RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE BANGALORE, KARNATAKA.

ANNEXURE II

PROFOMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 / Name of the candidate and address / SHRUTHI. K. NAIK
I YEAR MSC NURSING
ST. ANNS COLLEGE OF NURSING
MULKI
MANGALORE
2 / Name of the institution / ST.ANNS COLLEGE OF NURSING
MULKI MANGALORE
3 / Course of the study and subject / MSC. NURSING
COMMUNITY HEALTH NURSING
4 / Date of admission to course / 15/6/2011
5 / Title of the topic
EFFECTIVENESS OF AN AWARENESS PROGRAM ON KNOWLEDGE AND ATTITUDE REGARDING BREAST CANCER AMONG WOMEN IN A SELECTED RURAL COMMUNITY OF MULKI.
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8 / BRIEF RESUME OF THE INTENDED WORK:
6.1 Need for the study
Every country in the world is confronted by various health problems. The changing values of society, urbanization, modernization have been influencing the health care tremendously. Besides the emerging problem, the existing problem has posed a threat to the health care delivery system. Breast cancer is the most common cancer in many countries in the world. Improving the breast health is a challenge that may overcome with collaboration from multisectors, both public and private1.
Each year 10.9 million people suffer from breast cancer world wide that result 6.7 million deaths from the disease. The breast cancer is prevalent in almost all regions of the world and there is no country in which cancer is a rare occurrence. In India, the number of new breast cancer cases is about 1,15,000 per year and this is expected to rise to 250,000 new cases per year by 2015.
According to Kidwai Memorial Institute Of Oncology (KMIO), Cancer of the cervix uteri continues to be the most predominant site of cancer and accounted for 26.7% of all cancer in females. Cancer of breast cancer is the second most common site of (16.6 %) followed by cancers of oral cavity(11%), esophagus (5.7%), and ovary (5%). Over the years, a gradual decrease in the numbers and relative proportion of breast cancer is observed. Breast cancer has overtaken cervical cancer to become the leading site of cancer in metro cities like Delhi, Bangalore, Mumbai, Chennai, Bhopal, Ahmadabad and Kolkata with relative proportion ranging from 21.7% to 28.7%.2
The risk factors pointed out by the oncology experts are increasing age probability, lack of child bearing or breast feeding, higher hormone levels, late age of menopause, smoking, alcohol and economic status. The life time probability of developing breast cancer in India is one in 22 women compared to one in eight in US and other developed countries.3
Breast cancer is a cancer that starts in the tissue of the breast. There are two main types of breast cancer. They are Ductal carcinoma (milk duct) and Lobar carcinoma (lobules, parts of the breast). Breast cancer may be invasive or non invasive. Invasive means it spreads from the milk duct, lobule to other tissues in the breast. Noninvasive means it has not yet invaded other breast tissue. Non invasive breast cancer is called “in situ”. Many breast cancers are sensitive to the hormone estrogen. This means that estrogen causes the breast tumor to grow. Such cancers have estrogen receptors on the surface of their cells. They are called estrogen receptor – positive cancer.
The risk factor which cannot be modified include :
  • Age and gender- breast cancer cases are found in women over age 50. Women are 100 times more likely to get breast cancer than men.
  • Family history –about 20 -30 % of women with breast cancer have family history of the disease.
The risk factor which can be modified include:
  • DES – women who took diethylstilbestrol to prevent miscarriage may have an increased risk of breast cancer after 40 yrs.
  • Hormone replacement therapy (HRT)- One has a risk of breast cancer if one has received hormone replacement therapy with estrogen for several years or more.
  • Obesity – obesity has been linked to breast cancer, the theory says that obese produces more estrogen.
  • Radiation –one who has received therapy as child or young adult to treat cancer of the chest area, you have a much higher risk for developing breast cancer.4
A pre- experimental study was conducted, to assess the knowledge on early detection of breast cancer among school teachers in Mangalore. The sample consists of 60 school teachers selected by purposive sampling technique. The mean post test knowledge score (O2- 24.05) was higher than the mean pre test knowledge score (O1- 12.48). Thecomputed‘t’ value (24.14) was higher than the table value (t – 1.67) at 0.05 level of significance. Thus conclusion was derived that planned teaching programme improved the knowledge and helped for early detection of breast cancer.5
A descriptive study was conducted, to assess the knowledge on breast cancer and its early detection measures among rural women in Ibadan, Nigeria. The assessment was performed with the use of self – structured knowledge questionnaire. The sample consists of 420 women randomly selected from the two districts. The mean knowledge score on breast cancer was 55.4 SD 5.4, while the mean knowledge score on early detection of breast cancer was 24.8, SD 2.3 and only 54(13.3%) claimed to have heard of breast self examination. This study revealed that respondent lacked knowledge of vital issues about breast cancer and early detection measures6.
Breast cancer is seen much in younger age than earlier, the number of breast cancer cases is risingrapidly. Breast cancer in the young tends to be more common than cancers in the older population. So the need of the hour is breast cancer awareness, beginning from 20 years of age and regular screening from a qualified doctor. Hence, it is possible to detect the cancer early and treat it in an earlier stage, there by improves a chance of longer life for the patient and also decreasing the chance
Of metastasis. This urged the investigator to take up the present study.7
6.2 Review of literature
A pre- experimental (one group pretest post test) design was adopted for a study conducted in Mangalore. The sample comprised of female teachers of the age group 21- 60 yrs, working in selected primary and secondary schools in Mangalore. Purposive sampling technique was used. Data was collected using baseline characteristics and structured knowledge questionnaire. The mean post test knowledge score (24.05 i.e 80. 17%) was higher than the mean pre test knowledge score (12.48 i.e 41.61%). The‘t’ value (24.14) was higher than the table value(1.67) at 0.05 level of significance. This indicates that planned teaching program was effective in increasing the knowledge of teachers on early detection of breast cancer8.
A quasi experimental study was conducted to assess the knowledge on breast self examination among adolescent girls in a selected degree college in Mangalore. The sample size was 60 students between the age group of 17 – 20yrs. The sampling technique adopted for the study was simple random sampling. The tool used for the study was a structured knowledge questionnaire. Mean pre test score was 19.83 whereas post test knowledge score 31.38( t= 24.97, p< 0.005). The study revealed that the education on breast cancer helps to improve knowledge among adolescent girls.9
A pre experimental study was conducted to assess knowledge on breast cancer and breast self examination among religious sisters in Kerala. Sample size was 30. The sampling technique adopted for the study was convenient sampling. The tool used was a structured knowledge questionnaire. Findings of the study revealed that the mean knowledge score had improved from 25.29 to 38.94 after the administration of self instructional module and suggested that health education need to be given to women regarding breast self examination.10
A descriptive study was conducted to determine the two dimensions of breast cancer awareness and breast screening awareness among 418 women aged 18 yrs and older, employed as nurses and teachers in selected private hospitals and schools in Amman, Jordan. A convenient sampling technique was used for sample selection and the data was collected by structured knowledge questionnaire. Nurses were more aware than teachers of the importance of breast cancer screening.The adjusted mean screening awareness score for nurses was 88.3 % compared with 73.1 % for teachers (p= < 0.0001). These results provide important information about the level of beast cancer awareness among women nurses and teachers in Jordan and may be useful for developing future prevention and education programme.11
6.3 Statement of the problem
Effectiveness of an awareness programme on knowledge and attitude regarding breast cancer amongwomen in a selected rural community of Mulki.
6.4 Objectives of the study
6.4.1. To determine the level of knowledge of women regarding breast cancer using structured knowledge questionnaire.
6.4.2. To assess the attitude of women regarding breast cancer using attitude scale.
6.4.3.To find the effectiveness of awareness program on breast cancer in terms of gain in knowledge score and change in attitude score.
6.4.4. To find the relationship between the knowledge and attitude of rural women regarding breast cancer.
6.5 Operational definition
6.5.1 Effectiveness:
In this study effectiveness refers to the extent to which awareness program on breast cancer has achieved the desired effect as evidenced by gain in knowledge score and change in attitude score.
6.5.2 Knowledge:
In this study, knowledge refers to the correct response given to the structured knowledge questionnaire by the women on breast cancer and expressed in terms of knowledge score.
6.5.3 Attitude:
In this study, attitude refers to the expressed belief or feeling or opinion of women towards breast cancer as measured using attitude scale and expressed in terms of attitude score.
6.5.4 Awareness Programme on breast cancer:
In this study, it refers to systematically developed teaching aid on breast cancer designed by the investigator for the women in rural community. The awareness programme includes meaning, risk factors, signs and symptoms, diagnostic investigations, breast self examination, preventive measures and management of breast cancer.
6.5.5 Rural Community:
In this study, it refers to the village that comes under the selected panchayat of Mulki.
6.5.6 Women:
In this study, women refer to the females aged 25-50years residing in a selected rural community of Mulki.
6.6 Assumptions
6.6.1 Women may have some knowledge on breast cancer.
6.6.2 Education creates awareness on early detection of breast cancer.
6.7 Delimitation
The study is delimited to
6.7.1 Women between the age group of 25- 50 years in selected rural community of Mulki.
6.8 Hypotheses
All hypotheses will be tested at 0.05 level of significance.
6.8.1H1: There will be significant difference between the mean pre and post – test knowledge score of rural women regarding breast cancer.
6.8.2H2: There will be significant difference between the mean pre and post test attitude score of rural women towards breast cancer
6.8.3H3: There will be significant relationship between the mean pre test knowledge and attitude scores of Women on breast cancer.
MATERIALS AND METHODS:
7.1 Source of data
Data will be collected from the women of selected ruralcommunity of Mulki.
7.1.1Research design
Pre experimental (one group pre and post test) design will be used for the present study.
7.1.2 Setting
The study will be conducted in selected rural community of Mulki. The area comprises 46,000 populations.
7.1.3 Population
The population for this study includes all the women of aged between 25 – 50Yrs in selected rural
Communityof Mulki.
7.2 Method of collection of data
7.2.1 Sampling procedure
A purposive sampling technique will be used to select the study participants.
7.2.2 Sample size
The sample size of this study will be 60 women in a selected rural community of Mulki.
7.2.3 Inclusion criteria for sampling
  • Women between the age group of 25- 50 yrs belonging to selected rural community of Mulki.
  • Women who can read and write Kannada/ English.
  • Women who are willing to participate in the study.
7.2.4 Exclusion criteria for sampling
  • Women who are not available at the time of data collection.
  • Women who have already received teaching on breast cancer.
  • Women who have been diagnosed to have breast cancer.
7.2.5 Instruments intended to be used
The tool designed for the study consist of
TOOL I: Structured knowledge questionnaire on breast cancer.
Part I: Base line characteristics
Part II: Structured knowledge questionnaire on breast cancer
TOOL II: Attitude scale on breast cancer.
7.2.6Data collection method
The investigator will obtain formal written permission from the concerned authorities.
•The investigator will introduce herself to the participants.
•The investigator will obtain written consent from the participants.
•The purpose of the study will be explained to theparticipants.
•Pre test will be conducted using structured knowledge questionnaire and attitude scale.
•After pre-test, awareness program on breast cancer will be conducted to the women.
•Post test will be conducted by administering the same structured knowledge questionnaire and attitude scale on 7th day.
7.2.7 Data analysis plan
  • Collected data will be analyzed using descriptive (frequency, percentage, mean, median, standard deviation) and inferential statistics.
  • The data will be analyzed for significance of difference between the pre- test and the post – test scores using paired’t’ test.
  • Relationship between knowledge and attitude will be found using co- efficient correlation.
  • The data will be presented in the form of tables and graphs.
7.3 Does the study require any investigation or intervention to be conducted on patients or other humans or animals? if so , please describe briefly.
Yes, the investigator needs to assess the knowledge and attitude of rural women on breast cancer and also to administer awareness program after getting written consent from them.
7.4 Has ethical clearance been obtained from you Institution in case of 7.3?
Yes, ethical clearance is obtained.
LIST OF REFERENCE
  1. A guide for women with early breast cancer,Sydney.BMJ South Asia. 2003 Jan;12(4):13-14.
  2. Breast cancer cases in India to double by 2015: Experts. [internet]. 2011, Oct 19. [cited on Oct 31]. Available from:
  3. Reddy KR. Kidwai memorial institute of oncology: statistics. [Internet]. 2005 [cited on 2011 Oct 31]. Available from :
  4. Jenifer.B. Campbell. Literature on breast cancer.Nursing times;2009.74 (2).Pol:10,1023/A: 187-192.
  5. A guide for women with early breast cancer. Sydney: British medical journal south Asia. 2003 Jan;12(4):15-17.
  6. Oluwater A, olapdepo. Know of breast cancer and its early detection measures among rural women in kinyle local government area. Nigeria. BMC Cancer 2006;6: 271.
  7. Marhlogee. Breast cancer. Nursing times. 2008 March;11(7):123-125
  8. Salome M.C. chacko. Effectiveness of planned teaching programme on knowledge of early detection of breast cancer among school teachers in selected schools. 2010.
  9. Mrs. Manish Kadam . Study on assessment of knowledge on breast self examination amongwomen in urban area. Nursing times. 2007 july; 3(4)
  10. E. Hemaltha. A study to assess the knowledge towards breast self examination among college girls.[Thesis]2008.
  11. Madant h, Herrill R.M. Breast cancer risk factor and screening awareness among women nurses and teachers in Amman, Jordan. 2002;24(4): 276-282.

9 / Signature of the candidate
10 / Remarks of the guide
11 / Name and designation
11.1 Guide
11.2 Signature
11.3 Co- guide
11.4 Signature
11.5 Head of the department
11.6 Signature / MRS. SUDHA MAHESWARI
ASSOCIATE PROFESSOR
HOD OF COMMUNITY HEALTH NURSING.
MULKI, MANGALORE.
PROFESSOR SISTER. JACINTHA D’SOUZA
PRINCIPAL, ST. ANN’S COLLEGE OF NURSING
MULKI, MANGALORE.
MRS. SUDHA MAHESWARI
ASSOCIATE PROFESSOR
HOD OF COMMUNITY HEALTH NURSING.
MULKI, MANGALORE.
12 / 12.1 Remarks of the principal
12.2 Signature