Effectiveness of Educational Intervention Programme on Knowledge Regarding Breast Self Examination Among Higher Secondary School Girls of Biratnagar

Introduction Breast self-examination (BSE) is a self-generated, non-invasive and non-irradiative method of breast cancer detection. Self examination of the breasts each month after the menstrual cycle is the simplest yet extremely important way to detect early breast cancer. It has been observed that women can detect 95% of breast cancers and 65% of early minimal breast cancers themselves. This method is harmless, less time consuming and can be performed by any woman. Objective To assess the effectiveness of educational intervention programme regarding Breast Self Examination among girl students of study school. Methodology Pre experimental one group pre-test post-test design was adopted for this study. In total, 61 girls were included. The result were analysed by using both descriptive as well as inferential statistics. Results In pre-test 75.4% had inadequate and only 1.6% had adequate knowledge regarding Breast Self Examination, in contrast, after the intervention the adequate knowledge was increased to 62.3%. The overall mean score was increased from 33.07% to 85.14%. The test of significance revealed that the increment in BSE knowledge score due to program intervention was highly significant (P< 0.001). Conclusion The educational intervention programme on BSE was found to be highly effective as the knowledge score was significantly increased after intervention of the package among higher secondary school girls. Birat Journal of Health Sciences 2016 1(1): 13-19


Introduction
Breast self-examination (BSE) is a self-generated, non-invasive and non-irradiative method of breast cancer detection.Self examination of the breasts each month after the menstrual cycle is the simplest yet extremely important way to detect early breast cancer.It has been observed that women can detect 95% of breast cancers and 65% of early minimal breast cancers themselves.This method is harmless, less time consuming and can be performed by any woman.

Objective
To assess the effectiveness of educational intervention programme regarding Breast Self Examination among girl students of study school.

Methodology
Pre experimental one group pre-test post-test design was adopted for this study.In total, 61 girls were included.The result were analysed by using both descriptive as well as inferential statistics.

Results
In pre-test 75.4% had inadequate and only 1.6% had adequate knowledge regarding Breast Self Examination, in contrast, after the intervention the adequate knowledge was increased to 62.3%.The overall mean score was increased from 33.07% to 85.14%.The test of significance revealed that the increment in BSE knowledge score due to program intervention was highly significant (P< 0.001).

Conclusion
The educational intervention programme on BSE was found to be highly effective as the knowledge score was significantly increased after intervention of the package among higher secondary school girls.

Breast cancer, examination, school girls
Affiliation: women.BSE is specifically designed to detect the tumour at an early stage when the small painless lump of cancer is often ignored.Although little is known about the prevention of breast cancer, the chances of survival appears to be good, if it is found early and treated promptly.
BSE or regularly examining breasts by self can be an important way to find a breast cancer at early stage, when it is more likely to be treated successfully.Not every cancer can be found this way, but it is a critical step one can and should take for own self.Regular monthly BSE is an essential health maintenance activity.Teaching skills of BSE can be life saving and with regular performance, malignancy may be discovered at an earlier stage, which can save lives.
Despite an increase in women literacy rate and knowledge about breast cancer, there are certain barriers to practice BSE, like worry about breast cancer, embarrassment, lack of time, unpleasant procedure, lack of privacy, fear of discovering a lump and unfavorable attitude towards Breast 7,8,9,10 Self Examination.So, to remove this barrier awareness programmes are showing signs of success, with more women being screened and treated for breast cancer.The objective of this study was to evaluate the effectiveness of Breast Self Examination educational intervention package and its associating factors.
Quasi experimental one group pre-test post-test study design was adopted to see the effectiveness of the educational package.All girl students of grade 11 and 12 from Marryland Higher Secondary School of Biratnagar city, meeting the eligibility criteria were selected for the study.The intervention package was given to 61 girls among 297 total girls of the school, which accounts about 15% of total girl population.School was selected by simple random sampling technique and sampling units were selected consecutively.Before, proceeding data collection, ethical approval was taken from ethical review committee of Nobel Medical College and Teaching Hospital, Biratnagar.Permission from the school authority was obtained and oral informed consent was taken from each participants.Standard self-administered questionnaire was developed by consulting the specialists.The tool was pre-tested for reliability on 10% students in the same school and those subjects were excluded from the final study.Pre-test information was collected before the intervention of educational package on Breast Self Examination.A protocol for educators was designed, BSE related posters, slide, leaflets were used extensively as teaching learning materials and at the end video clip was demonstrated regarding steps of BSE.After 2 weeks of educational intervention, post-test information was collected in same participants with same questionnaire.All the participants who were participated in the pre-test were also participated in the post-test.Data was cleaned and entered in MS Excel 2007 and analyzed using SPSS 17 version.Paired t-test was used to test the significance of effectiveness and independent sample t-test and one way ANOVA were used to test the associating factors.
Assessment of knowledge on BSE before and after intervention was done and in addition socio-demographic determinants were explored.This study is able to cover only 61 adolescent girls for the intervention package; large scale study in similar intervention in diverse setting can give better generalization.
The educational intervention programme on BSE was found to be highly effective as the knowledge score was significantly increased after intervention of the package among higher secondary school girls.Among the various socio-demographic variables only mothers' education found to be effective with pre-test knowledge score.Therefore, the government and other health agencies should focus to apply educational intervention package for breast self examination along with focus to increase the education level among women.
We are thankful with all girls participants of Meryland School, Biratnagar.

CONFLICT OF INTEREST
Birat Journal of Health Sciences mothers' education found to be significantly related with knowledge score of Breast Self Examination.Hence, it is confirmed that mother's education plays an important role to increase the Breast Self Examination knowledge among the girl adolescents.Birat Journal of Health Sciences Vol.1/No.1/Issue1/ Sept-Dec 2016

Table 1
reveals that among 61 respondents, majority of respondents were from age years, consisting of 65.6% and the mean age was 16.62 ± 1.19 years.Majority of respondents (70.5%) were from grade 12.The Hindu religion was followed by 96.7% respondents and majority of respondents (55.7%) belonged to upper high caste.While observing the educational status of respondents' parents, higher proportions (32.8%) of mothers had completed secondary level education and 29.5% fathers had also completed same level of education.Similarly, 47.5% of respondent's fathers were engaged in business occupation; in contrast, 82% mothers were housewives.The Mean income of the family was reported NRs 18788.5±11307.5.

Table 2 : Respondents pre and post test knowledge level on BSETable 3 : Significance test on effectiveness of educational intervention programme on BSE
*** Strongly SignificantIn table3, the significance test results on effectiveness of educational intervention programme was illustrated.Paired t-test was applied to test the significance on the score obtained before and after intervention programme on BSE.

Table 4 : Difference in mean knowledge score by selected socio-demographic variables of respondents
Aniebue PN et al. (2008)survey done byAniebue PN et al. (2008)on awareness of breast cancer and Breast Self Examination among four hundred and twenty eight female secondary school teachers in Enugu Metropolis, South Eastern Nigeria revealed no significant relationship between age, educational attainment and knowledge of BSE which 16 strongly supports findings of this study.An interventional study conducted by Moustafa DG on Effect of a Breast-Self Examination (BSE) educational intervention 17 among 180 female university students showed that mothers' occupation were significantly related with knowledge level of BSE which is slightly contradictory to the findings of this study.
* Significant (paired t-test was used at 5% level of significance)DISCUSSIONKnowledge on BSE was assessed through self-administered structured questionnaire.Among the 61 respondents, majority of respondents were from age group 17-19 years, and the mean age was 16.62 ± 1.19 years.Majority of respondents (70.5%) were from grade 12 and Hindu religion was followed by 96.7%.Out of total respondents, 82% of respondents have not heard about BSE and the major source of information was media during the baseline (pre-test).Similarly, 75.4% of the respondents have inadequate knowledge before the intervention but after the intervention package all participants were gained either moderate or adequate level 12 the knowledge on BSE among school going girls.Another interventional study conducted by Tuna A et.al (2014) on effectiveness of online education on BSE supports the above findings which showed p<0.00 and overall increment of knowledge 63.4%, indicating teaching program 13 was effective in improving the knowledge on BSE.