KNOWLEDGE, ATTITUDE AND PRACTICES ON PROSTATE

CANCER SCREENING AMONG MALE PATIENTS VISITING THE

OUT-PATIENT DEPARTMENT IN JOOTRH, KISUMU COUNTY.

SUBMITTED BY:
MAUREEN MORAA.
D/UPHRIFT/21028/255

A RESEARCH PROPOSAL SUBMITTED TO THE DEPARTMENT OF

HEALTH RECORDS AND INFORMATION TECHNOLOGY IN
PARTIAL FULFILLMENT FOR THE AWARD OF DIPLOMA IN
HEALTH RECORDS AND INFORMATION TECHNOLOGY

KENYA MEDICAL TRAINING COLLEGE

P.O. BOX 711-90200
KITUI.

SEPTEMBER 2022
DECLARATION
I, Maureen Moraa hereby declare that this research proposal is my original work and has not
been presented by any other individual or group in other instituition for any other academic
qualification.

Submitted by:
NAME : MAUREEN MORAA
College no : D/UPHRIPT/21028/255.
Sign : ................................................
Date : ..........................................

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SUPERVISOR APPROVAL
The undersigned certify that they have read and recommended to the department health
records for acceptance of this research dissertation as a partial fulfillment for the Diploma
award in Health Records.

Internal Supervisor
NAME : Mr. Thomas Muange
Designation : Lecturer KMTC Kitui
SIGN :………………………
DATE : ..................................

External supervisor
NAME` :Mr. JOSEPH MUTUA
Designation : .
SIGN : ………………………
DATE : ..................................

2
DEDICATION
I wish to dedicated this research to my lovely parents for having granted me the opportunity
to study and acquire knowledge. I also dedicated to my brothers, sisters and friends for their
love, financial support and encouragement throughout the my project.

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ACKNOWLEDGEMENT
First, I thank the Almighty God for the great care and guidance throughout the study and my
learning. I also pass my sincere gratitude to the Principal and HOD Kitui KMTC for giving
me the chance to be in institution. Not forgetting my beloved parents, friends for their great
support and encouragement in either way.

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5
TABLE OF CONTENTS
DECLARATION
DEDICATION
APPROVAL
LIST OF ABBREVIATIONS
ACKNOWLEDGEMENT
ABSTRACT
TABLE OF CONTENTS
OPERATIONAL TERMS
CHAPTER ONE
1.0 Introduction
1.1 Background of the study
1.2 Problem statement
1.3 Study Justification
1.4 Research objectives
1.4.1 Broad objective
1.4.2 Specific objectives
1.5 Research questions
1.6 Study limitations
1.7 Study delimitation
CHAPTER TWO
2.0 Literature Review
2.1 Introduction
2.2 Socio demographic characteristics
2.3 Knowledge on prostate cancer screening
2.4 Attitude towards prostate cancer screening
2.5 Practices on prostate cancer screening
CHAPTER THREE
3.0 Methodology
3.1 Research design
3.2 Study area
3.3 Study population

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3.4 Sample size
3.5 Sampling criteria
3.6 Data collection tools
3.7 Sampling procedure
3.8 Study variables
3.8.1 Dependent variables
3.8.2 Independent Variables
3.9 Inclusion and Exclusion criteria
3.9.1 Inclusion criteria
3.9.2 Exclusion criteria
3.10 Data analysis technique
3.11 Data management and archiving.
3.12 Data dissemination.
3.13 Ethical considerations
4.0 DATA ANALYSIS, INTERPRETATION AND PRESENTATION.
4.1 INTRODUCTION
4.2 Questionnaire return rate
4.3 Data analysis
4.4 Data presentation and results
4.4.4 Demographics
4.4.6 Practices
4.4.7 Attitude
5.1. KNOWLEDGE
5.1.1. Demographic
5.2. Practices on prostate cancer screening
5.3. Attitude on patients on prostate cancer
6.0. CONCLUSION
7.0 Challenges
7.1. Recommendations
Appendix I: Research Budget
Appendix II: Work Plan
Appendix III: Questionnaire
Section A: Demographic Characteristics
Section B: Knowledge.

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Section C: Practices on Prostate cancer screening
Section D: Attitude
Appendix IV: Map of the Study Area

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LIST OF ABBREVIATIONS
ACS : American Cancer Society.
DRE : Digital Rectal Examination
GLOBOCAN : Global Cancer Incidence, Mortality and Prevalence
HBM : Health Belief Model
MCRH : Msambweni County Referral Hospital
PC : Prostate Cancer
PSA : Prostate Specific Antigen
WHO : World Health Organization
OPD : Outpatient Department
KAP : Knowledge Attitude and Practices

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DEFINITION OF TERMS

Cancer screening - refers to applying a sample test or procedures across a health

population in order to identify unrecognized cancer disease in
individuals before they develop symptoms.

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Cancer - Refers to a generic term for a large group of disease characterized by
the growth of abnormal cells beyond their boundaries that they can spread
to other organs.
Knowledge - it is a familiarity, awareness or understanding of someone or
something such as facts, information and description acquired
through experience or education by perceiving and learning.
Prostate cancer - An adenocarcinoma of the male prostate gland.

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ABSTRACT
The research is on knowledge, attitude and practices on prostate cancer screening among
male clients visiting the outpatient department in MCRH, Kwale county. The main
objective is to establish the knowledge, attitude and practices on prostate cancer screening;
the study is based on Knowledge on prostate cancer screening, attitude towards prostate
cancer screening and practices on prostate cancer screening among males in MCFH facility.
Therefore prostate cancer has become a health burden which needs to be addressed.
The study used the cross sectional study design to determine the knowledge, attitude and
practices on prostate cancer screening, Probability sampling, simple random sampling was
used where a sample was chosen randomly from a population by chance. Questionnaires were
used to collect data on demographic, knowledge, practices and practices on prostate cancer
screening, The raw data was obtained and was entered on a Microsoft Excel spreadsheet and
analyzed using the two types of data analysis.
The findings of the study showed that most of the individuals had some knowledge, good
attitude and had undergone the screening test and most were willing to participate in
screening. A good number of respondents believed that they could prevent prostate cancer,
they knew the risk factors to prostate cancer, which method is best for screening purposes and
how often to do the screening. Therefore the ministry of Health at both levels could promote
information on treatment and preventive measures of prostate cancer that may enhance goo
knowledge on prostate cancer screening.

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 CHAPTER ONE
1.0 Introduction
1.1 Background of the study
Cancer refers to a generic term for a large group of disease characterized by the growth of abnormal
cells beyond their usual boundaries that can then spread to other organs (World Health Organization
2018). According to WHO (2018), some of the most common types of cancers affecting men are those
of the prostate, colon, lung, liver, rectum, esophagus and stomach, in females, breast, cervical, lung,
colon, rectum and stomach cancers are the most common. Jamel et al., (2011) states that in developing
countries cancer is the leading cause of death. Moreover, out of 12.7 million cancer cases and 7.6
million related deaths in 2008, 56% detected cases and 64% of the deaths occurred in developing
countries. According to Ferlay et al., (2011) and Lozano et al., (2012), Prostate cancer (PC), an
adenocarcinoma of the male prostate gland, is increasingly becoming an important health burden
among men in the world. An estimated 0.9 million cases and 0.26 million deaths of prostate cancer
occur annually in the world (Ferlay et al., 2011).
Prostate cancer is the most common type of cancer and contributes largely to increased mortality rates
in Africa, it accounts for 13% (40,000) of all male cancer incidences and 11.3% (28000) of all male
cancer-related deaths (Ferlay et al., 2011). Its incidence in black men is multiple of those from other
cases in several studies. The reason for this is not yet clear and the explanation for the disparity may
lie in studies involving black men from different populations to see if there is an enhancing factor
associated with the racial origin of these men (Akinremi et al., 2011; American Cancer Society, 2016).
In East Africa, prostate cancer ranks third in both incidence and mortality, and leads to an estimated
9,000 (9% of all male cancers) cases and7,300 (8.5% of all male cancer) deaths annually (Ferlay et
al., 2011). Lozano et al., (2012), noted that the global PC incidences increased by 64.5% between
1990 and2010. According to GLOBCAN, (2018) prostate cancer is the commonest cancer in male
with 14.9% (2,864 new cases). The Global Cancer Project (2018) indicated that prostate cancer was
more prevalent (35.3%) in men aged 65-74 years with few cases (4.4%) in patients above 84 years of
age. The Kenya National Cancer Screening Guidelines, (2018), indicates that prostate cancer in Kenya
presents at a similar age at diagnosis but at a more advanced stage in comparison with the developed
countries.
The lack of awareness about prostate cancer and other prostate related issues has been identified as a
cause of low survival and higher mortality rates among black men (Kabore, et al., 2013). Another
research also indicated that knowledge of prostate cancer impact male participation in prostate cancer
screening (American Cancer Society, 2013). Lack of proper education and attitude has influenced the
prognosis of cancer (Othman et al. 2011). The demand for quality cancer care is on the rise and can
only be achieved through awareness and change in an individual’s attitude Significant advances have
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been made in its treatment following today’s medicine understanding the nature of cancer (Othman et
al. 2011). In a research conducted in Nairobi, Kenya, only about a half of the respondents had good
knowledge levels on prostate cancer with less than a half of them knowing the signs and symptoms,
treatment and preventive measures for prostate cancer (Wanyaga, 2013). Knowledge levels on prostate
cancer are influenced by educational levels among men in Nairobi County (Wanyaga, 2013).

Prostate cancer screening is an attempt to diagnose prostate cancer in asymptomatic men (Nakandi et
al., 2013). The principles of screening of prostate cancer are measurement of serum prostate specific
antigen (PSA) and digital rectal examination (DRE). A study by Adibe et al., (2017), found out that,
in the developed world, the probability of being diagnosed with prostate cancer was more than twice
as high as in developing countries. A common challenge encountered is late presentation by the
affected patients (Jo et al., 2013). This has been attributed to poor awareness, inadequate health
education lack of screening programs for prostate cancer & poverty (Olapade et al., 2008). Screening
for PC is relatively high in other European countries but woefully low in developing countries
of Nigeria Uganda, Ghana and Kenya (Yeboah et al., 2016). Arguably a PC screening program that
identifies asymptomatic men with localized tumors could reduce PC-related deaths substantially
(Yeboah et al., 2016). The relatively low screening for prostate cancer has been attributed to
several factors that include poverty, lack of awareness and knowledge(Yeboah et al., 2016). The
uptake of prostate cancer screening is very low among men in Nairobi County; however, most of the
men are willing to undertake prostate cancer screening and know more about the disease (Wanyaga,
2013). In another research conducted in Kenya, 91.4% of the participants were willing to undertake
prostate cancer screening once they are fully aware of the methods involved (Makori, 2015).
Knowledge regarding the perceptions of what quality cancer care constitute is inadequate (Ntoburi et
al., 2010). Evaluating the patients experience provides vital information on their perception of the
quality of care and treatment provided (Hess, 2013). Fatalistic beliefs are a major barrier for uptake of
screening and have been found to be more prevalent among underserved populations and black males.
A study conducted in the United Kingdom associated fatalism with under-utilization of prostate cancer
screening (Vrinten et al., 2016). A study conducted among black Caribbean males found that there
was a significant difference in perception of prostate cancer fatalism (Cobran et al., 2014). Similar
findings were reported where the black men who were born in the USA had less prostate cancer
fatalism compared to black men born in Caribbean (Odedina et al., 2009). Fatalist beliefs regarding
Prostate cancer have been associated with low levels of education and low levels of awareness and
knowledge of Prostate cancer (Powe et al., 2009). Perception levels on self-vulnerability to prostate
cancer are low among men in Nairobi County and are influenced by religious affiliation, knowledge
and educational levels. Awareness levels on prostate cancer are high among men in Nairobi County

16
(Wanyaga, 2013). Following the gaps on prostate cancer it is important to carry out more researches
related to the topic and appropriate measures taken with regards to the study findings.

1.2 Problem statement

Prostate cancer is increasingly becoming an important health burden in the world with an estimated 0.9
million cases and 0.26 million deaths occurring annually (Ferley et al., 2011 and Lozano et al.,
2012). According to Kenya National Cancer Screening Guidelines (2018), cancer is the 3 rd cause of
high mortality. Prostate, oesophageal and colorectal cancers are the leading in cancer related deaths
(Kenya National Cancer Screening Guidelines 2018). Global cancer project (GLOBOCAN, 2018),
suggests that 5% of all cancer related mortalities are caused by prostate cancer. The major problem in
Kenya is the late stage presentation when cure is difficult (WHO, 2018). Kenya National Cancer
Screening Guidelines (2018), also suggest that cancer burden can be reduced through early detection
and management. According to Makori, (2010) good perception on prostate cancer was correlated
positively with university, diploma or secondary education.

In Sub-Saharan Africa, prostate cancer reports have been hospital-based and as such very few
studies, have been conducted on the populations (Wanyaga, 2013). This can be related to the
increasing incidences and mortality resulting from prostate cancer in Kenya as shown by a study
conducted by Ferlay et al., (2011).There were similar results retrieved from five researches
conducted in Kisumu. Due to this incidence and limited number of studies conducted, there is an
urgent need to assess the level of awareness, knowledge and perception on prostate cancer among
male clients at MCRH outpatient department.

1.3 Study Justification

This study will establish the awareness, knowledge and perception on prostate cancer among male
clients at MCRH, outpatient department. The research may help to the hospital as information obtained
can be utilized in further studies and in the drafting of appropriate policies and designing of
control strategies on the disease. The findings of this study may also contribute towards
promoting awareness and knowledge of prostate cancer amongst Kwale County residence. This
could lead to early detection, improved management of the disease and reduced cost of patient
care which should enhance the quality of lives for prostate cancer patients. It will also provide
recommendations for further research work on the topic. The findings may also provide a baseline for
policy formulation on management and prevention of prostate cancer by the government in
collaboration with non-governmental organizations and hospital management.

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1.4 Research objectives
1.4.1 Broad objective
To establish the knowledge, attitude and practices on prostate Cancer screening among male patients
visiting outpatient department in MCRH KwaleCounty.

1.4.2 Specific objectives

1. To find out the knowledge on prostate cancer screening among male clients visiting outpatient
department at MCRH Kwale County.
2. To astablish the attitude towards prostate cancer screening among male clients visiting
outpatient department at MCRH, Kwale County
3. To establish practices on prostate cancer screening of patients visiting Out-patient in MCRH on
prostate cancer.

1.5 Research questions

1. What is the knowledge towards prostate cancer screening among male clients visiting
outpatient department at MCRH , KwaleCounty?
2. What is the attitude towards prostate cancer screening among male clients at visiting outpatient
department MCRH,KwaleCounty?
3. What is the practice on prostate cancer screening among clients visiting outpatient department
at MCRH, Kwale County?

1.6 Study limitations

The study will be conducted at the hospital during the hospital working hours, this may interfere with
the time spend in data collection. A self- administered questionnaire will be used which may affect the
questionnaire return date.

1.7 Study delimitation

The view of the study will be only from prostate cancer patients on factors such as knowledge, attitude and
practices on prostate cancer screening.

1.8 Assumption of the study

The assumption of the study will be that the respondents shall give information that will be true based
on their knowledge.

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 CHAPTER TWO
2.0 Literature Review
2.1 Introduction
Prostate cancer is the most common non skin cancer and the second leading cause of male cancer
deaths among American men. It is estimated that 198,100 new cases prostate cancer will be
diagnosed among American men (World Health Organization, 2018). The high incidence of this
cancer ,the aging of the population, the prominence and advocacy of individuals who have suffered it
and organization concerned about it, as well as the tendency for our society to believe that aggressive
intervention is best, have led to a surge in interest and use of screening for this disorder over the past
decade.

2.2 Socio demographic characteristics

Traditionally, research exploring factors that influence the use of cancer screening tests begins only
after compelling epidemiological data permit development of definitive screening guidelines (Cancer
Screening Guidelines, 2018). An alternate approach is to study early adopters of cancer screening tests
while screening guidelines are emerging. Characterizing in the absence of definitive recommendations,
who is and is not being screened may permit appropriate Implementation procedures to be more
rapidly defined once guidelines are widely accepted.

A relevant example comes from screening mammography. When the health insurance plan of greater
New york (Shapiro S,venet W et al, 2010). Early intervention studies assumed that the cost of
mammography an individual health belief were the major barriers to screening (Hartmann et al, 2013).
Prostate cancer screening guidelines are currently being debated and little is known about the factors
influencing screening behavior. Prostate cancer is the most common malignancy and the second most
common cause of cancer related mortality in men (Stephenson et al, 2012).

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Although American cancer society has recently recommended annual DRE and PSA examination for
all men 50 years of age or older and for younger men at increased risk of the disease (e.g. African
Americans and those with a family history of prostate cancer there are no universally accepted
screening guidelines. Research has examined participation in prostate cancer screening in clinic
population(Williams RB and Johnson RE).Patients knowledge about prostate cancer screening
characteristics of men who volunteer for prostate cancer screening (Denmark-Wahnefried et al,2010),
attitude and beliefs of African American men and physicians towards screening. The present study
adds to this research by examining prostate cancer screening in a non-clinical, national cohort of
middle aged male Vietnam era veterans. Non clinical studies are particularly important preventive
health research because they solicit information from individuals with widely varying preventive
health behaviours. We measured self-reported prevalence of DRE and PSA screening and the socio
demographic and health status characteristics associated with participation in screening (Hoffman et
al., 2011).

2.3 Knowledge on prostate cancer screening

Prostate cancer was among the major health problems in the world (Alghamidi et al,. 2013). In a
similar study it was the most common diagnosed non-skin adenocarcinoma in the United States
and the third leading cause of cancer deaths (Hass et al. 2008). It was therefore noted that prostate
cancer was among the significant source of negative effects on patients' and their caregivers' quality of
life, and results to a high cost of leaving (Oranusi et.al. 2012). In other research conducted, it was
found that the disease dominates males between the age of 60 and 70 (Oranusi et al. 2012). The
etiology of prostate cancer is not clear, but it is believed that risk factors like; aging, positive family
history, and race (e.g. African race) are among the predisposing factors (So et al. 2014). Studies show
that the nature of prostate cancer is such that as long as there is no local progression or metastasis to
other parts of the body it is less fatal and when symptoms starts it becomes detrimental. (Madu et al.
2010).Therefore, early detection through screening of the disease in its early stages can be an effective
measure in reducing its mortality rate in asymptomatic men (Smith et al. 2014). According to an
article published in Novel diagnostic biomarkers for prostate cancer, it was realized that survival rate
in men with localized (i.e., without metastasis) prostate cancer was almost 100%, while the rate among
men with metastatic prostate cancer was only 31% (Madu et al. 2010).Nigerian had low knowledge of
the etiology, treatment and prevention of development of the disease and attending the screening was
low (oldadimeji et al 2010).Therefore , studies among native urban Nigerian population showed that
large proportion of men had low knowledge of prostate cancer screening using the PSA method.
Patients in India showed that most men had low knowledge on prostate cancer screening (Dailey and
xn, 2012).providing health talk on prostate cancer will improve knowledge of the leading disease to
enhance screening for early detection

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Knowledge regarding Prostate cancer screening was measured using 14- item scale with six dormain.
Twelve items from this scale were developed by Weinrich et al (2010) and two more items were added
to asses dietary knowledge (Scrivens, et al, 2011) and screening controversy. The overall prostate
cancer knowledge was low, which was consistent with the findings from studies conducted on older
men (Consedine, et al 2011). Rural residents also scored significantly lower on their knowledge scores
than those from sub urban areas, which could be explained by their significant geographical economic,
limitations (Casey, 2011). In addition, studies have also reported that black males are less likely to talk
about health issues like prostate cancer (Allen & Gilligan, 2011).

First substantial numbers of African American men do not have adequate knowledge about prostate
cancer although slightly more than 19% of the sample scored relatively high on questions related to
prostate cancer. The study among African American men stated that having a regular physician was
related to a respondent understanding of prostate cancer and whether a participant ever had a
discussion with their doctor about prostate cancer screening was associated with their level of
understanding (American cancer society, 2016). 38.4% reported to be unaware of prostate cancer
screening. Most of the respondents stated that if screening for cancer were available and could make a
difference, they would participate (Warren, 2013).

The findings that African American men are respective to screening supports the finding study
conducted in Chicago by (Myer et al, 2011). More than half of the latter group had more than a high
school education, whereas the comparable percentage was 17.9%. Additionally, the earlier sample
consisted of men who had already had at least one Digital Rectal Examination (DRE), which would
predispose them to having more knowledge about prostate cancer screening (Bretton, 2010).

2.4 Attitude towards prostate cancer screening

The study of the impact of undergoing prostate carcinoma screening on knowledge done in USA
showed that men who chose not to get screened had less knowledge about prostate cancer and a less
positive attitude towards prostate cancer screening than men who chose to get screened (Hoffman,
2011).The finding suggests that the men information about prostate cancer screening would increase
screening. The participants who practiced prostate cancer screening and regular checkup within the
last year in the current study ranged from 8-30%. Deficits in knowledge and attitude about prostate
cancer screening among cohorts in the present study also reported in Australia study (Anorld-Reed et
al., 2010). On the other hand, the result of brazil study reported 40.5% of men had a proper attitude

21
and those participants with adequate attitude reported almost twice adequate practice for the detection
of prostate cancer (Pereira et al., 2010).

An interesting findings were that Egypt had the least practice activities despite the highest attitude
percentage of their participants towards screening and examination of prostate cancer. In a study of
teachers in a high risk group, a high proportion of teachers had 64.5% with positive attitude towards
prostate cancer screening having knowledge compared to 34.7% of male teachers with positive attitude
who had low knowledge. Our findings collaborate this assertion of knowledge of prostate cancer is
associated with good perception and attitude towards prostate cancer screening, agreed that practice
cancer screening is important that prostate cancer could be treated if detected earlier. Although our
respondents demonstrated positive attitude, the majority had not screened for prostate cancer though
they mentioned the intention to. In a similar study conducted in Nigeria immigrants found to have
better attitude towards prostate cancer screening compared to indigenous Nigerian men (Enaword et
al., 2016).

The success of screening programme depends very much on the attitude and the willingness to
participate. Present study showed that the general attitude of Malaysian population towards prostate
and colorectal cancer screening was poor where about 97% had poor attitude towards colorectal
screening. Another study on attitude towards prostate cancer screening in the primary care population
found that 14%of the study population had negative attitude (Taskila et al, 2010). The reason for such
a poor attitude could be accounted by the deficiency of knowledge about prostate cancer.
A study among African American men, there was little willingness to participate in prostate cancer
screening, only a few of the participants indicated that they could be motivated to participate in
screening, they felt that having medical insurance and knowledge about the disease were major
incentives towards obtaining screening behavior (Marshal ,2011).

The study among African American indicated that, compared with the low known socio economic
respondents, the middle socio economic participants were more likely to express a willingness and
good attitude to participate in prostate cancer screening (Haynes, 2012). Most individuals understood
cancer as a disease and were fatal of getting a test, they had greater attitude to participate in screening
after information about a disease.

According to (Digman et al., 2013) focus group discussion have been an essential ingredient in
developing effective culturally sensitive cancer education programs in African American, therefore the
qualitative study described in this article was designed to identity attitude associated with willingness

22
of African American to participate in prostate cancer screening. Qualitative research often is used to
gain insight into the dynamic relationship of attitude, motivation and concerns of minority populations
(Marshal, 2011).

2.5 Practices on prostate cancer screening

In a study conducted in the United States ,it was realized that prostate cancer screening remained a
controversial issue as it was the only method recognized to control prostate cancer disease
through early detection. Alongside that it was realized that a lot of evidence had shown that
prostate specific antigen (PSA) screening can detect early stage prostate cancer. (American
urological association, 2012). Men at high risk, based on race and family history, should begin
early screening with PSA blood test and digital rectal exam (DRE) at age 45 years.(American
Cancer Society, 2010). To add on that research shows that screening will be of great benefit as a
preventive measure as opposed to that ,PSA screening should not be conducted for men below 40
years and above 70 years (American Urology Association, 2012). This is based on the findings
that screening pose a lot of complications such as painful biopsies, bleeding from site of
biopsy, infection, hematuria(blood in urine), dysuria, which occur in 10-70% of patients (America
urological association, 2012). Undeserved population and Africans recorded low levels of prostate
cancer screening (Conde et al., 2011). Lack of knowledge of availability of the screening services is
the major contributing factor to low uptake (Conde et al., 2011).

In another study conducted by Oladimeji et al.,(2010) in Nigeria, it was found that uptake of
Prostate cancer screening could be associated with good knowledge and perception on self-
vulnerability to prostate cancer. The Kenya National Cancer Screening Guidelines, (2018), indicates
that prostate cancer in Kenya presents at a similar age at diagnosis but at a more advanced stage in
comparison with the developed countries. According to a study by Wachira et al., (2018) 98.7% had
never been screened for prostate cancer. Wachira et al., (2018) found out that none of the respondent
in their study knew any person who had undergone prostate cancer screening. A study conducted by
Wanyagah, (2013) showed only 7.1 % knew screening methods Wanyagah (2013) also indicated that
68.3% knew PSA as the specific method of screening Lack of screening has been attributed to an
increase in prostate cancer related mortality, as patients present in advance stages of the disease
(Wasike & Magoha, 2007). It can therefore be deduced that good knowledge of prostate cancer is
paramount for enhancing uptake of screening for the disease, which could be achieved through formal
and informal education and reinforced through focused health education activities. (Makori, 2015).

1.1 CONCEPTUAL FRAMEWORK

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The framework of this study is divided into three components: a) the knowledge that

men have regarding prostate cancer; b) the attitudes and how the men feel towards

prostate cancer and c) their screening practices regarding prostate cancer.

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The first objective was to measure the level of knowledge, whether adequate or

inadequate based on the Likert scale. The way the men feel about prostate cancer

was assessed by their attitude response, as per the second objective. Based on the

knowledge and attitudes, the screening practices, PSA and DRE that they are

engaged in were evaluated.

Figure 1.1 shows the demographic variables that play a role in the knowledge and

attitudes of patients with prostate cancer for participation in screening activities.

The primary variables that affect attitudes are education, age, religion, occupation

and marital status. Together these factors affect the practice of participation in

screening activities.

In the present study four variables, marital status, education, occupation and monthly

income were seen as the most dominant factors in Namibia that affected participation

by men with prostate cancer in screening activities.

25
 Educa Marital Status

Religi

Occupa

A
ttitude
s

K
nowledg
e

Practice

Figure 1.1 Interaction of Knowledge, Attitudes and uptake of screening practice

towards prostate cancer

Redesigned from (Paul, 2014)

26
 CHAPTER THREE
3.0 Methodology
This chapter highlights on the study methodology which includes research design, study area, study
population, sample size determination, sampling techniques, sampling procedures, study variables,
inclusion and exclusion criteria.

3.1 Research design

The study will adopt a cross-sectional descriptive study design to determine the knowledge, attitude
and practices on prostate cancer screening among male patients visiting outpatient department in
MCRH Kwale County.

3.2 Study area

The study will be conducted at the outpatient department, JOOTRH, Kisumu county, Kenya, located
on longitude 0.0887 0S, and latitude 34.7720 0E. JOOTRH is located in Kisumu city between Kibuye
and Kondele Sub town, along Kisumu –Kakamega highway, approximately 3km from Kisumu town.
Currently, this hospital serves more than 100 districts and sub-district hospitals in Western region of
Kenya including larger hospitals such as Kakamega Provincial General Hospital. The hospital was
founded by the colonial government about 1900 and was commonly known as Russia Hospital. It was
fully expanded in late 1960 and currently is a teaching and referral hospital. Our main topic focuses on
the outpatient department which is among the three major departments (outpatient, inpatient and
administrative). It comprises of MCH, comprehensive care clinic, special clinics and the gender based
violence clinic. It is located about 100m from the main gate next to the administration block.

3.3 Study population

Total monthly male patients being 21,571(MCRH Health records, 2022), our target population was the
male clients visiting outpatient department at MCRH Kwale County during the period of the study.

9 Inclusion and Exclusion criteria

3.9.1 Inclusion criteria
i) Male patients aged 18 years and above visiting outpatient department tin MCRH KwaleCounty
who were able and willing to give consent.
ii) Male patients with the ability to comprehend English .

3.9.2 Exclusion criteria

i) Those who will not be consent to participate.
ii) Male patients who are critically ill.

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8 Study variables
The study will have both the dependent and independent variable.

3.8.1 Dependent variables

Prostate cancer screening.

3.8.2 Independent Variables

i) Knowledge on prostate cancer screening.
ii) Attitude on prostate cancer screening.
iii) Practices on prostate cancer screening.

5 Sampling criteria
Probability sampling that is, simple random sampling was used. This is whereby a sample will be
choosen randomly from a population by chance, such that each individual had the same probability of
being choosen at any stage during the sampling. Every male patient visiting the outpatient department
at MCRH KwaleCounty and found to have met the inclusion criteria will be eligible to participate in
the study. Daily targeted number of questionnaires being 14, number 1 to 20 will be written, clients
who picked any number from 1 to 14 participated in the study, choosing numbers 1-20 client will be
randomly selected, to enable the required number of sample size to be met within the period of study
and to avoid bias.

3.7 Sampling procedure

A simple random sampling technique will be used, whereby a certain number will be given to every
respondent of the accessible population. The numbers will be placed in a container and picked
randomly. Entire respondent will have an equal chance of drawning and 62 respondents will be
included in the study.

3.4 Sample size determination

The researcher will use standard Fisher et al (2008) formula to determine the sample size, n=z2pq/d2
Where n= desired sample size.
(1.962)x0.05x0.95/0.052
=73
Z=standard deviation of the required confidence (1.96) level of 95%.
P=proportion of target population estimated as 5% =0.05(the local disease prevalence from prostate
cancer) according to (WHO, 2018).
Q=1-p therefore=1-0.05 =0.95

28
D= The level of statistical significance set which is 0.05
Therefore the statistical formula of population will be used i.e.
NF=n/1+n/N Where n=Sample Size
N=estimated number of patients (383)
NF=desired sample size
73/1+73/383
=62 respondents

3.6 Data collection tools

The study will use self-administered questionnaire as the stool for data collection which had four
sections (demographic, knowledge, attitude and practice on prostate cancer screening). The research
questionnaires will be pretested among 10% of the sample population. The research questionnaires
will be distributed to the participants by the researchers. This questionnaire will containe both closed
and open-ended questions. The questionnaires wil be hand- delivered to the respondents and collected
from them after being filled, within 20-30 minutes.

3.1.1 Validity
The validity of a test is the extent to which the test measures the variables under the

study (Designs, n.d.). It ensures accuracy and correct interpretation of the results of

the study. In this study validity was achieved by cross-checking, inspecting and

scrutinizing the information entered in the questionnaires to ensure that the data

collected was accurate, relevant, complete, consistent and homogeneous.

Validity was well ensured by verification of the men’s passports (health cards with

basic information on their medical history) to ensure that they have never been

diagnosed with prostate cancer. Validity was also enhanced as adjustments were

made to the questionnaire as a result of pretesting the data collection tool.

3.1.2 Reliability
29
Reliability is the consistency of a measure that ensures consistency of a test. In this

study, reliability of the questionnaires was ensured by designing closed-ended

questions that measure KAPs of prostate cancer.

Furthermore the conditions in which the questionnaires were administered ensured

that the results obtained from the study is accurate. The participants were briefed on

what the study was all about, with additional supervision of the research assistants to

minimize errors and ensure data accuracy.

30
 3.2 PRETESTINGTESTING OF THE DATA
COLLECTION INSTRUMENT

A pretesting of the questionnaires was done among 15 participants who met

the inclusion criteria. This helped to identify any ambiguities, relevance,

sensitivity and acceptability of the questions and likely duration of

administering.

At the end of the pretesting testing, the questionnaire was modified to align

with the findings. Changes to a few questions were made such as another

column of “unemployed” was added to question 4, Co-habitation was added

to one of the optional answers in question 5 and another option “Other

reasons” was added to question 40 in Section D

3.10 Data analysis technique

Responses from the questionnaires will be entered and analyzed in MS Excel for descriptive
analysis to generate frequencies, percentages and technique tabulations. Descriptive statistics,
including frequency and percentages will be generated for age, religion and marital status to
analyze the socio-demographic characteristics of the sample. The summaries of findings will
be presented using tables, graphs and charts then discussed. Frequencies and percentage
distribution will be used to examine the relationship between independent and dependent
variables individually.

3.11 Data management and archiving.

Responses from the questionnaires will be entered and analyzed in Ms Excel for descriptive
analysis to generate frequencies, percentages and tabulations. Descriptive statistics, including
frequency and percentages will be generated for age, religion and marital status analyze the

1
socio-demographic characteristics of the sample. The summaries of the findings will be
presented using tables, graphs and charts then discussed. Frequencies and percentages
distribution will be used to examine the relation between independent and dependent
variables individually.

3.12 Data dissemination.

The study finding will be typed and printed after which a copy will be given to the Kenya
Medical Training college ,Kitui Kmtc research and ethics committee and to MCRH,
department of research. The research findings will be published into medical websites and
journals and will be used for future plans and further studies.

3.13 Ethical considerations

Permission to conduct the study will be sought from National Council of Science and Technology
(NACOSTI) through the Director KMTC to the Course supervisor at Kenya Medical Training College
(Kitui Campus). Then will be presented to Deputy Sub county commissioner for the approval of the
study.
. The participants in the study will be offered a detailed explanation about the study,
confidentiality of their data and their right to voluntarily participate or withdraw from
participating in the study. Researchers will not obtain from individuals, names and/or contact
information of other potential participants without the others’ permission, and therefore, this
ensured anonymity. An anonymous number will also be assigned to each respondent for the
purpose of identification to enhance confidentiality. Finally, the information obtained from
the respondents will not be used for other purposes other than drawing the conclusion of this
study.

4.0 DATA ANALYSIS, INTERPRETATION AND PRESENTATION.

4.1 INTRODUCTION
In this chapter, data collected from respondents was analyzed and presented in
sequence in relation to research objectives, related themes and responses elicited from the
questionnaire. Tables, bar graphs, pie charts and percentages are used to present data.

2
4.2 Questionnaire return rate
This is the proportion of the intended respondents that participated in the study. From
the 62 questionnaires administered, only 55 were dully filled and returned. The return rate
was 84.59%, this therefore was a fair representation for purposes of the research.

4.3 Data analysis

Once the raw data was obtained, it was entered on a Microsoft Excel spreadsheet.
This study was mainly quantitative in nature. Thus, two types of data analysis were involved,
namely: A descriptive analysis where quantitative data, obtained from the questionnaire, was
analyzed in percentage form and presented in and graphs, pie charts and tables. The analysis
of qualitative data, obtained through comments of the respondents who completed the open-
ended questions in the questionnaire

4.4 Data presentation and results

4.4.4 Demographics

Figure 4 distribution of sampled patients' age

3
 The figure above shows that 40% (n=22) of the respondents were between the age of 18-
25,17% (n=9) aged between 26-30, 17% (n=9) aged between 31-35 and above 35
represented 26% n=14

Pe
rc
en
ta
ge
s
of
sa
m
ple
d
pa
tie
nts

Patients marital status

Figure 5 distribution of sampled patients' marital status

From the figure above we can see majority of the respondents were married making up 56 %
(n=31) followed closely with those who were single with 43 % (n=23) , 1% (n=1) was
divorced and only 0% was widowed.

Per
cen
tag
e of
sa
mpl
ed
pati
ent
s

Patients religion
Figure 6 distribution of sampled patients' religion

4
 In the figure shown above, 96%(n=52) were Christian, 3%(n=2) were Muslims and only 1%
(n=1) were traditional believers.

Per
cen
tag
es
of
sa
mp
led
pa
tie

Patients responses
Figure 7 distribution of sampled patients' who had heard about prostate cancer

In the figure above 89%(n=49) had heard about prostate cancer screening while 11% (n=6)
had never heard about it.

Per
cen
tag
es
of
sa
mp
led
pa
tie
nts

Patients Responses
Figure 8 distribution of sampled patients' who knew someone with prostate cancer

In the figure above, 42% (n=23) knew someone with prostate cancer while 58% (n=32) gave
a response of not knowing anyone with prostate cancer.

5
 Figure 9 distribution of sampled patients' response on the gender affected by prostate cancer

In the figure above, 75% (n=41) stated that prostate cancer affected men only, 11% (n=6)
stated that prostate cancer affected both men and women, 12% (n=7) didn’t know which
gender was affected by prostate cancer while 2% (n=1) of the respondents stated that
prostate cancer affected women.

Ris
k
fac
tor
s

Percentages of sampled patients

Figure 10 distribution of sampled patients' response on risk factors

In the figure above, majority of the respondents 34% (n=19) knew more than one risk factors
for prostate cancer. 30% (n=17) didn’t know of any risk factors. 14% (n=8) indicated family
history of the disease as a risk factor. 12% (n=7) indicated old age to be a risk factor, 7%

6
(n=4) indicated alcohol to be a risk factor while 2% (n=1) indicated inadequate intake of
fruits and vegetables to be a risk factor; and 1% (n=1) indicated lack of exercise to be a risk
factor.

Figure 11 distribution of sampled patients' response on whether there is something they can
do to prevent prostate cancer

In the figure above, 61% (n=34) of the respondents believed that there are practices they
could do to prevent self from getting prostate cancer. 34% (n=19) believed that there’s
nothing they could do to prevent self from getting prostate cancer. 5% (n=3) didn’t know
what to do to prevent prostate cancer.

7
Per
cen
tag
es
of
sa
mpl
ed
pati
ent
s

Patients Responses
Figure 12 distribution of sampled patients' response on whether they had received
information from health care providers

In the figure above 81% (n=45) stated to have not Received information from health care
providers regarding prostate cancer; while 19% (n=10) indicated to have Received
information from health care providers.

Figure 13 distribution of sampled patients' on information received

In the figure above the information received was as follows: risk factors (38%), screening
22%, prevention 15%, signs and symptoms 8%, effects 7%, treatment 7% and causes 2%.

8
Sympt
oms
associ
ated
with
prosta
te
cance
r

Percentages of sampled patients

Figure 14 distribution of sampled patients' on symptoms associated with prostate cancer

In the figure above, 59% (n=32) didn’t know of signs associated with prostate cancer, 17%
(n=9) stated blood in urine as a sign of prostate cancer 16% (n=9) knew more than 1 sign, 6%
(n=3) excess urination, 1% (n=1) outlined fever and headache as the associated signs.

4.4.6 Practices

9
 Figure SEQ Figure \* ARABIC
Per 15 distribution of sampled
cen patients' on whether they had
tag heard of prostate cancer
es
of
sa
mpl
ed
pati
ent
s

Means of information
Figure 16 distribution of sampled patients' response on where they had heard the
information from

From the figure above 71% (n=39) have heard of prostate cancer screening while 29% (n=16)
have never heard of prostate cancer screening. Most of the respondents reported getting
information on prostate cancer screening from hospital 55% . Other sources of information
were 29% radio, 9% ,4% and 3% [e.g. school] and 1% respondents were relative.

10
Pe
rc
en
ta
ge
s
of
sa
m
pl
ed
pa
tie

Patients responses
Figure 17 distribution of sampled patients' response on whether they believed that they are at
a higher risk for prostate cancer

From the figure above,52%(n=29)of the respondent reported that they are not at a higher risk
of having prostate,41% (n=22) reported that they believed that they are at a higher risk of
having prostate cancer.7% (n=4)of the respondents didn’t know if they are at a higher risk of
having prostate cancer.

Figure 18 distribution of sampled patients' on whether they had been screened for prostate
cancer

Of the 324 respondents, a majority had never been screened for prostate cancer 94%
(n=52), . 6% (n=3) have been screened for prostate cancer.

11
 Figure SEQ Figure \* ARABIC 19
distribution of sampled patients' on
whether they knew anyone who had
Pati
undergone prostate cancer screening
ents
rela
tion
ship

Percentages of sampled patients

Figure 20 distribution of sampled patients' response on the relationship with the person who
had undergone prostate cancer screening test

From the figure 76% (n=42) of the respondent reported not knowing anyone who has taken
prostate cancer screening test whereas 24% (n=13) reported knowing someone who had
taken prostate cancer screening test. Out of those who knew anyone who knew someone who
has taken prostate cancer screening test, 60% (n=33) were their friends, 26% (n=14) were
their relative and 14 % (n=8) where their family members.

12
 Figure 21 distribution of sampled patients' on whether they wanted to know more about
prostate cancer

In the figure above it clearly demonstrates that 99% (n=54) would like to know more
about prostate cancer screening, 1 % (n=1) of the respondent reported they would like to
know more.

Perc
ent
age
s of
sam
pled
pati
ents

Patients responses
Figure 22 distribution of sampled patients' on whether prostate cancer screening is
embarrassing

From the figure, 64% (n=35) of the respondent said that it is not embarrassing to have
prostate cancer test.30% (n=16) reported that it is embarrassing to have prostate cancer test

13
 and the remaining 6% (n=) reported they don’t know if it is embarrassing to have prostate
cancer test.

Perce
ntage
rate
of
sampl
ed
patie
nts

Responses on Frequency of prostrate

cancer screening

Figure 23 distribution of sampled patients' response on the frequency of prostate cancer

screening

From the figure above it shows that 53% (n=29) of the respondent reported that they don’t
know how often should one go for prostate cancer screening,38% (n=21) of the respondent
reported that one should go yearly,5% (n=28) reported 3yrs and 4% (n=22) reported 2yrs is
the frequency that one should go for screening.

14
Factors
hinderi
ng
prostat
e
cancer
screeni
ng

Percentages of sampled patients

Figure 24 distribution of sampled patients' responses on factors hindering prostate cancer
screening

From the figure above it demonstrates that 56% (n=31) of the respondents reported lack of
knowledge as the main factor hindering people from going for prostate cancer screening, 34%
(n=19) reported that fear of the unknown is the factor that hinders people from getting
screened, 8% (n=4) reported that deliberately, not wanting to know is the reason most don’t
go for screening and 2% (n=11) said God protects, why bother? As the reason behind people
not going for screening.

Figure 25 distribution of sampled patients' responses on where they had heard prostate
cancer screening from

15
 Figure 26 distribution of sampled patients' response on whether they knew prostate
screening by name

Perc
enta
ge
rate

Methods of screening

Figure 27 distribution of sampled patients' responses on specific prostate screening method

heard

From the figure above, 92% (n=51) reported not to know any prostate cancer screening by
name, 8% (n=4) of the respondent reported to know prostate cancer screening test by name.
Out of the 25 respondent who reported to know the prostate screening test by name,60%
(n=33) reported to know PSA as the specific screening test,32% (n=18) reported DRE to be
the specific screening test and the remaining 8% (n=4) reported biopsy as the screening test
they have heard. From the 25 respondent who had about the specific prostate cancer
screening test, 88% (n=48) reported to have heard it at the hospital, 8% (n=4) reported to
have heard it from radio while the remaining 4% (n=2) reported to have heard it on
newspaper.

16
 4.4.7 Attitude

Pa
tie
nts
atti
tud
e

Percentages
Figure 28 distribution of sampled patients' response on their perception on whether someone
can have prostate cancer without any symptoms

From figure it is seen that most people 47% (n=25) don’t know the answer to if a man can
have prostate cancer without having any pain or symptoms. While 32 % (n=18) said it is false
for a man to have prostate cancer without having any pain or symptoms and 21% (n=12 said
it is true a man can have prostate cancer without having any pain or symptoms.

VARIABLES AGREE percentage DISAGREE percentage DON’T Percentages

17
 s KNOW

Prostate 4 7% 40 73% 11 20%

cancer is a
disease of
men with
many wives

Prostate 7 12% 39 70% 9 18%

cancer cannot
be prevented

Prostate 4 8% 37 67% 14 25%

cancer is
sexually
transmitted

Prostate 10 19% 34 61% 11 20%

cancer is not
curable

Prostate 15 28% 35 63% 5 9%

cancer is
embarrassing
to man

Individual 7 13% 40 72% 8 16%

can’t have if
not aware

Prostate 4 8% 43 79% 7 13%

cancer is for
white men

Treatment 45 83% 5 9% 4 8%
increases
chances of

18
life

If I develop 4 8% 39 70% 12 22%

prostate
cancer, I
would not
live more
than five
years

If one 4 8% 43 78% 8 14%

develops
prostate
cancer it is
too late to get
treatment

VARIABLE AGREE percentag DISAGREE percentage DON’ Percentage

e T
KNO
W

Treatment 46 83% 5 9% 4 8%
increases
chances of
life

Table 1 distribution of sampled patients' responses on their attitude

Overall patients attitude on prostate cancer

Good attitude 39 (70.3%)

19
Poor attitude 16 (29.7%)

Table 2 distribution of sampled patients' average responses on their attitude

5.0 DISCUSSION

5.1. KNOWLEDGE

5.1.1. Demographic

Demographic variables were examined for their contribution on practices on prostate

cancer screening. The association between married and prostate cancer screening have been

found in studies of African-American men and prostate cancer (Finney et al., 2005; Swan et

al., 2003). From our findings majority of the respondents were married making up 56 %. This

finding is similar to a study conducted in Kenya which showed that 87.6% were married

(Makori., 2015). From our findings most of our respondents 40% were between the age of

18-25 years. This was because those who were above 35 years were too sick hence not

meeting our inclusion criteria and some were unwilling to participate. The high percentage of

this age group contributed to most respondents perceiving themselves at low risk of getting

prostate cancer.

Knowledge on prostate cancer screening

89% had heard about prostate cancer screening. This correlates to a study in Ghana

among male university students out of 438 participants, 88.1% had heard of prostate (Binka

et al. 2016).Similar result was found in a study conducted in Uganda in which 97.5% were

reported to have heard about prostate cancer (Nakandi et al., 2015) In a similar study

conducted in Kenya by Wanyaga (2013), most of the respondents 84.6% were aware of

prostate cancer disease. 58% gave a response of not knowing anyone with prostate cancer.

20
This corresponds to a study by Wachira et al. (2018) whereby majority of the respondents

(75%) did not know of anyone suffering from the disease. 75% stated that prostate cancer

affected men only, 40% stated that prostate cancer affected both men and women, 11% didn’t

know which gender was affected by prostate cancer while 2% of the respondents stated that

prostate cancer affected women. This corresponds to a study by Wanyaga (2013), whereby,

the majority (71.5%) of the participants indicated that prostate cancer affects only men while

(14.5%) did not know the gender prostate cancer affects.

61% of the respondents believed that there are practices they could do to prevent self

from getting prostate cancer. Similar results were outlined by Wanyaga, who indicated that

48% reported that prostate cancer was preventable. However, the figures, contradicts those by

Wachira et al. 2018, where 52% of the respondents had no idea on how to prevent prostate

cancer this was because their research was conducted in different setting(Level 3 hospital)

which has direct influence on literacy level of people visiting the facility.19% stated to have

received information from health care providers regarding prostate cancer, this finding is

similar to a study by Wanyaga, (2013), 1.2% reported to have received information from the

healthcare providers. A similar study by Wachira et al., (2013) stated that only 6.4% had

received information from health care providers. A similar study by Makori,(2015) shows

that 31.5% of the respondents had received information from health care providers.

Our findings on the information received were as follows: risk factors, 38%,

screening, 22%, prevention, 15%, signs and symptoms, 8%, effects, 7%, treatment, 7% and

causes, 2%. According to Wachira et al., (2018) the level of knowledge on prostate cancer in

relation to the presenting signs and symptoms, prevention, screening and management was

low.

59% of the respondent didn’t know of signs associated with prostate cancer, 17% stated

blood in urine as a sign of prostate cancer, 16% knew more than 1 sign, 6% excess urination,

21
1% outlined fever and headache as the associated signs. This corresponds to a research by a

study by Wachira et al., (2018) where the level of knowledge on prostate cancer in relation to

the presenting signs and symptoms, prevention, screening and management was low.

Majority (87%) of the respondents were not aware of the symptoms of the disease.

5.2. Practices on prostate cancer screening

The awareness level on prostate cancer screening reported by respondents enrolled in

this study was 71%.This figure is similar to a research conducted by Wanyaga, (2013), which

found the level of awareness to be 48.2% although it differs in similar research (Oladimeji et

al.,2010) showed 22.5% of Nigerian men were aware of prostate cancer screening since this

research was conducted among Muslim religion. In our study, 52% of the respondents

perceived they are not vulnerable towards developing prostate cancer. The findings are

similar to a previous studies conducted among Nigerian men that showed only 86.6% of the

men perceived themselves not at a risk of developing prostate cancer (Oldameji et al. 2010).

This differ from a study by Wanyaga, (2013), which showed that 58% of the respondents

believed that they were at a higher risk. This difference of result can be attributed to the

difference in age group, most of our respondents were between 18 and 25 of age. The uptake

of prostate cancer screening reported by respondents enrolled in this study was only 6%.This

figure is consistent with a level of 4.5% previously reported for Nigerian men (Oladimeji et

al., 2010).The same findings also mirror a research conducted in Kenya by Wanyaga, (2013)

that showed only 4.1% had been screened for prostate cancer. Those who had been screened

reported DRE as the only method that was used in screening. In our study 76% of the

respondent reported not knowing anyone who has taken prostate cancer screening test. This

finding is similar to a study conducted by Wachira et al., (2018) which indicated that none of

the respondent in their study knew any person who had undergone prostate cancer screening.

Our finding in this study, 99% would like to know more about prostate cancer screening. This

22
finding is similar to a study conducted in Nairobi County by Wanyaga, (2013) which showed

that 97.2% of the respondents were willing to learn more about prostate cancer. Of the 1% the

following were the replies, one stated he isn’t sick so no need, another said he doesn’t want to

be stressed and the third one said isn’t ready, time will come. From our study, 64% of the

respondent said that prostate cancer test is not embarrassing. However, there are no

researches supporting and contradicting our finding. Our study recorded 53 % (172) of the

members didn’t know how often one should one go for prostate cancer screening. These

finding are inconsistent with a research conducted by Wanyagah. (2013) which showed that

45.8% who reported the frequency of prostate cancer screening is yearly this variation may

be due to variation of the sample size (wanyaga sample size was 538) and target population

(wanyaga target population was male aged above 30).

From our findings, only 8 % (25) knew specific prostate cancer screening test. The

findings are similar to a study conducted by Wanyagah, (2013) which showed only 7.1 %

knew screening methods. Out of the 25 respondent who reported to know the prostate

screening test by name, 60 % (15) reported to know PSA as the specific screening test. This

findings close relate to findings in a research conducted by Wanyagah (2013) which showed

that 68.3% knew PSA as the specific method of screening. These findings differ from

observations by (Ajape et al., 2009) showing that only 5.8% of the Nigerian urban men were

aware of the PSA test. The dissimilarities in the findings may be accounted for by the

differences in the educational and religious backgrounds given that most of the respondents

in the Nigerian study were Muslims with less than secondary level education. In addition, the

Nigerian study only examined the PSA method of screening while respondents in the current

study reported knowing the three test procedures (PSA, DRE and biopsy).

23
5.3. Attitude on patients on prostate cancer

Our findings in the study of impact of undergoing prostate carcinoma screening on

knowledge done in USA showed that 88% men who chose not to be screened had a less

positive attitude towards prostate cancer screening than the 12% men who chose to be

screened (Hoffman, 2011). It was also agreed that the results of the Brazil study reported

40.5% of men who had a proper attitude and the59.5% of those participants with adequate

attitude reported almost twice adequate practice for the detection of prostate cancer (Pereira

et al., 2010). The finding from a research by Wanyagah, (2013) which showed that 48.7%

agreed that one can have prostate cancer screening without symptoms, this disparity may be

due to difference in sample size since Wanyaga had a larger sample size and also difference

in settings. On average 70.3% of the respondents had good attitude towards prostate cancer

while 29.7% has a poor attitude. The findings were also consistent with research conducted in

Nairobi by Wanyaga, 2013 which found that 58% of the respondents had a good attitude

while 42% had a poor attitude. From his findings, 58% of the respondents said that prostate

cancer can be prevented, 61.6% said one would still live for more than five years if diagnosed

and 62.0% said it is not too late to get treatment if diagnosed with prostate cancer.

24
 6.0. CONCLUSION

Based on the findings of this study the researchers draw the following conclusions.

1. Most patients had heard of prostate cancer; however, majority did not know anyone

affected by the disease. A good number of the respondents believed that they could

prevent prostate cancer. Despite the high level of awareness, 81% reported not to have

received any information from the hospital. This could indicate a gap in health care

provision contributing directly to poor knowledge. The study also indicates that the

most received information from the hospital was on risk factors. The knowledge on

prevention and signs associated with the disease was also low.

2. The study also indicated high levels of awareness, however, majority of them did not

know any screening method by name. Among the few who knew the prostate cancer

by name, majority of them identified PSA. Most of the respondents had also not

undergone prostate cancer screening. The few (6%) who had undergone prostate

cancer screening cited DRE as the screening method done. Majority of the

respondents also did not know how often one should do screening. The study also

indicates that almost all the respondents (99%) were willing to learn more about

prostate cancer screening, this is a good indication and good attitude towards prostate

cancer.

3. Most of the respondents had good attitude. However, most of them indicated that they

were willing to go for prostate cancer screening tests. This is because most

respondents were below 40 years of age. A low number of individuals also perceived

that one can have prostate cancer without having any pain. Most of them cited that

having prostate cancer was not embarrassing and neither is screening.

25
7.0 Challenges

● The allocated time for data collection was short, considering the sample size that we

had to collect information from.

● Most of the adults aged above 35 years who are at risk of prostate cancer were

unwilling to fill the questionnaire.

● Some of the clients couldn’t complete filling the questionnaire and some even didn’t

return the questionnaires.

● Lack of adequate resources required in data collection.

7.1. Recommendations

● The Ministry of Health at national and county levels, and cancer stakeholders to

promote information on the signs and symptoms, treatment and preventive

measures of prostate cancer that will enhance further awareness and knowledge of

the disease.

● The Ministry of Health at national and county levels, and cancer stakeholders to

promote good knowledge on prostate cancer to increase men’s perception of self-

vulnerability towards the disease and hence increase PC screening uptake amongst

men at risk in the Kwale County.

● The Ministry of Health at national and county levels should expand screening

services at health facilities and public health promotion will enhance uptake of

prostate cancer screening leading to ameliorating the burden of the disease in

Kenya.

To the Hospital

26
 ● Msambweni County Referral hospital medical staff to provide health education to

all male clients visiting the hospital in order to create awareness of the burden in

the society.

To the School KMTC

● KMTC to create more opportunity and finance more studies to be conducted on

prostate cancer on areas that have not been researched before.

● Increase the time allocated for data collection

To the Community

● Advocate for voluntary annual PSA screening for males aged 40 years and above,

including in the high-risk bracket.

27
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undergo prostate specific antigen testing. African Health Sciences. 2016; 16: 524-
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9. Ferlay, J., Shin, H. R., Bray, F., Forman, D., Mathers, C., & Parkin, D. M. (2011).
Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer,
127(12), 2893-2917
10. Forrester-Anderson IT, (2005) Prostate cancer screening perceptions, knowledge
and behaviors among African American men: focus group findings. J Health
Care
11. JOOTRH Health Records (2018)
12. Kaninjig E., Rahman S., Close F., Pierre R., Dutton M., Lamango N.,Onokpise O
(2017) Prostate screening knowledge ,attitudes ,and beliefs among men in
Bemenda,Camerron.Internation Journal of public Health and Epidemiology. Vol 6

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13. Makori, RN, Kirui, A.C, Karani, A.K. (2015) Factors associated with uptake of
prostate cancer screening among patients seeking health care services at
kenyatta national hospital.
14. Malmi H, Ruutu M, Maattanen L, Stenman UH, Juusela H, Tammela TL,
(2010); Why do men opt out of prostate-cancer screening? Attitudes and perception
among participants and non-participants of a screening trial. BJU into 2010;
106(4):472–7.
15. Nakandi H, Kirabo M, Semugabo C, Kittengo A, Kitayimbwa P, Kalungi S,
Knowledge, attitudes and practices of Ugandan men regarding prostate cancer. Afr
J Urol 2013;19(4):165–70
16. National Cancer Institute (2018), genetics of prostate cancer (PDQ) Health
Professional Version
17. National Cancer Screening Guidelines, (2018).
18. National Guidelines for Cancer Management Kenya, (2013).
19. Oedina, F., Campbell ,E.,LaRose-pierre M.,Scrivens,j.,Hill A (2008) personal factors
affecting African –American men’s prostate cancer screening
behavior .Journal of the national medical association.Vol .100,NO 6 June 2008.
20. Oladimeji, O., Bidemi, Y. O., Olufisayo, J. A., & Sola, A. O. (2010). Prostate cancer
awareness, knowledge, and screening practices among older men in Oyo State,
Nigeria.
21. Int Q Community Health Educ, 30(3), 271-286.
22. Smith, R. A., Von Eschenbach, A. C, Wender, R., Levin, B., Byers, T &
Rothenberger, D. 2001. American cancer society guidelines for the early
detection of cancer: Update of early detection guidelines for prostate,
colorectal and endometrial cancers.
23. Steele, C. B., Miller, D. S., Maylahn, C., Uhler, R. J., & Baker, C. T. (2000).
Knowledge, attitudes, and screening practices among older men regarding
prostate cancer. Am
24. Public Health, 90(10), 1595-1600.
25. Wachira, B.W., Meng’anyi, L.W., Mbugua, G.R., (2018).Knowledge,Perception and
Uptake of Prostate cancer screening;A crossectional study at level 3 hospital in
Kenya,

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26. Public Health Research,Vol. 8 No. 4, 2018, pp.81-87. Doi;
10.5923/j.phr.20180804.01.
27. Wanyaga Paul (2013), prostate cancer awareness, knowledge, perceptionon self-
vulnerability and uptake of screening among men in Nairobi County, Kenya.
28. Wasike,R.W. & Magoha,G.A.O., (2007).Descriptive case series of patient presenting
with cancer of the prostate and their management at Kenyatta National hospital in
Nairobi.
29. World Health Organization, 2018
30. Veten,c ., wardle,j ,&marlow ,L . A. (2016). Cancer fear and fatalism among ethnic
minority in the united kingdom. British Journal of Cancer,114(5), 597-604.
http://doi..org/10.1038/bjc.2016.15
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prostate gland among African Males

30
Appendix I: Research Budget

ITEMS QUANTITY AMOUNT TOTAL

(KSHs) (Kshs)
1. STATIONARY
Biro pens 3 @ 20 60.00
Pencil/Ruler 1 @ 50 50.00
Stapler/pins 1 @ 200 200.00
Ruled fool scarps 2reams @ 300 600.00
Sub totals 910.00
2. COMPUTER
SERVICES
Flash disk 1 @ 500 750.00
Internet expenses 5hrs @ 50 250.00
Typing proposal 38pages x 2 @ 10 760.00
Binding proposal 38pages x 2 @ 50 100.00
Questionnaire(photocopy) 2copies @ 400 800.00

Sub totals 2660.00

3. OTHER SERVICES
Lunch/supper 30days @ 60 1,800.00
Authorization letter 1 @ 100 100.00
Accommodation 30days @ 4,000 4,000.00
Transport (Fare) 30days @ 50 1500.00
Ethical review fee @ 1500.00

Sub totals 12,400.00

Grand sub-totals 14,470.00
Miscellaneous 10% of 1,297.00
grand sub-total
Grand totals 16700.00

31
Appendix II: Work Plan
2020

Activity Feb March Apri May June July Aug Sept Oct Nov
l

Identification
of a research
topic

Writing of a
research
proposal

Submission
of proposal

Preparation
of research
tools

Data
collection

Data analysis

Discussion
of findings
and
interpretation

Presentation
and
submission

32
Appendix III: Questionnaire
Section A: Demographic Characteristics
Instruction: Please, tick as appropriate [√]
1. Age range in years
(a) 18-25 []
(b) 26-30 []
(c) 31-35 []
(d) Above 35 [ ]
2. Marital status:
(a) Single []
(b) Married []
(c) Divorced [ ]
(d) Widowed [ ]
3. Religion:
(a) Christian []
(b) Muslim []
(c) Traditional Beliefs [ ]
Section B: Knowledge.
Instruction: Please tick as (√)
2. Have you heard about prostate cancer before?
(a) Yes [ ]
(b) No [ ]
3. Do you know anyone that has had prostate cancer before?
(a) Yes [ ]
(b) No [ ]
4. Prostate cancer affects which gender?
(a) Men only [ ]
(b) Women only [ ]
(c) Both men and women [ ]
(d) Don’tknow [ ]
5. Which of the following factors could make a person more likely to develop prostate
cancer? Instruction: Kindly tick as many options as applied.

33
(a) Family history of the disease condition []
(b) Drinking excessive alcohol [ ]
(c) Lack of Exercise [ ]
(d) Older age [ ]
(e) Inadequate intake of vegetables and fruits [ ]
(f) Don’t know [ ]
6. I believe that there is nothing I can do to prevent me from getting prostate cancer:
(a) Agree []
(b) Disagree []
(c) Don’t know [ ]
7. Have you ever received information from your healthcare giver about prostate cancer?
(a) Yes [ ]
(b) No [ ]
8. If yes to question 7, kindly list the information about prostate cancer that you
received from your healthcare provider?
(a)___________________________________
(b)_________________________________
9. If yes, which symptoms are associated with prostate cancer? Instruction: Please kindly tick
as many options applied to the question11.
a) Excessive urination at night [ ]
b) Headache []
c) Blood in urine []
d) High temperature []
e) Don’t know []

34
Section C: Practices on Prostate cancer screening
1. Have you heard of prostate cancer screening?
(a) Yes [ ]
(b) No [ ]
ii) If yes, where did you hear it from?
(a) Hospital []
(b) Friend []
(c) Relative []
(d) radio/television [ ]
(e) newspapers/books/magazines [ ]
(f) Other specify…………….
2. Have you ever been screened for prostate cancer?
(a) Yes [ ]
(b) No [ ]
If yes, which method was used?
(a) Prostate specific antigen (PSA) [ ]
(b) Direct rectal examination (DRE) [ ]
(c) Biopsy []
(d) I do not know [ ]
3. Do you know anyone who has taken a Prostate Cancer Screening test?
(a) Yes [ ]
(b) No [ ]
ii) If yes, who are they to you?
(a) Family member [ ]
(b) Relative []
(c) Friend []
4. Would you like to know more about Prostate Cancer-screening?
(a) Yes [ ]
(b) No [ ]
ii) If No, give reason?
5. Doing prostate cancer screening/test is embarrassing for me
(a) Agree []
(b) Disagree []

35
(c) Don’t know [ ]
6. From what you know, how often should one go for prostate cancer screening?
(a) Yearly []
(b) Every two years [ ]
(c) Every three years [ ]
(d) Do not know []
7. What do you think gets in the way of people getting screened/ tested for prostate cancer?
(a) Lack of knowledge [ ]
(b) Fear of the unknown [ ]
(c) Deliberately not wanting to know [ ]
(d) God protects, why bother [ ]
8. Do you know of specific prostate cancer screening tests by name?
(a) Yes [ ]
(b) No [ ]
ii) If yes, specify ….…………….
iii) Where did you hear the tests from?
(a) Hospital [ ]
(b) Friend [ ]
(c) Relative [ ]
(d) radio/TV [ ]
(e) newspapers/books/magazines [ ]
(f) Cannot remember [ ]
Section D: Attitude
1. Do you believe that you are at a higher risk of getting prostate cancer than other me n?
Agree [ ] Disagree [ ] Don’t know [ ]
2. A man can have prostate cancer without having any pain or symptoms
(a) True [ ]
(b) False [ ]
(c) I do not know [ ]
3. Do you opt going for a prostate cancer screening
(a) Yes [ ]
(b) No [ ]
Question Agree Disagree Strongly Don’t

36
 Disagree Know

Prostate cancer is a disease of men with many

wives

Prostate cancer cannot be prevented

Prostate cancer is sexually transmitted

Prostate cancer is not curable once you have it

Prostate cancer is embarrassing to manhood

An individual can’t have prostate cancer if not

aware

Prostate cancer is only for white men.

Being treated for prostate cancer may increase

chances of living a healthier life.

If I developed prostate cancer, I would not live

more than 5 years

If someone has prostate cancer, I think it is already

too late to get treated for it:

37
Appendix IV: Map of the Study Area

38