KNOWLEDGE AND PRACTICES ON SELF-BREAST EXAMINATION AMONG

FEMALE CLIENTS ATTENDING KABALE REGIONAL REFFERL HOSPITAL,

KABALE DISTRICT

A RESEARCH REPORT SUBMITTED TO KABALE SCHOOL OF COMPREHENSIVE

NURSING IN PARTIAL FULFILMENT OF

THE REQUIREMENT FOR THE AWARD OF A DIPLOMA

IN NURSING EXTENTION

AINEMBABAZI JACKLINE

Ainembabazijack@gmail.com

NSIN NUMBER:

JAN21/U008/DNE/002

May2022
 DECLARATION

I AINEMBABAZI JACKLINEdeclare to the best of my knowledge that this research report is

my original work and that it has never been submitted to this institution for the award of a

diploma in nursing.

……………………………….. ……../……/……….

Signature Date

i
 REPORT APPROVAL FORM

Name of the student: AINEMBABAZI JACKLINE.

Title of research study:Knowledge and practices of self-breast examination among female

clients attending Kabale KRRH, Kabale district

I hereby accept this reportfor the above research study and approve it for submission to Kabale

School of Comprehensive Nursing Research Committee.

Signature ……………………………….. Date: ……………..

MR. DANGI RONALD

Supervisor

Signature: ………………………………….. Date: ………………

NAMBIRO JOSEPHINE KIGOZI (MRS)

Principal

ii
 TABLE OF CONTENTS

DECLARATION..............................................................................................................................i

REPORT APPROVAL FORM.......................................................................................................ii

TABLE OF CONTENTS...............................................................................................................iii

LIST OF ABBREVIATIONS........................................................................................................vi

DEFINITION OF KEYS...............................................................................................................vii

CHAPTER ONE: INTRODUCTION..............................................................................................1

1.1Background of the study.............................................................................................................1

1.2 Problem statement.....................................................................................................................3

1.3Purpose of the study....................................................................................................................3

1.4Specific Objectives.....................................................................................................................3

1.5 Research questions.....................................................................................................................4

1.6 Justification of the study............................................................................................................4

CHAPTER TWO: LITERATURE REVIEW..................................................................................5

2.0 Introduction................................................................................................................................5

2.1 Knowledge of self-breast examination among female clients...................................................5

2.2 Practices of self-breast examination among female clients.......................................................6

CHAPTER THREE: METHODOLOGY......................................................................................10

3.1 Introduction..............................................................................................................................10

3.2 Study design.............................................................................................................................10

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3.3 Study setting............................................................................................................................10

3.4 Study population and sample size determination....................................................................11

3.4.1 Study population...................................................................................................................11

3.4.2Samplesize determination......................................................................................................11

3.5 Sampling procedure.................................................................................................................11

3.6 Inclusion criteria......................................................................................................................11

3.7 Definitions of variables............................................................................................................12

3.7.1 Dependent variables..............................................................................................................12

3.7.2 Independent variables...........................................................................................................12

3.8 Research instrument.................................................................................................................12

3.9 Data management and Analysis...............................................................................................12

3.9.1 Data management.................................................................................................................12

3.9.2 Data analysis.........................................................................................................................12

3.10 Ethical considerations............................................................................................................12

3.11 Limitations of the study.........................................................................................................13

3.12Dissemination of results.........................................................................................................13

CHAPTER FIVE...........................................................................................................................32

DISCUSSION, CONCLUSION AND RECOMMENDATIONS.................................................32

5.0 Introduction..............................................................................................................................32

5.1 Discussion of findings.............................................................................................................32

iv
5.1.1 Demographic characteristics.................................................................................................32

5.1.2 Knowledge of respondents towards SBE.............................................................................32

5.1.3 Practice on SBE....................................................................................................................34

5.2 Conclusion...............................................................................................................................35

5.3 Recommendations....................................................................................................................35

5.4 Implication to nursing practice................................................................................................36

5.5 Limitations of the study...........................................................................................................36

5.6 Recommendations for future studies.......................................................................................36

APPENDIX I: CONSENT.............................................................................................................40

APPENDIX II: QUESTIONNAIRE..............................................................................................41

APPENDIX V: BUDGET..........................................................................................................49

APPENDIX VI: MAP OF UGANDA SHOWING LOCATION OF KABALE DISTRICT.......50

APPENDIX V: A MAP OF KABALE DISTRICT SHOWING KRRH.......................................51

v
 LIST OF ABBREVIATIONS

KSCN: Kabale School of Comprehensive Nursing

LAB: Laboratory

MCH: Maternal Child Health

OPD: Outpatient Department

RRH: Regional Referral Hospital

SBE: Self-Breast Examination

WHO: World Health Organization

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 DEFINITION OF KEYS

Knowledge: Awareness about SBE

Practices: What women are doing concerning breast self-examination

Breast self-examination: SBE is the examination done by the individuals to help identify

any abnormality within the breasts. Self-breast examination involves the process where by

women inspect the breasts regularly to detect any abnormal swelling and ready for taking

medical care for early recognition of breast cancer, self-breast examination is a useful tool.

vii
 CHAPTER ONE: INTRODUCTION

1.1Background of the study

This chapter explores the introduction to the study, problem statement, and background to the

study, research objectives, and research questions, Purpose of the study andJustification of the

study.

Globally, over one million breast cancer cases and other breast related diseases are diagnosed

annually and breast cancer is the second leading cause of cancer death in women and poses a

global public health concern. In addition, there is an increased burden of breast cancer in both

developed and developing countries including Uganda (Ferlay J, et al, 2012)

In sub-Saharan Africa, breast cancer is on the rise with incidence of 33.8 per 100000 women per

year, especially in Uganda where it has risen by 5.2% per year during the past 15 years (Scheelet

al, 2018).

Uganda, a low income country has breast cancer age standardizes incidence of 21.3/100000

population and mortality rates of 10.3/100000 population (Bray,et al, 2018) indicating that

nearly one half of Uganda women who are diagnosed with breast cancer will die of their disease.

Up to 89% of women in Uganda will present with stage III/IV disease, a time at which breast

cancer is more difficult to treat and the outcomes are poor (Galakande M et al, 2015)

For early identification of breast cancer, BSE is an important and inexpensive method which can

help detect cancer at an early stage. Breast self-examination is the examination done by

individuals to help identify any abnormality within the breasts, It involves visually and by hand

examining the breasts and It is done at age of 20 years and monthly rather a few days after an

individual menstrual period when breasts are slightly swollen(NG Dinegde, 2020) . Breast self-

viii
examination (BSE) involves a process whereby women inspect their breasts regularly to detect

any abnormal swelling and ready for taking medical care.

For early recognition of breast cancer, breast self-examination is a useful tool. It is therefore

more practical approach in a resource limited setting like Uganda to detect and manage breast

cancer early for good prognosis (Ardahanet al, 2015).

According to Mohammed (2013), Breast self-examination is most important skill in prevention

of breast cancer and by performing it regularly women can save themselves from getting the

disease and death can have prevented too. It is very simple, requires no instrumental and easily

performed by every woman. Early diagnosis is important for effective treatment and long term

survival in breast cancer. Knowledge also plays an important role in improvement of health

seeking behavior. Knowledge and practices of breast self-examination plays an important role in

early detection of breast cancer.

Inadequate knowledge about breast cancer is documented as an important factor in preventing

women from visiting screening facilities, engaging in BSE, and delayed treatment, and thus

contributes to the high morbidity and mortality rates (Ma & JEMAL, 2013)

Numerous studies have indicated the need for conducting more research on breast cancer

knowledge, screening practices and factors such as life style changes to address the increasing

morbidity rates (Howell et al, 2014).

Although SBE is a simple, quick and cost free procedure, it appears that many women either

perform it incorrectly or not at all. There is a need to know awareness level and screening among

these females. Therefore, this study will be to access the knowledge and practice of breast self-

examination of breast cancer screening among female clients attending Kabale RRH.

ix
1.2 Problem statement

Breast self-examination is an ideal way for detecting cancer at its early stages which can easily

be managed and complications prevented, also the practice of SBE has been seen to empower

women taking responsibility of their own health. Although SBE is a simple quick and cost free

practice, it appears that many women either perform it incorrectly or not at all.

Considering a study by C. Joyce et al, (2020), less than 50% of the participants had ever had

about SBE and 41.4% had never done SBE and 32.6% had ever practiced and last did it a month

ago. Only 16.9% did SBE monthly while 33.7% practiced whenever they felt unwell.

At Kabale RRH, there is no documentation on knowledge and practice about SBE.So there is

limited knowledge and low practice. Lack of knowledge on SBE is anticipated to continue being

responsible of increasing breast cancer cases if not addressed.

This has motivated the researcher to undertake the study in order to make some

recommendations to stake holders so as to increase knowledge of female clients on SBE.

1.3Purpose of the study

The purpose of the study is to establish knowledge and practices among female clients

attendingKabale RRHKabale district.

1.4Specific Objectives

1. To establish knowledge of self-breast examination among female clients attending

Kabale RRH.

2. To identify practice of self-breast examination among female clients attending Kabale

RRH.

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1.5 Research questions

1. What is the level of knowledge of self-breast examination among female clients attending

Kabale RRH?

2. What are the practices of self-breast examination among female clients attending Kabale

RRH?

1.6 Justification of the study

The study finding will help to identify the gaps or priority areas on improving knowledge and

practices on SBE so that they can pass on knowledge to other clients in communities. This will

further help to detect changes in their breasts hence timely management which enhances good

outcomes of prognosis.

This study finding will also help nursing practitioner to develop suitable interventions so as to

enforce the practice of SBE among female clients attending Kabale RRH.

Study will further help to identify knowledge and practice gaps in self-breast examination among

female clients attending Kabale RRH. These gaps will further be for future research.

xi
 CHAPTER TWO: LITERATURE REVIEW

2.0 Introduction

This chapter reviews literature related to Knowledge and practices of SBE among female clients

both in Uganda and internationally.

2.1 Knowledge of self-breast examination among female clients

A study by Segniet al., (2016) assessed knowledge of regular SBE among nurses at Adam

University, Ethiopia revealed a mean age of 22.9 years and majority 94.2% respondents were

less than 30years old. 62% being orthodox religion and more than 80% of them were single.

A study in Malaysia found out that women in rural areas had lower levels of knowledge about

BSE than those in urban areas (Khan T.M, et al., 2015).

Conde P, et al., 2018, found out that, 56.9% of the female practiced SBE and Practice was

associated with level of education.

C. Joyce, et al., (2020) reported that less than half of the respondents (39.4%) reported having

heard about Self Breast Examination and (60.6%) did not hear about Self Breast Examination.

Out of the 152 respondents who heard about Self Breast Examination, majority (55.9%) obtained

the information from the health worker followed by News/media (23%). This indicates that there

is moderate flow of information about BSE.

Study carried out among university students of Tabuk which revealed that almost all (95.5%) of

the participants had knowledge on Self Breast Examination and the primary source of

information was news/media (40.3%) followed by health workers (21.7%) (Gonzales et al.,

2018) In addition, a study by Katende G, et al., (2015) revealed a high awareness of breast

cancer (98.0%) and BSE practices (76.5%) among female students. Katende G, et al., further
xii
states (56.9%) of female students received information about breast cancer via mass media.

Cross-sectional study by Amoran and Toyobo (2015) which examined the factors influencing

SBE awareness and practice among women in Ogun State in Nigeria indicated that 58.2% had

awareness of SBE while 24.4% had ever performed it, and only 5.3% carried it out on monthly

basis. About 58.2% had awareness of SBE, while 24.4% had ever performed it, and only 5.3%

carried it out on monthly basis. A house hold survey in Kyadondo County conducted by

Atuheirwe during June, 2014 to august, 2015 revealed that 54% of the population had no

knowledge about BSE, 24% knew but never practiced it correctly and only 22% did it correctly.

2.2 Practices of self-breast examination among female clients

A study conducted by Farley J, et al., (2012) in Nigeria that found that respondents were unable

to identify practices related to SBE in cancer awareness e.g.; high-fat diets and obesity as risk

factors for breast cancer.

Knowledge of breast cancer is paramount in promoting SBE practices. A study by Habu H, et

al., (2017) in Ghana, showed that a great majority (95.4%) had heard about self-breast

examination while 2.8% had not heard about it while 1.8% was undecided. Furthermore, a great

number (69.7%) of the female nursing students heard about SBE from health professionals

followed by television (19.5%), friend (8%) and other medium (2.8%).

In addition, 41.3% stated that SBE should be done from age 18-23 years while 36.7% stated that

SBE should be done at 12-17 years and 22% from 24 and above. Furthermore, study among

nursing students in Lahore reported 100% knowledge on SBE. This is possibly because nursing

students may have heard about SBE from school and the training hospitals (Umbreen and

Medical, 2017)

xiii
In South Africa, only 2% of the studied rural women recognized SBE as a screening method for

breast cancer, even though more than a third knew how to do SBE correctly (Ramathuba DU, et

al., 2015)

A study by Joyce, et al., (2020) indicated that 58.6% had heard about Self-Breast Examination,

only 24.3% of them reported correctly that it should be done on a monthly basis, and 46.7% did

not know how often it should be done. When asked about the time of the month Self-Breast

Examination should be done, only 11.8% of the respondents reported correctly that it should be

done one week after periods while 44.1% of the respondents did not know the correct time of the

month to do examine their breasts. Furthermore, Segni, (2016) among health science students

indicated that (44.1%) of the respondents correctly reported that B Self-Examination should be

done monthly and while 25.6% of the respondents didn’t know when and how often it should be

done.

Previous studies have also documented that women who are more aware about the benefits of

early detection of breast cancer are more likely to perform Self Breast-Examination (Khan T.M,

et al., 2015).

A study carried out in 3 universities in Ajman where 22.7% of the participants had ever done

Self Breast-Examination and more than half (77.3%) had never done SBE (Al-Sharbattiet al.,

2018). Furthermore, C. Joyce, et al., (2020) revealed that out of 152 participants who heard

about Self Breast-Examination, more than half (N = 89, 58.6%) had ever practiced SBE and

41.4% had never practiced it. Looking at above, practice is low. Cross-sectional study by

Amoran and Toyobo (2015) which examined the factors influencing SBE awareness and practice

among women in Ogun State indicated that 24.4% of the respondents had ever performed it.

Amoran and Toyobo further indicated that only 5.3% carried out SBE on monthly basis.

xiv
In a study to determine the prevalence and factors determining the practice of SBE in Nigerian

women attending a tertiary outpatient clinic, indicated that self-reported prevalence of SBE

practice was 62.1%, out of which only 12.6% performed it monthly. The highest prevalence was

among older women, 76.2%; married women, 65.6%; and women with tertiary education,

68.9%; civil servants, 78.1%; women with previous history of breast disease, 68.2%; and women

with family history of breast disease, 63.6%OgunbodeA.M. et al., (2015)

In a study to assess breast cancer knowledge, screening practices, and educational preferences

among outpatients at Tanzanian Government-supported hospitals Morse E.P, et al., (2014)

reported that awareness among female respondents was 56%. Of these, 25.4% practiced SBE

regularly, 34.1% practiced it occasionally, and 40.5% never practiced it.

In another study that described Cameroonian women’s knowledge of SBE and their impression

on the practice of SBE, 36.7% recognized breast self-examination as a breast cancer prevention

method, while 59.2% claimed to know how to perform SBE with 35% reportedly practicing it

monthly (Suh M.A, et al., 2012)

A study to assess the KAP of self-breast examination among women attending a health facility in

Gaborone, Botswana, and indicated knowledge of SBE was 74.7% with 37% practicing monthly.

This indicates that skills related to SBE were found low. (Tieng’O JG, et al., 2011)

In cross-sectional study among 170 female traders with aim to determine the knowledge and

practices of SBE among market women at Makola shopping mall, Accra, Ghana, 93% were

aware SBE, but only 27% practiced SBE as recommended due to lack of knowledge of basic

skills to do BSE (Kudzawu, E, et al., 2016). Furthermore, Tieng’O JG, et al., (2011) stated that,

the most common reason given by those who did not practice was lack of knowledge on how to

do SBE.

xv
Katende. G, et al., (2015) about Self Breast examination Practices among Female University

Students in Kampala, Uganda found out that over half the students (61.3%) had an intermediate

level of knowledge about SBE and risk factors related to breast cancer For example, half of the

students were unaware that a family history of breast cancer. In addition, few participants were

able to identify late menopause, late initiation of breastfeeding, and having the first child after

the age of 30 years as risk factors.

In Uganda, both the knowledge and practices of self-breast examination is low. Less than 50% of

the participants had ever had about SBE and its intentions like early detection of cancer. Only

24% of those who had ever heard SBE correctly reported that it should be one monthly (K

Godfrey, 2016)

xvi
 CHAPTER THREE: METHODOLOGY

3.1 Introduction

This chapter covered the study design, study area, study population, sample size determination

and procedure, inclusion criteria, study variables, data collection tool, data collection techniques

and procedures, data analysis, data presentation, ethical considerations, limitations of the study

and dissemination of results.

3.2 Study design

Across sectional research design employing quantitative method was used. This design was

chosen because it allows the researcher to correct primary data from respondents directly hence

saving time on the research.

3.3 Study setting

Kabale regional referral hospital is located at Makanga hill 1km east of the post office and

406km from Kampala capital city of Uganda. It has bed capacity of 800 and serves the district of

Kabale, Kanungu, Kisoro, Rukungiri and some parts of Ntungamao. The hospital offers various

specialized fields of medicine under departments that include OPD, LAB, medical, surgical,

MCH, gynecological, family planningand obstetrics, pediatrics, psychiatry, among others. The

study was specially carried out in family planning unit, gynecological ward and MCH.

xvii
3.4 Study population and sample size determination

3.4.1 Study population

Female clients attending the family planning unit, gynecological ward and MCH in Kabale

regional referral hospital. They were undertaken for the study because they serve a big number

of female clients.

3.4.2Samplesize determination

The sample size was determined by Roscoe (1985) who revealed that sample size larger than 30

and less than 500 is appropriate for most researches. The study therefore considereda sample size

of 50 respondents. This was because it was adequate to make generalization and also made sure

that the selected sample was good representative for the whole population and it avoided biases.

3.5 Sampling procedure

The respondents were explained to the study and its rationale, the ones whoconsented became

part of the study and they were many then the researcher employed a simple random procedure,

the researcher wroteyes and No words on small pieces of papers, then folded them and placed

them in a small box and mixed thoroughly. Female clients who were at the study site during the

study time of study and who picked the yes paper and consented took part in the study

3.6 Inclusion criteria

All female clients above 18yrs whoattendedfamily planning unit, gynecological ward and MCH

who consented for the study were recruited into the study.

xviii
3.7 Definitions of variables

3.7.1 Dependent variables

Self-breast examination

3.7.2 Independent variables

Knowledge and practice about self-breast examination

3.8 Research instrument

A semi structured researcher-administered questioner designed in English was constructed and

used because it catered for both literate and illiterate. It consisted of subsections A, social

demographic characteristics, B, knowledge, C, practices.

3.9 Data management and Analysis

3.9.1 Data management

Data from the study was collected by the researcher, who also clarified on un clear

questionnaires to the respondents for better understanding, to ensure consistency, completeness

and accuracy of the data that was collected. Completed questionnaires were organized and kept

in safe protected place. Backup copy was kept on email, flash disk to avoid its loss.

3.9.2 Data analysis

Data collected was entered in Microsoft excel, cleaned, coded, and imported to SPSS version

16.0 statistical package for analysis. For level of knowledge each response was givena score of 1

and wrong response score of 0.

3.10 Ethical considerations

Approval to carry out research was obtained from principal

xix
Kabale school of comprehensive nursing and introductory letter was given to head of nursing

department Kabale regional referral hospital to allow and introduce the researcher to the

proposed departments and the researcher obtained consent form from respondents.

3.11 Limitations of the study

The researcher waslimited by government directives that discourage gatherings due to rapid

spread of corona virushowever this was overcame by encouraging social distancing and proper

use of masks, inadequate finance in terms of printing, stationery, which was solved by

followingand not exceeding the drawn budget. There was also time factor as the researcher was

attending to other studies and this wasovercame by making time table and be followed.

3.12Dissemination of results

Three hard copies were printed and distributed as follows;Uganda nurses and midwives

examination board for award of diploma in nursing,Kabale school of comprehensive nursing

library for record and reference purposes, Kabale regional referral hospital for implementation of

recommendations especially how to improve the health education services.

xx
 CHAPTER FOUR: RESULTS

4.0 INTRODUCTION

The presentation of the findings reflects responses to the research questions as on demographic

characteristics of respondents, knowledge of an individual and practices that contribute to

respondent’s knowledge and practice on SBE at kabale Regional Referral Hospital. The data was

collected from 90 respondents using researcher administered questionnaire. The findings are

presented inform of table.

4.1 Demographic data.

This part covered respondents’ age, place of residence, tribe, marital status, number of children

and level of education.

Table 1: showing age distribution among respondents

Age range(years) Frequency =90 Percentage

14-17 6 12

18-30 22 44

31-45 21 42

Above 45 1 2

Total 50 100

xxi
In table 1, the results show that most respondents were in age range of 18-30years making a

percentage of 44%. The least was of above 45 years which had only 2%.

Table 2: Showing place of resident of respondents.

Place of resident Frequency Percentage

Urban 22 44

Rural 26 52

Campsite 0 0

Others 2 4

Total 50 100

xxii
In table 2, the results show that majority of the respondents lived in rural area which had the big

percentage of 52% and least being campsite which had no respondent, followed by others which

had 4% and the respondents where from the police barracks.

Table 3: showing tribes of respondents

Tribe Frequency Percentage

Mukiga 38 76

Munyankole 8 16

Mufumbira 4 8

Muganda 0 0

Others 0 0

Total 50 100

Majority of the respondents shown in table 3 were Bakiga carrying the percentage of 765 of all

respondents. Other tribes that participated were Banyankole and Bafumbira only.

xxiii
 60%

50%

40%

30%

20%

10%

0%
Married Single Widowed Divorced

From figure 1, results show that majority of respondents were married being 56% in number,

then 24% were single, 4% widowed and 16% divorced.

Table 4: Showing the number of children respondents had.

Number of children Frequency Percentage

1-3 22 44

4-6 19 38

7-12 8 16

Above 12 1 2

xxiv
 Total 50 100

According to table 4, most respondents (44%) had children between1-3 and those who had more

than 12 were few with percentage of 2. The mother who had more than 12 children had multiple

pregnancies and had 13 children in 9 pregnancies.

Table 5: Showing educational level of respondents.

Education level Frequency Percentage

None 2 4

Primary 22 44

Secondary 20 40

Tertiary 6 12

Total 50 100

Results in table 5 show that most of the clients 22(44%) had attained primary education,

20(40%) had reached secondary level, 6(12%) had attained a certificate while 2(4%) did not go

to any school.

xxv
4.2 Knowledge of respondents towards SBE

Table 6 showing that the respondents have ever heard about self-breast examination

Responses Frequency Percentage

Yes 8 16

No 42 84

Total 50 100

In table 6, most respondents had never had about self-breast examination with the highest

percentage of 84% and only 16% had ever heard about self-breast examination.

Figure 2 shows where respondents who had heard about SBE had gotten information

xxvi
 health workers
televiosion

In figure 2 above, majority of the respondents obtaining 83.3% had gotten information from the

health workers whereas 16.7% got information from the television.

Table 7 showing how respondents define SBE

DEFINITION FREQUENCY PERCENTAGE

Assessment made on 43 86

individual to check for lump

Assessment made by the 7 14

nurse or doctor to check for

lump

All the above 0 0

xxvii
 None of the above 0 0

Total 50 100

The above table 7 showing how respondents define SBE revealed that majority of the

respondents defined SBE as assessment made by individual to check for lumps and obtained the

highest percentage of 86% where as others defined it as assessment made by a nurse or doctor to

rule put lumps and had percentage of 14%. The question was answered by all respondents and

none gave more than one definition.

Table 8 shows respondents knowledge on risk factors related to breast diseases.

Risk factors Frequency Percentage

Not breastfeeding 4 8

Young age 8 16

Old age 32 64

Family history 6 12

Others 0 0

xxviii
 Total 50 100

Table 8 shows responses on risk factors, most respondents believed that old age contributes a lot

in breast related diseases with frequency of 32, followed by those who believed its young age

with frequency of 8, family history was the next with frequency of 6 , not breastfeeding had had

4 and least being others without any respondent.

Table 9 shows signs and symptoms of a diseased breast

Signs and symptoms Frequency Percentage

Large breasts 22 44

Painless breast lump 0 0

Nipple discharge 28 56

Others 0 0

Total 50 100

Results in table 9 shows that majority of the respondents 56% knew nipple discharge is the most

sign of a diseased breast and 44% of them knew that large breasts is the sign of diseased breast

Figure 3 shows when SBE should start.

xxix
 From birth
From puberty
From 20yrs
No idea

The above pie chart shows that respondents said SBE should be started at puberty with highest

frequency of 32 respondents, 12 said it should be started from age of 20years, 5 had no idea

while 1 said that it should be started from birth.

Table 10 shows respondents’ knowledge on how often should SBE is done

Responses Frequency Percentage

Daily 6 12

Once a week 12 24

Once a month 22 44

Once 3 months 6 12

xxx
 Others specify 2 4

Total 50 100

In table 10 above, results indicate most respondents ie 22 reported SBE should be done every

month, then 12 reported that it should be done once a week, 6 reported daily and other 6 once in

3 months where other 2 said whenever they are unwell.

Table 11 showing best time to do SBE

Responses Frequency Percentage

During menstrual flow 8 16

5 days after menstruation 10 20

A week after period 20 40

No idea 12 24

Total 50 100

Results in table 11 show that most respondents ie 40% know that SBE should be done a week

after periods, 24% had no idea, 20% said 5 days after menstruation whereas least of the

respondents ie 16%said it should be done during menstruation.

xxxi
Table 12 showing respondent’s knowledge on benefits of SBE.

Responses Frequency Percentage

Early detection of abnormal 30 60

changes

Individual to know shape and 4 8

size

Cosmetic purpose 2 4

Exercising the breast 14 28

Others 0 0

Total 50 100

In table 12, the results show that respondents who did BSE, most of them with percentage of 60

did it detect abnormal changes early, 28% did for exercising the breast, 8% for individual to

know shape and size and 4% for cosmetic purposes. The question was answered by all.

Practice on SBE

Figure 4 showing number of respondents that ever practiced SBE

xxxii
 100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%
Yes No

In figure 4, it shows that 88% of the respondents had never practiced SBE and only 12% did it.

Table 13 showing how often SBE is done

Responses Frequency Percentage

Once in my life 2 33

When it comes to my mind 1 17

Regularly at least every 0 0

month

When unwell 3 50

Total 6 100

xxxiii
In table 13, 6 respondents who ever did SBE, 2 did it once in their lives, 1 did whenever it came

into their mind, other 3 did whenever they are unwell and none did regularly at least every

month.

Table 14 showing why respondents haven’t been doing SBE.

Responses Frequency Percentage

Don’t know how to do it 10 22

No breast abnormalities in 5 11

my family

Don’t remember 3 9

Fear of finding abnormalities 6 13

Others 20 45

Total 44 100

In table 14 that shows why respondents haven’t been doing SBE revealed that most of them 45%

had no idea about it, 22% didn’t know how to do it, 13% feared to find abnormalities, 11% said

xxxiv
they had never had any abnormality in their family and only 9% couldn’t remember to do it even.

Table 15 showing if respondents had ever found any abnormality

Responses Frequency Percentage

Yes 2 4

No 48 96

Total 50 100

Results in table 15 that shows if respondents had ever had any abnormality, reveals that 96% of

the respondents had never had any breast abnormality in their life and only 4% had ever had it.

Table 16 showing what was done when they found an abnormality

Responses Frequency Percentage

Prayed over it 0 0

Saw the doctor 2 100

Did some lab tests 0 0

xxxv
 Others specify 0 0

Total 2 100

Results in table 16 shows that out of the respondents who had had abnormalities in the breasts all

saw the doctor for intervention making it 100%

Table 17 showing respondents thought about SBE

Responses Frequency Percentage

Yes 45 90

No 5 10

Total 50 100

Table 17 results shows that most respondents 90% believed that SBE is a good practice and only

10% didn’t find any importance of doing SBE.

Figure 5 showing the best time to do SBE

xxxvi
 Every time you remember
During menstruation
After menstruation
Every morning

In figure 5 above , results show that most respondents{26 believed that SBE should be done

every morning, 18 believed that every time you remember, 4 said after menstruation and only 2

said its better done during menstruation.

Table 18 showing methods used by respondents to examine their breasts.

Responses Frequency Percentage

Standing in front of the 1 2

mirror

Lying on the bed and using 6 12

your palm

Using your fingers to feel 42 84

xxxvii
 Doing ultrasound of the 1 2

breast

Doing mammography 0 0

Total 50 100

Results in table 18 shows that most respondents 84% used fingers to examine their breasts while

12% lied on bed and used their palm and 2% used ultrasound scan, 2 % standing in front of

mirror and none did mammography

xxxviii
 CHAPTER FIVE

DISCUSSION, CONCLUSION AND RECOMMENDATIONS

5.0 Introduction

This chapter discusses the study findings in relation to the reviewed literature. It also draws

conclusion and presents the recommendations of the study to the different stakeholders.

5.1 Discussion of findings

5.1.1 Demographic characteristics.

Majority of the respondents were aged between 18 & 45 years, 44% aged between 18-30 and

42% aged between 31-45 years and 52% of them were residing in rural areas. Majority, (76%)

were bakiga, 56% married, and only 25% had never been married. All respondents had children,

with majority 44% having less than ≤3 children. Majority had attained some level of education,

with primary and secondary levels leading with 445 and 40% respectively and only 12% had

studied up to tertiary level.

5.1.2 Knowledge of respondents towards SBE

Most of the respondents (84%) had never had about self-breast examination and only 16% had

ever heard about it and of these, majority 83% had received the information regarding SBE from

health workers and only 17% had gotten the information from the television shows, suggesting

that health workers play a key role in informing the public about SBE, and that there are few

sources of information regarding SBE. These findings are consistent with those of the study by

Joyce, et al., (2020), that found out that majority (60.6%) had never heard about SBE, and only

39.4% had ever heard about SBE, majority (55.9%) of whom had gotten the information from

xxxix
health workers, however they are inconsistent with the findings of Gonzales et al., (2018) where

the primary source of information regarding SBE was media for 40.3% followed by health

workers at 21.7%.

Majority (86%) of the respondents appropriately defined SBE as assessment made by individual

to check for lumps, with only 14% giving a wrong definition.

Regarding respondents’ knowledge of the risk factors associated with breast disease, most (64%

%) believed that old age, followed by young age at 16%, family history of breast disease at 12%

and not breastfeeding at 8%, which reveals that respondents had some knowledge about breast

disease. This disagrees with the findings by a study in Nigeria by Farley et al., (2012) that

revealed that the respondents were unable to identify risk factors of breast disease.

Regarding the knowledge of the features of breast disease, 56% reported a nipple discharge, and

44% reported large breasts as features of a diseased breast.

Concerning respondents’ awareness about when SBE should be started, majority (64%) reported

that it should be started at puberty 24% said it should be started from age of 20years while 10%

had no idea, contrary to the findings by Umbreen and Medical, (2017), where majority (41.3%)

reported that SBE should be started at 18-23 years, followed by 37% who reported 12-17 years

and 22% reported 24 years and above.

When asked how often SBE should be done, 44% reported SBE should be done once a month,

24% reported that it should be done once a week, daily and once in 3 months each had 12% and

4% said whenever they are unwell. Therefore, majority were aware of the correct frequency of

doing SBE, a finding that is inconsistent with the study findings by Joyce et al., (2020) where

majority of the respondents were not aware of the correct frequency of doing SBE with only 24%

xl
reporting correctly that SBE should be done on a monthly basis. An earlier study in Uganda by

Godfrey, (2016) revealed that of the less than 50% of the respondents that had ever heard about

SBE, only 24% reported that it should be performed monthly.

Regarding the best time to do SBE, most of the respondents (40%) knew that SBE should be

done a week after periods which is the correct timing, a figure higher than that of Joyce et al.,

(2020) in their study, where only 11.8% reported correctly that it should be done one week

following menstrual periods. 24% had no idea, 20% said 5 days after menstruation whereas least

of the respondents (16%) said it should be done during menstruation.

On respondents’ knowledge of the benefits of SBE, majority (60%) reported early detection of

abnormal changes, while 28% reported that it helps in exercising of the breast. Other benefits

reported include, to know shape and size of the breast 8% and cosmesis at 4%, contrary to the

findings of the study by Ramathuba et al., (2015) in South Africa where SBE was recognized as

a screening method for breast cancer. Previous studies have demonstrated a correlation between

awareness about the benefits of SBE and the high likelihood of performing SBE

5.1.3 Practice on SBE

Only 12% of the respondents had ever practiced SBE. Majority (88%) had never practiced SBE,

consistent with the findings of the study by Al-Sharbattiet et al., (2018) where majority (77%)

had never done SBE with only 23% having ever done SBE. Of those that had ever conducted

SBE, 50% would do it whenever they were feeling unwell, 33% did it only once in their life

time, 17% did it whenever they would remember it. None did SBE regularly at least every month

as recommended. These findings are different from those from a study in Tanzania by Morse et

xli
al., (2014) that reported that 25% practiced SBE regularly once a month, 34% practiced it

occasionally and 41% never practiced SBE.

Of these respondents only 33% had ever identified an abnormality in their breasts, and all of

them sough for medical attention from the hospital after identifying the abnormality.

Of those respondents that had never conducted SBE, majority (45%) had no idea about it, 22%

had an idea but didn’t know how to do it, 13% were afraid of finding abnormalities, 11% said

they had never had any abnormality in their family and only 9% couldn’t remember to do it.

5.2 Conclusion

There was little/insufficient information regarding SBE as majority of the respondents had never

heard about SBE.

Health workers are an important source of information regarding SBE, however there is scarcity

of information sources regarding SBE.

There is poor practice of SBE among the respondents. Only a few had ever practiced SBE, and

of these none was performing SBE regularly on a monthly basis as recommended.

5.3 Recommendations

In view of the above findings, the study recommends that;

Health workers should inform the public frequently about SBE, how it is conducted and the

benefits and how to deal with the findings on SBE. This can be done while patient are waiting

for services in the waiting area as well as on ward and clinical rooms.

SBE should be regarded as and important part of early detection and management of breast

cancer and health educate the public through as may channels as can be available including

xlii
church services, radio talk shows and television.

5.4 Implication to nursing practice

This study will contribute to the literature available for future researchers in a related field of

study.

Findings and recommendations of the study can help improve SBE practice and thus improve

early detection and management of breast cancer.

Findings of the study can inform health care workers on the areas to focus on during health

education on SBE.

5.5 Limitations of the study

This study focused on the knowledge and practices of the females, excluding the males.

The study also never focused on identifying the barriers to, or the factors hindering the practice

of SBE.

5.6 Recommendations for future studies

A study to determine the barriers to the practice of SBE

xliii
 REFERENCES

Al-Sharbatti, S., Shaikh, R. B., Mathew, E., &Albiate, M, (2018). Breast self-examination

practice and breast cancer risk perception among female university students in Ajman,

UAE Shatha. GULF Medical Journal, 2(5), 42–55.

American Cancer Society (2014).American Cancer Society recommendations for early breast

cancer detection in women without breast symptoms. Retrieved at http://

www.cancer.org/cancer/breastcancer/moreinformation/

breastcancerearlydetection/breast-cancer-early-detectionacs-recs; accessed 12 May 2014.

Amoran OE, Toyobo OO (2015). Predictors of breast self-examination as cancer prevention

practice among women of reproductive age-group in a rural town in Nigeria. Niger Med

J. 2015; 56:185–9. [PMC free article] [PubMed] [Google Scholar]

Ardahan, M., Dinc, H., Yaman, A., Aykir, E., Aslan, B., (2015).Health Beliefs of Nursing

Faculty Students about Breast Cancer and Self-Breast Examination. 16, pp. 7731–7736.

Conde P, Kava AC, El Fakir S, Tachfouti N, Nejjari C, Diakite DO, et al. Attitude and practice

of BSE in women in Morocco. J Glob Oncol. 2018;4(Supplement 2):201s–201s. [Google

Scholar]

Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and

mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J

Cancer 2015 Mar;136(5):E359-E386.

Gonzales, A., Alzaatreh, M., Mari, M., Saleh, A., Alloubani, A., (2018).Beliefs and Behavior of

Saudi Women in the University of TabukToward Breast Self-Examination Practice. 19,

pp. 121–126.

xliv
Habu H, Emmanuel O, Chukwu D, Inuwa A, Kever R, Maigara B, Lola N, Dathini H (2017).

Knowledge and practices of Breast Self-Examination, among female nursing students in

university of Maiduguri, Borno state, Nigeria.International Journal of Clinical Oncology

and Cancer Research. Vol.2, No.3, 2017, pp. 55-64. Doi:10.11648/j.ijcocr.20170203.12

Howell A, Anderson AS, Clarke RB, Duffy SW, Evans DG, Garcia-Closas M, et al. Risk

determination and prevention of breast cancer. Breast Cancer Res 2014; 16(5):446.

Katende. G., Tukamuhebwa. A., and Joyce, N., 2015. Breast Cancer Knowledge and Breast Self-

examination Practices among Female University Students in Kampala, Uganda: A

Descriptive Study. Oman Medical Journal [2016], Vol. 31, No. 2: 129–134. DOI

10.5001/omj.2016.25

Kudzawu E, Agbokey F, Ahorlu CS. A Cross sectional study of the knowledge and practice of

self-breast examination among market women at the Makola shopping mall, Accra,

Ghana.Adv Breast Cancer Res. 2016;05:111–20. [Doi: 10.423/abcr. 201.53013] [Google

Scholar]

Ma J, Jemal A. Breast cancer statistics. Breast Cancer Metastasis and Drug Resistance: Springer;

2013; p. 1-18.

Mohamed H, El-Naggar N, Sayed HY. Knowledge, attitudes and practices regarding breast self-

examination among female undergraduate students in the faculty of applied medical

sciences at Umm Al-Qura University. Journal of American science. 2013;9:622-32.

Morse EP, Maegga B, Joseph G, Miesfeldt S. Breast cancer knowledge, beliefs, and screening

practices among women seeking care at district hospitals in Dar Es Salaam, Tanzania.

Breast Cancer (Auckl) 2014;8:73–9. [PMC free article] [PubMed] [Google Scholar]

xlv
Ogunbode AM, Fatiregun AA, Ogunbode OO (2015). Breast self-examination practices in

Nigerian women attending a tertiary outpatient clinic. Indian J Cancer. 2015;52:520–4.

[PubMed] [Google Scholar]

Omoyeni OM, Oluwafeyikemi PE, Irinoye OO. Assessment of the Knowledge and Practice of

Breast Self-Examination among Female Cleaners in ObafemiAwolowo University Ile Ife,

Nigeria.International Journal. 2014;7(1):239.

Ramathuba DU, Ratshirumbi CT, Mashamba TM. Knowledge, attitudes and practices toward

breast cancer screening in a rural South African community. Curationis.2015; 38

doi:10.4102/curationis.v38i1.1172. [PMC free article] [PubMed] [Google Scholar]

Scheel, J.R., Parker, S., Hippe,D.S., Patrick, D.L., G. Nakigudde,G., Anderson , BO., et al.,

(2018). Role of Family Obligation Stress on Ugandan Women’s Participation in

Preventive Breast Health. pp. 1–8.

Segni M, Tadesse D, Amdemichael R, Demissie H (2016). Breast Self-Examination: knowledge,

attitude and practice among female health science students at Adama Science and

Technology University, Ethiopia. GynecolObstet(Sunnyvale) 6:368. Doi:10.4172/2161-

0932.1000368

Suh MA, Atashili J, Fuh EA, Eta VA. Self-breast examination and breast cancer awareness in

women in developing countries: A survey of women in Buea, Cameroon. BMC Res

Notes.2012; 5:627. [PMC free article] [PubMed] [Google Scholar]

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 APPENDIX I: CONSENT

Title of the study is: “Knowledge And Practices Of Self-Breast Examination Among Female

Clients Attending Kabale RRH KabaleDistrict”

I am a student of KabaleSchool of comprehensive nursing pursuing diploma in nursing, I

therefore urge you to participate freely by giving appropriate response to the brief questions that

you will be asked. The information obtained will be kept confidential and used only for

educational purposes.

Benefit of the study: This study will identify the “knowledge and practices of self-breast

examination for breast cancer screening among female clients attending Kabale regional referral

hospital in Kabaledistrict”

Risks:There are no risks of human participation in this study.

Participation in this study is voluntary and your decision is highly respected. I therefore ask you

to be free and openly respond to these questions below for the betterment of our health.

I acknowledge the above explanation and I agree to participate in the above study voluntarily.

Date………………………………………… Sign……………………………….

xlvii
 APPENDIX II: QUESTIONNAIRE

INSTRUCTIONS: Tick the appropriate answer for all sections.

SECTION A: Part 1: SOCIO DEMOGRAPHIC CHARACTERISTICS.

1. What is your age?

a) 14-17

b) 18-30

c) 31-45

d) Above 45

2. Where do you live?

a) Urban Centre

b) Rural setting

c) Camp site

d) Others specify……………………………………………………………………….

3. What is your tribe?

a) Mukiga

b) Munyankole

c) Mufumbira

d) Muganda

e) Others specify ………………………………………………………………………

4. What is your marital status?

a) Married

xlviii
 b) Single

c) Widowed

d) Divorced

5. How many children do u have?

a) 1-3

b) 4-6

c) 7-12

d) Above 12

6. What is your level of education?

a) None

b) Primary

c) Secondary

d) Tertiary

SECTION A: Part 2: KNOWLEDGE ABOUT SBE

7. Have you ever heard of BSE?

a) Yes

b) No

8. If yes, from where? Specify your answer…………………..

a) Unaware d) Others

b) Friends and relatives specify……………………………………

c) Health workers

xlix
9. If yes define, SBE

a) Assessment made on the breast by an individual to check for lump

b) Assessment made by a doctor or nurse to check for lump

c) All of the above

d) None of the above

10. WhyisBSEdone?

a) Because is a recommendation by h/w

b) For breast cancer detection

c) To look for masses in the breast

d) Others specify………………………

11. What are the Risk factors to development of breast related diseases? You can choose as many

answers as possible

a) Not breastfeeding

b) Young age

c) Old age

d) Family history of breast related diseases

e) Others specify ……………………………………………………………………..

12. What are the Signs and symptoms of a diseased breast?

a) Large breasts

b) Painless breast lump

l
c) Nipple discharge

d) Others specify…………………………………………………………………

13. At what age should SBE be started?

a) From birth

b) From puberty

c) From 20 years

d) No idea

14. How often should SBE be done?

a) Daily
v
b) Once a Week

c) Once a Month

d) Once 3 months

e) Others specify……………………………

li
15. What is the best time to do SBE?

a) During menstrual flow

b) 5 days after menstruation

c) A week after period

d) No idea

16. Who should do BSE?

a) A doctor d) Health worker

b) Trained nurse

c) Self

17. What are benefits of SBE?

a) helps in early detection of any abnormal changes in the breast

b) helps an individual to know the shape and size of her breast

c) it’s for cosmetic purpose

d) helps in exercising the breast

e) Others specify……………………………………………………….

SECTION B: PRACTICES

18. Have you ever performed/practicedSBE?

a) Yes

b) No

19. If yes, how often do you perform SBE?

a) Once in my life c) Regular at least every month

b) Sometimes/when it comes to mind d) Others specify………………………….

52
20. If no, why not?

a) Don’t know to do it

b) No breast abnormalities in my family

c) Don’t remember

d) Fear of finding abnormalities

e) Others specify………………………….…

21. Have you ever discovered any abnormality in your breast?

a) Yes b) No

22. If yes, what did you do?

a) Prayed over it

b) Saw the doctor

c) Did some lab tests

d) Others specify ……………………………

23. Do you think SBE is a good practice?

a) Yes

b) No

24. When is the best time to do BSE?

a) Every time you remember

b) During menstruation

53
 c) After menstruation

d) Every morning

e) Others specify……………………………

25. What is the method that you use to self-examine your breast? You may tick more than one

answer

a) standing in front of the mirror

b) laying on bed and using your palm

c) using your fingers to feel

d) Doing ultrasound of the breast

e) Doing mammography

END

54
 sAPPENDIX IV: WORK PLAN FOR THE STUDY

OCT Nov Dec Jan Feb Marc April

S/N Activity
2021 2021 2021 2022 2022 2022 2022

1. +Topic identification

2. Writing of draft proposal

3. Presentation of draft proposal

4. Discussion with the supervisor

5. Correction of draft proposal

6. Presentation of final proposal

7. Pre-test instruments

8. Field data collection

9. Data entry and analysis

10. Report writing

11. Submission of dissertation

55
 APPENDIX V: BUDGET

ITEM UNIT COST QUANTITY TOTAL COST

Transport 100,000/= 100,000/=

Typing, printing and 50,000/= 3 150,000/=

binding research

proposal

Typing, printing and 80,000/= 3 240,000/=

binding of dissertation

Flash disc 50,000/= 1 50,000/=

Pens and pencils 1,000/= 5 5,000/=

Miscellaneous 100,000/= 100,000/=

Grand Total 645,000/=

56
APPENDIX VI: MAP OF UGANDA SHOWING LOCATION OF KABALE DISTRICT

KABALE DISTRICT

57
APPENDIX V: A MAP OF KABALE DISTRICT SHOWING KRRH

KABALE REGIONAL REFERRAL HOSPITAL

58