improving knowledge, attitudes and practice of breast self ...€¦ · availability of bse gloves,...

Improving Knowledge, Attitudes and Practice of Breast self Examination (BSE) among Pharmacists in Abuja, Nigeria

1 2Funmilayo Jumoke Morebise and Obiageri Obodozie1Department of Academic Standards, National Universities Commission, Abuja.

2National Institute for Pharmaceutical Research and Development, Abuja.

Corresponding Author: Funmilayo Jumoke MorebiseEmail: [email protected] Phone: 08035974255

ABSTRACT

Background: Pharmacists as healthcare professionals constitute direct source of medical information to the public and can play an important role in the awareness of breast cancer (BC) screening.

Objectives: This study assessed the knowledge, attitude and practice of Breast Self Examination (BSE) and the effect of an educational intervention on female Pharmacists in Nigeria's Federal Capital City, Abuja.

Methods: The study was an experimental study design. There was a pre-intervention baseline data collection using a self-administered questionnaire to purposively sampled pharmacists who were available at various pharmaceutical fora. The intervention was offering of educational presentations/materials on BSE to a sub-group of the pre-intervention study participants over a six-month period. A post intervention data collection was also done to evaluate the effect of the intervention.

Results: The findings revealed that 87.4% of Pharmacists in FCT have a good overview understanding of BC and BSE. However, knowledge of specifics involved in both BSE and BC were found to be poor as indicated by knowledge of time (15.9%), positioning for BSE (9.9%), BC signs/symptoms (10.5%). Attitude towards BSE was found to be good, but its practice was poor (31%). The intervention impacted positively on the knowledge of participants as regards BSE and BC with a 69.8% increase in the number with adequate knowledge of timing for BSE and 50% increase in those with adequate knowledge on signs/symptoms of BC.

Conclusion: The study showed that Pharmacists had good knowledge of definition of BSE and BC, their knowledge of time of BSE, signs and symptoms for both was poor. The practice of BSE among female Pharmacists was poor but an enthusiasm to be involved in Public Health campaign for BSE was found.

Key words: Breast self examination, Pharmacists, Breast cancer.

West African Journal of Pharmacy (2013) 24 (2) 94-101

West African Journal of Pharmacy (2013) 24 (2) 94

Correspondante: Morebise, Funmilayo JumokeEmail: [email protected] Phone: 08035974255

RÉSUMÉ

Contexte : Les pharmaciennes en tant que professionnelles des soins médicaux représentent, pour le public, une source directe d'information médicale et peuvent jouer un rôle important dans la conscience du dépistage du cancer du sein (CS).

Objectifs : Cette étude a évalué la connaissance, l'attitude et la pratique de l'auto-examen du sein (AES) et l'effet d'une intervention pédagogique sur des pharmaciennes au TCF.

Méthodologie : Il s'agit d'une étude expérimentale. Au préalable, nous avons rassemblé des données de base à l'aide d'un questionnaire distribué à des pharmaciennes délibérément choisies au cours de divers événements pharmaceutiques. Avant l'intervention, il s'agissait de proposer du matériel pédagogique sur l'AES à un sous groupe de participantes pendant une période de six mois. Après l'intervention, les données ont encore été rassemblées pour évaluer l'effet de l'intervention.

Résultat : Les conclusions ont révélé que 87,4% des pharmaciennes du TCF ont une bonne compréhension générale de l'AES et du CS. Cependant, on a constaté que leur connaissance des détails de l'AES et du CS était faible à en juger par la connaissance sur le moment propice (15,9%), sur le positionnement pour l'AES (9,9%), et sur les signes/symptômes (10,5%). On a constaté une bonne disposition à l'égard de l'AES, mais la pratique était faible (31%). L'intervention a eu un effet positif sur la connaissance que les participantes détenaient sur l'AES et le CS. Il y a eu une augmentation de 69,8% dans le nombre de celles ayant une connaissance adéquate sur le moment propice pour l'AES et une augmentation de 50% dans le nombre de celles ayant une connaissance adéquate sur les signes/symptômes du CS.

Conclusion : L'étude a montré que les pharmaciennes avaient une bonne connaissance de l'AES et du CS et une mauvaise connaissance du moment propice pour l'AES et des signes et symptômes des deux. La pratique de l'AES était peu répandue chez les pharmaciennes mais on a constaté qu'elles sont bien disposées à participer aux campagnes en faveur de causes de santé publique comme l'AES.

Une Étude de la Connaissance, des Attitudes et de la Pratique de L’auto-Examen du sein (AES) Chez les Pharmaciennes au Territoire Capital Fédéral (TCF)


West African Journal of Pharmacy (2013) 24 (2) 94-101

INTRODUCTIONBreast Cancer, is that tumour that forms in tissues of the breast, usually the ducts and lobules. It occurs in both men and women, although male breast cancer is

1very rare. Approximately 1 in every 8 women will develop breast cancer in her life time. Breast Self Examination (BSE) is a screening method used in an attempt to detect breast cancer early. The method involves the woman herself looking at and feeling each breast for possible lumps, distortions or swelling. Often times, the woman can involve her healthcare provider also in the Breast Self Examination.Pharmacists can play an important role in increasing awareness of breast cancer screening among women because; they are repeatedly cited amongst most trusted and accessible health care professionals; function as useful bridge between patients and physicians by identifying an individual patients needs and facilitating referrals to health care providers when appropriate; the key source of drugs and drug information to women regarding Mammography, Clinical Breast Examination (CBE) and Breast Self-

2Examination (BSE). Breast Cancer is responsible for about 16% of all

3cancer related deaths in Nigeria. The relative frequencies of breast cancer among other female cancers from cancer registries in Nigeria were 35.3% in Ibadan, 28.2% in Ife-ijesha, 44.5% in Enugu, 17% in Eruwa, 37.5% in Lagos, 20.5% in Zaria and 29.8% in

4Calabar. Reports showed that majority of cases occurred in pre-menopausal women. The mean age of occurrence ranged between 43-50 years across the regions. The youngest age recorded was 16 years,

4from Lagos. The peak age of incidence in Nigeria is

542.6 years. There are established risk factors for Breast Cancer which include age, family history, genetics, personal history of breast cancer and others, while emerging risk factors include low level of Vitamin D, low light exposure especially at night, diethylstilbestrol (DES) exposure, eating of unhealthy food which is responsible for about 30% to 40% of all cancers, exposure to chemicals in cosmetics, exposure to chemicals from lawns and gardens, exposure to chemicals in plastic, and exposure to chemical sunscreens. The signs and symptoms of BC include swelling of all or part of the breast, skin irritation or dimpling, breast pain, nipples pain or the nipple turning inwards, redness, scaliness or thickening of the nipple or breast skin, nipple discharge other than

breast milk, and a lump in the underarm area. These changes also can be signs of less serious conditions that

1are not cancerous, such as infection or a cyst. The traditional role of pharmacists as healthcare practitioners was to distribute drugs that had been prescribed to patients; act as a learned intermediary between a prescriber and the patient. Pharmaceutical care involves taking direct responsibility for patients and their disease states, medications, and the management of each in order to improve the outcome for each individual patient. It also involve patient education on breast cancer, breast cancer screening methods, public advocacy, care giving and support.To the government and the public the benefits of BSE includes reduction of escalating cost of care for breast cancer, reduces burden on the healthcare delivery system and enhances productivity through a healthy work force. The practice of breast self examination has

6Clinical, humanistic and economic benefits to patients. The perception of the pharmacists in reducing threat to

7health related problem is generally poor , more frequent and meaningful interaction with patients, like BSE Campaign will increase Pharmacists opportunity to contribute to improved patient outcomes. Pharmacist-Patient-Public relationship is improved. This improves professional image, growth and development. It also provides additional earnings for Pharmacists.Low level of awareness of breast cancer has been

8reported among Nigerians . The awareness of risk factors and early warning signs of the disease among

9different groups were below average. Affordability of healthcare is highly limited by its skyrocketing cost. Access to screening and diagnostic medical equipment and medicines in developing countries is inadequate for the majority of the population. There is

10need to detect breast cancer at its earlier stage. Health professionals constitute direct source of medical information to the public. Pharmacists can play an important role in increasing the awareness of breast cancer screening among women. Regular screening and surveillance of women at risk for breast cancer may prove very useful in detecting disease at early stage, thus decreasing the associated morbidity and mortality.The aim of this study was to assess the effects of health e, attitudes and practice of breast self examination (BSE) among pharmacists in FCT, Abuja. The specific objectives includeducational intervention on the knowledge assessing the knowledge, attitude and practice of BSE among female Pharmacists in the FCT, to institute health education intervention among female


Breast self Examination (BSE) among Pharmacists

Pharmacists in FCT towards BSE and to assess the effect of health education intervention on the knowledge, attitude and practice of BSE among Pharmacists in FCT.

METHODS The study was an experimental study design. There was a pre-intervention baseline data collection using a self-administered questionnaire to pharmacists who were available at various pharmaceutical fora. The purposive sampling method was used. The intervent ion was offer ing of educat ional presentations/materials on BSE to a sub-group of the pre-intervention study participants over a six-month period. A post intervention data collection was also done to evaluate the effect of the intervention.The data collected was analyzed using frequency distribution for descriptive statistics. Chi square was used for the inferential statistics. The Statistical Package for Social Sciences (SPSS version 17, 2010) was used as tool in the analysis. Data generated was presented as percentages in the form of tables and charts. P-value of less than 0.05 was used in tabulation using Pearson Chi Square.

RESULTSThe findings revealed that 74.3% of Pharmacists had good knowledge about the risk factors of BC such as age, gender, family history, genetic, personal history of BC etc. 89.1% of respondents agreed that regular BSE will help enhance the early detection of BC. 87.4% of respondents had good knowledge of the definition of

BSE. Large proportion 77.8% had no knowledge of the availability of BSE gloves, even though the BSE glove is new in Nigeria market. Only 48(15.99%) knew the best time for BSE. (10.9%) had good understanding about Symptoms of BC and what to look for during BSE. Only 30(13.2%) of those that know BSE is done in steps 227(75.2%) could state the three steps correctly. The attitude of the Pharmacists towards BC & BSE is generally good. 238(78.8%) believed anybody can get breast cancer while 228(75.5%) felt they were not well informed about BC. 69% of female pharmacists never practiced BSE before giving one reason or the other. Only 8(16%) of the female who practiced BSE do it correctly. The area of Practice of Pharmacists had significant effect on responses on the time of BSE and signs and symptoms of BC (P<0.05), attitude towards recognizing breast irregularities (P<0.05) and significant effect on the practice of BSE among female Pharmacists (P<0.05).

The educational intervention impacted positively on the knowledge of respondents on other methods that can be used to detect BC early. Higher proportions now felt well informed about BSE (34.5%). Awareness on the availability of BSE glove increased by 72.1%. No significant improvement in the practice of BSE by the female respondents (27.5%). There was a remarkable improvement in the knowledge of the technical specifics of the conduct of BSE, timing (69.8%) and Signs & symptoms (50%).

Figure 1: Knowledge of respondents on the definition of Breast Cancer


Funmilayo Jumoke Morebise and Obiageri Obodozie

Figure 2: Understanding of respondents on the definition of Breast Self Examinations (BSE).

Figure 3: Have you ever done BSE?

Figure 4: Impact on best time of the month for BSE



Figure 5: Impact on BSE, signs of Breast Cancer

Figure 6: Ever done BSE after the presentations

Figure 7: Impact on knowledge of respondents on other methods that can be used to detect breast cancer early



DISCUSSIONThe good knowledge of both definition of BC, BSE and risk factors for BC were similar to studies among

11,12,13,14nurses and also similar to that of Iranian 15women. The responses of the participants might

have been influenced by their education, training and experience as a pharmacist.Good knowledge about BSE in enhancing the early detection of developing cancer (89.1%) may be because pharmacist are privileged to have information of BC from course work or training and during practice, notwithstanding an intensive training and research in pharmacotherapy of BC is needed in the training and education of Pharmacists.The poor knowledge of BSE techniques, like time signs and symptoms of BC, positioning and other methods of detecting BC early indicated that most of the respondents were lacking in knowledge of the technical details that are important in the practice of BSE and its use in reducing the prevalence of cancer. The study is in contrast to similar cross sectional study carried out among nurses in Lagos Nigeria, which found that knowledge about symptoms and methods of diagnosis and self breast examination were

12generally good.The poor practice (31%) among the female Pharmacists in the study was comparable to results of

16,17,18similar studies among Edo women. This was also the trend amongst doctors, nurses, radiographers,

19laboratory scientists, pharmacists, nursing and

20midwifery students in other studies. Also the poor practice compared to results of studies among women

21,22,23,24in other parts of the world . This contrast the study carried out among nurses in Jordan and Singapore which revealed that 86% and 93%

14,25respectively reported to be performing BSE. The area of practice having significant effect on the knowledge, attitude and practices among pharmacists in FCT might be as a result of the fact that pharmacists working in both community and hospital settings are key drug information providers to

2patients.Comparing pre-intervention and post intervention analysis, there was improvement in the knowledge, attitude of respondents towards BC and BSE, though there was no significant improvement in the practice of BSE by the female respondents. Finally, in addition to aggressive educational intervention amongst pharmacists, the pharmacy curriculum should be expanded to cover current public health issues including breast cancer

education. The mandatory continuing professional development programme for pharmacists should be updated and enriched with emerging public health issues.The study had some limitations, time constraint was an important as all the Pharmacists recruited during intervention could not be followed up during Post intervention. This might have affected the impact assessment result. From the demographic distribution, a large proportion of respondents were between ages 29-39 years, this age group may lead to bias as they are not likely to be concerned with BC, since older women are more predisposed to breast cancer. This might have affected their practice of BSE.

CONCLUSIONThe study showed that pharmacists in the FCT had good understanding of what breast cancer is, as well as the causes and risk factors. Also, the pharmacists had good knowledge of definition of BSE but poor knowledge of technical specifics such as time to perform BSE, signs and symptoms positions for BSE. Respondents' attitude towards BSE was found to be good. The knowledge gap as regards BSE has to be filled to equip pharmacists' practice of BSE and provide these services in pharmaceutical care and public health. The practice of BSE among pharmacists in the FCT was poor. There was a significant relationship between area of practice and knowledge of time of BSE, signs and symptoms of BC but not on the attitude towards BC. A significant relationship between the areas of practice of the female pharmacists and their practice was also observed. The presentation impacted greatly on the knowledge and attitude of BSE but there was no remarkable impact on the practice.Lastly, pharmacists have a significant role to play in creating awareness on BSE in cancer prevention in Nigeria. Also, their professional involvement through health education and other processes of BSE can contribute in no small measure to public health and therefore enhance achievement of the Millennium Developments Goals (MDGs) in Nigeria

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improving knowledge, attitudes and practice of breast self ...€¦ · availability of bse gloves,...

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