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Health Care for Women International Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/uhcw20
Breast Cancer Screening Among Women of Child-Bearing Age a
a
a
Daphne Munyaradzi , James January & Julita Maradzika a
Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe Accepted author version posted online: 29 May 2014.Published online: 24 Jul 2014.
To cite this article: Daphne Munyaradzi, James January & Julita Maradzika (2014) Breast Cancer Screening Among Women of Child-Bearing Age, Health Care for Women International, 35:7-9, 818-827, DOI: 10.1080/07399332.2014.920843 To link to this article: http://dx.doi.org/10.1080/07399332.2014.920843
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Health Care for Women International, 35:818–827, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 0739-9332 print / 1096-4665 online DOI: 10.1080/07399332.2014.920843
Breast Cancer Screening Among Women of Child-Bearing Age
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DAPHNE MUNYARADZI, JAMES JANUARY, and JULITA MARADZIKA Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
We explored behavioral factors that contributed to late presentation of breast cancer. A cross-sectional survey of 120 women of child-bearing age was employed, and data were collected using interviewer-administered questionnaires addressing predisposing, enabling, and reinforcing factors associated with breast cancer screening. A total of 53.5% knew what breast cancer screening was; breast self-exam was the most commonly known form of screening, although only 7.5% practiced it. Lack of awareness ( p = .004) and the knowledge of someone who previously had breast cancer ( p = .0004) were prominent predictors for breast cancer screening, leading to either delay in or early presentation of the condition, respectively. Screening for breast cancer is an imperative intervention in resource-limited settings such as Zimbabwe where the majority of women have little access to health care services. Although there are a lot of studies on breast cancer screening in other world regions, there still remains a paucity in research on breast cancer screening in Zimbabwe. Cancer recently has been reported to be killing more people than HIV/AIDS, tuberculous (TB), and malaria combined, with almost 14 million people receiving cancer diagnosis and close to 8 million people dying from the condition worldwide every year (Centers for Disease Control and Prevention, 2014). More than 55% of new cancer cases and more than 60% of cancer deaths occur in less-developed regions of the world, with breast cancer being the second-most-diagnosed form of cancer globally (Ferlay et al., 2010).
Received 30 October 2013; accepted 30 April 2014. Address correspondence to James January, Department of Community Medicine, College of Health Sciences, University of Zimbabwe, P.O. Box A178, Avondale, Harare, Zimbabwe. E-mail: [email protected] or [email protected] 818
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The increase in cancer burden in Africa is partly due to the aging and growth of the population as well as the rising prevalence of risk factors associated with economic transition, including smoking, obesity, physical inactivity, and reproductive behaviors (Jemal et al., 2012). According to the Zimbabwe National Cancer Registry (2009), breast cancer accounts for 11.7% of total cancers, making it the second-most-common cancer in Zimbabwe. Although breast cancer incidence has been reported to be lower in sub-Saharan Africa as compared with Western nations, women with breast cancer in Africa have poorer survival rates than those in the developed world (Fregene & Newman, 2005). Due to inadequate resources and other pressing public health concerns such as HIV/AIDS, malaria, and TB (Jemal et al., 2012), the cancer burden in Africa still continues to receive relatively low public health priority. In addition, Zimbabwe and most developing countries lack clear health education programs on cancer awareness, and the absence of screening facilities in these resource-poor settings contributes to late presentation cancer cases (Anim, 1993). An understanding of women’s perceptions on breast cancer is especially important in the development of preventive health programs in Zimbabwe and other resource-limited settings. Our purpose for this study, therefore, was to assess the determinants of behaviors that hinder or promote the practice of breast cancer screening. We sought to explore the predisposing, enabling, and reinforcing factors associated with the practice of breast cancer screening among women of child-bearing age.
METHODS Design and Sample A cross-sectional descriptive study was used to describe and quantify the distribution of variables in our study population. In selecting the study design, we considered type of information to be obtained depending on the state of knowledge about the problem, resources available, and nature of the problem. Since knowledge of the situation and problem was superficial, this was deemed to be a suitable design as it was a small survey. We conveniently sampled a total of 120 women who were attending outpatient services at Marondera Provincial Hospital. This hospital was purposefully selected because it is the major referral hospital in the Mashonaland East province. The sample size was determined using the Dobson formula, which yielded a total sample size of 108, assuming a prevalence of breast cancer screening to be 7.6%. This was subsequently adjusted to 120 participants to increase the study’s precision. The eligibility criteria for participation in the study included being a woman of child-bearing age (15 years to 49 years), being a resident of Marondera, and attending the outpatient department. Women
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were excluded from the study if they were seriously ill, had a psychiatric illness, or were non-Shona language speakers.
Downloaded by [Flinders University of South Australia] at 16:30 08 October 2014
Data Collection Interviewer-administered questionnaires with three sections—(a) demographics, (b) predisposing, and (c) enabling and reinforcing factors—which were used for data collection. The instrument was developed using constructs from phase four of the Precede–Proceed Model (Green & Kreuter, 2005). The tool was administered in the local Shona language by a native Shona speaker. We pretested the questionnaire at a local clinic with 10 randomly selected women. The clinic offered a relatively similar setup to the main hospital used in the study. The purpose of this exercise was to refine the questions in the questionnaire to suit the women in our study, which enhanced the validity of the data collection instrument. The study protocol was approved by the institutional review board of the University of Zimbabwe, College of Health Sciences. Women were recruited in the outpatient department of the hospital. The purpose of study was verbally explained to all the participants, confidentiality was assured, and written informed consent was obtained after which women responded to the items on the questionnaire. Each interview lasted an average of 60 minutes.
Data Analysis After checking the collected data for completeness, we entered data into the Epi Info software package (version 3.5.3). Descriptive statistics including percentages, means, and standard deviations were calculated. Cross tabulations were performed to establish associations between demographic, predisposing, enabling, and reinforcing factors, with the utilization of breast cancer screening services. The chi-square and Fisher exact statistics were used to test for associations.
RESULTS Demographics A total of 120 women participated in the interviews at Marondera Provincial Hospital. The age range for the women was 16 years to 46 years (Mean = 28; SD = 8.65). Fisher’s exact test was used to assess the significance of association between age and utilization of breast cancer screening services. Age was not found to be a predisposing factor for breast cancer screening. Of the women interviewed, 3.3% were divorced, 14.2% were single, 2.5% were widows, and the majority of them were married (80%). The majority of the women were housewives (45%), 13.3% were students, 10% were
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nurses, 13.3% were nonmedical professionals, and the rest were general laborers. Women in the study who had reached secondary school level of education amounted to 70%, a fifth (20.8%) had tertiary education, with 9.2% having primary education only. Level of education predicted practice of breast cancer screening (p = .001). A quarter of the respondents belonged to the apostolic sects, 34.2% were Pentecostal, 32.5% were either Catholic or Protestant, and 8.3% were Traditionalist. There was no association between knowledge of breast cancer screening and religion (p = .58); therefore, we learned that religion is not a significant predictor for breast cancer screening. In relation to participants’ family income, a preponderance of the respondents (71.7%) considered their monthly income to be insufficient. In all tests, p values
Health Care for Women International Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/uhcw20
Breast Cancer Screening Among Women of Child-Bearing Age a
a
a
Daphne Munyaradzi , James January & Julita Maradzika a
Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe Accepted author version posted online: 29 May 2014.Published online: 24 Jul 2014.
To cite this article: Daphne Munyaradzi, James January & Julita Maradzika (2014) Breast Cancer Screening Among Women of Child-Bearing Age, Health Care for Women International, 35:7-9, 818-827, DOI: 10.1080/07399332.2014.920843 To link to this article: http://dx.doi.org/10.1080/07399332.2014.920843
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Health Care for Women International, 35:818–827, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 0739-9332 print / 1096-4665 online DOI: 10.1080/07399332.2014.920843
Breast Cancer Screening Among Women of Child-Bearing Age
Downloaded by [Flinders University of South Australia] at 16:30 08 October 2014
DAPHNE MUNYARADZI, JAMES JANUARY, and JULITA MARADZIKA Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
We explored behavioral factors that contributed to late presentation of breast cancer. A cross-sectional survey of 120 women of child-bearing age was employed, and data were collected using interviewer-administered questionnaires addressing predisposing, enabling, and reinforcing factors associated with breast cancer screening. A total of 53.5% knew what breast cancer screening was; breast self-exam was the most commonly known form of screening, although only 7.5% practiced it. Lack of awareness ( p = .004) and the knowledge of someone who previously had breast cancer ( p = .0004) were prominent predictors for breast cancer screening, leading to either delay in or early presentation of the condition, respectively. Screening for breast cancer is an imperative intervention in resource-limited settings such as Zimbabwe where the majority of women have little access to health care services. Although there are a lot of studies on breast cancer screening in other world regions, there still remains a paucity in research on breast cancer screening in Zimbabwe. Cancer recently has been reported to be killing more people than HIV/AIDS, tuberculous (TB), and malaria combined, with almost 14 million people receiving cancer diagnosis and close to 8 million people dying from the condition worldwide every year (Centers for Disease Control and Prevention, 2014). More than 55% of new cancer cases and more than 60% of cancer deaths occur in less-developed regions of the world, with breast cancer being the second-most-diagnosed form of cancer globally (Ferlay et al., 2010).
Received 30 October 2013; accepted 30 April 2014. Address correspondence to James January, Department of Community Medicine, College of Health Sciences, University of Zimbabwe, P.O. Box A178, Avondale, Harare, Zimbabwe. E-mail: [email protected] or [email protected] 818
Downloaded by [Flinders University of South Australia] at 16:30 08 October 2014
Breast Cancer Screening
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The increase in cancer burden in Africa is partly due to the aging and growth of the population as well as the rising prevalence of risk factors associated with economic transition, including smoking, obesity, physical inactivity, and reproductive behaviors (Jemal et al., 2012). According to the Zimbabwe National Cancer Registry (2009), breast cancer accounts for 11.7% of total cancers, making it the second-most-common cancer in Zimbabwe. Although breast cancer incidence has been reported to be lower in sub-Saharan Africa as compared with Western nations, women with breast cancer in Africa have poorer survival rates than those in the developed world (Fregene & Newman, 2005). Due to inadequate resources and other pressing public health concerns such as HIV/AIDS, malaria, and TB (Jemal et al., 2012), the cancer burden in Africa still continues to receive relatively low public health priority. In addition, Zimbabwe and most developing countries lack clear health education programs on cancer awareness, and the absence of screening facilities in these resource-poor settings contributes to late presentation cancer cases (Anim, 1993). An understanding of women’s perceptions on breast cancer is especially important in the development of preventive health programs in Zimbabwe and other resource-limited settings. Our purpose for this study, therefore, was to assess the determinants of behaviors that hinder or promote the practice of breast cancer screening. We sought to explore the predisposing, enabling, and reinforcing factors associated with the practice of breast cancer screening among women of child-bearing age.
METHODS Design and Sample A cross-sectional descriptive study was used to describe and quantify the distribution of variables in our study population. In selecting the study design, we considered type of information to be obtained depending on the state of knowledge about the problem, resources available, and nature of the problem. Since knowledge of the situation and problem was superficial, this was deemed to be a suitable design as it was a small survey. We conveniently sampled a total of 120 women who were attending outpatient services at Marondera Provincial Hospital. This hospital was purposefully selected because it is the major referral hospital in the Mashonaland East province. The sample size was determined using the Dobson formula, which yielded a total sample size of 108, assuming a prevalence of breast cancer screening to be 7.6%. This was subsequently adjusted to 120 participants to increase the study’s precision. The eligibility criteria for participation in the study included being a woman of child-bearing age (15 years to 49 years), being a resident of Marondera, and attending the outpatient department. Women
820
D. Munyaradzi et al.
were excluded from the study if they were seriously ill, had a psychiatric illness, or were non-Shona language speakers.
Downloaded by [Flinders University of South Australia] at 16:30 08 October 2014
Data Collection Interviewer-administered questionnaires with three sections—(a) demographics, (b) predisposing, and (c) enabling and reinforcing factors—which were used for data collection. The instrument was developed using constructs from phase four of the Precede–Proceed Model (Green & Kreuter, 2005). The tool was administered in the local Shona language by a native Shona speaker. We pretested the questionnaire at a local clinic with 10 randomly selected women. The clinic offered a relatively similar setup to the main hospital used in the study. The purpose of this exercise was to refine the questions in the questionnaire to suit the women in our study, which enhanced the validity of the data collection instrument. The study protocol was approved by the institutional review board of the University of Zimbabwe, College of Health Sciences. Women were recruited in the outpatient department of the hospital. The purpose of study was verbally explained to all the participants, confidentiality was assured, and written informed consent was obtained after which women responded to the items on the questionnaire. Each interview lasted an average of 60 minutes.
Data Analysis After checking the collected data for completeness, we entered data into the Epi Info software package (version 3.5.3). Descriptive statistics including percentages, means, and standard deviations were calculated. Cross tabulations were performed to establish associations between demographic, predisposing, enabling, and reinforcing factors, with the utilization of breast cancer screening services. The chi-square and Fisher exact statistics were used to test for associations.
RESULTS Demographics A total of 120 women participated in the interviews at Marondera Provincial Hospital. The age range for the women was 16 years to 46 years (Mean = 28; SD = 8.65). Fisher’s exact test was used to assess the significance of association between age and utilization of breast cancer screening services. Age was not found to be a predisposing factor for breast cancer screening. Of the women interviewed, 3.3% were divorced, 14.2% were single, 2.5% were widows, and the majority of them were married (80%). The majority of the women were housewives (45%), 13.3% were students, 10% were
Downloaded by [Flinders University of South Australia] at 16:30 08 October 2014
Breast Cancer Screening
821
nurses, 13.3% were nonmedical professionals, and the rest were general laborers. Women in the study who had reached secondary school level of education amounted to 70%, a fifth (20.8%) had tertiary education, with 9.2% having primary education only. Level of education predicted practice of breast cancer screening (p = .001). A quarter of the respondents belonged to the apostolic sects, 34.2% were Pentecostal, 32.5% were either Catholic or Protestant, and 8.3% were Traditionalist. There was no association between knowledge of breast cancer screening and religion (p = .58); therefore, we learned that religion is not a significant predictor for breast cancer screening. In relation to participants’ family income, a preponderance of the respondents (71.7%) considered their monthly income to be insufficient. In all tests, p values
