ISSN 2277 -7067

UGC CARE Group 1

PRE-EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF SELF

INSTRUCTIONAL MODULE (SIM) ON KNOWLEDGE AND ATTITUDE TOWARDS
BREAST SELF-EXAMINATION TO DETECT CHANGES IN BREAST LEADING TO
CANCER AMONG SCHOOL TEACHERS IN URBAN COMMUNITY DELHI, INDIA.

Ms. Sunita Waswani

Tutor, Florance Nightingale College of Nursing, GTBH-110095
Dr. Neenumol K Jose
Associate Professor, Jagannath Gupta Institute of Nursing Sciences, India, Kolkata-700137
Mr. Justin V Sebastian
Associate Professor, Jagannath Gupta Institute of Nursing Sciences, India, Kolkata-700137

Abstract
Each year, more than 1.15 million new instances of breast cancer are identified throughout
the world. The high breast cancer-related death rate among women is exacerbated by the late
detection of the disease. Early detection of breast cancer improves not only the chances of
successful treatment, but also the chances of survival. A study was conducted utilising a
quantitative research approach with a pre-experimental, one-group, pre-test, and post-test research
design. Non-probabilistic, purposive sampling was used to pick 40 female school teachers in the
Delhi-National Capital Region. A structured knowledge questionnaire and attitude scale were
utilised to evaluate the effectiveness of the Self Instructional Module (SIM) on the knowledge and
attitude of female school teachers regarding Breast Self-Examination (BSE) to detect any changes
in the breast that may lead to breast cancer. The mean post- test knowledge and attitude scores
44.125 and 13.35 were significantly higher than mean pre-test knowledge and attitude scores
26.425 and 11.3. Difference among Mean Post Test and Pretest Knowledge Score is 17.7 and in
Attitude, it is 2. The ‘Z’ Value calculated is 4.95 and 0.51 whereas ‘Z’ Value tabulated at 0.05
level of significance (P Value) is 2 and 0.29 respectively which indicates that the ‘Z’ calculated is
greater than ‘Z’ Value tabulated. Hence, null hypothesis was rejected and Self-Instructional
Module on Breast Self-Examination was found to be effective. There was no significant
association of pretest knowledge score with selected demographic variables such as age (X2 = 3.4),
previous education on breast self-examination (X2=0.20), religion(X2=1.44), marital status
(X2=2.62), income (X2=2.9), educational status (X2=1.57) at 0.05 level of significance. The above
findings clearly depict that the intervention was effective in enhancing the knowledge and attitude
among school teachers regarding breast self-examination.
Keywords: Breast Self-Examination, school teachers, detect changes in breast.
Introduction
Most forms of cancer cells eventually develop a lump or mass called a tumour, which is
named for the portion of the body where the tumour originates. Breast cancer is the most prevalent
form of cancer among American women (other than skin cancer). Each year, more than 1.8 million
women in the United States are diagnosed with breast cancer. The most prevalent kind of breast
cancer is ductal carcinoma, which originates in the ductal cells. The cancer that originates in the
lobes or lobules is known as lobular carcinoma, and it is more prevalent in both breasts than other

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types of breast cancer. Family history of breast cancer, menarche before 12 years of age,
menopause after 55 years of age, null parity or first child after 30 years of age, obesity and
excessive exposure to ionising radiation before 30 years of age, personal history of breast cancer,
hormonal dysfunction, stress, and an unhealthy lifestyle are the most significant risk factors for
breast cancer.
It is estimated that over 100,000 new cases of breast cancer are diagnosed annually in India.
Breast cancer is the most prevalent cancer among women in the urban registries of Delhi, Mumbai,
Ahmedabad, Calcutta, and Trivandrum, where it accounts for > 30% of all female cancers. The
age-standardized incidence rates for Indian women range from 6.2% to 39.5% per 100,000. The
standard incidence rates vary by geography, ethnicity, and religion, with the highest incidence
reported in the Parsi community of Mumbai (48.3 per 100,000 women). According to the World
Health Organization, breast cancer is the most common cancer among women, affecting over 2
million women annually and causing the most cancer-related deaths among women. WHO
emphasises early detection of breast cancer, which allows for more effective treatment and reduces
the risk of breast cancer-related death.
Statement of the problem
Pre-Experimental Study To Assess The Effectiveness Of Self Instructional Module (SIM)
On Knowledge And Attitude Towards Breast Self-Examination To Detect Changes In Breast
Leading To Cancer Among School Teachers In Urban Community Delhi, India.
Methods and Material
A quantitative research strategy that includes a pre-experimental one-group pretest and
post-test was employed as the research design. A non-probabilistic purposive sampling was used
to pick forty female school teachers from Delhi-NCR. Utilizing a systematic knowledge
questionnaire and attitude scale, the effectiveness of self-instructional modules (SIM) on
knowledge was determined. This study utilised a pre-experimental, one-group, pre-test and post-
test research design. In a one-group pre-test–post-test strategy, the researcher administers a base
measure before and after the scheduled exposure, denoted by O1 and O2 accordingly. Knowledge
and attitude scores of school teachers regarding Breast Self-Examination (BSE) to detect breast
changes leading to cancer at selected schools in Delhi-NCR were selected as dependent variables
for the study. The Self-Instructional Module (SIM) on knowledge and attitude regarding breast
self-examination (BSE) to detect breast changes leading to breast cancer served as the study's
independent variable. The study population consisted of female school instructors over the age of
20 from selected Delhi-NCR schools. Forty female school teachers from selected Delhi-NCR
schools served as samples. Purposive sampling was employed for this study. The sampling criteria
includes all female school teachers over the age of 20 from chosen Delhi-NCR schools. The study's
data collection instrument and method were a questionnaire and questioning. Parts of the
Structured Questionnaire 1-Demographic Data such as: Age, Religion, Marital Status, Teacher's
Education, Teacher's Occupation, Teacher's Income (Annual Income), Teacher's Place of
Employment, Ever attended an educational programme on Breast Self-Examination, and Any
Family History of Breast Cancer. Part 2 of the Breast Self-Examination and Breast Cancer
Knowledge Questionnaire consists of 35 questions. For each accurate response, "2" (two) marks
will be awarded, and for each incorrect response, "0" (zero) marks will be awarded. Ten items
comprise PART 3-Attitude Scale regarding Breast Self-Examination The most appropriate

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response will receive a 2, and the least appropriate response will receive a 0. (zero). Part 4-
Treatment-Development of Self-Instructional Module (SIM) on information and attitude regarding
Breast Self-Examination (BSE) in order to detect any breast changes leading to breast cancer.

EXPERIMENTAL
PRE TEST TREATMENT POST TEST
GROUP

Schematic outline of the research design.

Results
Analysis and interpretation of the data are organized under the following sections:
Section A - Demographic Characteristics of Study Subjects
Section B - Mean, Standard Deviation, Range and Z Test values of knowledge and attitude scores
of female school teachers regarding Breast Self-Examination and Breast Cancer
Section C - Association between knowledge & attitude scores and selected demographic variables
SECTION A: Demographic Characteristics of Study Subjects
Table 1-Frequency and Percentage distribution of sample characteristics (n=40)
SL.No DEMOGRAPHIC DEMOGRAPHIC FREQUENCY %
VARIABLES VARIABLES

1 Age (in years) 21-30 12 30%

31-40 22 55%
41-50 - -
51-60 6 15%
2 Religion Hindu 22 55%
Muslim 12 30%
Christian 6 15%
Others - -
3 Marital Status Married 34 85%
Unmarried 6 15%
Divorced/ Separated/ - -
Widow

4 Teacher’s Education Graduation 22 55%

Post-Graduation 12 30%
M. Phil - -
PhD 6 15%
5 Teacher’s Occupation Private School 40 100%

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6 Teacher’s Income High Economic Status 4 10%

(Annual Income) Middle Economic 30 75%
Status

Low Economic Status 6 15%

7 Ever attended any Yes 6 15%
Educational No 34 85%
programme on Breast
Self-Examination?

8 Any Family history of Yes - -

Breast Cancer? No 40 100%

SECTION B: Mean, Standard Deviation, Range and Z Test values of knowledge and attitude
scores of female school teachers regarding Breast Self-Examination
Table 2: Mean, Range and SD of knowledge scores regarding Breast Self-Examination

MAX. ZC P
Z
COMPONENTS RANGE MEAN SD SE
al Tab
SCORE Value

Pretest scores (K) 70 40-20 = 20 26.425 3.6

Post test scores (K) 70 60-28 = 32 44.125 8

3.57 0.51 0.05 0.29

Pre test scores (A) 20 16-8 = 8 11.3 2.34

Post test scores (A) 20 20-12 = 8 13.35 4 4

4.95 0.05 2

Table 2 - shows that the difference among Mean Post Test and Pretest Knowledge Score is 17.7
and in Attitude, it is 2. The ‘Z ’Value calculated is 4.95 and 0.51 whereas ‘Z ’Value tabulated
at 0.05 level of significance (P Value) is 2 and 0.29 respectively which indicates that the ‘Z ’
calculated is greater than ‘Z ’Value tabulated. Hence, null hypothesis was rejected and Self-
Instructional Module on Breast Self-Examination was found to be effective.
Figure 1- Pre-Post Test Knowledge and Attitude Mean Scores of Study Subjects

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50.
44.13

40.
32.
30. 26.43
20.
20.
13.35
11.3
10. 8 8. 8.
4 4 4.95
2
0.51
0.

Figure 1 represents the mean of knowledge and attitude scores of study subjects before and after
administration of SELF-INSTRUCTIONAL MODULE ON BREAST SELF- EXAMINATION
i.e. Pre-Post Test Mean Scores.
H1: There will be a significant difference between pretest & posttest knowledge & attitude score
regarding breast self -examination regarding early detection of changes in breast.
SECTION C: Association between Post-test knowledge mean scores and selected
demographic variables
Table 3: Mean and Chi Square of post-test knowledge scores regarding breast self-
examination according to selected demographic variables

Scores
Freque Mean Mean( 2
A. AGE Knowledg c Df
ncy Attitude (K) A)
e
(Post)
(Post)

a) 21-30 12 504 151 42 12.58

b) 31-40 22 1003 284 45.5 12.9 3.16NS 2

c) 51-60 6 258 99 43 16.5

B. EVER ATTENDED ANY EDUCATIONAL PROGRAM ON BREAST SELF
EXAMINATION
a) Yes 6 308 79 51.3 13.16 1

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b) No 34 1457 455 42.85 13.38 0.20NS

C. RELIGION

a) Hindu 22 973 290 44.2 13.18

b) Muslim 12 546 166 45.5 13.83 1.44NS 2

c) Christian 6 246 78 41 13

D. MARITAL STATUS

a) Married 34 1477 441 43.44 12.97

2.62NS 1
b)
6 288 93 48 15.5
Unmarried

E. INCOME (Economic Group)

a) High 4 160 48 40 12

b) Middle 30 1345 399 44.8 13.3 2.9NS 2

c) Low 6 260 87 43.3 14.5

F. EDUCATIONAL STATUS

a)
22 988 292 44.9 13.27
Graduation

b) Post- 2
12 504 177 42 14.75
Graduation 1.57NS

c) PhD 6 273 65 45.5 10.83

Table 3 depicts that the tabled χ2 value for 1, 2 and 3 degree of freedom was 3.84, 5.99 and 7.82
at p<0.05 level of significance and the calculated ‘χ2’ value is less than the tabled value among all
selected demographic variables and post-test knowledge scores of female school teachers above
20 years of selected schools of Delhi-NCR regarding breast self-examination. The difference was
found to be statistically non-significant in all above cases.
H2: There is no significant association between post-test knowledge score and selected

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demographic data as calculated p value is greater than the calculated chi square value.
Discussion
The difference between the mean post-test and pre-test knowledge score is 17.7 and the
mean post-test and pre-test attitude score is 2. The calculated 'Z' Value is 4.95 and 0.51, whereas
the tabulated 'Z' Value at the 0.05 level of significance (P Value) is 2 and 0.29, indicating that the
computed 'Z' is bigger than the tabulated 'Z' Value. Thus, the null hypothesis was rejected and the
effectiveness of the Self-Instructional Module on Breast Self-Examination was determined. The
post-test knowledge mean scores regarding breast self-examination were higher in age group 31-
40 (knowledge) and age group 51-60 years (attitude) relative to other age groups, higher in
Muslims (knowledge and attitude) relative to other religions, higher in PhDs (knowledge) whereas
attitude mean scores were higher in Post Graduates (attitude) relative to others, higher in those
who belonged to the Middle-Economic Group (knowledge) whereas attitude mean scores were
lower in those who belonged to According to the results of the present study, all specified
demographic characteristics and knowledge and attitude ratings of female schoolteachers on breast
self-examination did not differ in a statistically significant manner.
Summary and Conclusion
The present study was conducted to evaluate the Effectiveness of Self-Instructional Module on
Breast Self-Examination among female schoolteachers working in selected schools of Delhi-NCR.
Data was collected by structured questionnaire regarding knowledge of female school teachers
regarding breast self-examination. Literature related to incidence, causes and prevention of breast
self-examination was retrieved. The tool was prepared and pretested for validity and reliability.
The Pilot Study was conducted from 19.03.21 to 26.03.21 in selected schools of Delhi-NCR on 5
samples selected with the help of purposive sampling method to check feasibility and practicability
of the study in the setting. Final study was carried out in selected schools of Delhi-NCR between
1-15 of April 2021. Descriptive and inferential statistics were employed to analyse the data.
The following conclusions were made based on findings of the study:
• It was found that Average knowledge and attitude score was 63% and 66.75%.
• Study subjects were deficit of knowledge regarding breast self-examination.
• The Self-Instructional Module was effective in enhancing the knowledge and attitude
regarding breast self-examination among female schoolteachers.
• Also, it indicates that Self-Instructional Module was effective in updating, motivating and
encouraged female schoolteachers to participate, learn and maintain positive attitude regarding
breast self-examination and breast care.
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