# Effectiveness of a Health Awareness Program for Early Detection of Breast Cancer Among Female Patient Attendants in a Selected Hospital in North-East India: A Preexperimental Pretest–Posttest Study

## TL;DR

A health awareness program improved knowledge and skills of breast cancer detection among female hospital attendants in India.

## Contribution

The study demonstrates the effectiveness of a targeted health awareness program in improving breast cancer detection knowledge and BSE skills.

## Key findings

- Participants' knowledge of breast cancer and BSE improved significantly after the program.
- BSE skill scores increased from 3.32 to 19.08 following the health awareness program.
- Only a small percentage of participants practiced BSE regularly or had undergone mammography.

## Abstract

Introduction

Breast cancer (BC) is the most frequent malignancy among women. Early diagnosis of BC can be achieved through breast self-examination (BSE) and breast cancer screening tests (BCST). BC prevention is most effective when people are aware of the disease. The present study aims to assess the effectiveness of a health awareness program for early BC detection among the female attendants of admitted patients at a tertiary care center.

Methods

The study adopted a preexperimental one-group pretest-posttest design and included 450 female attendants of admitted BC patients at the Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, India (Tata Memorial Centre). The participants were selected using non-probability convenience sampling. The data collection tools included the demographic proforma; the knowledge questionnaire for BC, BSE, and BCST; the skill checklist for BSE; and the practice questionnaire for BC and BCST. On the first day, a pretest was administered. Following the pretest, a health awareness program focused on early detection of BC was delivered. The health awareness program included lectures and discussions covering the anatomy of the breast, risk factors, signs and symptoms, diagnosis, treatment, and prevention of BC; the meaning of BSE; when to perform BSE; changes to look for during BSE; what to do if a lump is discovered during BSE; and a demonstration of BSE using a breast model. The health awareness program lasted 45 minutes. The posttest was completed on the eighth day using the identical instruments as the pretest, except for the demographic proforma. Descriptive and inferential statistics were used to analyze the data. The difference between mean scores at pretest and posttest was tested using a paired t-test or Wilcoxon signed-rank test, while the difference between proportions was compared using a z-test for two proportions or McNemar's test, as per the normality of the data.

Results

Of the 450 participants, 339 (75.3%) were in the 20-30-year age group, and 315 (70.0%) were from rural areas. Most of the participants were literate, with 172 (38.2%) holding a high school diploma, and the majority belonged to low-income families and were unemployed (n = 283, 62.9%). Most participants (278; 61.8%) had heard of BC, and they primarily learned about it from the media (n = 251; 55.8%). The majority (393, 87.3%) had no family history of BC. At the pretest, 232 (51.6%) participants had average knowledge of BC, BSE, and BCST. Furthermore, 417 (92.7%) had poor BSE skills. After the health awareness program, the majority (319, 70.9%) of participants demonstrated excellent knowledge. At posttest, 324 (72.0%) demonstrated excellent BSE skills. A statistically significant difference was observed between the pretest and posttest knowledge scores (Z = -18.10, p < 0.01). The mean BSE skill scores of participants increased significantly from 3.32 at pretest to 19.08 at posttest. Only 11.6% (n = 52) of participants had done BSE at pretest, which increased to 17.6% (n = 74) at posttest. Only 23 (5.1%) participants reported regular BSE practice at posttest. None of the female participants had ever undergone mammography.

Conclusions

The health awareness training on early identification of BC improved participants' understanding of BC, BSE, and screening tests, as well as their ability to perform BSE. The prevalence of BSE and BCST was extremely low and sporadic among the participating females.