ADAMSON UNIVERSITY

College of Nursing

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.

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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 researchers 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

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College of Nursing
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.

ADAMSON UNIVERSITY
College of Nursing
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

ADAMSON UNIVERSITY
College of Nursing
consequently, improving the university clinics prior programs for health education among
students and having an effective execution of the said program.
Significant Others, this study will have a birds 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.

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College of Nursing

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

ADAMSON UNIVERSITY
College of Nursing
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)

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College of Nursing
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.

ADAMSON UNIVERSITY
College of Nursing

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

ADAMSON UNIVERSITY
College of Nursing
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.

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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.
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

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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

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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. Highquality 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

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14

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

Dundars study (2006), it was found that more knowledge about breast cancer had a positive
effect on performing BSE.
Hyuns 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

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role that teachers play in educating young women, they should be encouraged and motivated
to increase their own knowledge on breast cancer screening.
In Pentas 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

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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.

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College of Nursing
Attitude
Having a positive attitude towards breast care, even though the respondents havent
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 ones 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.

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College of Nursing
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 todays 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 selfexams 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

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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 Models
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.

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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 womans 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.

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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 respondents 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).

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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. Saludeens
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 selfexamination (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

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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 womens health, Womens
Bodies, Womens Wisdom, If a woman approaches her breasts in this way, to get to know
them and not just to find lumps, shell 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 dont 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 anxietyprovoking is to make it a more routine, relaxed part of your normal self-care routine. Dr.

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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 dont 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 piewedge 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

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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 dont give their breasts a lot of
attention. As Northrup (2009) recommends in her wonderful book on womens health,
Womens Bodies, Womens Wisdom, If a woman approaches her breasts in this way, to get to
know them and not just to find lumps, shell 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 dont want to find.
Breast Care is important, and by making a few simple choices women can keep their
breasts healthy and reduce discomfort.

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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

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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

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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.

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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.

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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

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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
1.81

Strongly
1.80 Disagree
2.60 Disagree

2.61
3.41
4.21

3.40 Not Sure

4.20 Agree
5.00 Strongly Agree

Lowly Negative Attitude

Negative Attitude
Neither Low nor High Level of
Attitude
Positive Attitude
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.

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Formula:

P=

f
x 100
n

Where:
P = percentage
f = frequency of responses
N = total number of subjects
3. Slovens 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.

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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:

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34

Table 1.1 Demographic Profiles of the subjects in Terms of Age

Age
16
17
18
19
20
21
22
23
24
Total

Frequency
4
20
68
119
91
67
16
12
3
400

Percentage
1.0%
5.0%
17.0%
29.8%
22.8%
16.8%
4.0%
3.0%
0.8%
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

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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
persons 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.

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36

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

Age at first
menstruation
9
10
11
12
13
14
Total

Frequency

Percentage

6
16
51
165
134
28
400

1.5%
4.0%
12.8%
41.4%
33.6%
7.0%
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.

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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 selfexamination (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

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Do you have any family
history of Breast
Problems?
Yes
No
Total

38

Frequency

Percent

59
341
400

14.1%
85.9%
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

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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.

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40

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

Health Information
Source of Breast Care Awareness
Frequency
Teachers
Physician
Family
Peers
Internet
TV
Magazine
Newspaper

28
99
160
126
288
244
216
81

Percentag
e
7.0%
24.8%
40.0%
31.5%
72.0%
61.0%
54.0%
20.3%

Rank
8
6
4
5
1
2
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%.

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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. Saludeens 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

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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.

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43

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

Breast Care

1.Breast care can encourage

women to be responsible to
their health
2. Having enough knowledge
about breast care can help
women not to get the wrong
impression about what she
felt from her breast.
3. Do you know that there
are different types of Breast
Care Examinations?
4. Do you agree that Breast
self examination is the most
preferred method for women
in early detection of breast
problems?
5. Do you know that Clinical
Breast Examination is more
thorough procedure to detect
breast problems?
6. Breast Examination is
ONLY done by health
practitioners/doctors.
7. Would it be best to learn
how to perform Breast Care
with the supervision of a
health care provider?
8. Is the armpit also
examined during Breast Self
Examination?
9. Lumps are seldom found
along the underside of the
breast.

Frequency
of Yes

Percentage

Frequency
of No

percentage

275

68.8%

125

31.3%

230

57.5%

170

42.5%

140

35.0%

260

65.0%

225

56.4%

175

43.6%

237

59.3%

163

40.8%

246

61.5%

154

38.5%

224

56.0%

176

44.0%

200

50.0%

200

50.0%

240

60.0%

160

40.0%

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10. You should limit pressure
applied on the breast?
11.BSE can be done while
taking a shower/bath
12. Is it true that applying
pressure may injure breast?

44

172

43.0%

228

57.0%

186

46.5%

214

53.5%

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% doesnt 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

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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.

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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.

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47

Table 2.1 Knowledge Level of the Female Students of Adamson University towards
Breast Care
Knowledge Level
Below Passing
Passing and Above
Total

Scores
16
7 12
12

Frequency
232
168
400

Percentage
58%
42%
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 didnt 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.

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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

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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

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ATTITUDE
1. I feel that Breast Care is an important
practice in detecting breast problems in its
early stage.
2. Breast Care will help me to be more
conscious and familiar with my physical
changes.
3. I believe that I have enough knowledge
about Breast Care
4. I believe that I have the necessary skill for
doing Breast Care
5. I search for new information related to my
health regarding Breast Care
6. I take time to perform Breast Care
Examination in various methods
7. It is embarrassing for me to do monthly
breast care.
8. My family/ friends would make fun of me if
I did breast self-exams.
9. I am willing to attend a seminar regarding
breast care.
10. I am willing to submit myself to the health
professionals for further examination regarding
my breast care.
11. I believe there is nothing I can do to
prevent my getting breast cancer
12. I believe exercising daily can prevent
breast cancer
General Weighted Mean

50

Weighted
Mean

Verbal
Interpretation

3.83

Agree

3.90

Agree

3.77

Agree

3.57

Agree

3.78

Agree

3.82

Agree

3.48

Agree

3.35

Not Sure

3.50

Agree

3.50

Agree

3.57

Agree

3.70
3.41

Agree
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.

ADAMSON UNIVERSITY
College of Nursing
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 ones 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

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stress, and overall physical and mental vigour. But in todays 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

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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
Models Perceived or Anticipated Benefits, which stated that the person believed that

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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 selfcare 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.

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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

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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.

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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

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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 clinics 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.

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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 Universitys 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.

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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.

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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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