DECLARATION

We hereby declare that the work presented, except for references to other people’s work

which have been duly acknowledged, is entirely the product of our effort carried out in

College of Nursing, Ntotroso. This is an original research work which has neither in a whole

nor in part been submitted for any other Diploma in General Nursing.

CERTIFICATION

NAME OF STUDENT INDEX NUMBER SIGNATURE

GOKA CHRISTIANA YAYRA B52015076 …………………

GYAMAA SANDRA B52015077 .…………………

HABIB MOHAMMED B52015078 …………………

IBRAHIM HAMIDATU B52015079 ………………….

NAME OF SUPERVISOR ………………………………………………………….

RANK…………………………………………………………………………………

DATE………………………………………………………………………………..

NAME OF PRINCIPAL……………………………………………………………

DATE ………………………………………………………………………………

SIGNATURE……………………………………………………………………….

iii
 ABSTRACT

Background: Globally, breast cancer arguably remains the most common cancer and most

notable cause of cancer-related mortalities among women (Parkin & Fernández, 2006). While

incidence rates had previously been higher in the developed world, there has been a current

increase in incidence and mortality in the developing countries (Porter, 2009). In Ghana,

breast cancer is the second commonest cancer among women after cervical cancer (Cancer

Society of Ghana, 2017). The general objectives of the study was to identify factors

influencing breast screening for cancer among women at Ntotroso Zongo in the Asutifi North

District of Brong Ahafo.

Methods: The target population were women who were aged 15 to 60 years. Using an

exploratory descriptive cross-sectional survey design, a sample size of 50 respondents were

chosen for the study and to prevent bias, random sampling method was employed. Structured

questionnaire with both open and closed ended questions based on the objectives set for the

research were presented and read to respondents, after which the data collected was then

analyzed using simple frequency tables, bar chart, column chart and pie chart.

Result: Demographic data: 60% of respondents were aged between 18-30 years, 56% were

unemployed, 60% earned between GHC 0-500, 24% were illiterates, 58% of respondents

were Muslims and 48% were married.

Knowledge on breast cancer and breast cancer screening: 98% had heard about breast cancer,

40% heard about it from media sources, breast self examination was the commonest method

known to respondents, 36% of respondents taught that practising proper breastfeeding may

lead to breast cancer, 56% didn’t know the number of times breast self examination should be

done in a year.

Factors Influencing Breast cancer screening among women: 64% of respondents taught they

were not at risk of developing breast cancer, 96% said their religion supported breast cancer

iii
screening, 48% agreed their religion was against the opposite sex performing clinical breast

examination on them, 56% agreed their friends/family/partners supported them on breast

cancer screening, 62% said breast cancer screening was sexually embarrassing and 76% also

stated that regular screening can improve breast cancer survival.

Sociodemographic influences and health system influences: 86% asserted that high cost of

breast cancer screening(mammography) prevented them from undertaking it, 56% stated that

distance from their current place of abode to the nearest health facility prevented them from

undertaking breast cancer screening, 64%(32 respondents) said the healthcare-patient

relationship impacted them positively to go for breast cancer screening, (43 respondents)

never had any of their relatives suffering from breast cancer, 42 respondents agreed that their

work didn’t prevent them from going for breast cancer screening and lastly 44 respondents

will encourage women to go for breast cancer screening.

Based on these findings, recommendations have being made to government, NGO’s, policy

makers, health care workers and opinion leaders in the country in order to ensure that women

partake and fully undergo breast screening exercise to aid in the early detection of breast

cancer in the society. As this will go a long way to prevent and treatment of breast cancer.

iii
 TABLE OF CONTENT

CONTENT PAGES

DECLARATION ………………………………………………………………………… I

ABSTRACT ……………………………………………………. …………..……………II

TABLE OF CONTENT ………………………………………………………………... IV

LIST OF TABLES AND FIGURES …………………………………………………….VI

ACKNOWLEDGEMENT …………………………………………………………….. VIII

CHAPTER ONE

BACKGORUND OF THE STUDY……………………………………………………….

1.0 Background of the study……………………………………………………..…….
1.1 Statement of the problem……………………………………………………..……
1.2 Purpose of the study……………………………..…………………………………
1.3 Objectives of the study…………………………………………………….……. ...
1.4 Research questions……………………………………...……..………….…….…
1.5 Operational definitions/ acronyms ………..…………………………………...…..

CHAPTER TWO

LITERATURE REVIEW……………..…………………….………….………..………..

2.0 Introduction…………………………………………………………………………

2.1Knowledge on Breast Self-Examination……………………………………………

2.2 Factors Influencing Breast Cancer Screening Among Women……………………

4
CHAPTER THREE

MATERIALS AND METHODS…………………………………..…………....….…..….

3.0 Overview……………………….…………………………………………….………
3.1 Study Area ……………………….………….…………………………………..…..
3.2 Study Population………...………….………………………..…..….……………….
3.3 Research design……………………………………………………………..……….
3.4 Sampling And Sampling Size……….……………………………………...………...
3.5 Data Collection Tool and techniques...………………………………………...…….
3.6 Data Analysis techniques…...…………………………………………………..……
3.7 Limitations of the Study…………………………………………………….………..
3.8 Ethical Considerations……………………………………………………………….

CHAPTER FOUR

DATA ANALYSIS AND RESULTS ……………………….……………..……....……...

4.0 Introduction …………………………………………………..………………….
4.1 Demographic data………………………………………………………………….
4.2 Knowledge on breast cancer and breast cancer screening………………………
4.3 Factors Influencing Breast cancer Screening Among women…………………..
4.4 Sociodemographic influences and health system influences…………………….

CHAPTER FIVE

DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS…………………….…

5.0 Introduction…………………………………………………..………..…………...
5.1Discussion of findings ………………………………………..…………………..
5.2 Recommendations……………………………………………………...………….
5.3 Conclusion…………………………………….…………………………………...

REFERENCES …………………………………………………………………...….…….

QUESTIONAIRES……………………………………………….………………………...

5
 LIST OF TABLES

TABLES PAGES

Table 1 A percentage table showing the age group of respondents

Table 2 A percentage table showing the occupational status of respondents

Table 3 A percentage table showing the level of education of respondents

Table 4 A percentage table showing the religious background of respondents

Table 5 A percentage table showing the income level of respondents

Table 6 A percentage table showing the Marital Status of respondents

Table 7 A percentage table showing whether respondents had heard of breast cancer

6
 LIST OF FIGURES

FIGURES PAGES

Figure 1 A pie chart showing the Method of breast cancer screening that respondents had

heard of

Figure 2 A pie chart showing respondent’s source of information breast cancer screening.

Figure 3 A pie chart showing predisposing factors/causes of breast cancer

Figure 4 A pie chart showing whether respondents had screened for breast cancer before.

Figure 5 A pie chart showing how often a breast self-examination should be conducted

Figure 6 A pie chart showing whether respondents are at risk for developing breast cancer

Figure 7 A bar chart showing whether respondents’ religion or culture allowed BSE or CBE

Figure 8 A bar chart showing whether respondents’ religion or culture allowed the opposite

sex to perform CBE on them

Figure 9 A bar chart showing whether respondents’ family/friends supported breast cancer

screening

Figure 10 A bar chart showing whether respondents regarded breast screening as sexually

embarrassing

Figure 11 A bar chart showing whether regular screening can improve survival for breast

cancer

Figure 12 A pie chart showing whether discussion of sexuality affect the uptake of breast

cancer screening

7
Figure 13 A pie chart showing whether the cost of breast screening prevent respondents from

undertaking it

Figure 14 A line chart indicating if family history caused respondents to undertake breast

cancer treatment.

Figure 15 A pie chart indicating distance from respondent’s current residence to health

facility discouraged them from undergoing breast cancer screening

Figure 16 A pie chart showing the whether healthcare worker-patient relationship influenced

respondents decision to go for breast cancer screening

Figure 17 A line chart showing respondents relatives who had breast cancer before

Figure 18 A bar chart showing whether current employment status prevented respondents

from undertaking breast cancer screening

Figure 19 A bar chart showing whether respondents will encourage women to go for breast

cancer screening

8
 CHAPTER ONE

1.0 Background Of The Study

Globally, breast cancer arguably remains the most common cancer and most notable cause of

cancer-related mortalities among women (Parkin&Fernández, 2006). While incidence rates had

previously been higher in the developed world, there has been a current increase in incidence and

mortality in the developing countries (Porter, 2009).

According to the Cancer Statistics Worldwide (2005), more than one million new cases of female

breast cancers are diagnosed each year, making it the most commonly occurring disease in

women. It continues that the disease account for over one-third of the estimated annual

4.7million cancer diagnoses in females. It is also the most common female cancer in both

developed and developing countries with 55% of it occurring in the developing countries. In

addition, the annual worldwide incidences had almost doubled since 1975 and the prevalence and

incidence increased with increasing age (Althuis, 2005).

The incidence rates are higher in industrialized and more affluent countries probably as a result

of the availability of early cancer screening programs that detect early invasive cancer.(Parkin,

Bray, Frelay, &Pisani, 2005 they found that some of the cancers would have progressed to the

late stage of the disease and as a result, the mortality rate from the disease could have been

higher in these countries.

Conversely, breast cancer mortality rates are higher in developing countries as a result of late

detection and diagnosis. Breast cancer ranks second in cancer incidence and is still the second

principal cause of cancer mortality among women in Ghana (Yarney, Vanderpuye& Clegg, 2008)

1
According to Abdulkareem, (2013), breast cancer predominantly affect women aged twenty-five

and above, with less than 1% cases found in men. About 10 in 100,000 new cases are recorded in

women below twenty-five years and this increase up to 100 times by the age of forty-five years

(Abdulkareem, 2013). Additionally, in a review, Caucasian white women appeared to have a

higher risk for breast cancer, followed by African-American women, Hispanic women, with the

lowest rates in Asian women. Evidence confirmed that taller height is associated with increased

risk of breast cancer especially among postmenopausal women Abdulkareem, (2013). In Africa,

women with higher social class in terms of income, housing and education have increased risk of

breast cancer. This may be associated with their diet, low parity, and lack of breastfeeding, as

seen in developed countries.( Abdulkareem, 2013).

In Ghana, breast cancer is the second commonest cancer among women after cervical cancer

(Cancer Society of Ghana, 2017). It forms 15% of all cancer and 40% of female cancers (Cancer

Society of Ghana, 2017). Estimates from the WHO put the Age Standardized Incidence Ratio

(ASIR) at 37/100,000 of the population(National Strategy for Cancer Control in Ghana 2012-

2016, 2011). This also indicates that most patients (50-70%) present with advanced (stage III and

IV) disease, many months (8-10 months) after first noticing a change in their breasts (Cancer

Society of Ghana, 2017). It further states that the biological nature of breast cancers in Ghana

also confers a poorer prognosis. The WHO estimates the incidence-mortality ratio of Breast

cancer in Ghana as 0.68, compared to 0.2 in the USA (WHO, 2014). Mortality from the disease

is therefore relatively high in Ghana and other developing countries (WHO, 2014). Other related

studies conducted in Ghana, found a 5-year survival of only 25% in Korle -Bu Teaching Hospital

(KBTH) compared to over 85% in the USA in 2001 (Opoku, Benwell and Yarney, 2012)

2
Dr. Wiafe –Addai, president of breast care international, says 2,900 Ghanaians are diagnosed of

breast cancer every year and half of that number died from the disease. She went ahead to say

that the number represent only those who report at the various hospitals because most of the

patients seek treatment from other sources, such as herbalists, prayer camps and shrines. She also

called on cooperate bodies to support efforts to educate and create awareness to the people about

the disease (myjoyonline.com, Aug. 24, 2013)

1.1 Problem Statement

The global burden of breast cancer has increased over time, with an estimated 1.3 million women

diagnosed and 458,503 deaths per year, distributed disproportionately between the developed

(189,455) and developing (269,048) countries (Jemal et al., 2011). Incidence rates are increasing

rapidly in many developing countries, with greater increases occurring in Africa and Asia. The

findings from these studies demonstrate that breast cancer incidence and mortality is increasing

rapidly in many sub-Saharan African countries.

In recent years, Akarolo-Anthony, Ogundiran, and Adebamowo (2010) have found breast cancer

to be the leading cause of cancer-related deaths in Nigeria.

In Ghana, findings from the few epidemiological studies conducted have also shown that both

breast cancer incidence and mortality rates are increasing rapidly among women (Kirby, 2005).

In Ghana, only a few Ghanaian women really are conscious of breast screening for cancer

practices hence 50 - 70% of patient present for treatment when they are in advanced stages of III

and IV (National Strategy for Cancer Control in Ghana 2012- 2016, 2011).

3
According to Opoku, Benwell&Yarney (2011), breast cancer is not well understood by women.

Among Ghanaian women, some of the factors preventing early hospital presentation and thus

increasing mortalities are thought to psychosocial influences, sociodemographics factors and

cultural influences (Opoku, Benwell&Yarney, 2011). Lack of knowledge about breast cancer has

also been identified as an important factor preventing women from participating in breast cancer

screening and adds to delay in presentation and treatment. Therefore, it is important to explore

the factors influencing breast screening for cancer among women in Ntotroso Zongo in the

Asutifi North District.

1.2 Purpose of the study

The purpose of the study is to assess the factors that influence breast cancer screening among

women in Ntotroso Zongo( Asutifi North District). From the results of the study, appropriate

strategies would then be proposed with the ultimate aim of reducing the high mortality of breast

cancer in Ghana and to save the lives of women in the community and Ghana as a whole.

1. 3 Objectives Of The Study.

1.3.1 General objectives

The general objectives of the study was to identify factors influencing breast screening for cancer

among women at Ntotroso Zongo in the Asutifi North District of Brong Ahafo.

1.3.2 Specific objectives

a. To find out about the knowledge level of women of breast cancer and breast cancer screening

among women of Ntotroso Zongo in the Asutifi North District of Brong Ahafo.

4
b. To find out about the psychosocial and cultural factors that influence women of Ntotroso

Zongo in the Asutifi North District of Brong Ahafo.

c. To identify sociodemographic and health system factors that impede women of Ntotroso

Zongo from participating or undertaking breast screening methods.

1.4 Research Questions

a. What is the knowledge level of women in Ntotroso Zongo on breast cancer screening?

b. What factors are influencing breast cancer screening among women of Ntotroso Zongo

c. Does sociodemographic and health system factors influence women of Ntotroso Zongo from

participating in breast screening methods?.

1. 5 Operational definition of terms

For the purpose of this research, The following terms are described and used appropriately.

Breast cancer: Abnormal multiplication of breast cells

Screening: A health investigation to identify breast cancer among women

Knowledge: Having an idea about breast cancer and breast cancer screening practices

Sociodemographic factors: The sociological and demographic characteristics of a group of a

person or a group of people. This include age, educational status, marital status, family history

etc.

5
Psychosocial factors: The perception and belief about being susceptible to breast cancer

CHAPTER TWO

LITERATURE REVIEW

6
2.0 INTRODUCTION

Literature review is a vital part in the process of creating a research because there are a large

number of literature reviews that shows basis and grounds in supporting a point of view and

argument. The literature review will be on definition of breast cancer, knowledge of breast

cancer, forms of screening practices available and factors impeding periodic screening.

2.1 Knowledge on Breast Self-Examination

Like many cancers, the aetiology of breast cancer is unknown; however several factors were

highlighted in the literature as its risk factors. These include age, gender, ethnicity, family

history, early menarche, late menopause, nulliparity, older age at first childbirth, use of oral

contraceptives, obesity, alcohol and tobacco consumption, lack of physical activity, high body

mass index (BMI), and exposure to certain chemicals and radiation, Dumalaon-Canaria,

Hutchinson, Prichard & Wilson (2014). Furthermore, exposure to pesticide agents such as

dichlorodiphenyltrichloroethane (DDT) and dichlorodiphenyldichloroethylene (DDE), cadmium

and prolonged exposure to traffic emissions at the time of menarche, in premenopausal women

significantly increase the risk of breast cancer. (Abdulkareem, 2013)

In contrast, factors such as breast feeding, high parity, and early age at first child birth were

found to reduce the risk of breast cancer.( Abdulkareem, 2013).

While mortality rates have remained relatively stable in developed countries, they continue to

surge in developing countries. Of almost 460,000 breast cancer deaths observed in 184 countries

in 2008, about two thirds occurred in developing countries, particularly those in Africa and Asia

(Jemal et al., 2011). For example, in Uganda, Kamangar, Dores, and Anderson (2006) reported

that breast cancer mortality rates have been increasing since the 1960s. Similarly, Parkin et al.

7
(2008) observed a steady increase in breast cancer mortality rates among Zimbabweans and

indigenous South Africans.

There has been increase in awareness on breast cancer by various organizations including Civil

Society Organizations and Non-Governmental organizations notable among them is the Breast

Care International, an NGO led by Dr. Wiafe Addai . They periodically organize clinical breast

screening programs and promote self-breast examination. These were previously uncoordinated,

but presently there has been greater effort at coordination by the Ghana Health Service (National

Strategy for Cancer Control in Ghana, 2016).

Breast cancer affects Ghanaians from as young as age of 20 years, even though most of the

younger women have sarcomas of the breast. The disease is generally commoner as one gets

older, but the majority of breast cancer cases in Ghana are between the ages of 40 – 49 years

(Yarney, Vanderpuye&Clegg, 2008).

A research at the Komfo Anokye teaching hospital and university of Michigan have discovered

breast cancer strain in Ghanaian women, not found in women in other parts of the world. The

collaborative work finds women in Ghana with what is known medically as triple negative strain

which is never found in black and white Americans as studied in the eight-year period of the

study. The team is now growing tumors cells in mice to facilitate a search for the cause of disease

in Ghana.

Although the primary cause of rising breast cancer deaths in Ghana is unknown, the late

presentation for treatment (Clegg-Lamptey, Dakubo, & Attobra, 2009;) and the low screening

uptake (Opoku, Benwell, & Yarney, 2012) could be major contributing factors.

8
According to Opoku, Benwell and Yarney (2011) screening is linked to perceptions of risk,

benefit, and barriers through a reasoning process that includes personal and social influences and

attitudes.

According to Opoku, Benwell&Yarney (2011), even though most women had heard about breast

cancer, breast cancer is not well understood by women. Among Ghanaian women, some of the

factors preventing early hospital presentation and thus increasing mortalities are thought to

psychosocial influences, sociodemographics factors and cultural influences (Opoku,

Benwell&Yarney, 2011). Lack of knowledge about breast cancer has also been identified as an

important factor preventing women from participating in breast cancer screening and adds to

delay in presentation and treatment

Early detection and prompt treatment offer the greatest chance of long-term survival. These

include mammography, clinical breast examination and breast self-examination (BSE) which are

the secondary preventive methods used for screening in the early detection of breast cancer.

Cancer screening tests play a pivotal role in reducing breast cancer related mortalities (WHO,

2014). The American Cancer Society (ACS) recommends CBE and mammography in the early

detection of breast cancer (Smith, Saslow, Sawyer, Costanza, Hendrick&Eyre, 2006). According

to ACS recommendations, women should know how their breasts normally feel and report any

breast changes promptly to their health care providers. BSE is an option for women starting from

the early 20 s and an important viable optional substitute available in rural areas, where access to

CBE and mammograms is difficult and might still detect breast cancer early enough for

treatment which can be offered to prolong women's lives and reduce suffering. For younger

women, BSE training and adherence is a gateway health promotion behavior provides women

9
with the knowledge that sets the stage for adherence to CBE and mammography screening

guidelines later in life (American Cancer Society, 2005).

Early detection of breast cancer can be achieved by performing breast self examination (BSE),

clinical breast examination (CBE), and mammography. A recent study by Madong, Obekpa and

Orkar (1998) conducted in the State of Qatar reported that the incidence rate of breast cancer was

high (30.1 ⁄ 100,000). The increasing trend of incidence rate of breast cancer (Holcombe,

Weedon, & LIwin¸ 1999) shows the lack of knowledge about breast cancer and the screening

methods among women in Qatar. Recent studies have revealed that although Qatar women had

adequate general knowledge about breast cancer, the screening rates of BSE, CBE, and

mammography were low in women for early detection of cancer. Education appeared to be the

major determinant of level of knowledge and for practicing screening procedures (Spittle &

Morgan, 1999). In a study conducted in Ibadan on female traders by Balogun and Owoaje (2005)

one hundred and ninety two (68.3%) of the traders were not aware of breast self-examination

while 89 (31.7%), were aware and 51 (18.1%) of the traders had never checked their breast. The

level of awareness of breast self-examination was highest (38.7%) among those aged 50-59 years

and was lowest among those less than 30 years and 60 years. The women who had tertiary

education were more knowledgeable about breast self-examination while those who had primary

education were the least knowledgeable. In a study done in Ilorin Nigeria on secondary school

teachers, most respondents, 326 (95.6%) had heard about BSE at one time or the other. The

commonest source of information about the topic was the television, 97 (29.7%); closely

followed by information through friends, 92(28.2%). Sixty-four (19.6%) of those who have

heard about it heard from multiple sources while only 15 (4.6%) heard from health personnel.

One hundred and forty-six (42.8%) of those studied felt BSE should be done once monthly, 50

10
(14.7%) indicated three monthly, equal proportion of 23 (6.7%) each for twice yearly and once

yearly respectively while 99 (29.1%) did not know how often BSE should be done, 300 (88%)

thought they were not at risk of developing breast cancer. (Kayode, Akande & Osagbemi,

2005).

Clarke and Savage (1999) reported that BSE can be taught by a variety of professionals

including nurses, physicians, trained peer educators, researches and graduate students without

major differences. Heyman, Tyner, Phipps, Cave and Owen (1991) found that a program of

instruction improved the abilities of nurses to teach BSE to their patients.

Demirkiran, Balkaya, Memis, Turk, Ozvurmaz and Tuncyurek (2007) study revealed that the

percentage of participants who had knowledge of BSE was higher in nurses than in teachers

(81.5% versus 45.1%) .

The most common sources of information for nurses were written materials (42.6%), nursing

school education (38.6%) and health professionals (37.6%). Television programs (56.1%),

written material (38.3%) and health workers (35.6%) were the most frequent sources of

information for teachers. However, 93.4% of the nurses and 98.2% of the teachers mentioned

that they need more information about BSE

2.2 Factors Influencing Breast Cancer Screening Among Women

Psychosocial influences.

11
Intention to undergo breast cancer screening has been associated with many psychosocial factors

such as health beliefs, attitudes and knowledge (Othman et al., 2012). For example, women who

believe that mammography screening is effective in detecting breast cancer have been found to

have positive intentions towards screening uptake. Similarly, women who know that regular

screening can potentially improve survival of breast cancer are most likely to undergo screening

(Othman et al., 2012). Indeed, this finding suggests that knowledge of screening programs has a

significant bearing on women’s screening intentions and perhaps their behaviour. Unfortunately,

many women in Ghana have limited knowledge of breast cancer screening programs (Opoku et

al., 2012), and this in turn, may adversely affect their screening intentions.

In most studies, women who perceive themselves to be susceptible to breast cancer and who

view the disease as fatal have been found to have greater intentions to undergo BSE, CBE and

mammography screening (Othman et al., 2012). Similarly, high perceived benefits and low

perceived barriers have been associated with greater screening intentions (Othman et al., 2012).

A descriptive study in Tehran investigated how religion might contribute to breast self-

examination (BSE) among Muslim women. Ninety percent indicated BSE is not against their

religious beliefs, although only 6% of respondents stated they performed BSE consistently on a

monthly basis. Fifty-eight percent preferred to be examined by a female physician though 47%

said that a clinical breast examination by a male physician is not against their Islamic beliefs

(Montazeri, 2003).

Several researchers have reported that there is a strong relationship between beliefs and health

behaviors, such as mammography (Ajzen, 2004). In line with breast cancer screening via

mammography, beliefs include knowing the time and place of doing mammogram and other

12
information such as arranging for work leave and transportation are subjects that will increase

the mammography usage among women (Rutter, 2006).

Similarly, belief components such as touching of breasts by the technician, living longer, and X-

ray exposure are effective in doing mammography (Rutter, 2006).

The belief in the benefit of early detection among Asian such as Korean (Han et al., 2000) and

Turkish women (Secginli et al., 2006) are positively associated with screening behaviors. Poss

(2001) also stated that significant beliefs allow a better understanding of the cultural perspective

affecting the people’s behaviour. For instance, with regard to clinical breast exam in Tehran,

although, more than half of the women preferred to be examined by a female physician, forty

seven percent said that clinical breast exam by a male physician was not against their Islamic

beliefs. Likewise, the results showed the vast majority of the women believed that breast self-

exam was not against their religious beliefs (Montazeri etal., 2003).

Cultural influences.

Cultural beliefs provide a lens through which people conceptualize their attitudes towards a

particular disease or health care services. Such beliefs inform peoples’ behaviours regarding the

prevention of the disease (Giuliano, Mokuau, Hughes, Ho, & Mccaskill-Stevens, 20008). Breast

cancer screening behaviours have been shown to be influenced by several cultural factors

including beliefs about modesty and screening, as well as attitudes towards preventive care and

social support (Carroll et al., 2007). With regard to the influence of beliefs about modesty,

Ashing-Giwa (2009) reported that the belief that women’s breasts should be kept private and not

be exposed to others negatively influences African American women’s attitudes towards BSE,

CBE, and mammography screening uptake in the United States. Among Asian and Caucasian

13
women residing in the United States, Tang, Solomon, Yeh, and Worden (1999) found that

concerns about discussions around sexual issues prevented the uptake of BSE.

Mupepi et al. (2011) explored the factors influencing breast cancer screening behaviours among

Zimbabwean women. The results indicated that cultural beliefs about modesty prevented many

women from undergoing breast screening. Women who perceived breast screening as sexually

embarrassing were less likely than those without such beliefs to be screened. Also, Nguyen et al.

(2011) showed that beliefs about modesty impede participation in breast cancer screening among

Vietnamese immigrants in the United States. Women who considered touching and exposure of

women’s breasts as morally embarrassing reported lower screening behaviours. As well, Elsie et

al. (2010) identified concern about embarrassment as a significant barrier to breast cancer

screening uptake among women in South Africa and Uganda, respectively. In both studies,

screening procedures of CBE and mammography were considered sexually embarrassing, and

this perception in turn negatively affected women’s attitudes towards participation in the

screening programs.

Cultural beliefs may influence women’s perceptions about preventive health care and hence their

attitudes towards the uptake of preventive health services such as screening (Carroll et al., 2007).

In general, the concept of preventive care is generally unfamiliar to many individuals in Ghana.

For example, in the absence of severe symptoms of breast problems, some Ghanaian women do

not seek breast health care (Opoku et al., 2012). This attitude may have a potential effect on

women’s intentions to have CBE and mammography, and on the performance of BSE.

Considering the strong connectedness among individuals in Ghana, the potential effect of social

support on women’s intentions toward breast cancer screening cannot be overemphasized. In

most cases, however, when Ghanaian women have problems with their health, they first seek

14
non-medical support from their family and friends (Boateng & Flanagan, 2008). While no study

has examined the potential effect of this support on Ghanaian women’s screening intentions,

elsewhere, strong social support has been associated with strong intentions to undergo BSE, CBE

and mammography (Bowie et al., 2004; Lechner et al., 2004). For example, Messina et al. (2004)

reported higher compliance and uptake of screening among low-income women who received

both appraisal and logistical support from their family or friends. The authors observed high rates

of participation in mammography among women with higher levels of support than among those

with low or no social support.

Thus, it seems very reasonable to identify the cultural elements that influence the intention of

Ghanaian women to have BSE or undergo CBE or mammography.

Explicating the cultural determinants of intention to screen for breast cancer would be

particularly useful in developing culturally tailored interventions to facilitate the acceptance of

and participation in future population-based breast cancer screening programs in Ghana.

Sociodemographic influences.

Sociodemographic factors have been found to influence women’s intentions towards breast

cancer screening. For example, low mammography intention has been reported among women

who have low socioeconomic status, such as low education and income level (Othman et al.,

2012). In Ghana, low income women have been found less likely to undergo mammography

screening than those with higher income status (Opoku et al., 2012). The authors stressed that

high costs of mammography screening services prevent many women from undergoing such

screening. In addition, Elsie et al. (2010) found that employed Ugandan women were seven

times more likely to undergo mammography. This is primarily because the employed women had

15
higher incomes, which enabled easier access to mammography screening services. In Nigeria,

Ndikom and Ofi (2012) reported low mammography screening utilization among women with

low socioeconomic status. In that study, low income women considered breast cancer screening

to be of less importance because of numerous competing health needs.

McFarland (2003) examined cancer screening practices of Botswana women with various

income levels. Although all the women cited cost as a major barrier to cancer screening, those

with low income were the least likely to undergo cancer screening, compared to women with

high incomes. In addition, women in the medium income category had a negative attitude

towards screening. However, women in the high income category and those with health care

insurance had a positive attitude towards screening uptake, and were more likely to comply with

screening recommendations. In general, the high cost of screening services prevented uptake in

Botswana women.

Education has been found to be a great influence on women’s decisions about breast cancer

screening. Studies examining the association between screening intention and education have

shown consistent findings, with higher education levels showing increased intentions (Othman et

al., 2012). Similarly, a higher level of education has been associated with greater uptake of breast

cancer screening (Remennick, 2006). Opoku et al. (2012) found that highly educated Ghanaian

women were more likely than the uneducated to have mammography screening or CBE or to

perform BSE. Women with formal education were more likely to undergo screening as compared

to those with informal education. In addition, compliance with breast screening

recommendations was greater in women with more education than it was among the less

educated. For example, the majority of women who reported practicing BSE on a regular basis

had completed secondary school or higher (Opoku et al., 2012). Highly educated women

16
reported greater knowledge of screening guidelines and breast cancer risk factors and

symptoms––knowledge that can facilitate screening intention.

Other authors reported low rates of screening uptake among African women with low levels of

education. In Uganda, Elsie et al. (2010) found high rates of mammography screening uptake

among women with higher education attainment. For example, Ugandan women who had

completed primary education or higher were about four times more likely than those without any

education to be screened. Women with a low level of education were also more hesitant to seek

information about breast cancer screening than were educated women. In addition, lack of

education adversely affected women’s ability to comprehend and understand recommended

screening guidelines and other related issues such as breast cancer symptoms and risk factors

(Othman et al., 2012).

A number of studies have shown age-related variations in breast cancer screening intentions.

Higher screening intention has been consistently associated with older age (Othman et al., 2012),

with highest rates in the 50 to 60 year group. Both after and before this age, screening intentions

were lower among women in many populations. For example, Othman et al. (2012) found that

Jordanian women above age 50 years were more likely than those below that age to have

mammography screening. The high rate of screening intention often found in older women could

be explained by the fact that breast cancer risk increases concurrently with age, especially in

women above 50 years (Jemal et al., 2011).

A few authors have found a relationship between marital status and screening intentions of

women. Although findings are mixed, most studies have shown that married women are more

likely than single women to undergo breast cancer screening (Christou & Thompson, 2012). The

influence of marital status on screening intentions and behaviours appears to be highly prevalent

17
among low-income women, particularly those in African countries, where many women rely on

their partners or husbands for advice and financial support for health care (Boateng & Flanagan,

2008). Despite the potential influence of marital status on health-seeking behaviours of women,

no researchers have assessed its relative effect on breast cancer screening intentions or

behaviours in Ghanaian women. This therefore warrants empirical research into the potential

influences of marital status on women’s intentions to perform BSE or undergo CBE or

mammography screening in Ghana.

A family history of breast cancer has long been recognized as a significant predictor of breast

cancer screening intentions. Evidence suggests that women with a family history of breast cancer

are more likely than women without any history of the disease to initiate screening intentions at

an earlier age, and to undergo screening on a regular basis (Othman et al., 2012). Regarding

screening preferences, women with a family history of breast cancer are more likely to undergo

mammography than CBE and BSE (Price et al., 2010). Murabito et al. (2001) found that women

with a family history of breast cancer were three times more likely than those without such a

history to undergo mammography screening. As well, women with family history of breast

cancer were more likely than women without a history to receive a recommendation for

mammography. One of the explanations provided for the high screening intentions among

women with family history of breast cancer is that many such women believe that regular

screening could potentially reduce their chances of developing the disease (Othman et al., 2012).

In a related finding, women with a history of breast health problems such as swelling and pain

were found to undergo screening regularly as compared to those without such health problems

(O’Malley et al., 2001).

18
Health system influences. A number of explanations for the low breast cancer screening

intentions in low-income women have been proposed, but the most influential factor may be the

characteristics of the health care system. In Ghana, mammography screening is provided to

women who can pay for the service, suggesting that women who cannot afford it will be

excluded. Opoku et al. (2012) examined at the attitudes of Ghanaian women toward breast

cancer screening, and the findings showed that the high cost of mammography discouraged its

uptake. McAlearney, Reeves, Tatum, and Paskett (2007) investigated the effect of cost on uptake

among women, aged 40 years and older in the United States. While 77% of the women reported

that they could not afford mammography, 70% indicated that they would undergo the procedure

if they had the disease. Women who had no health insurance were three times more likely than

those without insurance to report cost as a barrier. In contrast, women who had ever had a

mammography were less likely to report cost as a barrier.

While no study has examined the impact of availability of screening services on intention to

screen for breast cancer in both low- and high-income countries, it is well established that long

distances to health care facilities discourages utilization of cancer screening services (Shaikh &

Hatcher, 2005). Mupepi et al. (2011) contrasted the screening behaviours of women living in

urban areas with those of women living in rural areas of Zimbabwe. The results showed that

about 91% of the women from rural areas had never in their lifetime participated in breast cancer

screening programs, and only 4.5% were likely to undergo screening in the future. Women who

lived in very remote rural areas were about 96% less likely to participate in screening than those

who lived in the urban areas. The low screening in rural settings was due to the fact that most

rural women did not have regular and convenient access to screening services.

19
One of the well-established predictors of breast cancer screening intention is a physician

recommendation. Several authors have suggested that women who receive a recommendation for

breast cancer screening tended to have strong screening intentions as compared to those who

have never received a recommendation (Carcaise-Edinboro & Bradley, 2008). Evidently, it is

only recently that health professionals in Ghana have recognized the need to encourage cancer

screening uptake among women (Abotchie & Shokar, 2009).

A key component of the health care system that may have a greater impact on women’s intention

towards breast cancer screening is the provider-patient relationship. A strong relationship has

been shown to be associated with greater intention and compliance with cancer screening

(Knapik, 2012). McFarland (2003) examined the knowledge and beliefs of Botswana women

regarding breast cancer screening, and found that negative attitudes of health professionals

toward patients discouraged participation in cancer screening. Provider attitudes that negatively

affected women’s intentions included lack of attention and frightening expressions during

medical care.

Relatively little attention has been given to the effects of waiting time on breast cancer screening

intention in both low-and high-income countries. However, the literature shows that long waiting

time negatively influences women’s attitudes towards screening (Gany et al., 2006). In their

study of breast cancer screening behaviours of Zimbabwean women, Mupepi et al. (2011)

demonstrated that lack of time (resulting from sociocultural and family responsibilities) prevents

many women from undergoing breast cancer screening on a regular basis. Gany et al. (2006)

noted that low-income women often find it difficult to take time off from their social and family

responsibilities to present for cancer screening in the United States. In that study, women who

were not undergoing screening reported that it would take too long to be screened at the hospital.

20
In conclusion, the findings from the literature demonstrate that intentions to perform BSE or

undergo CBE or mammography screening are influenced by individual and contextual factors.

The effect of the health system-related characteristics such as cost and availability on screening

intention was found to be more prevalent in low-income countries. Of the psychosocial factors,

knowledge, perceived susceptibility, barriers and benefits played a significant role in influencing

women’s intentions towards screening. Cultural factors that appear likely to be related to breast

cancer screening intentions among Ghanaian women include beliefs about modesty and

screening, attitudes towards preventive health care, and social support. Although the influence of

sociodemographic factors such as age, income, education, marital status, and history of breast

cancer and breast problems on screening intentions has been extensively explored in the

literature, little is known about its impact on Ghanaian women’s intentions to perform BSE or

undergo CBE and mammography screening.

CHAPTER THREE

METHOLOLOGY

21
3.0 Overview

This chapter explains the background of the study area, study population, study type/design, data

collection tools, data collection techniques, data analysis technique, ethical consideration and

limitations of the study.

3.1 Study area

Ntotroso is a town located in the Asutifi North District, Brong Ahafo. And it is the area for this

research. Ntotroso is bounded by Gyedu to the east and shares border to the northLandmark

facilities in the area include the College of Nursing and the Newmont Mining company.

The study was conducted in the Zongo Community of Ntotroso which is dominated by people of

the Muslim faith. Majority of them are into farming while some are engaged into mining

activities.

3. 2 Target Population

The target population for the study were all females who were aged 15 to 60 years of age within

the Ntotroso Zongo community. This population was chosen since they fell within the age target

and as such their opinion and input to the study, will give accurate information on the subject for

the research.

3.3 Research Design

Research design is the researcher’s overall plan for the collection and analysis of data. For the

purpose of the study, exploratory descriptive cross-sectional survey design was used to attain

information on the factors that influence breast cancer screening among women within the

22
Ntotroso Zongo community. This approach was selected because limited research exists that

explores the influence of these individual-level factors on screening intention in this population.

3.4 Sampling And Sampling Size

To ensure there was no bias and the study was fair, respondents were also chosen using a random

sampling method. A Non-Probability sampling method was used, typically convenience

sampling. Women aged between 18 to 60 years whom the researchers came into contact with

were chosen for the study. This is because the women were the target population as they are

predisposed to breast cancer.

A sample size of 50 respondents was used chosen for the purpose of the study. All respondents

were within the age limit set i.e 18 years to 60 years.

3. 5 Data Collection Tools And Techniques

Data collection tool used was a structured questionnaire. Open and closed-ended structured

questionnaire was presented to respondents to assess the factors that influence breast cancer

screening among women within the Zongo community of Ntotroso Township.

The method used for data collection was questionnaire. This was used to obtain information from

respondents on the subject of the research. Copies of the questionnaires were administered by

hand to respondents who could read for them to answer it themselves. The questionnaire was

read and interpreted to those who could not read and their answers were written on the

questionnaire sheet.

23
3.6 Data analysis techniques

Data obtained from the study were analyzed and presented in simple statistical frequency and

percentage with table, bar chart, column chart and pie chart. This ensured that the data obtained

was presented in graphical mode for easy interpretation and understanding.

3.7 Limitation Of The Study

The following were the main limitations encountered during the course of conducting this

research.

1. Lack of co-operation and shyness on the part of some respondents we came into contact with.

2. Inadequate sample size due to financial constraints; hence 50 respondents were chosen

for the study. This makes it difficult to generalize the findings from the study.

3. Some respondents were illiterates and as such we had to support them in filling the

questionnaire. This may have led to them not giving the exact answer.

4. Language barrier was also a problem. Some of the people we met could only speak

Housa. This made it difficult to interpret what they said, thus there was the need to look

for trusted interpreters to translate what both researchers and respondents were

communicating.

3.8 Ethical Considerations

For ethical purpose, an introductory letter was taken from the academic board of the College of

Nursing, Ntotroso and proper community entry done through the opinion leaders such as imams

and religious leaders in the Zongo Community. This was done to gain their support and trust. All

24
respondents were informed of the purpose of the study and given adequate information about the

topic. Respondents were assured of anonymity and confidentiality as they were not required to

write their names or any form of identity on the questionnaire. Respondents were informed of

their right to withdraw from the research at any time. Each respondent who participated in the

research did so out of their own will.

25
 CHAPTER FOUR

DATA ANALYSIS AND RESULTS

4.0 Introduction

The chapter entails the analysis and interpretations of the data obtained from the field. In

concurrence with the objectives of the study, the analysis covers the characteristics of the

respondents, and the factors that influence breast cancer screening for cancer among the women

in Ntotroso Zongo.

Methods used in the analysis are Pie chart, bar chart, line chart and tables.

4.1 Section A

Demographic data

1. Age group of respondents

Table 1 A percentage table showing the age group of respondents

Age group Number of respondents Percentage (%)

18-30 30 60
31-45 14 28
46-60 6 12

Total 50 100

Source: Field data

Table 1 shows that 60%(30 respondents) were aged 18-30 years, 28% (14 respondents) were

aged 31-45 years and 12% (6 respondents) were aged between 46-60 years.

26
 2. Occupation of respondents

Table 2 A percentage table showing the occupational status of respondents

Occupation of respondents Number of respondents Percentage (%)

Self employed 13 26
Government worker 9 18
Unemployed 28 56

Total 50 100

Source: Field data

Table 2 shows that majority of respondents were unemployed. 56% (28 respondents) were

unemployed, 26% (13 respondents) were self-employed and only 18% (9 respondents) were

government workers.

3. Level of education

Table 3 A percentage table showing the level of education of respondents

Level of education Number of respondents Percentage (%)

Primary 12 24
JHS/Middle school 6 12
SHS 10 20
Tertiary 10 20
Illiterate 12 24

Total 50 100

Source: Field data

27
The table above shows that 24% (12 respondents) were primary school leavers or illiterate,

20%(10 respondents) had SHS or Tertiary education and only 12%( 6 respondents) had

JHS/middle school education.

4. Religious background of respondents

Table 4 A percentage table showing the religious background of respondents

Religious background of Number of respondents Percentage (%)

respondents

Christianity 17 34
Islam 29 58
Traditionalist 0 0

Not affiliated 4 8

Total 50 100

Source: Field data

According to the table above, 58%(29 respondents) were Muslims, 34%(17 respondents) were

Christians and 8%(4 respondents) were not affiliated to any religion. No respondent was a

traditionalist.

5. Income level of respondents

Table 5 A percentage table showing the income level of respondents

Income level of respondents Number of respondents Percentage (%)

GHC 0-500 30 60
GHC 600-900 12 24
GHC 1000-1500(above) 8 16

Total 50 100

28
Source: Field data

60%(30 respondents) earned between nothing and GHC 500. Followed by 24%(12 respondents)

who earned GHC 600-900 and 16%(8 respondents) earned GHC 1000-1500 and above.

6. Marital Status of respondents

Table 6 A percentage table showing the Marital Status of respondents

Marital Status of respondents Number of respondents Percentage (%)

Single 18 36
Married 24 48
Divorced 1 2
Separated 4 8
Widowed 3 6

Total 50 100

Source: Field data

Table 6 shows that 48%(24 respondents) were married, 36%(18 respondents) were single, 8%(4

respondents) were separated from their partners, 6%(3 respondents) were widowed and 2%(1

respondent) was divorced.

SECTION B

4.2 Knowledge on breast cancer and breast cancer screening.

7. Whether respondents had heard of breast cancer

Table 7 A percentage table showing whether respondents had heard of breast cancer

Response Number of respondents Percentage (%)

Yes 49 98

29
No 1 2

Total 50 100

Source: Field data

The table shows that 49 respondents (98%) said they had heard about breast cancer and only 1

respondent(2%) said they had not heard about it.

8. Method of breast cancer screening that respondents had heard of

Figure 1 A pie chart showing the Method of breast cancer screening that respondents had

heard of .

30
 xray; 8.00%

mammography; 4.00%

clinical breast examination; 32.00% Breast self examination; 56.00%

Breast s el f exa mi nation cl i ni ca l brea st exa mi nation

ma mmogra phy xray

Source: Field data

The chart above shows that breast self examination was the commonest method of breast

screening among respondents (56%, 28 respondents), followed by clinical breast examination

(32%, 16 respondents), x-ray was 8%(4 respondents) and mammography was 4%.

9. Source of information on breast cancer screening

Figure 2 A pie chart showing respondent’s source of information breast cancer screening.

31
 Source of information

Friends/Family; 32.00%

Media; 40.00%

Health Care Workers; 28.00%

Medi a Heal th Care Workers Friends /Fa mi l y

Source: Field data

Figure 2 shows that media sources was 40% (20 respondents), friends/family was 32%(16

respondents) and health care workers was 28%(14 respondents).

10. Predisposing factors/cause of breast cancer

Figure 3 A pie chart showing predisposing factors/causes of breast cancer

32
 Exposure to
others(family pesticide; 16.00%
History); 20.00%

someone with
history of breast
cancer; 4.00%

proper
lack of breatfeeding; breastfeeding;
24.00% 36.00%

Source: Field data

Figure 3 shows that proper breastfeeding accounted for 36%(18 respondents), lack or not

breastfeeding was 24%(12 respondents), family history 20%(10 respondents), exposure to

pesticide was 16%(8 respondents) and only 4%(2 respondents) accounted for someone with

history of breast cancer.

11. Whether respondents had screened for breast cancer before

Figure 4 A pie chart showing whether respondents had screened for breast cancer before.

33
 Yes; 24.00%

No; 76.00%

Yes No

Source: Field data

Figure 4 shows that 76%(38 respondents) had never screened for breast cancer before and

12(24%) respondents had screened for breast cancer before.

12. How often breast self-examination should be conducted

Figure 5 A pie chart showing how often a breast self-examination should be conducted.

34
 once monthly; 24.00%

I don’t know; 56.00% once every 3 months; 8.00%

once yearly; 12.00%

once monthl y once every 3 months once yearl y I don’t know

Source: Field data

Figure 5 shows that 56% (28 respondents) didn’t know the number of times breast self

examination should be conducted, 24%(12 respondents) said it should be conducted once

monthly, 12%(6 respondents) said it should be conducted once yearly and 8%(4 respondents)

said it should be conducted once every 3 months.

Section C

4.3 Factors Influencing Breast cancer Screening Among women

35
 13. Whether respondents are at risk for developing breast cancer

Figure 6 A pie chart showing whether respondents are at risk for developing breast cancer

I don’t know; 8.00%

yes ; 12.00%

maybe; 16.00%

no; 64.00%

yes no maybe I don’t know

Source: Field data

The chart above shows that 32(64%) respondents taught they were not at risk of developing

breast cancer, 16%(8 respondents) were not sure, 12%(6 respondents) said they are at risk and

finally 8%(4 respondents) didn’t know whether they were at risk or not.

14. Religious acceptance of BSE or CBE

Figure 7 A bar chart showing whether respondents’ religion or culture allowed BSE or CBE

36
 50 48

45

40

35

30

25

20

15

10

5 2

0
yes no 0
maybe 0 know
I don’t

Source: Field data

The chart above shows that 48 respondents agreed that their various religions supported breast

screening method, 2 respondents said no and none of the respondents said maybe or I don’t

know.

15. Whether respondents religion or culture allowed the opposite sex to perform CBE

on them

37
Figure 8 A bar chart showing whether respondents’ religion or culture allowed the opposite

sex to perform CBE on them

24

16

yes no maybe I don’t know

Source: Field data

Figure 8 shows that 24 respondents said their religion was against the opposite sex

performing CBE on them, 16 respondents said it was not against their religion, 2

respondents said maybe and 8 respondents were not sure.

16. Whether respondents family/friends supported breast cancer screening

38
 Figure 9 A bar chart showing whether respondents’ family/friends supported breast cancer

screening.

28

10
8

yes no maybe I don’t know

Source: Field data

Figure 9 shows that 28 respondents agreed that their friends/ family/ partner supported

them going for CBE, 10 respondents didn’t know, 8 respondents said maybe and 4

respondents said their family/partners/ friends didn’t support breast cancer screening.

17. Whether breast screening is sexually embarrassing

39
Figure 10 A bar chart showing whether respondents regarded breast screening as sexually

embarrassing

31

19

YES NO

Source: Field data

The chart above shows that 31 respondents regarded breast cancer screening as sexually

embarrassing and 19 respondents regarded it as not sexually embarrassing.

40
18. Whether regular screening can improve survival for breast cancer

Figure 11 A bar chart showing whether regular screening can improve survival for breast

cancer

38

10

1 1

YES NO MAYBE I DON’T KNOW

Source: Field data

Figure 11 shows that 38 respondents agreed that regular screening can improve survival

for breast cancer, 10 respondents said it can’t improve survival, 1 said maybe and 1

respondents didn’t not know the answer for that question.

19. Whether discussion of sexuality affect the uptake of breast cancer screening

41
Figure 12 A pie chart showing whether discussion of sexuality affect the uptake of breast

cancer screening

yes ; 36.00%

no; 64.00%

yes no

Source: Field data

The chart above shows that 64%(32 respondents) agreed that discussion of sexuality

didn’t affect the uptake of breast screening methods while 36%(18 respondents) said it

affected the uptake of breast screening methods.

Section D

42
 4.4 Sociodemographic influences and health system influences

20. Whether the cost of breast screening prevent respondents from undertaking it.

Figure 13: A pie chart showing whether the cost of breast screening prevent respondents

from undertaking it.

NO; 14.00%

YES ; 86.00%

YES NO

Source: Field data

Figure 13 shows that 86%(43 respondents) agreed that the high cost of breast screening

methods such as mammography prevented them from undertaking it while 14%(7

respondents) said the high cost didn’t not prevent them from undergoing it.

21. Whether family history of breast cancer encouraged respondent to undertake breast

cancer treatment.

43
 Figure 14 A line chart indicating if family history caused respondents to undertake breast

cancer treatment.

44

0 0
YES NO MAYBE I DON’T KNOW

Source: Field data

The line chart above shows that 44 respondents agreed that family history of breast

cancer will encourage them to go for treatment themselves, while 6 respondents said no.

22. Whether distance from respondents current residence to health facility discouraged

them from undergoing breast cancer screening.

44
 Figure 15 A pie chart indicating distance from respondent’s current residence to health

facility discouraged them from undergoing breast cancer screening

28

14

yes no maybe I don’t 0

know

Source: Field data

The chart indicates that 28 respondents agreed that distance prevented them from breast

cancer screening, 14 respondents said No, while 8 respondents said maybe.

23. Whether healthcare worker-patient relationship influenced respondents decision to

go for breast cancer screening

45
Figure 16 A pie chart showing the whether healthcare worker-patient relationship influenced

respondents decision to go for breast cancer screening

indifferent; 12.00%

negative; 24.00%

positive; 64.00%

pos i tive negative i ndi fferent

Source: field data

The chart above shows that 64%(32 respondents) said the healthcare-patient relationship

impacted them positively to go for breast cancer screening, while 24% said it was

negative and 12 %(6 respondents) were not concerned about Healthcare worker-patient

relationship in seeking breast cancer screening.

24. Respondents relatives who had breast cancer before

Figure 17 A line chart showing respondents relatives who had breast cancer before

46
 43

3
2 2
0
mother gra ndmother great gra ndmother Aunty none

Source: Field data

The line chart shows that majority of respondents never had any of their relatives

suffering from breast cancer, 3 had their grandmothers suffering from breast cancer, 2

respondents’ mother and aunties’ developed breast cancer and none had their great

grandmothers developing breast cancer.

25. Whether current employment status prevented respondents from undertaking

breast cancer screening

47
Figure 18 A bar chart showing whether current employment status prevented respondents

from undertaking breast cancer screening

42

3 2 3

ye s no m ay b e I d o n ’ t k n ow

Source: Field data

The chart above shows that 42 respondents agreed that their work didn’t prevent them

from going for breast cancer screening, 3 respondents said it prevented them, 3

respondents didn’t know if their work prevented them and finally 2 respondents were not

sure whether their work prevented them from going for breast cancer screening.

26. Whether respondents will encourage women to go for breast cancer screening

48
Figure 19 A bar chart showing whether respondents will encourage women to go for breast

cancer screening

44

1 2

ye s no

Source: Field data

The chart above shows that 44 respondents will encourage women to go for breast cancer

screening while 6 respondents will not encourage women to go breast cancer screening.

CHAPTER FIVE

49
 DISCUSSION OF FINDINGS, RECOMMENDATIONS AND CONCLUSION

5.0 Introduction

This chapter discusses the study based on the findings from respondents on the various

objectives outlined in relation to the literature review.

5.1 Discussion of findings

Demographic Data

On the age group of respondents, 60%(30 respondents) were aged 18-30 years, 28% (14

respondents) were aged 31-45 years and 12% (6 respondents) were aged between 46-60 years.

Also concerning the occupational status of respondents, majority of respondents were

unemployed. 56% (28 respondents) were unemployed, 26% (13 respondents) were self-

employed and only 18% (9 respondents) were government workers. With their income level

pegged at 60%(30 respondents) earned between nothing and GHC 500, followed by 24%(12

respondents) who earned GHC 600-900 and 16%(8 respondents) earned GHC 1000-1500 and

above.

Moreover, 24% (12 respondents) were primary school leavers or illiterate, 20%(10 respondents)

had SHS or Tertiary education and only 12%( 6 respondents) had JHS/middle school education.

According to the data gathered, 58%(29 respondents) were Muslims, 34%(17 respondents) were

Christians and 8%(4 respondents) were not affiliated to any religion. No respondent was a

traditionalist. Regarding the marital status of respondents, 48%(24 respondents) were married,

36%(18 respondents) were single, 8%(4 respondents) were separated from their partners, 6%(3

respondents) were widowed and 2%(1 respondent) was divorced

50
Knowledge on breast cancer and breast cancer screening.

49 respondents (98%) had heard about breast cancer while only 1 respondent (2%) said they had

not heard about it. According to Opoku, Benwell&Yarney (2011), even though most women had

heard about breast cancer, breast cancer is not well understood by women. This backs our

findings.

Regarding the breast screening method respondents had heard of, breast self-examination was

the commonest method of breast screening among respondents (56%, 28 respondents), followed

by clinical breast examination (32%, 16 respondents), x-ray was 8%(4 respondents) and

mammography was 4%. In a study done in Ilorin Nigeria on secondary school teachers, most

respondents, 326 (95.6%) had heard about BSE at one time or the other. This affirms the findings

from our study.

On the source of information on breast cancer screening, media sources was 40% (20

respondents), friends/family was 32%(16 respondents) and health care workers was 28%(14

respondents). In 2005, Balogun and Owoaje research found that The commonest source of

information about the topic was the television, 97 (29.7%); closely followed by information

through friends, 92(28.2%). This supports our findings that also asserts that media sources were

the main source of information regarding breast cancer screening.

The predisposing factors that lead to breast cancer to respondents are proper breastfeeding

accounted for 36%(18 respondents), lack or not breastfeeding was 24%(12 respondents), family

history 20%(10 respondents), exposure to pesticide was 16%(8 respondents) and only 4%(2

respondents) accounted for someone with history of breast cancer. This findings contrast

51
Abdulkareem(2013) observation that factors such as breast feeding, high parity, and early age at

first child birth were found to reduce the risk of breast cancer.

Also on whether respondents had screened for breast cancer before, 76%(38 respondents) had

never screened for breast cancer before and 12(24%) respondents had screened for breast cancer

before. This is in line with National Strategy for Cancer Control in Ghana 2012 report that

concludes that In Ghana, only a few Ghanaian women really are conscious of breast screening

hence 50 - 70% of patient present for treatment when they are in advanced stages of III and IV.

Regarding how often breast cancer should be conducted in a year, 56% (28 respondents) didn’t

know the number of times breast self examination should be conducted, 24%(12 respondents)

said it should be conducted once monthly, 12%(6 respondents) said it should be conducted once

yearly and 8%(4 respondents) said it should be conducted once every 3 months. This is in

contrast with Kayode, Akande & Osagbemi (2005) studies that found that One hundred and

forty-six (42.8%) of those studied felt BSE should be done once monthly, 50 (14.7%) indicated

three monthly, equal proportion of 23 (6.7%) each for twice yearly and once yearly respectively

while 99 (29.1%) did not know how often BSE should be done.

Factors Influencing Breast cancer screening among women

32(64%) respondents taught they were not at risk of developing breast cancer, 16%(8

respondents) were not sure, 12%(6 respondents) said they are at risk and finally 8%(4

respondents) didn’t know whether they were at risk or not. In a study by (Kayode, Akande &

Osagbemi, (2005) that supports the findings of our study, the state that 300 (88%) of respondents

sampled for their research thought they were not at risk of developing breast cancer.

52
Regarding, if respondents’ religion supported breast cancer screening, 48 respondents agreed that

their various religions supported breast screening method, 2 respondents said no and none of the

respondents said maybe or I don’t know. Also, on whether respondents’ religion allowed the

opposite sex to perform CBE on them, 24 respondents said their religion was against the opposite

sex performing CBE on them, 16 respondents said it was not against their religion, 2 respondents

said maybe and 8 respondents were not sure. According to Montazeri, 2003, a descriptive study

in Tehran investigated how religion might contribute to breast self-examination (BSE) among

Muslim women. Ninety percent indicated BSE is not against their religious beliefs and 47% said

that a clinical breast examination by a male physician is not against their Islamic beliefs. This

partially agrees with our findings.

Messina et al. (2004) reported higher compliance and uptake of screening among women who

received both appraisal and logistical support from their family or friends. This supports our

findings that 28 respondents agreed that their friends/ family/ partner supported them going for

CBE, 10 respondents didn’t know, 8 respondents said maybe and 4 respondents said their

family/partners/ friends didn’t support breast cancer screening.

Furthermore, the research gathered that 31 respondents regarded breast cancer screening as

sexually embarrassing and 19 respondents regarded it as not sexually embarrassing. This

observation is in line with , Elsie et al. (2010), research findings that identified concern about

embarrassment as a significant barrier to breast cancer screening uptake among women in South

Africa and Uganda, respectively. In both studies, screening procedures of CBE and

mammography were considered sexually embarrassing, Women who perceived breast screening

as sexually embarrassing were less likely than those without such beliefs to be screened.

53
Smith, Saslow, Sawyer, Costanza, Hendrick&Eyre, (2006) states that early detection and prompt

treatment offer the greatest chance of long-term survival. This is in line with findings from our

research that found that 38 respondents approved that regular screening can improve survival for

breast cancer, 10 respondents said it can’t improve survival, 1 said maybe and 1 respondents

didn’t not know the answer for that question.

Sociodemographic influences and health system influences

The research also sought to identify sociodemographic influences and health system influences

respondents to seek breast cancer screening practices.

Data gathered shows that 86% (43 respondents) agreed that the high cost of breast screening

methods such as mammography prevented them from undertaking it while 14%(7 respondents)

said the high cost didn’t not prevent them from undergoing it. In Nigeria, Ndikom and Ofi (2012)

reported low mammography screening utilization among women with low socioeconomic status.

In that study, low income women considered breast cancer screening to be of less importance

because of numerous competing health needs. This findings supports our research findings.

Also, on whether family history of breast cancer encouraged respondent to undertake breast

cancer treatment, 44 respondents agreed that family history of breast cancer will encourage them

to go for treatment themselves, while 6 respondents said no. this is in line with Othman et al.,

(2012) that found that a family history of breast cancer has long been recognized as a significant

predictor of breast cancer screening intentions. Evidence suggests that women with a family

history of breast cancer are more likely than women without any history of the disease to initiate

screening intentions at an earlier age, and to undergo screening on a regular basis.

54
It is well established that long distances to health care facilities discourages utilization of cancer

screening services (Shaikh & Hatcher, 2005). This assertion supports our findings in which 28

respondents agreed that distance prevented them from breast cancer screening, 14 respondents

said No, while 8 respondents said maybe distance to the place or facility to test to breast cancer

prevented them from going for breast cancer screening.

Healthcare workers-patient relationship was also examined. Data gathered showed that 64%(32

respondents) said the healthcare-patient relationship impacted them positively to go for breast

cancer screening, while 24% said it was negative and 12 %(6 respondents) were not concerned

about Healthcare worker-patient relationship in seeking breast cancer screening. In agreeing with

our findings studies by Knapik(2012) and McFarland(2003) found that strong relationship has

been shown to be associated with greater intention and compliance with cancer screening and

that negative attitudes of health professionals toward patients discouraged participation in cancer

screening

Considering whether respondents current employment prevented them from going for breast

cancer it was identified that 42 respondents agreed that their work didn’t prevent them from

going for breast cancer screening, 3 respondents said it prevented them, 3 respondents didn’t

know if their work prevented them and finally 2 respondents were not sure whether their work

prevented them from going for breast cancer screening. This contrast previous studies such as ,

Elsie et al. (2010), that found that that employed Ugandan women were seven times more likely

to undergo mammography.

Lastly, 44 respondents will encourage women to go for breast cancer screening while 6

respondents will not encourage women to go breast cancer screening.

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5.2 Conclusion

Globally, breast cancer arguably remains the most common cancer and most notable cause of

cancer-related mortalities among women (Parkin&Fernández, 2006). While incidence rates had

previously been higher in the developed world, there has been a current increase in incidence and

mortality in the developing countries (Porter, 2009).

Due to this assertions, this research was carried out in the Ntotroso in the Asutifi North District.

The target population were women who were aged 15 to 60 years. A sample size of 50

respondents were chosen for the study and to prevent bias, random sampling method was

employed. The objectives for the study included finding the knowledge of the respondents on

breast cancer screening, the cultural, religious, sociodemographic and health factors that impede

women from undergoing breast cancer screening. Structured questionnaire with both open and

closed ended questions based on the objectives set for the research were presented and read to

respondents, after which the data collected was then analyzed using simple frequency tables, bar

chart, column chart and pie chart.

The study identified the following major findings;

Demographic data: 60% of respondents were aged between 18-30 years, 56% were unemployed,

60% earned between GHC 0-500, 24% were illiterates, 58% of respondents were Muslims and

48% were married.

Knowledge on breast cancer and breast cancer screening: 98% had heard about breast cancer,

40% heard about it from media sources, breast self examination was the commonest method

known to respondents, 36% of respondents taught that practising proper breastfeeding may lead

to breast cancer, 56% didn’t know the number of times breast self examination should be done in

a year.

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Factors Influencing Breast cancer screening among women: 64% of respondents taught they

were not at risk of developing breast cancer, 96% said their religion supported breast cancer

screening, 48% agreed their religion was against the opposite sex performing clinical breast

examination on them, 56% agreed their friends/family/partners supported them on breast cancer

screening, 62% said breast cancer screening was sexually embarrassing and 76% also stated that

regular screening can improve breast cancer survival.

Sociodemographic influences and health system influences: 86% asserted that high cost of breast

cancer screening(mammography) prevented them from undertaking it, 56% stated that distance

from their current place of abode to the nearest health facility prevented them from undertaking

breast cancer screening, 64%(32 respondents) said the healthcare-patient relationship impacted

them positively to go for breast cancer screening, (43 respondents) never had any of their

relatives suffering from breast cancer, 42 respondents agreed that their work didn’t prevent them

from going for breast cancer screening and lastly 44 respondents will encourage women to go for

breast cancer screening.

5.3 Recommendations

Based on the statements from respondents and findings from the study, the following

recommendations are being put forward for consideration by government, NGO’s, policy

makers, health care workers and the media. These recommendations will go a long way to ensure

the bottlenecks that prevents women from undertaking breast cancer screening.

Government must partner the media, NGO’s and healthcare workers to ensure there is massive

education on breast cancer and breast cancer screening methods available to all eligible women

in the country.

57
Government must make efforts to bear some of the cost that covers breast cancer screening

methods such as mammography and xray and CT scan to ensure more women are able to use

such method.

Health care workers must have positive attitude towards patients who attend their facilities to

ensure their attitude do not put them off from undergoing breast cancer screening.

Religious and opinion leaders must also join the fight to ensure women are screened for breast

cancer. Since all respondents were associated to one religion or the other, if they encourage their

followers to undergo breast cancer screening, they will partake in it fully.

The family and friends and most especially partners of women must also support and encourage

them to go for regular breast screening exercise.

Lastly, government must ensure join with NGO’s and healthcare workers to organize regular

screening exercise in communities where they do not have access to health facilities in their

communities.

REFERENCES

Abdulkareem, I. H. (2013). Aetio-pathogenesis of breast cancer. Nigerian Medical Journal:

Journal of the Nigeria Medical Association, 54(6).

58
Abotchie, P. N., & Shokar, N. K. (2009). Cervical cancer screening among college students in

Ghana: Knowledge and health beliefs. International Journal of Gynecological Cancer,

D. Albarracín, B. T. Johnson, & M. P. Zanna (Eds.), The handbook of attitudes (pp. 173-221).

Dumalaon-Canaria, J. A., Hutchinson, A. D., Prichard, I., & Wilson, C. (2014). What causes

breast cancer? A systematic review of causal attributions among breast cancer survivors

and how these compare to expert-endorsed risk factors. Cancer Causes & Control, Linpincot

Ghana Statistical Service. (2010). Population and housing census: 2010 report. Accra, GH:
Author. Retrieved from http://www.statsghana.gov.gh

Giuliano, A. R., Mokuau, N., Hughes, C., Tortolero-Luna, G., Risendal, B., Ho, R., & Mccaskill-
Stevens, W. J. (2000). Participation of minorities in cancer research: The influence of
structural, cultural, and linguistic factors. Annals of Epidemiology, 10(8) Retrieved from
http://www.annalsofepidemiology.org/article/S1047-2797(00)00195-2/abstract

Jemal, A., Bray, F., Center, M. M., Ferlay, J., Ward, E., & Forman, D. (2011). Global cancer

statistics. CA: A Cancer Journal for Clinicians, 61(2), 69-90.

Nguyen, A. B., Belgrave, F. Z., & Sholley, B. K. (2011). Development of a breast and cervical
cancer screening intervention for Vietnamese American women: A community-based
participatory approach. Health Promotion Practice Journal, 12(6), 876-886.

Opoku, S. Y., Benwell, M., & Yarney, J. (2012). Knowledge, attitudes, beliefs, behaviour and

breast cancer screening practices in Ghana, West Africa. Pan African Medical Journal, 11

Othman, A. K., Kiviniemi, M. T., Wu, Y. W. B., & Lally, R. M. (2012). Influence of
demographic factors, knowledge, and beliefs on Jordanian women’s intention to undergo

59
 mammography screening. Journal of Nursing Scholarship, 44(1), 19-26

Poss, J. E. (2001). Developing a new model for cross-cultural research: Synthesizing the Health

Belief Model and the Theory of Reasoned Action. Advances in Nursing Science Journal,

23(4)

Secginli S, Nahcivan NO (2006). Factors associated with breast cancer screening behaviors in a

sample of Turkish women: A questionnaire survey. International Journal of Nursing Studies

Sitas, F., Parkin, D. M., Chirenje, M., Stein, L., Abratt, R., & Wabinga, H. (2008). Part II:

Cancer in Indigenous Africans—causes and control. The Lancet Oncology, 9(8). Lancet

Publishing Company, Arizona

QUESTIONNAIRE

Dear Respondent,

60
We are students of College of Nursing, Ntotroso, conducting a research on factors that

influence breast cancer screening among women of Ntotroso Zongo (Asutifi North District).

The study is for academic purposes only; hence information given shall be treated as

confidential and be made available for such purpose only. To ensure anonymity, no name is

required. You can withdraw from the study anytime you deem necessary. We shall be grateful

if you would cooperate with us by giving your honest options. Thank you.

Kindly tick(√) the right option or write your response(s) where necessary.

SECTION A: BACKGROUND DATA

1. Age

a. 18-30 ( )

b. 31-45 ( )

c. 46-60 ( )

2. Occupation

a. Self-employed ( ) specify________________

b. Government Worker ( ) specify________________

c. Unemployed ( )

3. Level of Education

a. Primary ( )

b. JHS /Middle school ( )

c. SHS ( )

d. Tertiary ( ) e. Illiterate ( )

4. Which religion do you belong to?

a. Christianity ( )

61
 b. Islam ( )

c. Traditionalist ( )

e. Others,(specify)__________

5. Income level

a. Gh₵ 0-500 ( )

b. Gh₵ 600-900 ( )

c. Gh₵ 1000-1500 ( )

6. Marital status of respondents

1. Single { }

2. Married { }

3. Divorced { }

4. Separated { }

5. Widowed { }

Section B . Knowledge on Breast Cancer and Breast cancer Screening

7. Have you heard of breast cancer?

Yes ( ) No ( )

8. What method of breast cancer screening have you heard of?

Breast Self examination ( ) Clinical breast Examination ( )

Mammography ( ) X'ray ( )

Others, (specify)………………………………………………..

62
9. What was your source of information on breast cancer screening?

Media ( )

Health care workers ( )

Friends/family ( )

other Sources, (specify)…………………………………………..

10. Select any Predisposing factors /cause of breast cancer.

a) Exposure to pesticide agents such as dichlorodiphenyltrichloroethane (DDT)

b) Proper breastfeeding
c) lack of breastfeeding
d) Someone with history of breast cancer

Others, (Specify)…………………………………………….

11. Have you ever screened for breast cancer?

Yes ( ) No ( )

Give reason(s)………………………………………………………………..

12. How often should breast self-examination be conducted ?

Once Monthly ( )

Once every three months ( )

Once yearly ( )

I don’t know ( ).

Section C; Factors Influencing Breast Cancer Screening Among Women.

63
13. Do you think you are risk of developing breast cancer?

Yes [ ]

No [ ]

Maybe [ ]

I don’t know [ ]

14. Do you think your religion or culture allow breast screening method such as breast self-

examination or clinical breast examination?

Yes ( )

No ( )

Maybe ( )

I don’t know [ ]

15. Is it against your religion or culture for the opposite sex (male doctor, nurse, and technician)

to perform clinical breast examination on you?

Yes ( )

No ( )

Maybe ( ).

I don’t know [ ]

16. Does your family/friends/ husband/ partner approve/ support you in breast cancer screening?

Yes ( )

64
No ( )

Maybe ( )

I don’t know [ ]

17. Do you regard breast screening as sexually embarrassing?

Yes ( ) No ( )

18. Do you think regular screening can improve survival for breast cancer?

Yes ( )

No ( )

Maybe ( )

I don’t know [ ]

19. Discussions of sexuality affect the uptake of breast screening methods?

Yes ( )

No ( )

Give reason(s)………………………………………………………

Sociodemographic influences and Health system influences

20. Does the cost of breast screening method such as mammography prevent you from

undertaking it ?
65
Yes ( )

No ( )

Give reason(s)……………………………………………

21. Does family history of breast cancer encourage you to undertake breast cancer treatment

yourself?

Yes ( )

No ( )

Maybe ( ).

I don’t know [ ]

22. Does the distance from your current place of residence to the health facility discourage you

from undergoing breast cancer screening?

Yes ( )

No ( )

Maybe ( ).

I don’t know [ ]

23. How does healthcare worker-patient relationship influence your decision to go for breast

cancer screening?

Positive ( )

Negative ( )

66
Indifferent ( ).

24. How does breast cancer affect those who suffered it?

………………………………………………………………………………………………………

25.Which of these has had breast cancer before.

a) Mother [ ]
b) Grandmother [ ]
c) Great grandmother [ ]
d) Other(s), Specify…………………………………………………..

26. Does your current employment status prevent you from going for breast cancer screening?

Yes ( )

No ( )

Maybe ( ).

I don’t know [ ]

27. Will you encourage women to go for breast cancer screening?

Yes ( ) No ( )

28. What are your recommendations to ensure that more women go for breast cancer screening?

……………………………………………………………………………………..

……………………………………………………………………………………..

67