KNOWLEDGE, ATTITUDE AND PRACTICE OF BREAST SELF-

EXAMINATION AMONG FEMALE CLIENTS AT POSTNATAL CLINIC AT

SOROTI REGIONAL REFFERAL HOSPITAL.

A RESEARCH PROPOSAL SUBMITTED TO SOROTI SCHOOL OF

COMPREHENSIVE NURSING IN PARTIAL FULFILLMENT OF

THE REQUIREMENTS FOR THE AWARD OF DIPLOMA

IN NURSING BY UGANDA NURSES AND MIDWIVES

EXAMINATION BOARD

BY

IKWALING JOYCE MARY

REG No JAN/21/U030/040

MAY 2022
DECLARATION

I hereby declare to the best of my knowledge that the work presented in this Proposal is my

original work and has never been presented by anyone to any institution of learning for any

academic award or other purposes.

Name Signature

Ikwaling Joyce Mary ...............................

i
APPROVAL

This work has been done under my supervision and guidance. Therefore, I do approve for

data collection.

SUPERVISOR Signature …………………….

TUMUHIMBISE JUSTUS Date………………………….

PRINCIPAL Signature …………………….

ITOMET FRNACIS Date………………………….

ii
DEDICATION

This work is dedicated to my beloved Mother Atai Hellen Maculate for her unconditional

love, support, and care.

iii
ACKNOWLEDGEMENTS

First and foremost, I thank the Almighty God for having enabled me throughout my academic

endeavors, research work and life generally.

In a special way I would like to acknowledge the efforts of my beloved sponsor Sr. Laura

who has facilitated me financially and encouraged me during this course.

I would like to acknowledge my sisters Jane Frances Angida and Akia Jesca and brothers

Rev. Fr. Stephen Michael Iriso, Ekongo Jacob and Otai George for their genuine love and

support towards the production of this research work.

I extend my sincere appreciation to my supervisor TUMUHIMBISE JUSTUS for his time,

support, guidance and encouragement during the preparation of this work.

I acknowledge the role played by the teachers of Ngora High School and the entire staff of

Soroti School of Comprehensive nursing for guiding and developing me morally,

academically, spiritually and socially ready to serve the nation.

With great pleasure I would like to appreciate my dear friends Mr. Okalang David, Mr. Otim

Patrick, Mr. Ibwongo Stephen Richard, Ayaku Moses, Achen Agnes and Aujo Sarah for the

encouragement towards the success of this research.

May God bless all of you abundantly

iv
ABBREVIATIONS.

BC : Breast Cancer

BSE : Breast Self-Examination

CBE : Clinical Breast Examination

GLOBOCAN : Global Organization on Cancer

IARC : International Alliance Related to cancer

MOH : Ministry of Health Uganda

NGO : Non-Governmental Organization

UCI : Uganda Cancer Institute

WHO : World Health Organization

SPSS Statistical package for social sciences.

IRB Institutional Review Board.

REC Research and Ethics Committee.

SRRH Soroti Regional Referral hospital.

NA Not applicable.

v
 Table of Contents

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

APPROVAL..............................................................................................................................ii

DEDICATION..........................................................................................................................iii

ACKNOWLEDGEMENTS......................................................................................................iv

ABBREVIATIONS....................................................................................................................v

1.0 CHAPTER ONE:............................................................................................................9

INTRODUCTION......................................................................................................................9

1.1 BACKGROUND..............................................................................................................9

1.2 PROBLEM STATEMENT............................................................................................11

1.3 PURPOSE OF THE STUDY.........................................................................................12

1.4 STUDY OBJECTIVES..................................................................................................12

1.4.1 GENERAL OBJECTIVE........................................................................................12

1.4.2 SPECIFIC OBJECTIVES...........................................................................................12

1.5 RESEARCH QUESTIONS............................................................................................12

1.6 STUDY JUSTIFICATION.............................................................................................13

2.0 CHAPTER TWO:..............................................................................................................14

LITERATURE REVIEW.........................................................................................................14

2.1 INTRODUCTION..........................................................................................................14

2.2 KNOWLEDGE OF BREAST SELF-EXAMINATION AMONG WOMEN OF

REPRODUCTIVE AGE......................................................................................................14

vi
 2.4 PRACTICE OF BREAST SELF-EXAMINATION AMONG WOMEN OF

REPRODUCTIVE AGE......................................................................................................18

3.0 CHAPTER THREE:......................................................................................................21

METHODOLOGY...................................................................................................................21

3.1 INTRODUCTION..........................................................................................................21

3.2 RESEARCH DESIGN....................................................................................................21

3.3 STUDY SETTING.........................................................................................................21

3.4 STUDY POPULATION.................................................................................................22

3.4.1 SAMPLE SIZE DETERMINATION..........................................................................22

3.4.2 SAMPLING PROCEDURE........................................................................................22

3.4.3 EXCLUSION CRITERIA...........................................................................................22

3.4.3.1 INCLUSION CRITERIA.........................................................................................22

3.5 DEFINITION OF STUDY VARIABLES......................................................................23

3.6 RESEARCH INSTRUMENT........................................................................................23

3.7 DATA COLLECTION PROCEDURES........................................................................23

3.7.1 DATA MANAGEMENT............................................................................................24

3.7.2 DATA ANALYSIS AND PRESENTATION.............................................................24

3.8 ETHICAL CONSIDERATIONS...................................................................................24

3.9 LIMITATIONS OF THE STUDY.................................................................................24

3.10 DISSEMINATION OF RESULTS..............................................................................25

APPENDIX I: CONSENT FORM...........................................................................................29

APPENDIX II:.........................................................................................................................30
vii
BUDGET..................................................................................................................................30

APPENDIX III: WORK PLAN...............................................................................................31

APPENDIX IV: QUESTIONNAIRE......................................................................................32

APPENDIX V MORGAN TABLE FOR DETERMINING SAMPLE SIZE FROM AGIVEN

POPULATION.........................................................................................................................41

APPENDIX VI:........................................................................................................................42

MAP OF UGANDA SHOWING SOROTI REGIONAL REFERRAL HOSPITAL..............42

APPENDIX VII: MAP OF SOROTI DISTRICT....................................................................43

viii
 CHAPTER ONE:

INTRODUCTION

1.1 BACKGROUND.

Breast cancer is the second leading cause of cancer deaths in women and poses a global

public health concern (Agatha & Nankumbi, 2016).

Worldwide, breast cancer remains the most frequently diagnosed cancer and the leading

cause of cancer deaths among females accounting for 23% of the total cancer cases and 14%

of the cancer deaths with a 3% annual incidence and 1.8% death rate as cited by (Atuhairwe

et al., 2018).

Breast cancer is among the leading causes of cancer mortality in women worldwide. The

Incidence of breast cancer is rising more rapidly in population groups that enjoyed a low

Incidence of the disease (WHO, 2015).

More than half of all cancers (56.8%) and cancer deaths (64.9%) in 2012 occurred in less

developed regions of the world. Incidence rate remains highest in more developed regions but

mortality is much higher in less developed countries due to lack of early detection and access

to treatment facilities (Segni, 2016).

Women in low-income and middle-income countries face various barriers to breast cancer

care, from accessing early detection programs to receiving timely diagnosis and appropriate

treatment. This situation is reflected in breast cancer 5-year survival outcomes, which are 40–

60% in low-income and middle income countries versus 84% in North America (Birnbaum et

al., 2016.).

Breast cancer incidence in sub-Saharan Africa is increasing, particularly in Uganda where the

rate has risen by 5.2% per year for the past 15 years (Scheel John R, & Scott Parker., 2018).

9
In Ugandan women, breast cancer is the third most common cancer following Kaposi’s

sarcoma and cervical cancer with incidence rate of 22 per 100,000 women (Segni, 2016).

Early detection of breast cancer is crucial for early treatment and reduction in related

mortality. Recommended screening methods to reduce breast cancer mortality and morbidity

include; breast self-examination, clinical breast examination, and mammography.

Although there is debate surrounding the efficacy of routine breast self-examination in early

detection of breast cancer in women older than 20 years, breast self-examination is

recommended as a screening method for increasing breast health awareness, because it is

cheap, widely available, and does not require complex technical training and therefore a more

practical approach in a resource limited setting like Uganda (Ardahan, Dinc, Yaman, Aykir,

& Aslan, 2015).

The World Health Organization has recommended that mammography screening is highly

effective but it is only practical in countries with a good health infrastructure that can afford

long-term, organized, population-based screening programs (Khan, & Hayat, 2015).

In this study we assess the knowledge and practice of breast self-examination among female

clients at Soroti Regional Referral hospital.

10
 1.2 PROBLEM STATEMENT.

Globally Breast cancer causes 376,000 deaths a year worldwide and about 900,000 women

are diagnosed every year with the disease (WHO, 2016).

In Africa, breast cancer is responsible for 28% of all cancers and 20% all cancer deaths in

women. (16% & 11% both sexes) Incidence rates are still generally low in Africa, estimated

below 35 per 100,000 women in most countries (compared to over 90–120 per 100,000 in

Europe (Clegg-Lamptey, 2016)

Breast cancer remains a public health concern in low- and middle-income countries

particularly in Uganda where it is constantly on the rise. In Uganda less than 20% of patients

are diagnosed in early stages and more than 80% in the most advanced stages (III and IV)

(Moses Galukande, 2014). This is largely attributed to low level knowledge, attitude and

practice of breast self-examination. Though previous studies observed high knowledge of

breast cancer as a disease among female university students, knowledge of breast self-exam

and breast self-exam practices was lower. Many studies conducted in Africa and elsewhere

continue to reveal the gap between knowledge of breast cancer disease with relation to breast

self-exam (Agatha & Nankumbi, 2016).

In Uganda, women commonly seek for medical attention with visually obvious breast masses

or ulcerated tumours that have been present for many months or years where greater than

77% of women are given a diagnosis of advanced-stage disease, including 26% with

metastatic stage IV cancer at initial presentation. In a recent analysis of patients with breast

cancer treated at UCI, 187 presented with stage III or IV disease (Galukande et al, 2015).

Therefore the researcher intends to find out the level of knowledge, attitude and practice of

breast self-examination among female clients at Soroti Regional Referral Hospital.

11
1.3 PURPOSE OF THE STUDY

The purpose of the Study is to generate information on Self breast examination among

women of reproductive age in order to develop health education programs to improve on

women’s knowledge and practice of BSE in order to promote early detection and treatment of

Breast cancer.

1.4 STUDY OBJECTIVES.

1.4.1 General objective.

 To assess the knowledge, attitude and practice of breast self-examination among

female clients attending Postnatal Clinic at Soroti Regional Referral hospital.

1.4.2 Specific objectives.

1. To determine the knowledge of breast self-examination among female clients

attending Postnatal Clinic at Soroti Regional Referral hospital.

2. To assess the attitude of breast self-examination among female clients attending

Postnatal Clinic at Soroti Regional Referral hospital.

3. To identify practices of self breast examination among female clients attending

Postnatal Clinic at Soroti Regional Referral hospital.

1.5 RESEARCH QUESTIONS.

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

attending Postnatal Clinic at Soroti Regional Referral hospital?

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

Postnatal Clinic at Soroti Regional Referral hospital?

3. What are the practices of self breast examination among female clients attending

Postnatal Clinic at Soroti Regional Referral hospital?

4.

12
1.6 STUDY JUSTIFICATION.

This study will establish the knowledge, attitude and practice of breast self-examination in

order to promote evidence-based nursing care and related health education programs if the

need is realized. If this is not clearly established, female clients will miss out on the possible

health education programs which would be put in place after establishing the need. The

results will be of great importance as it may inform policy and also assist health professionals

in planning health education for all eligible female clients at Soroti Regional Referral

Hospital and the neighboring communities.

13
 CHAPTER TWO:

LITERATURE REVIEW.

2.1 INTRODUCTION.

This chapter presents literature put by other scholars on knowledge, attitude and Practices of

breast self-examination among women of reproductive age.

2.2 Knowledge of breast self-examination among women of reproductive age.

According to the study done by Godfrey et al in their study of breast cancer knowledge and

breast self- examination practices among female university students in Kampala, Uganda

carried out in 2013 revealed high knowledge of breast cancer (98.0%) and breast self-

examination practices (76.5%) among female students. However, they noted that skills

related to BSE practices were low (43.6%). Majority (56.9%) of students received

information about breast cancer via mass media. (Agatha & Nankumbi, 2016).

In a study carried out in Malaysia, it was found that most women in Malaysia had good

knowledge of breast cancer and its screening tools, particularly breast self-examination, but

only superficial in-depth knowledge about the disease. They also found that women in rural

areas had lower levels of knowledge than those in urban areas. It was reported that books,

magazines, brochures and television were among the most common sources of breast cancer

information (Khan et al., 2015).

In south west Nigeria, a study carried out by Oladimeji et al in Ibandan revealed that majority

of participants (70.8%) reported that they did not know how to perform breast self-

examination, while only 29.2% reported that they do. In the same study, out of 271

participants who responded to the question of when is the right time to perform breast self-

examination, only 8.1% knew correctly that ‘mid-cycle’ was the right time to perform breast

self-examination. The highest proportion (80.8%) reported incorrectly that the right time for a

14
woman to perform breast self-examination was ‘anytime’(Oladimeji, Tsoka-gwegweni, &

Igbodekwe, 2015).

A study carried out at Adama Science and Technology University in Ethiopia to assess the

knowledge, Attitude, and Practice of BSE among Female Health Science Students revealed

that (44.1%) of the respondents correctly reported that BSE should be done monthly and

(30.2%) of them reported annually, every 3 month or occasionally while (25.6) of the

respondents didn’t know when and how often BSE should be done. Nearly two fifth of the

respondents reported that BSE should be performed a week after menses while (30.2%) of the

respondents didn’t know when to perform BSE and that women of age above 20 years should

perform BSE (Segni, 2016).

In a study done by Samiri et al., (2021) noted that, nearly three quarters 74%) of women had

previously heard about BSE. Approximately 6 in every 10 women 59 % claimed to know

how to monthly.

As many as 40% of women had never done a BSE and Overall 25.6% o were not aware of

BSE they had never heard of BSE, had absolutely no idea on how to perform a BSE and

never practiced it while 39.17% were partially aware had heard of BSE, had a slight idea on

how to perform it but did not practice it often and 35% were substantially aware of BSE had

heard of BSE, knew how to perform it and practiced it often (Abo Al-Shiekh, Ibrahim, &

Alajerami, 2021)

Despite a substantial proportion of women not being aware of BSE nearly all of them (95%)

recognized the importance of BSE for their health.

In Angola, a study of 595 university students indicated that a majority of them where not

knowledgeable about breast cancer (Tura, 2019).

In Senegal a survey of 300 women indicated only 42.7% having knowledge about BSE and

only 29% practicing it (Heena et al., 2019)

15
The situation appeared worse in women of African descent in South Africa in whom a survey

indicated that close to one-fifth of women had not heard of breast cancer and half were not

aware of BSE (M. Galukande & Kiguli-Malwadde, 2012)

Study done in Nigeria reported that 51.77% of women were partially aware of the causes of

breast cancer, while 48.33% were substantially aware and On the other hand 5% of

respondents were not aware of risk factors of breast cancer did not know any breast cancer

risk factor (Ilbawi, Pretorius, & Lauer, 2018)

A study of female secondary students in Abuja indicated that while a high proportion knew

about BSE being used to prevent breast cancer very few (10.1%) practiced it (Onainor, 2019)

A study in Uganda revealed a high awareness of breast cancer (98.0%) and BSE practices

(76.5%) among university female students. Over half the students (61.3%) had an

intermediate level of knowledge about risk factors related to breast cancer and the signs and

symptoms of the disease. The majority (56.9%) of students received information about breast

cancer via mass media (Atuhairwe et al., 2018)

2.3 Attitudes of women towards breast self-examination

In a study on Nursing Students of Arab American University/Jenin, Palestine majority of the

Participants believed that all women should do BSE (63.9%). However, 4.2% of them stated

that BSE causes embarrassment and 29.9% feared to think about breast cancer. About 21.6%

wasn't interested in doing BSE (Ayed., 2015).

A study on School Teachers in Mosul City, Iraq revealed that more than half of the Study

sample believed that BSE is neither difficult and time consuming nor embarrassment.

However regarding checking, 40% of the study samples believed that if they do not have any

problem in their breasts, so there was no reason to examine their breasts since it would be

wastage of time and triggering other complications that they did not have (Maarab et al.,

2017) .

16
In Ghana, a study on female university students at Presbyterian University College

Respondents were asked if BSE is necessary and 65% of respondents strongly agreed that it

is necessary, while 35% of respondents agreed that is not necessary ( Sarfo et al., 2013).

In a study on School Teachers in Mosul City, Iraq One handed forty eight (74%) of the

responders stated that they had never done BSE. The commonest reason given for not doing

it, did not hear about did not hear about BSE (39.0%). Other reasons included: do not want

(16.0%), had no knowledge of procedure (9.5%), Afraid (5.5%), and not useful (4.0%)

(Maarab et al., 2017)

In Ghana, a study on female university students at Presbyterian University College had 76%

respondents responded yes and 24% responded no when respondents were asked if they

performed BSE. The minority of respondents (24%) who did not perform BSE, were further

asked on their reasons for not performing BSE and 30% said they do not have time, 11% said

they didn’t feel it was necessary, while 59% did not have a specific reason for not performing

BSE ( Sarfo et al., 2013). Furthermore, respondents were asked about the factors that

hindered their performance of BSE and 23% stated time as a factor, 15% indicated

procrastination, 25% indicated forgetfulness, 6% attributed it to laziness, 13% stated the fear

of discovering a lump in their breast, 6% indicated that they do not trust in their ability to

perform the procedure correctly, 6% stated they have no available specific training program

to guide them to perform the procedure correctly, and 6% stated they were anxious (Sarfo et

al., 2013)

In a study at College of Medicine of the University of Lagos, Nigeria, 65.4% of the

respondents thought that breast self-examination was necessary while 83.1% of the

respondents have carried out breast self-examination. Of those that have carried out breast

self-examination before, 87.4% did it to examine their breasts regularly while 6.8% did it

because they have a family history of breast cancer (Ink et al., 2018)

17
In the same study in Nigeria, the respondents who had never performed breast self-

examination, 46.7% did not because they do not have any symptom, 26.7% felt it was not

important, 22.6% did not know how to do it, 20% felt they can never have cancer, 10% of the

respondents felt they were violating themselves by touching their breast and did not believe

in the efficacy of the test and 3.3% of the respondents were scared of being diagnosed with

breast cancer. The respondents also felt that breast self-examination should be performed

daily (23.8%), some weekly (22.5%), some monthly (50.8%) and some yearly (2.9%) (Ink et

al., 2018)

A study done in Saudi Arabia more than two third of the respondents had positive attitude

toward BSE because they regarded it a normal health care practice and not a sexual abuse

(Dala et al, 2014). While a study conducted in, Iraq 89.7% of the female had positive attitude

toward learning the correct procedure of BSE with an intention to instruct others on the

technique (Nada et al., 2018) and Nigeria it showed that from 100 health workers, 92%

positive attitude (Oluwole et al., 2018). This difference may be due to the level of knowledge

between Nigerian health workers and 17 health students in our case and in other way the

sample size taken Nigeria was small compared to our study.

2.4 Practice of breast self-examination among women of reproductive age.

In a study carried out in Kampala, Uganda by K. Godfrey et al, they found out that; majority

of the participants (76.5%) had heard about breast self-examination, but less than half

(43.6%) had ever performed it. Less than half of participants (44.9%) stated that they

performed breast self-examination at least once a month. Of those who had not performed

breast self-examination before, 38% planned to perform breast self-examination in the next

month (Agatha & Nankumbi, 2016).

In this study done by Okantey 2017, lump sizes ranged from 2.4cm to 3.4 cm on average.

They were smaller (2.4cm) for those who has lumps but were not aware of them and had not

18
practiced BSE, and they averaged 3.4cm for those that were aware, they had the lumps.

Breast Self-Examination should be practiced correctly and this involves a number of aspects;

frequency, timing, a correct technique consistent application of it as well as acting on any

positive findings without much delay. In published work, women who practice BSE tend to

be younger, pre-menopausal and of a higher socio economic status (Okantey et al., 2017)

Possibly this has to do with access and exposure to health talk information through the media,

peers and health workers (Prolla et al., 2015).

In a study done in different part of developing countries in Asia and Africa including

Ethiopia in different times the practice toward BSE is low (Al-Mandhari, 2019) But in a

study in Nigeria and Ghana the practice of BSE is higher than this finding 80% and 76%

respectively (Azubuike & Okwuokei, 2013).Concerning the frequency of BSE only 5.5% of

the respondents did BSE monthly. This finding is lower than the studies done in other parts of

the world and the variation is attributable due to the study setting, study participants in our

case majority of the respondents were young ages and may have no concern about breast

cancer, in other way, the study participants were health professionals, there may have

adequate knowledge about breast cancer through experience (Asuming-Bediako, 2018).

In a study carried out in Lagos Nigeria, information on breast cancer and breast self-

examination obtained from friends and health workers and breast cancer comes with a heavy

cultural stigma, Women in the Middle East are sometimes abandoned by their family when

the disease is diagnosed, and such stories are discouraging (Azubuike & Okwuokei, 2013)

In a study carried out in Jordan, the practice of BSE was low amongst the sample tested. Only

152 (34.9%) of those aware of breast cancer knew of BSE as a method for detecting breast

cancer, and only 93 of those respondents (61.1%) had ever performed it. This is in line with

the findings of Abdel Hadi who found that 37.3% of his study population practiced

19
BSE(Ng’ida et al., 2019). Other studies that showed low rates of BSE practice were low

among women, regardless of their age and occupation (Al-Mandhari, 2019)

20
 CHAPTER THREE:

METHODOLOGY

3.1 Introduction

This chapter presents the methodology which will be used in the study. It includes study

design, study setting, study population, sample size determination, sampling procedure,

inclusion criteria definition of variables, research instrument, data collection procedures, data

management, data analysis, ethical considerations, limitations of the study and dissemination

of results.

3.2 Research design

A cross-sectional research design employing quantitative method shall be used. The study

shall use a cross-sectional research design based on a descriptive study approach to allow

participants to describe their characteristics and factors that contribute to the Knowledge and

practices of Breast self exam among women of reproductive age. The research design will be

used to collect data from individual participants from one point in time.

3.3 Study setting.

Soroti Regional Referral Hospital is located at the heart of Soroti City, in Eastern Uganda.

Soroti hospital is a government institution and a Regional referral in the eastern region. It has

a bed capacity of 400 occupants. This site is chosen for data collection because they serve

clients who easily suit the inclusion criteria and besides, the sites serve a relatively high

number of female clients which can be representative of the entire female population

obtaining services from Soroti Regional Referral Hospital. It was also convenient for the

researcher in terms of access to the research participants.

21
3.4 Study population.

Female clients above 18 years at the Postnatal Clinic at Soroti Regional Referral Hospital will

be interviewed.

3.4.1 Sample size determination

The sample size shall be determined using the Krejcie and Morgan table as attached.

According to the table, the sample size for the study will be 40 respondents. To simplify the

process of determining the sample size for a finite population, Krejcie & Morgan (1970),

came up with a table using sample size formula for finite population.as shown in the table in

Appendix V.

3.4.2 Sampling procedure

A simple random sampling technique will be used where the researcher will explain the

procedure to the participants, then small pieces of paper will be labeled 1 and 2 and a person

who picks number one will be considered to participate in the study this procedure will be

repeated every day before data collection process starts.

3.4.3 Exclusion criteria.

 The Female clients below the age of 18.

 Mothers with unsound mind

 Those who decline to consent

 Those who will pick No 2during sampling procedure.

3.4.3.1 Inclusion criteria.

All female clients who were at the study site, above 18 years of age and of sound mind who

will be provided written consent will be included in the study.

22
3.5 Definition of Study variables

The study variables were;

A variable is a factor or characteristic that changes .there are 2 types of variables

3.5.1 Independent variable

This variable can be manipulated or modified by the researcher (Dictionary). In this case the

independent variable will be the knowledge, attitude, Practices and the factors contributing to

Breast Cancer

3.5.2 Dependent variable

These are variables that depend on or are influenced by the independent variables and it only

changes when the causative factors are modified (Dictionary). Here the dependent variable

will be Knowledge and Practices of Self Breast Examination.

3.6 Research Instrument

The research will use Semi Structured questionnaires addressing the objectives of the study

will be used to collect data because it provides maximum confidentiality among participants

while answering. The Questionnaire has four sections: section A Socio-demographic B

knowledge section C Attitude and Section D the Practices of breast self exam.

3.7 Data collection procedures.

Data will be collected using interviewer administered questionnaires on a face to face

interaction with one client at a time.

Female clients at the Postnatal Clinic will be identified by the researcher. The researcher will

obtain informed written consent and questionnaire will be administered to clients who agree

to participate.

23
3.7.1 Data Management

All Questionnaires will be edited for accuracy, completeness and consistency Coding of the

work and Editing of the work which involved checking that each question had appropriate

response and completeness, Data will be stored in a password locked computers and an

external hard drive with only the principal investigator able to have access it and data

collection will take several steps which will involve Previsiting the study area, Pretesting the

research Instrument, Training of Research assistants,

3.7.2 Data analysis and presentation

The raw data Collected data will be entered in Microsoft excel, cleaned, coded and imported

to SPSS Version 16.0 statistical package for analysis.

3.7.1 Data presentation

The data will be presented on table’s bar graphs pie-charts and line graphs and Tables for

clear Analysis.

3.8 Ethical considerations

The introduction letter will be given from the school administration which will introduce the

researcher to the hospital administrator of which the hospital administration will forward the

researcher to the ward incharge to allow the researcher to conduct the study.

The researcher will introduce herself to the respondents and assure them of the protection of

the rights and confidentiality of the data and information obtained.

3.9 Limitations of the study

There is limited time to conduct the research due to the busy schedule at school. This is

managed through rescheduling the time allocated for the research and the rest of the

activities.

24
 Financial resources to support the research are inadequate since the researcher will incur

a lot of costs on transport and feeding. However the researcher will do her best to

minimize the costs by seeking support from family and friends.

3.10 Dissemination of results

The results of the study will be compiled into a report that and copies of the research report

will be presented to as follows;

i) Uganda Nurses and Midwifery Examination Board in partial fulfillment for the award of a

Diploma in Nursing

ii). Soroti School of Comprehensive Nursing for record keeping and future research

references

iii). Soroti Regional Referral Hospital to implement strategies to improve Antenatal

Utilization.

iv). Supervisor

v) The researcher.

REFERENCES

Abo Al-Shiekh, S. S., Ibrahim, M. A., & Alajerami, Y. S. (2021). Breast Cancer Knowledge

and Practice of Breast Self-Examination among Female University Students, Gaza.

Scientific World Journal, 2021. https://doi.org/10.1155/2021/6640324

Agatha, T., & Nankumbi, J. (2016). Breast Cancer Knowledge and Breast Self- Examination

Practices Among Female University Students in Kampala, Uganda: A Descriptive

Study, (March). https://doi.org/10.5001/omj.2016.25

Al-Mandhari, A. (2019). Achieving “health for all by all” in the eastern mediterranean

region. Eastern Mediterranean Health Journal, 25(9), 595–596.

25
 https://doi.org/10.26719/2019.25.9.595

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, 7731–7736.

Asuming-Bediako, A. (2018). Knowledge, Attitudes and Practices (Kap) of Breast Self-

Examination Among Female Soldiers At the 37 Military Hospital, (10203624).

Retrieved from http://ugspace.ug.edu.gh

Atuhairwe, C., Amongin, D., Agaba, E., Mugarura, S., & Taremwa, I. M. (2018). The effect

of knowledge on uptake of breast cancer prevention modalities among women in

Kyadondo County , Uganda, 1–8.

Azubuike, S., & Okwuokei, S. (2013). Knowledge, attitude and practices of women towards

breast cancer in Benin City, Nigeria. Annals of Medical and Health Sciences Research,

3(2), 155. https://doi.org/10.4103/2141-9248.113653

Birnbaum, J. K., Duggan, C., Anderson, B. O., & Etzioni, R. (n.d.). Articles Early detection

and treatment strategies for breast cancer in low-income and upper middle-income

countries : a modelling study. The Lancet Global Health, 6(8), e885–e893.

https://doi.org/10.1016/S2214-109X(18)30257-2

Clegg-Lamptey, J.-N. (2016). Epidemiology of Breast, 1–32. Retrieved from

http://oncologypro.esmo.org/content/download/102746/1814743/2017-ESMO-Africa-

Epidemiology-of-Breast-Cancer-in-Africa-Joe-Nat+Clegg-Lamptey.pdf

Galukande, M., & Kiguli-Malwadde, E. (2012). Mammographic breast density patterns

among a group of women in sub Saharan Africa. African Health Sciences, 12(4), 422–

425. https://doi.org/10.4314/ahs.v12i4.4

Galukande, Moses. (2014). Patient Delay in Accessing Breast Cancer Care in a Sub Saharan

African Country: Uganda. British Journal of Medicine and Medical Research, 4(13),

2599–2610. https://doi.org/10.9734/BJMMR/2014/7293

26
Gonzales, A., Alzaatreh, M., Mari, M., Saleh, A., & Alloubani, A. (2018). Beliefs and

Behavior of Saudi Women in the University of Tabuk Toward Breast Self Examination

Practice, 19, 121–126. https://doi.org/10.22034/APJCP.2018.19.1.121

Heena, H., Durrani, S., Riaz, M., Alfayyad, I., Tabasim, R., Parvez, G., & Abu-Shaheen, A.

(2019). Knowledge, attitudes, and practices related to breast cancer screening among

female health care professionals: A cross sectional study. BMC Women’s Health, 19(1),

1–11. https://doi.org/10.1186/s12905-019-0819-x

John R.Scheel, Scott Parker, Daniel S. Hippe, Donald L. Patrick, Gertrude Nakigudde,

Benjamin O. Anderson, Julie R. Gralow, Beti Thompson, Y. M. (2018). Role of Family

Obligation Stress on Ugandan Women ’ s Participation in Preventive Breast Health, 1–8.

https://doi.org/10.1634/theoncologist.2017-0553

Joyce, C., Ssenyonga, L. V. N., & Stanley, J. (2020). International Journal of Africa Nursing

Sciences Breast self-examination among female clients in a tertiary hospital in Eastern

Uganda. International Journal of Africa Nursing Sciences, 12(November 2019), 100186.

https://doi.org/10.1016/j.ijans.2019.100186

Khan, T. M., Pik, J., Leong, Y., Ming, L. C., & Hayat, A. (2015). Association of Knowledge

and Cultural Perceptions of Malaysian Women with Delay in Diagnosis and Treatment

of Breast Cancer : a Systematic Review, 16, 5349–5357.

Ng’ida, F. D., Kotoroi, G. L., Mwangi, R., Mabelele, M. M., Kitau, J., & Mahande, M. J.

(2019). Knowledge and practices on breast cancer detection and associated challenges

among women aged 35 years and above in Tanzania: A case in morogoro rural district.

Breast Cancer: Targets and Therapy, 11, 191–197.

https://doi.org/10.2147/BCTT.S199889

Okantey, C., Berchie, G., Abraham, S., & Agyare, D. (2017). Knowledge of Breast Cancer

and the Practice of Breast Self-Examination Among Female Student Nurses, 7.

27
 Retrieved from https://sigma.nursingrepository.org/handle/10755/623508

Oladimeji, K. E., Tsoka-gwegweni, J. M., & Igbodekwe, F. C. (2015). Knowledge and

Beliefs of Breast Self- Examination and Breast Cancer among Market Women in Ibadan

, South West , 339, 1–11. https://doi.org/10.1371/journal.pone.0140904

Onainor, E. R. (2019). Knowledge Attitude Towards Breast Self Examination, 1, 105–112.

Prolla, C. M. D., Da Silva, P. S., Oliveira Netto, C. B., Goldim, J. R., & Ashton-Prolla, P.

(2015). Knowledge about breast cancer and hereditary breast cancer among nurses in a

public hospital. Revista Latino-Americana de Enfermagem, 23(1), 90–97.

https://doi.org/10.1590/0104-1169.0185.2529

Ralaidovy, A. H., Gopalappa, C., Ilbawi, A., Pretorius, C., & Lauer, J. A. (2018). Cost-

effective interventions for breast cancer, cervical cancer, and colorectal cancer: New

results from WHO-CHOICE 11 Medical and Health Sciences 1117 Public Health and

Health Services 11 Medical and Health Sciences 1112 Oncology and Carcinogenesis.

Cost Effectiveness and Resource Allocation, 16(1), 1–14.

https://doi.org/10.1186/s12962-018-0157-0

Segni, M. T. (2016). Gynecology & Obstetrics Breast Self-examination : Knowledge ,

Attitude , and Practice among Female Health Science Students at Adama Science and

Technology University , 6(4). https://doi.org/10.4172/2161-0932.1000368

Tura, T. (2019). Assessment of Knowledge, Attitude and Practice of Breast Self-Examination

Among Female Students in Wolaita Sodo University, Ethiopia. International Journal of

Advanced Research, 7(8), 1155–1164. https://doi.org/10.21474/ijar01/9606

Umbreen, G., & Medical, S. (2017). BREAST SELF-EXAMINATION ( BSE );, (May).

https://doi.org/10.17957/TPMJ/17.3745

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APPENDIX I: CONSENT FORM.

TOPIC: knowledge, attitude and practice of breast self-examination among female

To determine the knowledge, attitude and Practices of breast self-examination among female
clients at Soroti Regional Referral hospital.

The study will involve random selection of the participants, eligible participants will be given
information concerning the study and contact address of the researcher, after it has been
ascertained that the information is clearly understood, eligible participants will be invited to
participate in the study for at least 30minutes.

The study findings will be used to inform policies that will to find out interventions to
mitigate stress among nurses.

Information collected from this study, is confidential. However, a study number, which will
only be known to the study subjects and the authorized study personnel, will be used instead
of your name and in the event of any publication regarding this study; your identity will not
be disclosed.

Taking part is voluntary. You are free to refuse to participate or to withdraw at any time.
Such a decision will not affect the medical care you are receiving.

Participant’s permission

I have been fully informed about the study and conditions of the study. I understand that my
participation is voluntary. My questions concerning this study have been answered. I
understanQAQd that at any time I may withdraw from this study without giving a reason. I
agree to take part in this study.

Participant’s signature/Thumb print: _________________________________________

Researcher’s name and signature: ___________________________________________

Date: __________________________________________________________________

29
APPENDIX II:

BUDGET

Item quantity Unit cost Total amount

Printing proposal 2 copies 10,000 20,000

Printing 400 300 120,000

Consent form 400 200 80,000

Printing

Pens 10 500 5,000

Final report 3 10,000 30,000

(PRINTING)

Airtime 100,000

Transport 100,000

Envelopes 10 50,000

Research 2 150000 300,000

assistants

IRB approval 100000

30
Lunch 150000

Note books 3 5000 15,000

TOTAL 1,070,000

APPENDIX III: WORK PLAN

Conten Activity Months in 2021 Months in 2022 Indicators

OCT NOV DEC JAN FEB MAR APR MAY

1.0 Proposal proposal

Development Writing

2.0 Pre-testing Research

instruments tools tested

3.0 Data Data

collection collected

4.0 Data entry Data

and analysis analyzed

5.0 Report Report

writing written

6.0 Report Report

presentation copies

submitted.

31
 7.0 Disseminatio Results

n of results presented

APPENDIX IV: QUESTIONNAIRE

Serial number……………………..................... Date………………………………

Section 1: Socio-demographic data of the participant

1. What is your age?

a) 18 - 30 years b) 31-40 years

c) 41-50 years

2. What was the highest level of education you attained?

a) No formal education b) Primary

c) Secondary education d) Tertiary education

3. What is your occupation?

a) Housewives b) Casual workers

c) Civil servants d) Self employed

e) Student

4. What is your religion?

a) Catholic b) Anglican

c) Islam d) Pentecostal

Section II. Knowledge on Breast self examination

32
5. Do you have any one in your family who has suffered breast cancer

a) Yes b) No

6. If yes what is the relationship with that person

a) Cousin b) Aunt

c) Mother d) Grandmother

e) others.

7. Have you ever heard of Breast self examination

a) Yes b) No

8. Is it common in your environment?

a) Yes b) No

9. Can it be detected early?

a) Yes b) No …………….

10. How………………………………………………………….

11. How will early detection of breast cancer help in your survival?

……………………………………………………………………..

12. How did you hear about it

a) Home b) Peer group

c) Television/ radio d) Newspaper

e) Others (specify…………………………………)

33
 13. Who should perform breast self examination?

a) Males only b) Females only

c) Both males and females

14. Have you ever heard of breast self examination

a) Yes b) No.

15.

16. At what age should breast self examination be started?

a) Less than 19 years b) More than 19 years

17. When often should breast self examination be carried out?

a) Daily b) Weekly

c) Monthly c) Annually

18. How is breast self examination performed?

a) Palpate with one finger

b) Palpate with palm and minimum of 3 fingers

Section III. Attitudes towards breast self-examination

Rating 1 2 3 4 5

No Attitude Strongly Disagree NT Agree Strongly

towards Disagree Agree

Breastself

34
 examination

1 Breast self

examination

could easily be

done

2 I can get

breast cancer

which makes

Breast self

examination

necessary

3 Breast self

examination is

not a sex

abuse action

4 I can never

know that I

have breast

cancer through

breast

self

examination

35
5 Self-breast

examination

causes no

harm

6 Screening/self-

breast

examination

helps in

prevention of

breast

carcinoma

7 I think

touching my

breasts is

obscene

8 Breast self

examination

will not

necessarily

lead to a

36
 positive cancer

test

9 Carcinoma of

the breast

cannot be

transmitted

10 If you

develop breast

lump, would

you hurriedly

go to

see a doctor

11 Do you

believe that

breast cancer

occur more

commonly

in old women

12 Am at a high

risk for

developing

37
 breast cancer

thus

should do

beast self

examination

Section IV Practices of Breast self-examination

1. Have you ever performed breast self examination?

a) Yes b) No

2. Reasons for not performing breast self examination

a) Am healthy

b) I’m afraid that it may reveal breast cancer

c) I haven’t just decided

d) It may be painful

e) I feel shy

f) others (specify)

3. If yes, how often do you perform BSE in a year?

a) Once in a month ……………..…….

b) Once in 3 month …………………………....

c) More than once in quarter of a year ………………………………….

d) Not very often…………………………………………………

38
e) Never in a year

4. At what age did you start practicing BSE (Breast Self Examination)

a) <25 of age b) 25-30

c) 30-35 d) >35 of age

5. If you don’t practice BSE regularly then what are the reasons (Skip those who

practice regularly, once in a month)one can answer more than one.

a) I don’t have breast problem. ………………………

b) I don’t think I should …………………………....

c) I don’t feel comfortable doing this …………..

d) I do not know how to do that ………………….

e) Carelessness ………………………………….

f) Too frequent to practice. ………………..

g) I don’t think it is necessary. …………………

h) Unsure about its benefit ……………………

i) Or, specify other reason……………..……

6. When was the last time you performed a breast self examination?

a) Less than a week ago …………………

b) Less than three to six months ago ……………………

c) More than one year ago …………………

8. Where do you usually perform breast self examination?

a) In front of a mirror b) Lying on the bed

c) In the bathroom

39
40
Appendix V MORGAN TABLE FOR DETERMINING SAMPLE SIZE FROM

AGIVEN POPULATION

41
 Appendix VI:

MAP OF UGANDA SHOWING SOROTI REGIONAL REFERRAL HOSPITAL

Soroti Regional Referral Hospital

42
APPENDIX VII: MAP OF SOROTI DISTRICT

43