alone greatly decreases the incidences rate of late cancer
presentation (Apffelstaedt, 2015).
The perspectives of students regarding breast cancer haven’t been widely studied. Though
universities are excellent agents for socialization of the youth into responsible reproductive
health, there will be reluctance in adoption of Breast Health Education (BHE) in universities and
there will be very little deliberate efforts that will be made to reach the university going students.

2
JUSTIFICATION
The study will impede equity in access to healthcare among vulnerable youths in Machakos
University hence increase the incidence and mortality associated to late breast cancer reporting.
It will be impracticable to understand thevarious factors that influence uptake of BSE and
clinical screening among youths in Machakos University for which there is little information.
The study also will be utilized by Ministry of Health in combating breast cancer thus
contributing to the millennium development goal 6 and vision 2030.

OBJECTIVES OF THE STUDY

1.4.1 BROAD OBJECTIVES

The study will examine on the factors that influence uptake of breast cancer screening among
Machakos university female students in MachakosCounty .

1.4.2 SPECIFIC OBJECTIVES

(a) To determine the level of awareness about breast care and breast screening among
MachakosCounty
(b) To determine the factorscontributing to screening of breast examination among
Machakos university female students in Machakos County.

RESEARCH QUESTIONS

1. What is the level of awareness of University students on breast cancer, BSE and screening
for breast cancer?
2. To what extent does the University school curriculum and school setting address Breast
Health Education (BHE)?
3. To what extent does the University students access Breast screening facilities and undertake
BSE and screening for breast cancer?
4. Do socio-economical, cultural and demographic factors (SECD’s), attitude and feelings
influence BSE and screening for breast cancer among University students?

SIGNIFICANCE AND ANTICIPATED OUTPUT

The study aimed at identifying factors that influence the uptake of breast cancer screening among
Machakos University female students by the researcher. The researcher will be able to how well

3
the university students are aware of breast cancer screening, how often do they do the screening
and how they practice breast self examination.

Secondly, by analyzing the factors, this study will be able to come up with a valid conclusion
through identifying where the problem is after accessing the factors that influence the uptake of
breast cancer screening among Machakos University female students. Identifying where the
problem is will help come up with ways on how to handle the problem causing non-compliance
to breast screening and examinations hence improving compliance to breast examinations.

Thirdly, the study provided the researcher identify the attitude of University students toward
breast examination. This is because the researcher can find that University students are aware of
breast examination, they know how to practice but they have negative attitude towardsself breast
examination, they assume the practice consumes most of their time.

The researcher will therefore educate and encourage the University students the Uptake of breast
self examination is effective and does not consume a lot of time.

Finally, this study contributed to the base of knowledge with considerations to the different
factors that impact BSE and input in clinical screening by the students for which very little
information is available, to the view that cancer is associated with old age.

DELIMITATIONS
In this study limited literature was available especially linked to breast cancer screening uptake
among the youth and breast self-examination, given that most research had been focused on
older women.
The study focused on University female students within Machakos County alone due to limited
point in time and financial resources at the disposal of the research.

LIMITATIONS
The study covered Machakos County only due to the cost of implication and limited time
available for conducting the study.

SCOPE
The study was carried out among Machakos University female students in Machakos County.

4
 CHAPTER TWO

LITERATURE REVIEW

2.1 BREAST HEALTH PROMOTION EDUCATION

Breast health promotion entails a two dimensional approach;Provides knowledge to try and
prevent it from happening or if it has occurred to find it and take care of it at its earlier stages
(David and Rassaby, 2015). Aknowledgeable public carried out breast self examination and
talked to medical specialists about the appropriate age to start breast screening (Ibid, 2015).
People choose to adopt healthier ways of living, if they get dependable information from the
system they trust, supported by vigorous hostilic debate.
(Teresa de Perez, 2013), decentralization of health promotion through personalized actions plan
in Cuba achieved the tremendous lifestyle changes especially through face education in order to
keep the public informed and by creating a generation of space for distribution and social
exchange of breast health knowledge.
An effective BHE program targeting the youth should include: educational hand-outs, seminar
programs, guides for health promotion and education prepared by MOE, television programs and
a commission to co-ordinate educational activities (Ibid,2003). Working with principals to
schedule educational sessions around class schedules empowers university students to take
control of their bodies through detection skills (Goode, Sockalingan and Lopez, 2013).
KBHP educates women to care for their bodies as well as their breasts through regular self-
examination and organized workshops for exchange of information with the public (Neondo,
2015). However, not so much effort has been put in place to reach university students. Health
promotion talks are given regularly by medical professionals in Kenya through the media outlets
but not all regions of the county get the broadcasts (Musimbi, 2015).
Educational interventions should be designed to improve breast cancer screening among the
teenage school going girls as well as the university girls (Bailey et al, 2012).
(Cohen et al, 2010) found out that during on 8 week advertisement campaign in inner Glasgow
for breast screening, 97% of women attending the screening liked the images and found the
messages reassuring, supportive and credible.

5
They stated that the advertisements should create awareness of the service, make woman more
aware of the benefits and change the public perception of the screening. Screening acceptance
improved in the areas that were covered by the advertisement and campaigns by 2-13%. Despite
the benefits associated to regular BSE, few women actually examine their breasts, infact a
majority do not even know how to do BSE (Stamler et al, 2010).

2.2 Socio- Economic, Cultural and Demographic Factors

Cross sectional studies have demonstrated that breast cancer screening uptake may be impacted
by socio-economic and demographic factor (SEDs) that include income status (Bouchardy, 2010)
and economic deprivation (Macleod et al, 2010). The uptake ofbreast screening tends to be lower
in socio-economically deprived inner cities of England (Breast Screening Program. England,
2004/2005.
(Banks el at 2012)observed that out of the 1064 women invited for screening in London, 55% of
the non-attendee’s came from the most deprived areas.
Ina study of the association between uptake of breast screening and solid economic poverty,
spatial disparities,rural-urban status, the setting and nature of the screening units the strongest
association wall with the socio-economic deprivation with significantly lower uptake from
deprive areas (Maheswarab, 2015).
Culture affects both the risk factors for cancer and the meaning of the disease yet it establishes
time norms for behavior and guides members to respond emotionally cognitively and socially to
the disease (Sadler et al 2011).
In some culture,cancer is a white man’sdiseases,while some believe that breast cancer is caused
by the devil or is accurse from God, where others believe in not exploring the
unknown.Therefore,if a lump of and in the breast in not addressed, it will never happen (Bailey
et al, 2012).
BSE is also influenced by among other factors ,culture belief about breast cancer (Smiley ,
2010).They believe in invulnerability to breast cancer ,by which young women link the
occurrences of breast cancer to tragic luck ,also delays reporting and screening uptake (Ibid,
2010).

6
Others believe that breast cancer isn’t a serious illness, whereas others believe that susceptibility
of the breast cancer is the will of God which can moderate the effects of perceived seriousness of
the disease on BSE practice and screening uptake
(Smiley,2010).
(Bulaporn and Clark,2015) found out that among Thai women found the cost of screening and
the distance to screening facilities play a major role in determining the uptake of screening
service for breast cancer .The high cost of clinical breast examination and as well the
mammography especially in developing countries is a big hindrance to the uptake of such
services by women and girls (WHO2014).
(Jepson, 2000) observed that a negative attitude towards breast cancer screening perception is
not necessarily and personally important one hindrances to the uptake of screening of breast
cancer.
The most common reason influencing the decision for the breast cancer screening in Ol-
kalou,Nyandaruadistrict-Kenya was that many women did not associate it to any direct benefits.
Given that breast cancer isn’t prevalent in the area,few people did not see the reason to take
breast cancerscreening (Muchiri,2015).This therefore showed that the presence of a qualified
nurse in an institution to provide intensive educational interventions and avail information about
the benefits of B.S.E and breast screening can improve the uptake of breast cancer screening
(WHO,2014).

2.3 Fear and Embarrassment

The fear finding somethingwrong has been cited as an obstacle to screening especially among the
black and the feeling that it is better not to be known is reported barrier among several
Europeans samples (Lastan,2011),other studies have suggested that greater fearless is associated
with higher like hood of screening uptake shyness, embarrassment and treatment (Ibid,2010),
among Jordan women.

2.4. Challenges of Breast Cancer Control in Africa

Cultural myths a report by( WHO,2014),are the greatest impediment to breast cancer screening
and many women are afraid to discuss openly the disease .Women would rather consult gods or

7
pray to know why and who is behind the conditions, denying as well as delaying the presentation
for screening and treatment (Ibid,2014).
Breast health awareness campaigns have been inadequate coupled with lack of affordable
screening facilities especially in most rural centers(McGrath, 2014).
(WHO, 2014) where screening facilities are available the cost is prohibitively high. Due to lack
of logistic and funds,health agencies can only provide B.H.E and promotion (Huertha and Grey,
2015).Lack of major cancer registries in African pole major challenge in providing statistics
about breast cancer reports for effective planning (Neondo, 2015).

2.5 Educational issues

A study conducted demonstrated that BSE accuracy of the students increased after education
besides their positive attitude and behavior towards BSE were improved hence they suggest that
the main reason why the students were not performing BSE were lack of knowledge and motive
prior education(Nevin, 2015).Teaching in social settings has also been shown to prove and
improve knowledge of BSE (Neondo,2015). This finding illustrates the need foran organized
curriculum to improve the uptake of BSE and breast cancer screening among University female
students.(Carolyn,2012) have proposed the introducing of breast health strategy through
multidisciplinary approach incorporating the school and community to normalize discussions
about breast health and promoting breast awareness.
(Royal college of Nursing, 2012) suggested that it is the health providers’ responsibility to
educate, encourage women and girls to be familiar with their breast, identify breast changes and
help them decide what to do if the change is identified.They empower women by proving
information advice and support with an organized curriculum is already overloaded.
In Kenya most schools acquire books majority for academic excellence an rarely for breast
health awareness.
Undergraduate cancer study program are quite short and are mainly held in outpatient clinics
issues about the suitability of nurse in breast health instruction (Musimbi, 2015).

2.6 Health Belief Models (H.B.M)

(Barnyard, 2002), The Health Belief model formed and took presumptions that populace are
frightened by the disease and the health actions of the people are provided by external extent of
professed threat (fear) and the anticipate reduction action plans,so long as the

8
strategiesoutweighs the physical and psychological delimitations to the benefits to make easy the
participations in rewarding the health actions.
The study however outlined using constructs of the health model;perceived susceptibility on
option of the students on their chance of being affected or developing the breast cancer disease.
It might drive them to engage in early breast examination and screening to prevent developing
the breast cancer or being affected later in life. This was the students believe that they may at a
higher risk of developing the breast cancer motivating them to take up the breast screening and
BSE for breast cancer to facilitate appropriate timey interventions .
Similarity perceived severity showed the students’ opinions on the seriousness of developing
terminals breast cancer that students would change their health behaviors and uptake on the
breast screening and BSE for cancer depending on how serious they consider the consequence of
developing terminals breast cancer.

9
 CHAPTER THREE

3.0 RESERCH METHODOLOGY

3.1 INTRODUCTION
The methodology chapter to be presented will describe the steps taken to achieve the study
objectives .This includes,study area ,study population,study design ,study sample size,sample
signs,sampling procedure,data collected with various tools and instruments,data collection
process and ethical considerations.

3.2 Study Area

My studyarea is MachakosUniversity which is the largest university in Machakos County and
some surrounding Counties such as Makueni and Kitui.The university is in town,central division,
Masaku township location and Eastleighsub-location.The MachakosUniversity is along Kitui and
Makueni road.Machakos is a town in Kenya,64 kilometers South East of Nairobi and
borderingKangundo and Yatta townto the North,Mwala to the East,Mbooni to the south and
Kajiado to the west

3.3 Research Design

A cross sectional study will be carried to obtain diverse information about the University
student’s attitudes,options,opinions and habits related to breast screening uptake using
questionnaires and interviews.The study information about factors that influence early screening
for breast cancer among University students was sought from the students.

The design is identified to be suitable for the study since it allows the researcher gather
information,summarize as well as interpreted data based on findings on conclusions and
recommendations of the study.

3.4 Study Population

The target population of the study is female student in MachakosUniversity.The population
targeted is a total of all females which includes females in all departments of the School of
Machakos University.

10
3.5 VARIABLE

3.5.1 Dependent variable

Uptake of breast screening cancer among Machakos university female students.

3.5.2 Independent variable

University school curriculum and setting distance to screening facilities,SEDs,attitudes
perceptions and feelings about breast cancer,BSE and breast cancer screening among Machakos
university female students.

3.6 INCLUSSION AND EXCLUSSION CRETERIA

3.6.1 Inclusion Criteria

The study included all the available students within the Machakos University.

3.6.2 Exclusion Criteria

The study excluded all the students who were not available within Machakos University and
those not given consent.

3.7 SAMPLING PROCEEDURE

The researcher used cross sectional survey research to provide a large and more representative
sample

3.8 SAMPLE SIZE

This was determined by Fisher et al method (Fisher et al.1998)to obtain the sample size

n= Z2pqD

d2

Where; n =the desired sample size when the population is greater than 10,000
Z =the standard normal deviation set as 1.96 at 95% confidence interval

P =the estimated proportion in the target population estimated to have characteristic

being measured and estimated prevalence of breast cancer in the population, 0.11

(Neondo,2006)

11
 q= 1-p=0.89

d = level of statistical signification set at 0.05

D = is design effect =1.

Therefore the desired sample size will be;

N=Z2pq

d2

n=1.962x0.11x0.89

0.052
n=0.3760

0.0025

n=150

Hence if n is for the population for over 10,000 and 11,150,but the target population will be less
than 10,000.Therefore the following final sample estimate (nf)was calculated using the formula

nf=n/1+n/N

Where

nf=the desired sample size (when the population is less than 10,000)

n=the preferred sample size (when the population is greater than 10,000)

N=the estimate of the population size

12
Where the researcher estimated an average of 9,000at Machakosuniversity total students

Therefore,if nf=n/1+n/N

nf=150

1+150/9000

nf=150

1+0.0166

nf=150/1.0166

nf=147055

nf=147

The desired sample size is 147 respondent 30% of the population will be used to cover the entire
population and represent the total population due to financial constraints hence all the 147
respondents might not be covered.

Therefore;30x 147/100

=44.1

=44 respondents(representatives)

3.9 DATA COLLECTION TOOLS

3.9.1 Construction of Research Instruments

Structured and open ended questionnaires was used in the study that will be from the objectives
of the study. This ensured that each item related on specific objective.Considerations were made
for how information obtained from each item will be analyzed.

3.9.2Pilot Study
The questionnaire will be randomly selected among the Machakos University female students
MachakosCounty whose samples were similar to the actual sample.

13
The questionnaire will be self administered and participants will be encouraged to make
suggestions about the instructions clarity of questions and relevance.

Treated with at most and confidentiality with no biasness as well as the purpose meant for the
study.

3.9.3Data Collection
Sources of data will be both primary and secondary. The secondary data was obtained by
analyzing the K.I.E syllabus to examine the extent of the Breast Health Education. Primary data
will be collected using pre-tested structured and open ended questionnaires.

Interviews were used to get accurate data. The type of data to be gathered include; awareness and
practice of BSE and BCS , level of establishment of BHE in the curriculum and the school
setting, role of socio-economic, cultural and demographic factors, role of fear and attitude in the
uptake of BSE and breast screening uptake.

3.9.4 Data Analysis

The data collected was analyzed using statistical package for social sciences (SPSS). Frequency
charts and proportions were used to compare the student’s responses to BSE and breast cancer
screening uptake.

The data was analyzed by use of frequency tables, pie-charts, histograms and bar graphs

3.9.5 Ethical Considerations

Approval letter was sought from the Kenya Medical college ethics and obtained clearance letter
from the Kenya Medical Training College that allowed the researcher continue with the study.
Further the researcher obtained consent from Machakos University and where the researcher
carried out his study. The information obtained would remain confidential.

14
CHAPTER FOUR

4.1 RESULTS AND DISCUSSION

4.2INTRODUCTION

This chapter presents the characteristics of the respondents, the main results obtained from the
results analysis of the research findings discussion and conclusions.

4.3RESULTS

4.3.1 Socio-demographic Characteristics of Respondents

The highest percentage of the respondents was in theage bracket of 21-30 year while the least
percentage was in the age bracket of above 30 years. The highest percentage of the respondents
was in the middle university and those in marital status.

Table 4.1 Respondents Gender

GENDER FREQUENTCY PERCENTAGE

FEMALE 44 100%
MALE 0 0%

All the respondents were female.

Table 4.2 RespondentsAge

AGE FREQUENCY PERCENTAGE
16.20years 11 25%
21-30years 24 55%
Above 30 years 9 20%

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Most of the respondents were aged between 21-30 years (55%) followed by 16-20 years (25%)
followed by above 30 years with (20%).

Figure 4.3 Information about Breast cancer screening

Information about Breast cancer screening

2%

Yes No

98%

According to the pie chart above 98% of the respondents have heard about breast cancer
screening.

Figure 4.4 Sources of information media

The bar graph below, majority of the respondents got their information from the television 20
(45.45) followed by radio 12(27.27%) followed by internet 8(18.18%) nurse3(6.81%) lastly by
others 1(2.27%).

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 KEY
50.00% 45.45%
45.00%
40.00%
35.00% 27.27%
30.00%
25.00% 18.18% KEY
20.00%
15.00% 6.80%
10.00% 2.27%
5.00%
0.00%
Televisoin Radio Internet Nurses/Doctor Others

Figure 4.5Uptake of Self Breast examination

The pie chart below is showing if the respondents have ever carried out self-breast examination

Key

32% yes
no

68%

17
Most of the respondents 30(68.18%) have carried out self breast examination followed by
14(31.81%) never carried out self breast examination.

Figure 4.6 Test for clinical breast examinations

Key

20%

no
yes

80%

The pie-chart above the highest respondents (79.54%) have never gone for clinical breast
examination screenings followed by nine respondents (20.46%) have ever gone for clinical
breast examination screening.

Figure 4.7 Educational Information sessions

The bar graph below provides information if the respondent has ever had educational lesson
about breast health and screening organized by health officers .10respondents (22.7%)frequently

18
have had followed by 20(45.5%) then once 4(9.1%)and costly never have had an educational
lesson 10(22.7%).

50.00%
45.00%
40.00%
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
frequently Rarely Once in a semister Never

Table 4.8 Ability to learn about self breast examination in their institution curriculum

NUMBER OF TIMES FREQUENCY PERCENTAGE

FREQUENCY 3 6.9%
RARELY 25 56.8%
ONCE IN A SEMISTER 15 34.1%
NEVER 1 2.2%

The table above presents the number of times the respondents have been taught self breast
exam.The highest respondents percentage was rarely 25(56.8)while the least percentage was
never 1(2.2%)who had never learnt about self breast examination in their institution.

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Figure 4.9 Self Breast Examination

The pie chart below most of the respondent 43(97.7%)ever carried out self breast examination
while 1(2.3%)have not.

Key
2%

YES
NO

98%

Table 5.0Roles of self breast examination

ROLES OF FREQUENCY PERCENTAGE
EXAMINATION
YES 40 90.9%
NO 4 9.1%

The table above shows most of the respondents have been taught the roles of breast self
examination 40(90.9%) followed by 4(9.1).
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Figure 5.1 Educational pamphlets and video programmes
The pie chart below 24(54.5%) of the respondent have been shown pamphlets hand outsfeaturing
breast screening and self examination while 20(45.5%)have not had programmed featuring self
examination.

BSE

YES
46% NO

55%

Figure 5.2 Academicequipping schools with Breast Healthmaterials

Column3
80.00%

70.00%

60.00%
Column3
50.00%

40.00%

30.00%

20.00%

10.00%

0.00%
AGREE DISAGREE AGREE STRONGLY DISAGREE STRONGLY

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According to the bar graph above, majority of the respondent disagreed equipping schools with
academic materials is most important 30(68.1%) while the least strongly disagreed with
equipping schools with breast health education material 1(2.2%).

Figure 5.3 Cultural Beliefs

2%

23%

1st Qtr
2nd Qtr
7% 3rd Qtr
4th Qtr

68%

According to the pie chart above 30(68.1%) respondent agree cultural belief and practices in the
community may prevent students from undertaking breast examination and cancer screening
while 1(2.2)disagree strongly it may not affect an individual cultural practice to undertake breast
screening and cancer breast examination.

Table 5.4 Stigmatization and social pressure influence

STIGMATIZATION OF CANCER FREQUENCY PERCENTAGE
YES 38 86.4%
NO 6 13.6%

Most respondents agreed social pressure and stigmatization of cancer may prevent students from
going for early cancer screening 38(86.4%) while 6(13.6%)said it will not affect and prevent one
from going for cancer and breast screening.

22
Figure 5.5 Cost of breast cancer screening
The Bar graph below 30(68.1%) agreed that the cost of breast cancer screening may prevent
students from going for early breast cancer screening while 1(2.3%)disagreed the cost may not
prevent students for going for cancer breast screening.

80.00%

70.00%

60.00%

50.00%

40.00%
Column1

30.00%

20.00%

10.00%

0.00%
Agree Disagree Agree srongly Disagee strongly

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 CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATIONS

5.1 INTRODUCTION
This chapter presents the investigations on the factors that influence the uptake of breast cancer
screening among Machakos University female students in Machakos County. Findings of the
study will hence contribute to some knowledge to stakeholders, policy makers on how to come
up with more effective curriculum to promote and enhance the curb cases of breast cancer not
only among the students in the country but the country at large.

This chapter contains a summary of the characteristics of respondents the study findings,
conclusions and recommendations on the ways of breast cancer at large.

5.1.1 Students level of awareness about Breast Cancer, Breast Self Examination and
BreastCancer Screening

Most of the respondents 56% were unaware of the breast cancer existence, BSE and breast
cancer screening. This can be clearly defined and shown in chapter four.

5.1.2 Institutional characteristics in Breast Screening Uptakeamong students

In the study the associations found was between, breast health education at school and
breast screening and uptake, guidance and follow-up by nurses on BSE and the uptake of
screening advertisement on breast cancer screening and uptake of the screening. Thirty one
point eight percent of the respondents who did not undertake screening and low knowledge about
breast cancer and the screening process, while79.5% of the students have never gone for clinic
breast examination never have been provided with breast health education from the hospital or
schools.

5.1.3 Psychosocial factors in Breast Cancer Screeninguptake

The research findings year and breast screening uptake, the anticipated pain during breast cancer
screening uptake among the respondents social stigma, the concern that breast screening is
embarrassing and the uptake of clinical breast examination, seventy nine point five of the

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respondents have never gone for or undertake BSE due to fear associated to finding breast
cancer .

5.1.5 Socio-Economicand Culture factors in Breast Cancer Screening uptake

A greater percentage showed travel distance to the screening facility and clinical breast screening
uptake ,the cost of screening and uptake of clinical breast screening ,commitments and uptake of
clinical breast examinations respondent was a major challenge ,79.5% of the respondents have
never gone for clinical breast examination due to long distance to screening facilities .whereas
68.1% of the respondents agreed that cost of breast cancer screening hindered them from
undertaking and going for the breast cancer screening . 86.4% of the respondents agreed
stigmatization would prevent them being done breast screening uptake

5.1.6 Demographic Factors

More findings showed most respondents were aged 21-30 years (55%) all female while the
minority above 30 years (20%).98%of the total respondents had heard about breast cancer
screening.

Institutional factors was also a major hindrance in the uptake of breast examination whereby due
to the attitude of the care givers contributed to drop out and reduce numbers of taking breast
cancer screening and examinations

Majority of the respondents said that distance to the screening facility was a weight to either go
for the BSE or not 68.1% of the total respondents agreed cultural beliefs and practices in the
community may prevent them from undertaking breast clinic examinations.

5.2 Implication of the study findings

Majority of the respondents 31.8% interviewed had never done or gone for any breast cancer
screening where as there is need for more innovative and aggressive ways to improve uptake
among the female students.

25
A larger percentage of the respondents (45.45%) received information about breast cancer and
screening programs and advertisements through the television where the is more need to explore
the

Television programmes and increased breast screening and examination advertisements on

breast cancer screening uptake to create awareness correct misconceptions and promote breast
screening cancer uptake.

26
 CHAPTER SIX

CONCLUSION AND RECOMMENDATION

6.1 CONCLUSION
The study and analysis was to establish factors that influence the uptake of breast cancer
screening among Machakos University students.

The following were found and concluded by the researcher

The study showed that 20%of the respondents hadnever gone for clinical breast examination
screening .The study showed that most of the respondents were informed well about the breast
cancer and the screening services.

The study also showed that educational forum will be a beneficial factor for knowledge purpose
for the students that most of the respondents were informed well about the breast cancer
screening services.

The study showed that educational forum will be beneficial factors for knowledge purpose for
the student’s health practioner should also be given opportunities to address the breast awareness
and provide screening services to the students.

6.2 Recommendation
Following the researchers findings, the researcher would like to make the following
recommendation;

The Ministry of Health in collaboration with the ministry of Education should create more level
and create awareness through advertisements on breast cancer and screening through radio,
internet, television, issue of brochures and posters to bring increased awareness and an attitude
change to promote the uptake.

The Ministry of Health comes up with a breast cancer screening policy to facilitate in price
reduction of consultation and screening fee to enable students who come from poor social
economic status uptake breast cancer screening.

27
The Ministry of Health should introduce mobile screening units to bring services closer to the
students willing and are able to uptake breast cancer screening so to improve the students well
being health will to improve the breast cancer screening uptake.

The ministry of Education and the Ministry of Health should work on the policy framework to
keep and spread the knowledge on breast cancer screening information to the students at the
school level through an intergraded curriculum and public forums to counter fears and also
misconceptions about breast cancer.

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REFERENCES
AkhatariZaare M, Hanafiah JM, Abdul MR et al(2011).Knowledge on breast cancer and practice
of breast self examination among select female university in Malaysia. MHSY,7, 49-56.

Bailey E.J. Erwin D.O and Beline, P. (2012) using cultural Beliefs and patterns to improve
mammography utilization among African-American Women; the eye witness project .J Nalal
made association ;92(3): 136-42.

Banks E. Beral V. Cameron R.Hogg A.and Langley N.(2012)Comparison of various

characteristic of women who Do and Do not attend for breast screening. Breast Cancer Research,
4(1):1465-5411.

Breast Screening Programme England: 2014/05 National Statistics/NHS Health and social care
Information centre.

MOH-Kenya (2010).The National Health Sector Strategic Plan 1994-2004. Government of

Kenya press Nairobi.

Musimbi A (2015). Cancer in Kenya American J of clinical Onco.

Neondo Henry (2015) The Kenya Breast Health Programme.Early detection saves lives.

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