final thesis chapter 1 to 5.docx

ADAMSON UNIVERSITYCollege of Nursing 1

Chapter 1

INTRODUCTION

Breast Cancer is the second common cause of death after cardiovascular diseases

worldwide according to the American Cancer Society (2007). The Philippines has the ninth

highest incidence rate of breast cancer in the world, citing a medical study showing that 50

out of 100,000 Filipino women have been diagnosed with breast cancer. It is also one of the

most leading mortality among women in the Philippines. According to the article published

by Manila Times (2008), breast cancer continues to be the top killer of women who are of

ages 35 to 54 all over the world. More than 500,000 women suffer and die from this cancer

every day, and more than a million die from this cancer without knowing it. Moreover, the

American Cancer Society (2005) states all women are at risk for breast cancer. The two most

significant risk factors are being female and getting older. But nowadays, it has been noted

that it increasingly affects younger women as early as the age of twenty.

Macabudbud (2012) of Manila Health Department stated on her talk regarding breast

care “Fifty percent (50%) of Breast Cancer are curable and Thirty-three percent (33%) are

preventable, so early detection means greater curability.” In addition, the American Cancer

Society (2007) has recommended monthly Breast Self Examination to aid in the early

detection of Breast Cancer and that women must perform breast self-exam once they reach

their 20s, and should be told about the benefits and limitations of self-examination of the

breast. By examining the breasts on a monthly basis, a woman is likely to notice changes,

including dimpling, swelling, and nipple discharges which are signs of breast cancer.


The researchers were concerned about this aspect of the reproductive health, due to

another factor of having breast cancer, which was genetic predisposition. One of the

members has been concerned of getting this cancer as both sides of her family had the said

disease. The researcher’s grandmother (maternal side) has died of breast cancer at the age of

65 and presently, her aunt (paternal side) has been diagnosed with the same disease at the age

of 39. It has been noted that they failed to recognize the symptoms of breast cancer,

particularly palpating for cysts or tumor. In addition with this concern, the researchers asked

some students regarding the examination of their breasts and they admitted that they were not

practicing self-examination of the breast monthly, and some were not confident enough on

how they would do it with themselves.

Although many Filipino women do regular breast self examination, a local study

revealed that only fifty-four percent (54%) had ever done a breast self examination, of whom

only twenty-seven percent (27%) are still practicing it at an average of 9.2 times a year.

There are still a remarkable number of these women who does not practice Breast Care.

Furthermore, according to this study, common reasons given for not doing the breast self

examination included: no symptoms, busy, do not know how, do not like, do not think

important, always forget, afraid and not aware (Breast Cancer Awareness, 2006). Performing

Breast Care regularly can help women become more familiar with their breast and be more

skilled in determining what is normal and what is not. While most women are aware of

monthly breast self examination, many still do not know how to perform it properly.

In lieu with the increasing incidence, the researchers strongly agree that prevention is

way lot better than cure, but the best way to prevent breast cancer is through health


education. According to World Health Organization (WHO), Health Education is concerned

with the change in knowledge and attitude of people. It concentrates on developing such

health practices as are believed to bring about the best possible state of well being. The

researchers’ endeavour for health education are mainly to help the Adamsonian female

students to develop a sound physique, to acquaint them with the proper procedures on breast

care, to promote the appreciation of the health programs undertaken by the school regarding

Breast Cancer Prevention and to improve the necessary materials for the execution of the said

programs.

The main objective of this study is to describe the knowledge and attitude on breast

care among the female students of Adamson University and to emphasize the importance of

breast care to the students. Results of this study could be use as a basis in formulating a

health teaching guide on breast care for the Adamson University clinic. The researchers

supposed if the students’ eyes are opened earlier to the current reproductive health situation,

the better the results will be.


Statement of the Problem

This study aimed to determine the knowledge and attitude of the female students of

Adamson University regarding Breast Care.

Specifically, the researchers sought to answer the following questions:

1. What are the demographic profile of the respondents in terms of :

1.1 Age

1.2 Menarche

1.3 History of Breast Health Problems in the Family

1.4 Source of Health Information

2. What is the level of Knowledge of the respondents on breast care?

3. What is the level of Attitude of the respondents on breast care?

Significance of the Study

This study determined the knowledge and attitude of the female students of Adamson

University on Breast Care.

Results of this study will be beneficial to the following:

Adamson University Students, by uplifting the Spirit of St. Vincent de Paul and

Social responsibility throughout the study, we would like our fellow Adamson Students to

mainly benefit with this study by enhancing their understanding and awareness about breast

care. This would also help them in preventing breast cancer in the near future.


School Administrators/ University Clinic, this study will lend a hand to the school

administrators to easily disseminate the importance of breast care to the university students

for health education purposes. The university clinic will also benefit to the study by having a

basis on what programs that they should implement regarding breast cancer prevention. And

consequently, improving the university clinic’s prior programs for health education among

students and having an effective execution of the said program.

Significant Others, this study will have a bird’s eye view of the advantages of breast

care among women not only for the students but also with their relatives and friends. In line

with the enhancement of their knowledge and attitude, they are encouraged to perform it

regularly.

Nursing Education, this study will uphold quality education for nursing students by

having a reference or literature to better understand the practice of breast care. This would

also impart knowledge about breast care examinations among students in Adamson

University so that student nurses can be a health advocate especially for female students in

regards for the prevention of Breast Cancer.

Nursing Research, this study will serve as a guide for future studies. It will be an

eye-opener to the previous studies for it to be updated in relation to breast care examination.

Nursing Practice, this study will help the health care providers in rendering health

teachings and health promotion regarding breast care examination that will aid in amplifying

the quality of health care and become more competent as they learn about the different ways

in preventing Breast Cancer.


Nursing Profession, this study will help them to generate new ideas and skills in

educating their clients to become more aware in handling their own health especially the

health promotion of breast care to prevent disease and also, they will become more equipped

in their careers in the future.

Theoretical Framework

Figure 1. A Theoretical Framework illustrating the connection involving variables

considered in this study.


This framework for motivating people to take positive health actions that uses the

desire to avoid a negative health consequence as the prime motivation. The Health Belief

Model has frequently been applied to breast cancer awareness such as the Breast Self –

Examination. The model stipulates that health – related behavior is influenced by a person`s

perception of the threat posed by a health problem and by the value associated with her

action to reduce that threat. Behavior is also a result of the belief that a certain action will

benefit the individual and that this benefit will out weight any barriers. The investigation of

attitudinal components of health related behavior has been important. If attitudes related to

health behavior can be identified, health protection interventions for attitudinal change can be

developed, and an increase in desirable health behavior would result. The Health Belief

Model is likewise based upon the idea that an individual must have the willingness to

participate in health interventions and believe being healthy is a highly valued outcome.

Definition of Terms

The following terms were operationally and conceptually used in the study:

Attitude. This pertains to the habitual engagement of oneself in performing breast care.

Awareness. It refers to the level of knowledge of the respondents on the purpose and skills

in performing Breast Self Exam.


Breast. This pertains to organ that will be assessed by the respondents. “This refers to either

of the pair of mammary glands extending from the front of the chest in pubescent and adult

human females and some other mammals.” (Merriam – Webster)

Breast Care. This pertains to the manner on how the respondent will prevent breast

problems. “This refers to a practical way to care for the breast and to check for changes, such

as lumps or thickenings, which may signal breast problems.” (Hofstetter, 2006)

Breast Self - Examination. It refers to the monthly examination of the breast for detection

of any changes in breast size, shape and colour of the skin as well as in the nipples and

discharges.

Care. This pertains to the means of showing concern by the students towards their breast.

“This refers to a term showing affection practice of loving kindness and equanimity within

context of caring consciousness.” (Jean Watson, 2001)

Demographic Profile. It refers to the set of data which includes personal details about the

respondents specifically the age of the respondents; menarche; history of breast related

problems in the family; and sources of health information.

Female. This pertains to a person or individual performing breast care.

Foundation. This pertains to the basis of the study. “This refers a structural plan or basis of a

project.”

Knowledge. It pertains to the amount of information that the respondents have regarding

breast care.


Students. The term pertains to the female students of Adamson University who are enrolled

in the summer class S. Y. 2011-2012.

Scope and Limitation

The study focused only on the knowledge and attitude towards breast care. It was

also limited only the female students of Adamson University. The respondents of this

research study were those who were taking up College of Business Administration, College

of Pharmacy, College of Science, College of Engineering, and College of Architecture

regardless of year level. The data was gathered within a period of two months during the

summer class of the school year 2012- 2013.

The male students were not included in the study. Another limitation of the study

was the skills of the subjects towards breast care. The researchers were not able to include

other government and private schools in Metro Manila.


Chapter 2

REVIEW OF RELATED LITERATURE

This chapter provides related studies and articles that enabled the researchers to have a

comprehensive grasp of issues related to current research such as the underlying philosophy,

theories, principles, concepts, and trends related with this study.

According to Penta (2006) in his article where he says that it is often said "knowledge

is power" and this is one instance where such a statement is absolutely true. Breast cancer

affects one in eight women. It is crucial that every woman take the time to learn about the

facts relating to breast self-examination that can dramatically impact their lives whether it is

the benefits of BSE or an understanding of other preventive measures. Not only will you

benefit from early detection should you have a problem, you will also gain a "piece of mind".

Although this benefit cannot be measured directly, we do know that chronic stress and

anxiety is not good for anyone and does play a role in many chronic health problems.

HBM (2002), as would a woman who wants to improve her health and she has

confidence of getting positive results, a woman who perceives that she is susceptible to

breast cancer and that breast cancer is a serious disease would be more likely to perform

regular breast examinations. Similarly, a woman who perceives more benefits from and

fewer barriers to BSE would be more likely to practice BSE. A woman who has an internal

cue (body perception) or who has been exposed to an external cue (e.g., the positive

influence of a health care provider or the media) would also more readily adopt BSE

This is congruent to Penta (2006) that where he stated that Breast self examination,

promotes awareness about breast cancer as well as other less serious breast conditions (cysts


etc.). Women are not doing exams because of their concerns about what they may find when

the findings may not ultimately be a serious concern. The anxiety is real and understandable.

However, after your "first" baseline self- examination, regular breast self-examinations can

help one become familiar with the findings and changes unique to their exam. This leads to a

level of control over your health that can be empowering and make you want to share what

you have learned with others.

Health education is a social science that draws from the biological, environmental,

psychological, physical and medical sciences to promote health and prevent disease,

disability and premature death through education-driven voluntary behavior change

activities. American Association for Health Education (2007)

Breast awareness is now a recognized part of health promotion and has replaced

previous guidance on breast self-examination for women. Since it was introduced in the

early 1990s, along with the breast awareness five-point code, it has become a key element in

the strategy to detect breast cancer at an early stage. Despite this, confusion about breast

awareness persists, with women still wanting to know how to examine their breasts properly

Breast Cancer Care, London (2005)

Breast awareness provides women with some acknowledgement of the part they can

play in being empowered to fight breast disease, not in terms of statistics used for mortality

but on the qualitative effects of reductions in morbidity. J. ClinNurs. (2009). (Bailey K.)

emphasize that nurses have a vital role to play in encouraging women to become more

breasts aware. Their health promotion activities in this area can have an important impact on

the uptake of breast screening initiatives.

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Bailey%20K%22%5BAuthor%5D

http://www.ncbi.nlm.nih.gov/pubmed/15840071


The findings strongly supported the idea that the majority of the respondents relayed

their health needs and beliefs to the physicians or nurses since they specialized in the given

field. In a featured health education research from Oxford Journal (2010), Worsley surveyed

667 respondents through a random population mail survey of diet and health beliefs. They

were asked to rate the perceived reliability of health information from each of 18 sources,

and to indicate whether they had referred to these sources in the previous year. The results

showed that the family doctor and pharmacist were generally regarded as the most reliable

sources, whereas TV advertisements, newspaper and magazine articles were among the least

reliable. Nurses and Physicians are part of the health care team. They are the qualified

people who deliver proper health care in a systematic and professional way to any individual

in need of health care services. Therefore the findings indicated a sign of good health

seeking behavior.

Knowledge

The students may be influenced by overconfidence, the “feeling-of-knowing”

(FOK) phenomenon, and the use of inappropriate inference rules either at encoding or

retrieval of informations (Camerer and Johnson, 2004). As a result, they tend to have more

information sinked in on their minds but often times, these becomes juggled and becomes

confusing on their part. This is also the same about their knowledge on breast care wherein,

the students have previous knowledge already about it, however, the things that they know

are not concise and thoughts appeared to be misinterpreted causing misconceptions about

breast problems most especially with breast cancer. In regards with this also, they know the

procedure on breast care and tend to do it on their own but when asked to do a


demonstration, they could not perform it accurately. Oskamp (2002), supported this findings

wherein he found that as the amount of given information increases, a decision-makers

confidence in his/her performance increases, but actual accuracy in performance does not.

Johnson and Karns (2011) stated that the educators’ instructive efforts should be

directly focused on research-based instruction and classroom intervention strategies that

work with their students. This is also true with the health educators in the university. High-

quality instruction, more responsive efforts, and targeted intervention strategies are required.

Without effective classroom instruction and intervention strategies, the health educators will

struggle to reach all students.

Another research shows that unless high-need students receive targeted interventions,

many will face increasing gaps in their learning and achievement (Rathvon, 2008). If no

interventions are provided at an early age, then many of these students may be destined for

special education support for years to come and worst, they will suffer from being illiterate

most especially about breast care that might lead to a higher risk of having breast cancer.

According to WHO (2009), health education is any combination of learning

experiences designed to help individuals and communities improve their health by increasing

their knowledge or influencing their attitudes. Furthermore Curt Graham (2008) said that

health education is defined as the principle by which individuals and groups of people learn

to behave in a manner conducive to the promotion, maintenance, or restoration of health.

The ultimate aim of Health Education is Positive Behavioural Modification. Additionally

education for health begins with people. It hopes to motivate them with whatever interests

they may have in improving their living conditions. Its aim is to develop in them a sense of

responsibility for health conditions for themselves as individuals, as members of families,


and as communities. Health education commonly includes an appraisal of what is known by

a population about breast problems, an assessment of habits and attitudes of the people as

they relate to spread and frequency of the disease, and the presentation of specific means to

remedy observed deficiencies (Washington State Department of Health, 2008)

Because of the results after the intervention, it can be drawn that students need

interventions that are engaging and use all of the senses. Effective interventions are

kinesthetically engaging, they are auditorally resonating, and they are visually stimulating.

There is a direct correlation between engagement and academic achievement, particularly for

students from the college level (Wilms, 2003). The most influential models of instruction are

interactive. Instruction actively engages the learner, and is generative. Instruction

encourages the apprentice to construct and produce knowledge in meaningful ways. Students

teach others interactively and interact generatively with their teacher and peers. This allows

for co-construction of knowledge, which promotes affianced learning that is problem-,

project-, and goal-based according to Ivey and Fisher (2006).

This study found that women with higher levels of knowledge in relation to

symptoms and screening demonstrated higher performance rates of BSE. Similarly, in

Dundar’s study (2006), it was found that more knowledge about breast cancer had a positive

effect on performing BSE.

Hyun’s study (2003) also revealed that women who are taught to perform BSE have a

better level of knowledge about breast cancer. Similarly a study done by Lee (2000) in

Korea showed that knowledge of the nature of breast cancer and what age to initiate breast

cancer screening were reported as the lowest knowledge items. Because of the important


role that teachers play in educating young women, they should be encouraged and motivated

to increase their own knowledge on breast cancer screening.

In Penta’s study (2006), he stated that Breast self examination, promotes awareness

about breast cancer as well as other less serious breast conditions (like cysts etc.). Women

are not doing exams because of their concerns about what they may find when the findings

may not ultimately be a serious concern. The anxiety is real and understandable. However,

after the "first" baseline self- examination, regular breast self-examinations can help one

become familiar with the findings and changes unique to their exam. This leads to a level of

control over their health that can be empowering and make them want to share what they

have learned with others.

With the sources of information in general, the media is the main source of healthcare

information for the public. Use of the media has been considered a popular and effective

health communication strategy. The media disseminates information concerning social

issues and some of that news may contain elements of a persuasive nature that prompts

women to engage in BSE. For example, a news report about a woman suffering from breast

cancer typically conveys a persuasive message of a cry for fear. This type of presentation

acknowledges the severity of the threat, and implicitly indicates that the students are able to

engage in the suggested actions. Vellozzi (2003) supports the results of this study wherein he

found that the media had been successful in encouraging Hispanic women to take action to

ensure breast health.

Kearney (2006) indicated that due to the lack of confidence to be able to detect breast

cancer by them, some women do not practice breast self-examination to avoid the


responsibility of not finding breast cancer early enough. However, Freire (2003), in his

"Pedagogy of the Oppressed," argued that "no matter how she lack of knowledge or live in a

silent culture, she can grasp a critical attitude to deal with her own reality through learning."

It is important to keep in mind that this study addressed the underlying considerations that

prompt women to learn BSE. This study recognized that how women decide to attend BSE

training is influenced by personal and social factors. Therefore, it is useful to integrate the

individual elements and social context in the design of a BSE program. They are convinced

that the knowledge and experience of BSE practitioners is very important. Women should

neither be limited by, nor entirely dependent upon, medical and technological systems when

facing these problems sine alternative solutions are available.

A study by Leslie (2003) showed that health education given to women by their health

providers is effective in increasing their knowledge about breast cancer and the benefits of

screening. Also, Secginli and Nahcivan (2006) examined the variables related to the breast

cancer screening behaviors of 656 Turkish women and found that knowledge of breast cancer

screening guidelines was a major predictor of regular screening. Women in this study told

that they received their knowledge about breast cancer and breast health from TV, maternity

and child health care female doctors, family members, neighbours, newspapers, radio,

internet, magazines, home visits by an outreach social worker and lectures.


Attitude

Having a positive attitude towards breast care, even though the respondents haven’t

received any interventions on health education yet, means that they have other factors that

contribute to this kind of attitude. Some factors noted are having previous knowledge on

breast problems, having an instinct of engaging with preventive measures regarding breast

cancer, and the role of media to their health seeking behaviour.

With these results of the study, it is shown that students should always be an optimist

towards health. Being an optimist does not only mean to see the brighter side of life. To be

an optimist means to view the surroundings wherein you make the most of your strengths and

achievements and diminish your weaknesses and apprehensions. Having a positive outlook

through one’s health will help each woman to become more responsible with their own

health status preventing diseases in later life. According to Mayo (2011), positive thinking

doesn't mean that you keep your head in the sand and ignore life's less pleasant situations.

Positive thinking just means that you approach the spitefulness in a more positive and

productive way. Which is the same as being engaged with breast care, wherein once students

would already have knowledge on how to take care of their breasts, the more likely they will

have a positive outlook on practicing breast care regularly.

It is being agreed by another theory which is that having a positive outlook enables you to

cope better with stressful situations, which reduces the detrimental health effects of stress on

your body. It's also thought that positive and optimistic people tend to live healthier

lifestyles. Alia Butler (2010). States that individual who have a positive attitude will feel the

impact on their health through lack of illness and overall increased positive well-being.


Furthermore, Mayo (2008) suggests that many health benefits have been influenced by a

positive attitude, including increased life span, increased resistance to the common cold,

lower rates of depression, increased cardiovascular health, reduced stress, and overall

physical and mental vigor. But in today’s life when one is thronged with worries and

tensions all around, it is very difficult to maintain a positive attitude as stated by Singal

(2012). Therefore, reinforcements such as continuous health education on breast care should

be given emphasis though the students already have a positive

Orel (2003).Which believes that BSE is a useful and essential screening strategy,

especially when used in combination with regular physical exams by a doctor and

mammography. About 20% of the time, breast cancers are found by physical examination

rather than by mammography. We recommend that all women routinely perform breast self-

exams as part of their overall breast cancer screening strategy.

It is crucial that every woman take the time to learn about the facts relating to breast

self-examination that can dramatically impact their lives whether it be the benefits of BSE or

an understanding of other preventive measures. Not only will you benefit from early

detection should you have a problem, you will also gain a "peace of mind". Although this

benefit cannot be measured directly, we do know that chronic stress and anxiety is not good

for anyone and does play a role in many chronic health problems.

As a woman who wants to improve her health and a confidence of getting a positive results,

the more likely to perform regular breast examinations. It would also include a woman who

perceives that she is susceptible to have breast cancer which is a serious disease. Similarly a

woman who perceives more benefits from performing breast self examination would


probably perform this regularly (HBM, 2002). A woman who has an internal are (body

perception) or even those who has been exposed to an external are which influence by health

care provider or by media would also more readily to adapt breast self examination.

Breast self - exam promotes awareness about breast cancer as well as to the other less

serious breast problems such as cysts in the breast as congruent to Penta (2006) literature.

Women who are not practicing breast self examination because of their concerns about what

they may found out though these findings may not be serious concerns. This anxiety is real

understandable, however after the first baseline of self examination, regular performing

breast self examination can help woman become familiar with the findings and changes upon

doing the exam. In connection in having an increased knowledge, this can also to increase

level of control over the health perception and health seeking behaviour of the students

beneficial in emphasising the importance of BSE in preventing future breast problems.

A good attitude towards breast health enables a respondent to practice BSE more, since she

appreciates her current state. This finding was supported by the Health Belief Model’s

Perceived or Anticipated Benefits, which stated that the person believes that benefits

stemming from the recommended behavior outweigh the costs and inconvenience, and that

they are indeed possible and within his or her grasp (www.enotes.com, 2010).

Having awareness is not enough, since the respondent must perform BSE regularly to be

said that she had a good attitude towards it. One of the reasons why the respondents may

have a good attitude towards BSE, but not be able to practice is because they assume that

they are free from having any breast pathologies after doing a few breast self-exams

previously.

http://www.enotes.com/


GK Cretain (2004) said that Breast self-examination (BSE) is an important self-care

activity for women to perform to maintain their life, health, and well-being. Although

women are budding on awareness of the importance of breast self-examination, it appears

that they lack sufficient motivation to perform it on a consistent basis. Nurses are ideal

health professionals to motivate women to perform BSE because of their knowledge, their

supportive-educative role, and their numbers located in various settings.

Moreover, Shields (2004) concluded that individuals with the belief that knowledge of

family history/genes can reduce cancer risk were about twice as likely to have ever looked

for cancer information controlling for educational attainment, personal and family history of

cancer, magazine reading in previous week, ever use of Internet, race/ethnicity, gender, age,

income, and having a usual health care provider

According to Moms (2007), things such as age and race are factors that cannot be

changed no matter how we try. Other risk factors for breast cancer come from the

environment. Others are correlated to personal lifestyle and behaviors such as eating habits

and overall diet, smoking and drinking. Gender is of course a factor that cannot be altered.

By simply being a woman in the first place they are more at jeopardy for developing breast

cancer. Women have more breast cells than men but this is not what classically causes the

risk to augment. The main reason is because a woman’s breast cells are continuously open to

the elements of female hormones progesterone and estrogen which encourage growth.

Another risk factor for developing breast cancer that cannot be altered is the family history of

the disease. Those who have family members, close blood relatives that is, that have been

diagnosed with breast cancer are at a higher risk for developing the disease themselves.


Breast Care among Female Students

Monthly breast examination for women can play an important role in early detection of

disease resulting in a greater chance or cure and less complex treatment Kozier and Erbs

(2008).

When practicing Breast Self Examination, a woman familiarizes herself with her own

body, which is the most emphasized purpose of BSE by American Cancer Society (2010).

This would help the respondents learn the normal state from what is unusual leading to early

detection of breast health problem.

Practice of breast self examination correctly and this may be attributed to their profile

that most of the respondent’s source of health information were the physicians and nurses.

One must practice her skills on breast self-exam under supervision until she feels

comfortable and confident. (American Cancer Society, 2010)

According to Moms today magazines (2008), that breast self - examination, is an easy

and very cost effective procedure is one of the best ways to monitor changes in your breast.

The students enrolled in courses under health-related Sciences also usually are trained

how to perform Breast Care since it is incorporated in their curriculum, thus, increasing their

awareness. This can be explained by Malcolm Knowles’ theory of Andragogy, stating that

experience provides the basis for learning activities, and that adults are most interested in

learning subjects having immediate relevance to their work and/ or personal lives. (De

Young, 2007).


Technology plays a key role in the dissemination of health information. In a study

conducted by Saludeen (2009), Twenty three point six percent of the respondents in the study

first heard of breast self examination from television while 18.6% and 18.2% first heard of

breast self examination from health workers and on radio programs respectively. Saludeen’s

study population is literate and listens to radio programs, watches the television and interacts

with health workers when confronted with problems.

The American Cancer Society (2010). states that all women over the age of 20 should

practice regular monthly self - breast examinations. According to them, it should be done

when the breasts are least tender, usually 7 days after the start of menstrual period. Regular

physical examination plays a vital role in the maintenance of health. Doctors recommend

starting as early as age 20. Early diagnosis remains an important early detection strategy,

particularly in low- and middle-income countries where the diseases is diagnosed in late

stages and resources are very limited. There is some evidence that this strategy can produce

"down staging" (increasing in proportion of breast cancers detected at an early stage) of the

disease to stages that are more amenable to curative treatment Yip et al (2008).

Komen (2012) supposes that women have the option to do regular breast self-

examination (BSE). Breast Self - Examination can help you stay in touch with your body and

take charge of your own health and started at age of 20 above.

American Cancer Society (2007) mention that having a first degree relative (mother,

sister and daughter) with breast cancer almost doubles a woman`s risk. Having 2 first degree

relatives increases her risk about 3 fold. In addition those women who had more menstrual


cycles because they started menstruating at an early age (before age 13) and or went through

menopause at a later age (after age 55) have a slightly higher risk of breast cancer.

Breast awareness may lead to an earlier diagnosis of breast cancer and young women

are therefore encouraged to do Breast Self - Examination every month. Helping detection of

any abnormal signs can possibly save lives as well as help them to learn and understand their

body more. Breast Self Examination is an option for women starting from the early 20

Dundar (2006), American Cancer Society (2008, 2009) Mayo Foundation for Medical

Education and Research (2008)

Despite the efforts of DOH and Philippine Cancer Society in (October 25, 2011) they

emphasized the need to strengthen advocacy efforts on early detection.

As Northrup (2009) recommends in her wonderful book on women’s health, Women’s

Bodies, Women’s Wisdom, “If a woman approaches her breasts in this way, to get to know

them and not just to find lumps, she’ll be surrounding them with a much more positive

energy field than the usual energy engendered by the breast self-exam, in which you examine

to find what you don’t want to find. Examining your breasts in a spirit of fear simply

increases the fear and is the opposite of what you need to create healthy breast tissue.

Women should try to get in the habit of doing a self breast exam once a month. Becoming

familiar with how your breasts feel and look is an important part of establishing good breast

health. Examine yourself several days after your period ends, when your breasts are least

likely to be swollen and tender. If you are no longer having periods, pick a day that is easy

to remember, such as the first or last day of the month. One way to help the BSE be less

anxiety-provoking is to make it a more routine, relaxed part of your normal self-care routine.


Dr. Northrup suggests taking a monthly breast care ritual bath. Prepare a warm bath, light

scented candles, and put on some calming music. As you relax, slowly massage each part of

your body, starting at your feet and working your way upwards. Check in with your breasts

along the way, but don’t give them any more or less attention than you do the other parts of

your body. This helps keep the breast exam in the right context. By not making a big deal

about it, much of the anxiety and tension of the self-examination is diffused.

According to (Kosters JP, Gotzsche PC 2003) the woman then palpates her breasts with

the pads of her fingers to feel for lumps (either superficial or deeper in tissue) or soreness.

There are several common patterns, which are designed to ensure complete coverage. The

vertical strip pattern involves moving the fingers up and down over the breast. The pie-

wedge pattern starts at the nipple and moves outward. The circular pattern involves moving

the fingers in concentric circles from the nipple outward. Some guidelines suggest mentally

dividing the breast into four quadrants and checking each quadrant separately. The palpation

process covers the entire breast, including the "axillary tail" of each breast that extends

toward the axilla (armpit). This is usually done once while standing in front of the mirror

and again while lying down.

A screening programme is a far more complex undertaking that an early diagnosis

programme WHO (2009). Irrespective of the early detection method used, central to the

success of population based early detection are careful planning and a well organized and

sustainable programme that targets the right population group and ensures coordination,

continuity and quality of actions across the whole continuum of care.


SUMMARY

This study is about the knowledge and attitude for breast care among the female

students in the Adamson University. The single most important way for women to actively

pursue breast care is with regular Breast Examination, the second most important way is to

become more knowledgeable.

American Cancer Society (2007) mention that having a first degree relative (mother,

sister and daughter) with breast cancer almost doubles a woman`s risk. Having 2 first degree

relatives increases her risk about three (3) fold. In addition those women who had more

menstrual cycles because they started menstruating at an early age (before age 12) are also a

factor for the risk having a breast cancer in the future.

According to Moms today magazines (2008) that breast self - examination is an easy

and very cost effective procedure is one of the best ways to monitor changes in your breast.

While some of the benefits of Breast Care are questionable, breast Care is a free and easy

way to look for cancer. Not much is taught about breast care - unless there is a

disease/discomfort, meaning a lot of women nowadays really don’t give their breasts a lot of

attention. As Northrup (2009) recommends in her wonderful book on women’s health,

Women’s Bodies, Women’s Wisdom, “If a woman approaches her breasts in this way, to get

to know them and not just to find lumps, she’ll be surrounding them with a much more

positive energy field than the usual energy engendered by the breast self-exam, in which you

examine to find what you don’t want to find.


Breast Care is important, and by making a few simple choices women can keep their

breasts healthy and reduce discomfort.

The uniqueness of this study is the result of the research, which is framework for health

teaching guide. The development of the health teaching guide as an output of the study is the

main uniqueness of this undertaking. It was based on the result of the study, focusing more

on the items at which the respondents ranked low and lowest per category regarding the level

knowledge and attitude on breast care


Chapter 3

METHODOLOGY

This chapter discusses the research design, subjects and sampling technique, research

instrumentation, data gathering procedure, and statistical treatment.

RESEARCH DESIGN

The researchers utilized the Descriptive Design of research. Polit and Beck (2005)

defined descriptive research as a second broad class of non experimental studies; Its’ idea

was to observe, describe and document aspects of a situation as it naturally occurred and

sometimes served as a starting point for hypothesis generation or theory development.

It also involved collection of data in order to test the hypothesis raised or to answer

the questions concerning current status of the subject of the study (Polit & Beck, 2005).

Since the main goal of the study was to determine the knowledge and attitudes of

female Adamson university student on breast care, it required description, recording,

analysis, and interpretation of data collection which were the main actions in a descriptive

research. Thus, this research was geared towards assessing the respondents’ understanding

and attitude regarding breast care.


Some extraneous variables could have affected the interpretation of the study. To

remove some sampling biases, the researchers used the some controls for external and

internal factors. The researchers’ control to eliminate further effects of other extraneous

variables was affected by the willingness of the respondents to participate in the study.

RESPONDENTS AND SAMPLING TECHNIQUE

The researchers utilized the convenience sampling that used the most readily

available or most convenient group of people or objects as subjects. The sampling frame of

this study was the total population of all female students of Adamson University. Due to

the time constraint faced by the researchers, the criteria for the sample population were the

students who were officially enrolled in summer school year 2011-2012.

. From 2168 female students of Adamson University, 400 of which or 18.5% of the

total population were the respondents of the study. A reasonable sample size was decided

to represent the total population of the study. According to Kirchoff (2005), a sample size

of not less than 5% of the expected population or whichever is greater, is enough to be the

total subjects of a study and thus, can be statistically measured.


The respondents of the study were the female students of Adamson University who

were officially enrolled in summer school year 2011-2012 and agreed to answer the

questionnaire.

RESEARCH INSTRUMENT

The researchers utilized a self-made questionnaire divided into two (2) aspects, the

knowledge and attitude. The first part of the questionnaire consisted of the demographic

profile and 12 items about knowledge on breast care. The second part of the questionnaire

consisted 12 items, which elicited information on the attitude of the respondents.

The questionnaire was validated by three experts on different fields. Then their

comments and suggestions were integrated on the self-made questionnaire.

A sample of 22 subjects was included in a pilot testing. The results of this pilot

testing identified potential problems and pitfalls and ironed out in advance. It also refined

and developed the steps in the actual research process.


DATA GATHERING PROCEDURE

The researchers produced a consent letter and questionnaires. It was disseminated to

the respondents for them to fill out. Instructions on to how to answer the questionnaires

were indicated in the letter given to all the respondents.

In Phase 1, determination of the sampling size was the first step. To obtain the

population of female undergraduates in the university, a letter has been given to the

University Registrar and to the Head of the Information Technology Center. There were

2168 female students who were enrolled on summer S.Y. 2011-2012. A total of 400

respondents answered the survey form. All data related to the knowledge and attitudes of

the respondents were secured from the various undergraduate colleges of Adamson

University.

In Phase 2 of the process, the respondents answered the questionnaires to determine

the knowledge ad attitude of the students regarding breast care. Data gathering employed

the questionnaire which consists of 12 knowledge questions and 12 attitude questions

regarding breast care. After the data were collected, it was statistically treated, analyzed

and interpreted.


STATISTICAL TREATMENT

The following statistical tools were used by the researchers to analyze the responses

in the questionnaires.

1. Weighted mean

The weighted mean (WM) referred to the overall average of responses of the study

subjects. (Salustiano, 2009) and also an average computed by giving different weights to

some of the individual values. If all the weights are equal, then the weighted mean was the

same as the arithmetic mean. Whereas weighted means generally behave in a similar

approach to arithmetic means, they do have a few counter instinctive properties. (nCal,

2012).

It was used in this study to measure the level of attitude of the respondents.

The weighted mean was interpreted as follows:

Weighted Mean Verbal Interpretation

1.00 1.80Strongly Disagree Lowly Negative Attitude

1.81 2.60 Disagree Negative Attitude

2.61 3.40 Not SureNeither Low nor High Level of Attitude

3.41 4.20 Agree Positive Attitude4.21 5.00 Strongly Agree Highly Positive Attitude

Formula:

Where:

WM = weighted mean

∑ fw= sum of the product of the frequency and the unit weight

N = total number of subject


2. Percentage

The percentage was computed to determine the proportion of a part to the whole.

(Salustiano, 2009).

In this study percentage was used to determine the level of knowledge of the

respondents.

Formula: P = fn

x 100

Where:

P = percentage

f = frequency of responses

N = total number of subjects

3. Sloven’s Formula

In this study, it is used to determine the idea of the sample size for a population.

Formula:

n=N/[1+(N*e2)]

Where:

n = number of samples

N = total population

E = margin of error

4. Five - Point Likert Scale

It is a psychometric scale commonly involved in research that employs

questionnaires. It is also the most widely used approach to scaling responses in survey


research and simply a statement which the respondent is asked to evaluate according to any

kind of subjective or objective criteria; generally the level of agreement or disagreement is

measured. It is considered symmetric or "balanced" because there are equal amounts of

positive and negative positions. It is used in this study to measure the level of agreement or

disagreement of the respondents on some statements regarding practice of breast care to

know their attitude towards it.


Chapter 4

PRESENTATION OF FINDINGS

This chapter presented the findings of data obtained based on research methods and

procedures done during the data gathering period. Collected data were tabulated,

synthesized, interpreted and analyzed to answer questions declared in the statement of the

problem and are presented as follows:

Table 1.1 Demographic Profiles of the subjects in Terms of Age

Age Frequency Percentage16 4 1.0%17 20 5.0%18 68 17.0%19 119 29.8%20 91 22.8%21 67 16.8%22 16 4.0%23 12 3.0%24 3 0.8%

Total 400 100.0%

Table 1.1 shows the demographic profile of the respondents in terms of Age. Based

on the table, the respondents were mostly 19 years old which is 29.8% of the sample

population. Next is 20 years old which is 22.8%, then 17% of the sample population is

composed of 18 years old students. 21 years old students comprised the 16.8% of the


sample population, 20 students were at the age of 17 which is 5% of the total sample size,

4% of the subjects were at the age of 16, 3% were 23 years old students then next is 16

years old which is 1% and the least percentage among the subjects is at the age of 24 which

is 0.8%.

Mostly, the respondents of the study were students who were 19 years old; it meant

that the development of thinking of the respondents were still not that sufficient to

understand that women nowadays need to take care of their health specifically their breast.

This study was similar with the research conducted by Collins (2005) entitled,

“Correlates of Breast Self- Examination: Application of the Transtheoretical Model of

Change and the Health Belief Model” because both study stressed the importance of Breast

Self Examination, which was a primary concern in breast care, starting at the age of 20, and

the subjects in Collins’ thesis were also female college students.

It was noted that a high number of Filipinas with breast problems only sought

consultation when the problem had persisted at a graver level. In a local study regarding

the determinants of late-stage diagnosis of breast cancer among Filipino patients revealed

their reasons for not consulting early, such as economic factors, unawareness on breast

cancer and the fear of the outcome of the consultation like being diagnosed with cancer.

With this, health education about breast care should be stressed as early as possible so that

when a woman would reach the age of 20, it was more likely that she would be performing

regular breast care, especially the Breast Self-Exam. Moreover, early detection increased a

person’s chances for a successful treatment (www.blessinghospital.org, 2010).


According to Penta (2006) in his article where he said that it was often said

"knowledge is power" and this was one instance where such a statement appeared to be

absolutely true. Breast cancer affected one in eight women (WHO, 2009). It was crucial

that every woman took the time to learn about the facts relating to breast self-examination

that could dramatically impact her life whether it came from the benefits of BSE or an

understanding of other preventive measures. You would not only benefit from early

detection but also, you would gain a " peace of mind". Although this benefit could not be

measured directly, we knew that chronic stress and anxiety were no good for anyone and

definitely played a role in many chronic health problems.

Table1.2. Demographic Profiles of the subjects in Terms of Menarche

Age at first menstruation

Frequency Percentage

9 6 1.5%10 16 4.0%11 51 12.8%12 165 41.4%13 134 33.6%14 28 7.0%

Total 400 100.0%


Table 1.2 showed the demographic profile of the respondents in terms of their age on

the first menstruation or what was called as “Menarche”. The table showed that most of

the subjects started menstruating on the age of 12.

The age of 12 who started menstruating got the highest percentage of 41.4% while the

menarche age of 13 got the percentage of 33.6 %, then the next was at the age of 11 who

started their menstruation got the percentage of 12.8%, while the ages of 14 got the

percentage of 7%, then youngest got the age of 10 with the percentage of 4% and by the

age of 9 got the percentage of 1.5%

The impact of this early menstruation to the women was that they were at a higher

risk from acquiring oncogenic disease and also prone to having breast problems in the

future.

According to American cancer society that women who had more menstrual cycles

because they started menstruating at an early age (before age 12) and or went through

menopause at a later age (after age 55) had a slightly higher risk of breast cancer.

The American Cancer Society (2010) stated that all women over the age of 20 should

practice regular monthly self-breast examinations. According to them, it should be done

when the breasts were at least tender, usually 7 days after the start of menstrual period.

Regular physical examination played a vital role in the maintenance of health. Doctors

recommended the same starting as early as age 20. Early diagnosis remained an important

early detection strategy, particularly in low- and middle-income countries where the

diseases were diagnosed in late stages and resources were very limited. There were some


evidences that this strategy could produce "down staging" (increasing in proportion of

breast cancers detected at an early stage) of the disease to stages that were more amenable

to curative treatment Yip et al (2008).

Komen (2012) supposes that women have the option to do regular breast self-

examination (BSE). Breast Self Examination can help you stay in touch with your body and

take charge of your own health and started at age of 20 above.

Table 1.3. Demographic Profiles of the subjects in Terms of History of Breast Health

Problems in the Family

Do you have any family history of Breast

Problems?Frequency Percent

Yes 59 14.1%No 341 85.9%

Total 400 100.0%

Most of the respondents of the study had no family history of Breast Cancer as shown

in Table 1.3. The table also showed that 85.9% of the respondents had no relatives with

breast cancer while only 14.1% had a genetic predisposition to the said disease.

It meant that there was a low chance of inheriting the disease from their relatives, but

it did not mean that they were exempted in acquiring the disease, because genetic


predisposition was not the only factors that might contribute to the disease, there were also

other factor such as lifestyles, diet, obesity, smoking, and early-late menarche.

According to the American Cancer Society (2011), about 5% to 10% of breast cancer

cases were thought to be hereditary, resulting directly from genetic defects inherited from a

parent. It also readily implied that the female students of Adamson University had a lesser

risk of acquiring Breast Cancer if we will be basing it through genetics. Nevertheless,

those subjects who had family history of having the disease were more prone to have it in

the near future.

The most common cause of hereditary breast cancer was an inherited mutation in the

BRCA1 and BRCA2 genes. In normal cells, these genes helped prevent cancer by making

proteins that helped keep the cells from growing abnormally. If you had inherited a

mutated copy of either gene from a parent, you had a high risk of developing breast cancer

during your lifetime. The risk might be as high as 80% for members of some families with

BRCA mutations. These cancers tend to come about in younger women and more

frequently concern both breasts than cancers in women who were not born with one of

these gene mutations. Moreover, having a first-degree relative like a mother, sister, or

daughter with breast cancer roughly doubles a woman's risk. Having 2 first-degree relatives

increased her risk about 3-fold. Although the exact risk was unknown, women with a

family history of breast cancer in a father or brother also have an amplified risk of breast

cancer (www.cancer.org).


But in general, according to the study made by the American Cancer Society, less

than 15% of women with breast cancer had a family member with this disease. This could

mean that most (85%) women who acquire breast cancer did not have a family history of

this disease. This implied that genetics increased the risk of having breast cancer but it did

not mean that it was improbable to get the disease. Subsequently, early breast care was

essential in the lives of every woman whether with genetic predisposition or not.

Furthermore, we needed to reinforce more on the knowledge and attitude of the students

without a familial history of the said disease because they might be lacking sources of

information on how to care for their breast and how to prevent breast problems compared

with those students who have a family history of breast cancer.


Table 1.4. Demographic Profiles of the Respondents in Terms of their Sources of

Health Information

Source of Breast Care Awareness Frequency Percentage Rank

Teachers 28 7.0% 8Physician 99 24.8% 6

Family 160 40.0% 4Peers 126 31.5% 5

Internet 288 72.0% 1TV 244 61.0% 2

Magazine 216 54.0% 3Newspaper 81 20.3% 7

Table 1.4 showed the consensus of the respondents regarding their sources of

information regarding Breast Care and Breast Cancer. The internet which was ranked

number 1 got a percentage of 72.0% and it was the main source of the information about

Breast Care while the teachers ranked at number 8 with a percentage of 7.05%.

It meant that nowadays, students relied on the internet for information because of the

innovation era that the young generations’ experiencing right now and it made them more

open to the World Wide Web that aided them to find reliable information and trigger their

minds to explore new things that helped them developed their intellectual aspects. On the

other hand teachers were considered by the respondents as traditional source of information

which made the respondents uninterested in the course of acquiring knowledge.

According to Saludeen (2009), Technology played a key role in the dissemination of

health information. In a study conducted by Twenty three point six percent of the


respondents in the study first heard of breast self examination from television while 18.6%

and 18.2% first heard of breast self examination from health workers and on radio

programs respectively. Saludeen’s study population was literate and listened to radio

programs, watched the television and interacted with health workers when confronted with

problems.

With the sources of information in general, the media was the main source of

healthcare information for the public. Use of the media had been considered a popular and

effective health communication strategy. The media disseminated information concerning

social issues and some of that news might contain elements of a persuasive nature that

prompted women to engage in BSE. For example, a news report about a woman suffering

from breast cancer typically conveyed a persuasive message of a cry for fear. This type of

presentation acknowledged the severity of the threat, and implicitly indicated that the

students were able to engage in the suggested actions. Vellozzi (2003) supported the results

of this study wherein he found that the media had been successful in encouraging Hispanic

women to take action to ensure breast health.

The findings disagreed with idea that the majority of the respondents relayed their

health needs and beliefs to the physicians or nurses though they specialized in the given

field. In a featured health education research from Oxford Journal (2010), Worsley

surveyed 667 respondents through a random population mail survey of diet and health

beliefs. They were asked to rate the perceived reliability of health information from each of

18 sources, and to indicate whether they had referred to these sources in the previous year.

The results showed that the family doctor and pharmacist were generally regarded as the


most reliable sources, whereas TV advertisements, newspaper and magazine articles were

among the least reliable.

Lee (2000) in Korea showed that knowledge has an important role and that teachers

play also an important role in educating young women. Consequently, students should be

encouraged and motivated to increase their own knowledge on breast cancer screening.

Moreover, health educators should not only use the usual way of teaching students

regarding breast care but also, they should integrate other forms of sources of information

to have a higher level of knowledge and a positive attitude towards breast care.

Table 2. Perception of the Female Students of Adamson University towards

Breast Care

Frequency of Yes

Percentage Frequency of No

percentage

1.Breast care can encourage women to be responsible to

their health275 68.8% 125 31.3%

2. Having enough knowledge about breast care can help

women not to get the wrong impression about what she

felt from her breast.

230 57.5% 170 42.5%

3. Do you know that there are different types of Breast

Care Examinations?140 35.0% 260 65.0%


4. Do you agree that Breast self examination is the most

preferred method for women in early detection of breast

problems?

225 56.4% 175 43.6%

5. Do you know that Clinical Breast Examination is more

thorough procedure to detect breast problems?

237 59.3% 163 40.8%

6. Breast Examination is ONLY done by health practitioners/doctors.

246 61.5% 154 38.5%

7. Would it be best to learn how to perform Breast Care

with the supervision of a health care provider?

224 56.0% 176 44.0%

8. Is the armpit also examined during Breast Self

Examination?200 50.0% 200 50.0%

9. Lumps are seldom found along the underside of the

breast.240 60.0% 160 40.0%

10. You should limit pressure applied on the breast?

172 43.0% 228 57.0%

11.BSE can be done while taking a shower/bath

186 46.5% 214 53.5%

12. Is it true that applying pressure may injure breast?

191 47.8% 209 52.3%

Table 2 results showed that item number one (1) ask over if breast care can

encourage women to be responsible to their health and it result 275 students a percentage of

68.8% answered it with a YES while 125 students a percentage of 31.3% answered it with

a NO. This signified that students believed that breast care could encourage women to be

responsible with their health.

Item number two (2) ask over having enough knowledge about breast care can help

women not to get the wrong impression about what she felt from her breast and the result

230 students a percentage of 57.7% answered it a YES and 170 students a percentage of


42.5% answered NO. It signified that students believed that having enough knowledge

about breast care can help women not to get wrong impressions about what they could feel

from their breast especially during and after their menstruation.

Item number three (3) ask over the different types of breast care examination and

260 students a percentage of 65.0% doesn’t know that there are different types of Breast

care examination while 140 students a percentage of 35.0% has an idea about different

types of breast care. This signified that few students knew about different types of breast

care examinations.

Item number four (4) ask over if the breast self examination is the most preferred

method for women in detecting breast problems and it turn out that 225 students percentage

of 56.4% agreed that this was the most preferred method and 174 students percentage of

43.6% did not agree about it. This signified that breast self examinations was the most

desired method in early detection of breast problems.

Item number five (5) ask over about the thorough procedure to detect breast

problems which is the clinical breast examination and 237 students a percentage of 59.3%

answered it Yes and 163 students percentage of 40.8% answered that Clinical breast

Examination was not the thorough procedure for detection of breast problems.

Item number six (6) ask over about health practitioners/doctor are the only who can

performed Breast self examination and 246 students percentage of 61.5% believed that

only health practitioners/doctor can performed Breast self examination and 154 students

percentage of 38.5% did not believe that health practitioners/doctor only can carry out

breast self examination. This signified that majority of the respondents always sought for

their health to the doctors and other health practitioners.


Item number seven (7) ask over that it can be best to learn breast care with the

supervision of health provider and 224 students percentage of 56.0% believe it and 176

students 44.0% it can be learn even without the supervision of health provider. This

signified that the respondents sought guidance about their health.

Item number eight (8) ask over if the armpit included in breast self examination and

half of the 400 students which was around 200 students with a percentage of 50% answered

that armpit was included and the other half 200 students percentage of 50% answered that

armpit was not included. This signified that the respondents have the idea that the armpit

was also included during the breast self – examination, but they were still in doubt if the

armpit was really had to be included during the breast self – examination.

Item number nine (9) ask over if the lumps are seldom seen along the underside of

the breast 160 students which 40% of the respondents answered that lumps were seldom

seen along the underside of the breast and 240 students which 60% believed that lumps

were not seldom seen along the underside of the breast. This signified that the respondents

had deficient knowledge about the breast lumps are located in the body.

Item number ten (10) ask over about the pressure should limited on breast 228

students which 57% answered that the pressure should be limited while 172 students 43.0%

answered that it should not limited. This signified that the respondents did not know the

real purpose of palpating with firm pressure on the breast.

Item number eleven (11) ask over breast self examination can be done while taking

shower/bath and 214 students with a percentage of 53.0% believed that breast self

examination could be performed while taking a bath/shower while 172 students which


43.0% believed that breast self examination could not be done while taking a bath/shower.

This signified that the respondents knew when to perform the breast self – examination.

Item number twelve (12) ask over that applying pressure can cause injury 209

students a percentage of 52.3% believe that applying pressure could cause injury on breast

and 191 students with a percentage of 47.8% that for them applying pressure might not

injure the breast. This signified that the respondents did know the real purpose of applying

pressure on the breast and they did not know that applying pressure could not cause injury

in the breast.

Table 2.1 Knowledge Level of the Female Students of Adamson University towards

Breast Care

Knowledge Level Scores Frequency Percentage

Below Passing 1 – 6 232 58%

Passing and Above 7 – 12 168 42%

Total 12 400 100%

Table 2.1 showed that the level of knowledge of the respondents were at a below

passing level in which 232 respondents or 58% got a score of 6 and below while 42% or

168 respondents got a score of 7 and above. The results meant that most of the respondents

were not knowledgeable enough about breast care.


In general this meant also that even the female adolescents had the previous

knowledge about breast care, it didn’t mean that they already had the proper knowledge

regarding self-breast care. Also even though they had acquired some knowledge from

different sources, some were not very dependable sources to enhance their knowledge

regarding self-breast care.

Washington State Department of Health (2008) education for health begins with

people. It hoped to motivate them with whatever interests they might have in improving

their living conditions. Its aim was to develop in them a sense of responsibility for health

conditions for themselves as individuals, as members of families, and as communities. In

communicable disease control, health education commonly included an appraisal of what

was known by a population about a disease, an assessment of habits and attitudes of the

people as they relate to spread and frequency of the disease, and the presentation of specific

means to remedy observed deficiencies.

The students may be influenced by overconfidence, the “feeling-of-knowing”

(FOK) phenomenon, and the use of inappropriate inference ruled either at encoding or

retrieval of information (Camerer and Johnson, 2004). As a result, they tend to have more

information sink in on their minds but often times, these became juggled and became

confusing on their part. This was also the same about their knowledge on breast care

wherein, the students had previous knowledge already about it, however, the things that

they knew were not concise and thoughts appeared to be misinterpreted causing

misconceptions about breast problems most especially with breast cancer. In regards with

this also, they knew the procedure on breast care and tend to do it on their own but when

asked to do a demonstration, they could not perform it accurately Oskamp (2002),


supported this findings wherein he found that as the amount of given information increases,

a decision-makers confidence in his/her performance increases, but actual accuracy in

performance did not.

Johnson and Karns (2011) stated that the educators’ instructive efforts should be

directly focused on research-based instruction and classroom intervention strategies that

worked with their students. This was also true with the health educators in the university.

High-quality instruction, more responsive efforts, and targeted intervention strategies were

required. Without effective classroom instruction and intervention strategies, the health

educators struggled to reach all students.

Another research showed that unless high-need students received targeted

interventions, many will face increasing gaps in their learning and achievement (Rathvon,

2008). If no interventions were provided at an early age, then many of these students might

be destined for special education support for years to come and worst, they would suffer

from being illiterate most especially about breast care that might lead to a higher risk of

having breast cancer.

According to WHO (2009), health educations any combination of learning

experiences designed to help individuals and community as improve their health by

increasing their knowledge or influencing their attitudes. Furthermore Curt Graham (2008)

said that health education was defined as the principle by which individuals and groups of

people learn to behave in a manner conducive to the promotion, maintenance, or restoration

of health. The ultimate aim of Health Education is Positive Behavioural Modification.

Additionally education for health begins with people. It hopes to motivate them with

whatever interests they may have in improving their living conditions. Its aim is to develop


in them a sense of responsibility for health conditions for themselves as individuals, as

members of families, and as communities. Health education commonly includes an

appraisal of what is known by a population about breast problems, an assessment of habits

and attitudes of the people as they relate to spread and frequency of the disease, and the

presentation of specific means to remedy observed deficiencies (Washington State

Department of Health, 2008).

Table 3. Attitude of the Female Students of Adamson University towards Breast

Care

ATTITUDEWeighted

MeanVerbal

Interpretation1. I feel that Breast Care is an important practice in detecting breast problems in its early stage. 3.83 Agree2. Breast Care will help me to be more conscious and familiar with my physical changes. 3.90 Agree3. I believe that I have enough knowledge about Breast Care 3.77 Agree4. I believe that I have the necessary skill for doing Breast Care 3.57 Agree5. I search for new information related to my health regarding Breast Care 3.78 Agree6. I take time to perform Breast Care Examination in various methods 3.82 Agree7. It is embarrassing for me to do monthly breast care. 3.48 Agree


8. My family/ friends would make fun of me if I did breast self-exams. 3.35 Not Sure9. I am willing to attend a seminar regarding breast care. 3.50 Agree10. I am willing to submit myself to the health professionals for further examination regarding my breast care. 3.50 Agree11. I believe there is nothing I can do to prevent my getting breast cancer 3.57 Agree12. I believe exercising daily can prevent breast cancer 3.70 AgreeGeneral Weighted Mean 3.41 Positive Attitude

Overall, the general weighted mean were 3.41 suggested that the attitude of female

students were of positive attitude. Specifically, they agreed that they felt that breast care

was an important practice in detecting breast problems in its early stage. The effects of

having a positive attitude helped the students to be more aware on how they would take

care of themselves to prevent acquiring breast cancer in the near future.

Having a positive attitude towards breast care meant that they had other factors that

contributed to this kind of attitude. Some factors noted were having previous knowledge

on breast problems, having an instinct of engaging with preventive measures regarding

breast cancer, and the role of media to their health seeking behaviour.

With the results of the study, it was showed that students should always be an

optimist towards health. Being an optimist did not only mean to see the brighter side of life.

To be an optimist meant to view the surroundings wherein you made the most of your

strengths and achievements and diminished your weaknesses and apprehensions. Having a

positive outlook through one’s health would help each woman to become more responsible

with their own health status preventing diseases in later life. According to Mayo (2011),


positive thinking did not mean that you keep your head in the sand and ignore life's less

pleasant situations. Positive thinking just meant that you approached the spitefulness in a

more positive and productive way. Which was the same as being engaged with breast care,

wherein once students would already have knowledge on how to take care of their breasts,

the more likely they will have a positive outlook on practicing breast care regularly.

It was being agreed by another theory which stated that having a positive outlook

enabled you to cope better with stressful situations, which reduced the detrimental health

effects of stress on your body. It was also thought that positive and optimistic people tend

to live healthier lifestyles. Alia Butler (2010) stated those individuals who had a positive

attitude would feel the impact on their health through lack of illness and overall increased

positive well-being. Furthermore, Mayo (2008) suggested that many health benefits have

been influenced by a positive attitude, including increased life span, increased resistance to

the common cold, lower rates of depression, increased cardiovascular health, reduced

stress, and overall physical and mental vigour. But in today’s life when one is thronged

with worries and tensions all around, it was very difficult to maintain a positive attitude as

stated by Singal (2012). Therefore, reinforcements such as continuous health education on

breast care should be given emphasis though the students already have a positive attitude

towards it.

This was supported by Orel (2003) which believed that BSE was a useful and essential

screening strategy, especially when used in combination with regular physical exams by a

doctor and mammography. About 20% of the time, breast cancers were found by physical

examination rather than by mammography. We recommended that all women routinely

perform breast self-exams as part of their overall breast cancer screening strategy.


It seemed crucial that every woman took the time to learn about the facts relating to

breast self-examination that could dramatically impact their lives whether these were the

benefits of BSE or an understanding of other preventive measures. Not only will you

benefit from early detection should you have a problem, you will also gain a "peace of

mind". Although this benefit cannot be measured directly, we do know that chronic stress

and anxiety is not good for anyone and does play a role in many chronic health problems.

As a woman who wanted to improve her health and a confidence of getting positive

results, the more likely she would perform regular breast examinations. It would also

include a woman who perceived that she was susceptible to have breast cancer which was a

serious disease. Similarly a woman who perceived more benefits from performing breast

self examination would probably perform this regularly (HBM, 2002). A woman who has

an internal care (body perception) or even those who had been exposed to an external care

which were influenced by health care provider or by media would also more readily to

adapt breast self-examination.

Breast self-exam promotes awareness about breast cancer as well as to the other less

serious breast problems such as cysts in the breast as congruent to Penta (2006) literature.

Women who are not practicing breast self-examination because of their concerns about

what they may found out though these findings may not be serious concerns. This anxiety

is real understandable, however after the first baseline of self-examination, regular

performing breast self-examination can help woman become familiar with the findings and

changes upon doing the exam. In connection in having an increased knowledge, this can

also to increase level of control over the health perception and health seeking behaviour of


the students beneficial in emphasising the importance of BSE in preventing future breast

problems.

Curt Graham (2008) said that health education is defined as the principle by which

individuals and groups of people learn to behave in a manner conducive to the promotion,

maintenance, or restoration of health. The ultimate aim of Health Education is Positive

Behavioural Modification.

Bailey (2009) emphasized that nurses have a vital role to play in encouraging women

to become more aware on their breast. Their health promotion activities in this area can

have an important impact on the uptake of breast screening initiatives.

A good attitude towards breast health enabled a respondent to practice BSE more,

since she appreciated her current state. This finding was supported by the Health Belief

Model’s Perceived or Anticipated Benefits, which stated that the person believed that

benefits stemming from the recommended behavior outweighed the costs and

inconvenience, and that they were indeed possible and within his or her grasp

(www.enotes.com, 2010).

Having awareness was not enough, since the respondent must perform BSE regularly

to be said that she had a good attitude towards it. One of the reasons why the subjects

might have a good attitude towards BSE, but not be able to practice was because they

assumed that they were free from having any breast pathologies after doing a few breast

self-exams previously.


GK Cretain (2004) said that Breast self-examination (BSE) was an important self-

care activity for women to perform to maintain their life, health, and well-being. Although

women are budding on awareness of the importance of breast self-examination, it appeared

that they lacked sufficient motivation to perform it on a consistent basis. Nurses were the

ideal health professionals to motivate women to perform BSE because of their knowledge,

their supportive-educative role, and their numbers located in various settings.


Chapter 5

SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS

This chapter presents the summary, the conclusion drawn from the study, the

recommendation for students and the implications for further study.

SUMMARY

The following were the results of the study:

1. The demographic profiles of the respondents showed that in terms of age,

mostly were 19 years old or 29.8% and the least were 24 years old which is

0.8%. In terms of menarche, most of the respondents started menstruating at

the age of 12 which is 41.4% of the total sample population while the age of 9

which was the lowest had the percentage of 1.5%. In terms of health history of

breast cancer, 85.9% of the respondents did not have relatives with breast

cancer while 14.1% of the respondents had a relative with breast cancer. In

terms of the source of health information of the respondents regarding breast

care, the main source was the internet which ranked number 1 gaining a

percentage of 72.0% while the teachers with a percentage of 7.0% placed in

rank number 8.


2. The level of knowledge of the respondents were at a below passing level in which

232 respondents or 58% got a score of 6 and below while 42% or 168 respondents

got a score of 7 and above. The results showed that most of the respondents were

not knowledgeable enough about breast care.

3. The respondents have a positive attitude on breast care with a weighted mean of

3.41.

CONCLUSION

The researchers therefore conclude that the demographic profile of the respondents

affects their knowledge and attitude specifically the age, menarche, history of breast

problems in the family and sources of health information. The respondents level of

knowledge were at a below passing level but the respondents had a positive attitude

towards breast care.

Moreover, the findings of the study conclude that the primary source of health

information of the respondents nowadays was the internet in which it played a vital role in

increasing the knowledge and attitude of the respondents.


RECOMMENDATIONS

The researchers recommend the following based on the conclusion drawn from

the findings:

COLLEGE STUDENTS

A more thorough explanation of the breast care must be given so that they may

understand thoroughly the practice of breast care. This can be attained by the

dissemination of a health education that can be constructed based on the outcomes

of this study. The health education should be designed to be a lot informative so

that students will be encouraged to learn and develop a motivation to practice and to

perform breast care regularly. Since the technology and media are also the

students` sources of health information, health education should also utilize the

internet so that students get accurate and readily available information regarding

breast care for them to disseminate with their family or peers with the intention that

they can all have a positive attitude in caring for their breasts.


UNIVERSITY CLINIC

The clinic should have a readily available health educational material in the school`s

website and clinic regarding breast care to facilitate awareness to the students. It

should have a health education program once or twice a year so that it will be more

convenient for the students to ask any questions pertaining to breast problems and

breast care. Since the history taking is part of the clinic’s assessment, those students

who have a family history of breast problems should be a priority in the programs

pertaining to breast care and the preventive measures that they can do against

developing any breast problems in the future. Since the students trust the health care

providers, the university clinic should encourage the practice of breast care and

conduct a demonstration so that students will be able to practice it regularly and

correctly.

COLLEGE OF NURSING

The college should produce more researches focusing on health education towards

breast care to uphold the quality of education for nursing students by having a wide

spectrum of references or literatures to better understand the practice of breast care.

They should take the initiative to impart knowledge about breast care among

students in Adamson University so that student nurses could act as a health


advocate especially for the female students with regards in the prevention of breast

problems specifically breast cancer.

STUDENTS’ ORGANIZATION

Different student organizations should manage activities that would promote

awareness and change of attitude of the students, and would also assist the students

in establishing healthy and harmonious relationships with their social group to

achieve common goal aligned with one of the Adamson University’s core values,

which is Solidarity. This would promote not only proper utilization of the social

support from the Vincentian community, but also an environment conducive for

both academic purposes and students’ well-being.

FUTURE RESEARCHERS

The researchers should make research studies regarding the most effective way to

increase the knowledge and attitude of the female Adamsonian students thus, making

a framework for health teaching guide. The results obtained from the study may

serve as an additional reference for such studies that may share the same theme as

with this research. The researchers recommend that future researchers should also


conduct the same study but should make the male students of Adamson University as

focus of their study. This is suggested so as to widen their knowledge on breast care

and remove their stigma regarding the connotation that only women are affected with

breast problem specifically breast cancer, thus making Breast Care not only limited to

women.

NURSING PRACTICE

The results of the study showed that, intervention such as seminars would increase the

level of knowledge of the students regarding breast care as well a positive attitude

towards it. Therefore, the researchers recommend that a continuous education on

breast care should be stressed to the students so that each Adamsonian will be an

advocate against Breast Cancer not only for themselves but also for their peers and

family members.

NURSING PROFESSION

The researchers recommends that nurses, especially school clinic nurses and

nursing educators, must obtain knowledge and skills about breast care and use this

in organizing seminars and other forms of health education.

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