Level of Knowledge and Skills in Performing Breast Self-Examination among 4th year Female High School

Students of Beatriz D. Durano Memorial National High School:

Health Teaching Program in Breast Self Examination

A Research Study Presented

To the Faculty of the College of Nursing

Colegio de San Antonio de Padua

Guinsay, Danao City

In Partial Fulfilment of the Course

Requirements for the Degree

Bachelor of Science

in Nursing

Lojel Denray M. Durano Lois Stephanie L. Garado

Emmervon C. Lao Dysebel H. Manto

Mary Lou A. Menchavez Chen M. Manulat

Nichole Adrian Gomez Lorianne Mer L. Torralba

Jeffrey C. Sato

Kelly Thomas B. Tadena, RN, MAN

Research Mentor

Level of Knowledge and Skills in Performing Breast Self-Examination among 4th year Female High School

Students of Beatriz D. Durano Memorial National High School:

Health Teaching Program in Breast Self Examination

CHAPTER I

BACKGROUND AND ITS SETTING

• INTRODUCTION

Performing Breast Self-Examination is one of the most important things a woman can do to herself. It is an act of self-awareness that can ease one’s mind, soothe one’s body and save one’s breast. It could even save one’s life.

Many women have suffered from breast cancer because of insufficient knowledge on how to perform breast self examination. This perhaps shows the unending increased number of cases of breast cancer. Majority of these patients were diagnosed late due to lack of knowledge on early detection of breast cancer.

Survival of breast cancer patients are increased if early diagnosis is done. Breast cancer is the leading cause of cancer death in women between ages 15-54. Early detection of breast cancer, through monthly Breast Self-Examination offers the best chance of survival.

According to WHO Women’s health, Breast cancer is the leading cancer killer among women aged 20-59 years. Cancers of the breast, lung and colon are among the top 10 causes of death of older women globally.

Breast cancer is No. 1 cause of cancer deaths in the Philippines in a report released recently by the Department of Health; breast cancer is now the most common cancer in the Philippines, taking at least 16 percent of the 50,000 cases diagnosed with cancer.

This is made even more alarming by another report from the Philippine Breast Cancer Network, which announced that

the Philippines has now the highest incidence rate of breast cancer in Asia and is also considered to have the 9th

highest incidence rate in the world today.

And the incidence of breast cancer continues to rise and what’s more distressing is the fact that all women are at risk and anyone can be victim – mothers, daughters, sisters, and friends regardless of age, race, social or economic status.

The need for intensified efforts to educate the public should be highlighted. By enlightening women and the public in general of the importance of prevention

and not only early detection, more women can be saved from this fatal

disease.

Breast cancer is the leading cause of cancer-related death among Cebuano women, based on the Cebu population-based cancer registry of the foundation. From 1993 to 2007, the Eduardo J Aboitiz Cancer Center (EJACC) of RAFI recorded a total of 3,005 reported breast cancer cases in Metro Cebu.

Based on the above premises, the study is conducted to evaluate the Level of Knowledge and Skills in Performing Breast Self-Examination among 4th year Female High School Students of Beatriz D. Durano Memorial National High school.

The researchers also would like to know the relationship of the Level of

Knowledge to the Level of Skills in performing Breast Self-Examination.

THEORITICAL BACKGROUND This study is anchored on Bertrand Russell’s (1926) Theory of

Knowledge which states that knowledge is a product of doubt. Knowledge refers

to learning concepts, principles and information regarding a particular

subject(s) by a person through books, media, encyclopedias, academic institutions and other sources.

In the Tripartite Theory of Plato, there are three types of knowledge: Personal Knowledge, Procedural Knowledge and

Propositional Knowledge. Personal Knowledge is the knowledge of

acquaintance, knowledge in this sense is to do with being familiar with

something.

While Procedural Knowledge is the knowledge concerned on how to do

something, it states that even learning the theories behind task doesn’t

necessarily mean that a person can do the task proficiently.

The last type of knowledge is the Propositional Knowledge that focuses on the knowledge of facts or known facts of universal truth.

(http://www.marxists.org/reference/subject/philosophy/works/en/russell1.htm)

Crossman (1959) stated that an early view on how practice leads to performance improvements. He suggested that, when faced with a new task, they have many strategies that can potentially be used.

With practice at the task, they monitor the outcomes they produce as a result of

the various strategies used. With time they come to favour the more efficient strategies. These are used more often and this produces performance speed-

up.

Thus, Crossman’s model qualifies as an example of a theory that proposes that practice leads to more efficient procedures for performing a task.

The theory does not suggest that practice modifies strategies to make

them more efficient. Instead, practice leads to the selection of the most efficient strategy among several.

Crossman’s theory provides an account of the power law of learning. According to the theory, it is easier to find faster, more efficient methods early in practice, and so large gains in performance time are more likely at this stage.

(http://books.google.com.ph/books?id=sSAHgnSBJ4sC&pg=PA40&lpg=PA40&dq=Crosman)

One of the leading causes of death among women is Breast Cancer. Breast Cancer is a malignant tumor that typically begins in the ductal-lobular epithelial cells of the breast and spread via the lymphatic system to the axillary lymph nodes.

The tumor may then mestastasize to distant regions of the body, including lungs, liver, bone and brain. The finding of breast cancer in the axillary lymph nodes is not merely contiguous growth into the adjacent region of the breast.

Most primary breast cancers are adenocarcinomas located in the upper

outer quadrant of the breast (Black and Hawks, 2005)

Breast cancer is a type of cancer originating

from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts

are known as ductal carcinomas; those originating from lobules are known

as lobular carcinomas.

Breast cancer is a disease of humans and other mammals; while the overwhelming

majority of cases in humans are women, men can sometimes also

develop breast cancer.

The size, stage, rate of growth, and other characteristics of the tumor determine the kinds of treatment.

Treatment may include surgery, drugs (hormonal

therapy and chemotherapy), radiation and/or immunotherapy.

(http://en.wikipedia.org/wiki/Breast_cancer)

In order to detect easily the abnormalities of the breast, women are

encouraged to perform Breast Self-Examination. Breast Self-Examination

(BSE) is a screening method used in an attempt to detect early breast cancer.

The method involves the woman herself looking at and feeling each breast for possible lumps, distortions or swelling.

BSE was once promoted heavily as a means of finding cancer at a more curable stage, but large randomized controlled studies found that it was not effective in preventing death, and actually caused harm through needless biopsies and surgery.

(http://en.wikipedia.org/wiki/Breast_self-examination)

Figure 1. The normal and healthy breast compared to the breast with cancer.

Breast self Examination should be conducted once a month. A regular time is best --- such as immediately following menstruation, when breast

tenderness and fullness caused by fluid retention have subsided, or on the first

day of the month.

Women examine themselves regularly become familiar with the shape texture

of the breast. Any changes must be reported immediately to the physician for accurate diagnosis (Kozeir, Erb, Blais and

Wilkinson 2002).

Some facts that have been shared by the Philippine Breast Cancer Network All women are at risk. Approximately 70% of breast cancers occur in women with none of the known risk factors, only about 5% of breast cancers are inherited.

About 80% of women diagnosed with breast cancer will be the first to

be victims in their families.

One out of four who are diagnosed with breast cancer die within the first five years, 1 out of 13 Filipino women will develop breast cancer in her lifetime.

The Philippines has the highest incidence rate of breast cancer in Asia and

registered the highest increase of 589% among 187 countries over a 30 year

period from 1980 to 2010.

(http://www.pbcn.org/)

In 1989, Ngelangel et al. conducted a knowledge–attitude–practice survey, Fifty percent of women had heard/read about breast examination, only 37% of the women had ever received a breast check-up from a physician.

Medical personnel had only ever advised 36% on the importance of BSE and only about 67% knew the benefits of BSE.

Only 37% of the women had ever received a breast check-up from a

physician.

Medical personnel had only ever advised 36% on the importance of BSE and only about 67% knew the benefits of BSE. Only 54% had ever done a BSE, of whom only 27% are still practicing it.

Reasons given for not doing the BSE included no symptoms, busy, don’t know

how, don’t like, don’t think important, always forget, afraid and not aware.

(http://jjco.oxfordjournals.org/content/3

2/suppl_1/S52.full)

In a 1997 field trial of breast cancer screening conducted by the DOH–PCCP and IARC–WHO in Metro Manila, there was a large non-compliance rate (79.1%) among women found to have breast masses (2.8% positivity rate) in terms of consulting referral hospitals for re-evaluation and possible treatment.

Reasons such as fear, no money for transport/treatment/medical expenses, indifference, no time, non-awareness of gravity of the disease and spiritual fatalistic attitudes were commonly given,

it continues to campaign for monthly BSE and annual physician breast

examinations until such time that mammography becomes available and

affordable to most of the target population.

(http://www.doh.gov.ph/)

The Breast Cancer Control Program (BCCP) of the Philippines refers to the implementation of a nationwide anti-breast cancer scheme: public information and health education, case finding and treatment integrated into the community health structure and equipped to control breast cancer in a systematic sustained manner

Studies have shown a one-third reduction in mortality attributed to

breast cancer screening, mainly due to mammography.

However, the importance of annual clinical breast examination (by nurse, midwife or public health physician) and monthly breast self-examination (BSE)are to be emphasized, taking note that:

(a) sophisticated screening technology (mammography) is not easily available or affordable,

(b) mammography is mainly recommended for women ≥50 years old,

(c) many breast cancers are found among 35–50-year-old Filipino women

(d) a relatively inexpensive strategy

(BSE) involving physicians as examiners or a referral depot would be cheaper and more available than mammography and

physician time.

(http://jjco.oxfordjournals.org/content/32/suppl_1/S52.full.Prevention)

Reproductive factors associated with prolonged exposure to endogenous estrogens, such as early menarche, late menopause, late age at first childbirth are among the most important risk factors for breast cancer.

Exogenous hormones also exert a higher risk for breast cancer. Oral contraceptive and hormone replacement therapy users

are at higher risk than non-users. Breastfeeding has a protective effect

(IARC, 2008, Lacey et al., 2009).

(http://www.who.int/cancer/detection/breastcancer/en/index2.html)

Breast cancer is the top cancer in women both in the developed and the developing world. The incidence of breast cancer is increasing in the developing world due to increase life expectancy, increase urbanization and adoption of western lifestyles.

Although some risk reduction might be achieved with prevention, these

strategies cannot eliminate the majority of breast cancers that develop in low- and middle-income countries where

breast cancer is diagnosed in very late stages.

Therefore, early detection in order to improve breast cancer outcome and survival remains the cornerstone of breast cancer control.

The recommended early detection strategies for low- and middle-income countries are awareness of early signs

and symptoms and screening by clinical breast examination in demonstration

areas. (http://www.who.int/cancer/detection/br

eastcancer/en/index.html)

Figure 3. Schema of Study

Figure 3 shows the Schema of the Study, in which it was anchored on the Theory of Knowledge, Tripartite Theory

and the Skill Acquisition Theory. The inputs are the profile of the

respondents in terms of the Age, Civil Status and the Level of Knowledge and

Skills in Performing Breast Self-Examination.

The researchers utilized the researcher-made questionnaire of Breast Self-Examination Checklist as the process. The output is the Health Teaching Program in Breast Self-Examination.

THE PROBLEM

Statement of the Problem This study aimed to determine the

relationship between Level of Knowledge and skills in performing breast self-examination among 4th year Female High School Students of Beatriz D.

Durano Memorial National High school in order to propose an action plan.

Specifically, the researcher seeks answer to the following questions:

1. What is the profile of the respondents in terms of:

1.1 Age;

1.2 Civil Status?

2. What is the Level of knowledge in

performing Breast Self-Examination among the 4th Year Female High School Students of Beatriz D. Durano Memorial National High School?

3. What is the Level of Skills in

performing Breast Self-Examination among the 4th Year Female High School Students of Beatriz D. Durano Memorial National High School?

4. Is there a significant relationship

between the Level of Knowledge and Skills in Performing Breast Self-Examination among 4th Year Female High School Students of Beatriz D. Durano Memorial National High School?

5. What Health Teaching Program in

Breast Self-Examination can be proposed based on the findings of the study?

Statement of the Null Hypothesis

The hypothesis is tested at 0.05 alpha level of significance.

Ho: There is no significant relationship between the Level of Knowledge and Skills in Performing Breast Self-Examination among 4th Year Female High School Students of Beatriz D. Durano Memorial National High School.

Significance of the Study

This study is important and beneficial to the following entities:

Student Nurses will enhance their knowledge and skills in conducting health teachings on Breast Self-Examination and also to review their knowledge and skills.

Clinical Instructors will increase their knowledge and focus on one’s role modelling in moulding the behaviour of students regarding Breast Self Examination. Also, it enables them to focus on the weaknesses and strengths of each student on the knowledge and skills of performing Breast Self Examination.

High School Students will benefit from the health teaching program proposed by the researchers. In addition it will enhance their knowledge and skills in performing Breast Self-Examination and to correct errors and common malpractices.

The Researchers will be aware of the Level of Knowledge and Skills of the 4th Year High School Students in Performing Breast Self-Examination that may help them to early diagnose signs of breast cancer.

Future Researcher will derive from this study by other researchers, especially those who are interest in Breast Self-Examination. It encourages them to enhance the current research to provide more conductive data.

RESEARCH MATERIALS AND

METHODS

Research Method

The researchers used the descriptive-correlational design to determine the Level of Knowledge and Skills among the 4th Year Female High School Students of Beatriz D. Durano Memorial National High School in Performing Breast Self-Examination.

Research Respondent

The respondents of this study were the 4th year Female High school students of Beatriz D. Durano Memorial National High school. The researchers chose 30 respondents utilizing the purposive sampling.

Inclusion criteria:

The respondents must be a bonafide 4th year student at Beatriz D. Durano

Memorial National High School. They must be 15-20 years old.

Exclusion criteria: Those who are below 15 and above 20 will be excluded from being one of the

research respondents and those who are not 4th year High School Students.

Research Environment

The study were conducted at Beatriz D. Durano Memorial National High school – located at P.G Almendras Street, Lapu-lapu Suba, Danao City. It has a 4-storey building and has 6 ground floor rooms and 1 annex building that has classrooms and equipped laboratories.

It has 45 teachers headed by a principal. The total population is 1,539 students in

school year 2011-2012. It offers complete secondary education. They

started their operations in the year 1996.

Figure 4. Beatriz D. Durano Memorial

National High School Building.

Scope and Limitations of the Study

This particular study mainly determined the Level of Knowledge and Skills in Performing Breast Self-examination among 4th Year Female High School Students of Beatriz D. Durano Memorial National High school.

The researchers are aware of the limitations of the study, therefore these

limitations should be taken into consideration in their interpretation

analysis of the findings and also in the formulation of a conclusion:

1. The research instruments are not standardized.

2. The validity of the results lay on the

sincerity of the respondent in giving honest responses.

3. Willingness and the cooperation of

the respondent with regards to the research study.

The respondents who are involved in this study are only representative sample from 4th year High School Students of Beatriz D. Durano Memorial High School in Performing Breast Self-Examination.

Research Instrument

The researchers utilized a researcher made questionnaire and a Breast Self-Examination checklist to determine the Level of Knowledge and Skills in Performing Breast Self-examination among 4th Year Female High School Students of Beatriz D. Durano Memorial National High School .

Part I of the questionnaire is the researcher made questionnaire that

determines the Level of Knowledge in Performing Breast Self-examination among 4th Year Female High School

Students of Beatriz D. Durano Memorial National High school.

It is a 10 item questionnaire which answers have corresponding value. 5= I have exceptional understanding; 4= I have good understanding; 3= I have moderate understanding; 2= I have basic understanding; 1= I have no understanding.

The following hypothetical measures were utilized for interpretation of the

mean score:

Part II of the questionnaire is the Breast Self-Examination checklist to determine the Level of Skills. A 16 items checklist, which ratings have corresponding values 5= Excellent; 4= Very Good; 3= Good;

2= Fair; 1= Poor.

There were no numbers that are closer to 1 that would indicate that the

respondents got scores closer to 5. The following interpretation of their mean

score is shown below.

DATA COLLECTION AND

PROCEDURE

I. Preliminary Preparation

The Group presented the research proposal manuscript to the Research Committee for approval to conduct the study on Level of Knowledge and Skills among 4th year Female High School Students of Beatriz D. Durano Memorial National High school in Performing Breast Self-Examination.

Upon approval, the group sent a letter to the Dean of the College of Nursing of Colegio de San Antonio de Padua to inform her about the study. Another letter was addressed to the Vice President for Academic Affairs and Operations.

A letter was also addressed to Principal of Beatriz D. Durano Memorial National High school, asking for permission to conduct the study at the Beatriz D.

Durano Memorial National High School. Upon the approval, the researchers

informed each of the class presidents and asked for the assistance in the dissemination of the information.

II. Actual Data Gathering

As soon that it was approved, the researchers produced 20 copies for the pilot study and 30 copies for actual study. A pilot study was conducted by the researchers in order to determine the validity and reliability of the researcher-made questionnaire.

The researchers disseminated the questionnaires to the respondents with the informed consent, instructions were given upon starting, in answering the questionnaire the researchers were present if in case there were questions that are needed to be addressed or if there were any clarifications. After answering the 1st part of the questionnaire the papers were collected.

And for the 2nd part of the questionnaire the respondents were given 20-25 minutes to perform Breast Self-Examination and were observed by the Female researchers to evaluate the procedure done by the respondent. After the examination the data were rated, tabulated, analyzed and interpreted.

A. Percentage formula

To determine the profile of the respondents via percentage; percentage formula was utilized.

r = P/N x 100%

Where: r- Percent Rate

P- points

N- total number of respondents

STATISTICAL TREATMENT

B. Weighted Mean

To determine the weights of the scores of the respondents, the weighted mean was utilized.

x = ∑fx/∑F

Where: x= Weighted mean

f= frequency

x= weight of each score

fx= Sum of all the products of f and x where f is frequency of knowledge, skill and x is the weight of each score of knowledge, skill. ∑F= Sum of all the respondents

C. Pearson product-Moment Correlation

In order to determine the relationship between the Level of Knowledge and skills in performing breast self-examination among 4th year Female High School Students of Beatriz D. Durano Memorial National High school, the Pearson r product-Moment Correlation has been utilized.

r= ∑N (∑XY) – (∑X) (∑Y)

(∑N [∑X2] - [∑X]2) – (∑N [∑Y2] – [∑Y]2)

Where: r= Pearson r

∑= summation

N= the total number of respondents

X= the Level of Knowledge among 4th year Female High School Students

Y= the Level of Skills among 4th year Female High School Students

To interpret the correlation value (r) obtained, the following classifications may be applied:

An r from 0.00 to ± 0.20 denotes negligible correlation

An r from ± 0.21 to ± 0.40 denotes low or slight correlation

An r from ± 0.41 to ± 0.70 denotes marked or moderate relationship

An r from ± 0.71 to ± 0.90 denotes high relationship

An r from ± 0.91 to ± 0.99 denotes very high relationship

An r from ± 1.00 denotes perfect correlation

D. The t-test

In order to determine if the study participants are enough for the study as well as to check if there is a significant relationship between Level of Knowledge and Skills in performing Breast Self-Examination among 4th year Female High School Students of Beatriz D. Durano Memorial National High, the t test was utilized.

• t = r N-2

1 – r2

t= t-value

N= number of respondents

r2= coefficient of correlation squared.

Definition of Terms To clearly understand the concept, the following terms

were defined operationally.

Level of Knowledge: The understanding of the 4th Year High School Students in the facts about Breast Self Examination.

Skills: The ability of the 4th Year High School Students to perform Breast Self-Examination.

Breast Self-Examination: The procedure done by the 4th Year Female High School Students in this study.

4th Year Female High School Students: They are the researchers’ respondents in conducting the study of “Level of Knowledge and Skills among the 4th Year Female High School Students of Beatriz D. Durano Memorial National High School in Performing Breast Self-Examination”.

Health Teaching in Breast Self-Examination: The propose action plan of the researchers regarding the results of the study.

CHAPTER II

PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

This chapter presents the data that answer the questions raised in this study. There are six (6) tables made for this study.

Tables 1 and 2 shows the profile of the respondents in terms of their Age and Civil Status respectively. Table 3 presents the respondents’ Level of Knowledge, Table 4 shows the respondents’ Level of Skills.

Table 5 presents the relationship between Level of Knowledge and skills in

performing breast self-examination among 4th year Female High School

Students of Beatriz D. Durano Memorial National High school.

AGE PROFILE

Table 1 shows that among 30 study participants, 20 percent ages from 17-18 which comprises 6 study participants involve in the study, while the other 80 percent is from ages 15-16 which comprises 24 study participants that were involve in the study, while there were none for the age range of 19-20.

AGE

CATEGORY

FREQUENCY PERCENTAGE

19-20 0 0

17-18 6 20

15-16 24 80

TOTAL: 30 100

It is clearly shown in the study that majority of the respondents is from the age-range of 15-16; that comprises 24 students. Being a high school student specially in the 4th year level age fits in the range ages 15-16, minimal only in ages 17 and above for a 4th year high school level.

According to Erikson (1963) the psychosocial task of an adolescent is establishing the identity versus role confusion. The inability to settle on occupational identity commonly disturbs the adolescents. Erikson stated that adolescents help one another through this identity crisis by forming cliques and a separate youth culture.

These cliques often exclude all those who are different in skin colour, cultural background, aspects of dress or fashion,

gestures and taste in music.

During adolescents, peer groups assume great importance. The peer group has a number of functions. It provides a sense of belongingness, pride, social learning, and sexual roles. (Erikson, 1963 as cited by Kozier et. al. 2007)

Erikson notes the healthy resolution of earlier conflicts can now serve as a foundation for the search for an identity. If the child overcomes earlier conflicts they are prepared to search for an identity. He also said that the adolescent must make a conscious search for identity.

This is built on the outcome and resolution to conflict earlier stages, if the

adolescent cannot make deliberate decisions and choices, especially about vocation, sexual orientation, and life in

general, role confusion becomes a threat. ( Labiste, 2008)

CIVIL STATUS PROFILE

Table 2 shows that among the 30 students, 100 percent of the respondents are single.

Table 2: The profile of the respondents as to their

civil status

Civil l Status Frequency Percentage

Single 30 100

Married 0 0

Total: 30 100

It is clearly shown in the study that all of the 30 respondents and being a high school student are single. Erik Erikson said that in the adolescent period Teens need to develop a sense of self and personal identity. During adolescence, children are exploring their independence and developing a sense of self.

As they make the transition from childhood to adulthood, teens may begin to feel confused or insecure about themselves and how they fit in to society. As they seek to establish a sense of self, teens may experiment with different roles, activities and behaviors. According to Erikson, this is important to the process of forming a strong identity and developing a sense of direction in life.

(http://psychology.about.com/od/psychosocialtheories/a/identity-versus-confusion.htm)

LEVEL OF KNOWLEDGE AMONG THE

RESPONDENTS

Table 3 shows that in 10 questions in the researcher-made questionnaire for the Level of Knowledge, No question were rated “No understanding”, while there are 3 questions that are rated “basic understanding” which fell within the range score of 1.81 – 2.60 while 6 questions are rated “moderate understanding” which fell within the range score of 2.60 – 3.40,

while 1 question are rated “Good understanding” which falls within the range score of 3.41 – 4.20. There are no questions that fall on the “exceptional understanding”. The total weighted mean is 2.8 and is interpreted as “moderate understanding”.

The result shows that most of the time, the respondents graded low in the

questions have a replacement character.

Table 3: The level of knowledge among the

respondents Questions Mean Interpretation

1. Do you know Breast Self- Examination?

2.93 Moderate Understanding

2. Do you know that Breast Self

Examination should be performed 7-10

days after your period or on the same date

each month if you are having irregular

cycle?

3.03 Moderate Understanding

3. Do you know that you have an increased risk of having Breast Cancer if you have a first-degree relative (parent, brother, sister or child) that has cancer?

3 Moderate Understanding

4. Do you know that smoking can increase the risk of having breast cancer?

3.06 Moderate Understanding

5. Do you know that Breast Self-Examination is the most convenient and simple diagnostic tool against Breast Cancer?

2.8 Moderate Understanding

6. Do you know that maintaining a Healthy Lifestyle can help reduce the risk of having Breast Cancer?

3.63 Good Understanding

7. Do you know that you have increased risk of having Breast Cancer if you are overweight?

2.33 Basic Understanding

8. Do you know that you have increased chance of having Breast Cancer if you had never had child?

2.1 Basic

Understanding

9. Do you know that you have increased risk of having Breast Cancer if the beginning of menstruation happens before age 12?

2.36 Basic

Understanding

10. Do you know that you

have increased risk of

having Breast cancer if you

are drinking alcohol (more

than one drink a day)?

2.8 Moderate

Understanding

Total Mean: 2.8 Moderate

Understanding

Knowledge is a familiarity with someone or something, which can include facts, information, descriptions, or skills acquired through experience or education. It can refer to the theoretical or practical understanding of a subject. It can be implicit (as with practical skill or expertise) or explicit (as with the theoretical understanding of a subject); it can be more or less formal or systematic.

(http://oxforddictionaries.com/view/entry/m_en_us1261368#m_en_us1261368)

Knowledge acquisition involves complex cognitive processes: perception, communication, association and reasoning; while knowledge is also said to be related to the capacity of acknowledgment in human beings.

(Stanley Cavell, "Knowing and Acknowledging," Must We Mean What We Say? (Cambridge University Press, 2002), 238–266.)

THE LEVEL OF SKILLS AMONG THE

RESPONDENTS

Table 4 shows the respondents Level of Skills in performing Breast Self-Examination. In 16 questions of the Breast Self-Examination checklist, No procedure has been rated as “Poor” which falls on range score of 1.00-1.80 and there are no procedure rated as “Fair” which falls on the range score of 1.81-2.60, while there are procedure rated as “Good” which falls in the range score of 2.61-3.40,

while there are 11 procedures that has been rated “Very Good” which falls on the range score of 3.41-4.20 and there is only 1 procedure that has been rated “Excellent” which falls on the range score of 4.21-5.00. The total weighted mean is 3.61 and interpreted as “Very Good” in the level of skills.

The finding of this study shows that the respondents have a very good rating in

terms of performing Breast Self-Examination.

Table 4: The Level Of Skills among the respondents

Questions Mean Interpretat

ion

1. Examine your breast during

bath or shower.

3.26 Good

2. Fingers flat, move gently

over part of each breast.

3.76 Very Good

3. Use right hand to examine

left breast, left hand for the

right breast.

4.06 Very Good

4. Check for any lump, hard

knot of thickening.

3.6 Very Good

5. Inspect your breast

with arms at your sides.

3.53 Very Good

6. Raise your arms high

overhead.

4.3 Excellent

7. Look for any changes in

contour of each breast, a

swelling, dimpling of skin or

changes in the nipple.

3.43 Very Good

8. Rest palms on hips and

press down firmly to flex

your chest muscles. Left and

right breast will not, exactly

match.

3.16 Good

9. Regular inspection

shows what is normal for

you and will give you

confidence.

3 Good

10. To examine your right

breast put a pillow of

folded towel under your

right shoulder.

3.23 Good

11. Place right hand behind

your head.

4.13 Very Good

12. With left hand, fingers flat,

press gently in small circular

motion around an imaginary clock

face.

3.66 Very Good

13. Begin at outermost top of

your breast for 12 o’clock, then

move to 1 o’clock, and so on

around the circle back to 12.

3.63 Very Good

14. Then move an inch, toward

nipple, keep circling to examine

every part of your breast,

including nipple. This requires at

least 3 more circles.

3.6 Very Good

15. Now slowly repeat

procedure on your left

breast with pillow under

your left shoulder and left

hand behind head.

3.9 Very Good

16. Finally, squeeze the

nipple of each breast gently

between thumb and index

finger. Any discharge, clear

or should be reported.

3.6 Very Good

Total Mean: 3.61 Very Good

There are factors that might affect the person’s skills like practice that could lead to increase proficiency on the given task. This was stated by Crossman (1959) that practice can lead to performance improvements

He also stated that faced with a new task, a person will have many strategies

that can potentially be used. With practice at the task, they monitor the

outcomes they produce as a result of the various strategies used and also practice

leads to the selection of the most efficient strategy among several.

Steinaker and Bell (1979) stated that conceptualized experiential learning as a sequence of progressive stages: exposure, participation, identification, internalization, and dissemination. Exposure represents a consciousness of the event and anticipation towards involvement in it. Participation is actual involvement in the experience.

Identification occurs when the participant starts to apply earlier-learned experiences and knowledge to the situation. Internalization has occurred when the participant is able to apply learned concepts to other situations. Last, the dissemination stage is achieved when the participant can advise/teach others about the experience and manage their involvement. (http://www.umdnj.edu/idsweb/idst5340/models_skills_acquisition.htm)

Fitts and Posner (1967) stated that the learning process is sequential and that we move through specific phases as we learn. There are three stages to learning a new skill:

Cognitive phase - Identification and development of the component parts of the skill - involves formation of a mental picture of the skill,

Associative phase - Linking the component parts into a smooth action - involves practicing the skill and using feedback to perfect the skill and

Autonomous phase - Developing the learned skill so that it becomes automatic - involves little or no conscious thought or attention whilst performing the skill - not all performers reach this stage.

The learning of physical skills requires the relevant movements to be assembled, component by component, using feedback to shape and polish them into a smooth action. Rehearsal of the skill must be done regularly and correctly.

(FITTS, P.M. and POSNER, M.I. (1967) Human performance. Oxford, England: Brooks and Cole)

There are factors that might affect the person’s skills like practice that could lead to increase proficiency on the given task. This was stated by Crossman (1959) that practice can lead to performance improvements. He also stated that faced with a new task, a person will have many strategies that can potentially be used.

With practice at the task, they monitor the outcomes they produce as a result of

the various strategies used and also practice leads to the selection of the

most efficient strategy among several.

RELATIONSHIP BETWEEN LEVEL OF

KNOWLEDGE AND SKILLS

Table 5 shows the relationship between level of knowledge and skills in performing breast self- examination among 4th year female high school student of Beatriz D. Durano Memorial National High School.

It shows that by obtained value of r is 0.025, utilizing Pearson r product-Moment Correlation, and the critical value of r is 0.3494, the obtained value of r is less than the critical value of r, which means that there is no significant relationship between Level of Knowledge and Skills in Performing Breast Self-Examination among 4th year Female High School Student of Beatriz D. Durano Memorial National High School.

To check if the respondents in the study was enough to determine the significance between Level of Knowledge and Skills in Performing Breast Self-Examination the t test was utilized. The result shows that the obtained t value is 0.132 while the critical t is 2.048.

Since the obtained t value is less than the critical t value, it conveys to the researcher that the respondents are enough and there is no significant relationship between Level of Knowledge and Skills in Performing Breast Self-Examination. The result of the study clearly shows to the researcher that they need to accept the null hypothesis.

Table5: The relationship between level of knowledge and skills in performing Breast Self- Examination

among 4th year female high School Student of Beatriz D. Durano Memorial National High School.

Obtained

r value

Critical r

value

Obtained

t value

Critical t

value

Significance Decision

on Ho

0.025 0.3494 0.132 2.048 No

Significance

Accept

Klausmeier (1971) stated that thinking involves a mental activity which originates with the feeling of perplexity, doubt, or dissatisfaction as the individual perceives something in his environment that is not completely satisfying or meaningful

For the thinking to be productive, rather than aimless daydreaming, there is

focusing on a problem or on perceived elements of environment.

Once the problem is intellectualized, thinking is directed to the solution. After a solution is tentatively accepted, it is tested or evaluated.

The present information and the method one has, his hypothesis about the

solution, and the particular social or other context of the efforts are all related to the testing or evaluating

aspect of thinking.

(General Psychology 4th Edition Custodiosa A.Sanchez, Paz F. Abad,

Loreto V. Jao pg. 155)

In 1989, Ngelangel et al. conducted a knowledge–attitude–practice survey, Fifty percent of women had heard/read about breast examination, only 37% of the women had ever received a breast check-up from a physician

Medical personnel had only ever advised 36% on the importance of BSE and only about 67% knew the benefits of BSE.

Only 37% of the women had ever received a breast check-up from a

physician.

Medical personnel had only ever advised 36% on the importance of BSE and only about 67% knew the benefits of BSE. Only 54% had ever done a

BSE, of whom only 27% are still practicing it.

Reasons given for not doing the BSE included no symptoms, busy, don’t know

how, don’t like, don’t think important, always forget, afraid and not aware.

(http://jjco.oxfordjournals.org/content/32/suppl_1/S52.full)

In a 1997 field trial of breast cancer screening conducted by the DOH–PCCP and IARC–WHO in Metro Manila, there was a large non-compliance rate (79.1%) among women found to have breast masses (2.8% positivity rate) in terms of consulting referral hospitals for re-evaluation and possible treatment.

Reasons such as fear, no money for transport/treatment/medical expenses, indifference, no time, non-awareness of gravity of the disease and spiritual fatalistic attitudes were commonly given, it continues to campaign for monthly BSE and annual physician breast examinations until such time that mammography becomes available and affordable to most of the target population. (http://www.doh.gov.ph/)

The Breast Cancer Control Program (BCCP) of the Philippines refers to the implementation of a nationwide anti-breast cancer scheme: public information and health education, case finding and treatment integrated into the community health structure and equipped to control breast cancer in a systematic sustained manner

Studies have shown a one-third reduction in mortality attributed to

breast cancer screening, mainly due to mammography.

However, the importance of annual clinical breast examination (by nurse, midwife or public health physician) and monthly breast self-examination (BSE) are to be emphasized, taking note that:

(a) sophisticated screening technology (mammography) is not easily available or affordable,

(b) mammography is mainly recommended for women ≥50 years old,

(c) many breast cancers are found among 35–50-year-old Filipino women and

(d) a relatively inexpensive strategy (BSE) involving physicians as examiners or a referral depot would be cheaper and more available than mammography and

physician time. (http://jjco.oxfordjournals.org/content/3

2/suppl_1/S52.full.Prevention)

Bugelski (1986) describes learning as the mental activities by means of which knowledge and skills, habits, attitudes and ideals are acquired, retained, and utilized resulting in the progressive adaptation and modification of behaviour.

It is a process that needs to be stimulated and guided toward desirable

outcomes. (General Psychology 4th Edition Custodiosa A.Sanchez, Paz F.

Abad, Loreto V. Jao)

CHAPTER III

SUMMARY, FINDINGS, CONCLUSIONS AND

RECOMMENDATIONS

This chapter presents the summary, findings, conclusions, and

recommendations of the study. This was done to provide a concise and clear

presentation of the study.

SUMMARY

This study aimed to determine the profile as to the age and civil status of the respondents in Performing Breast Self-Examination among 4th Year High School Students in Beatriz D. Durano Memorial National High School.

Specifically, this study sought to answer the following questions:

1. What is the profile of the respondents in terms of

1.1 Age;

1.2 Civil Status?

2. What is the Level of knowledge and

Skills in Performing Breast Self-Examination among 4th Year Female High School Students?

3. Is there a significant relationship

between the Level of Knowledge and Skills in Performing Breast Self-Examination among 4th Year Female High School Students?

4. What Health Teaching Program in

Breast Self-Examination can be proposed based on the findings of the study?

The study adopted the following hypothetical statements:

Ho: There is no significant relationship between the Level of Knowledge and

Skills in performing Breast Self-Examination among 4th Year High School Students of Beatriz D. Durano Memorial

National High School.

Moreover, this study employed the descriptive research design to determine the relationship between Level of Knowledge and Skills in Performing Breast Self-Examination among 4th Year High School Students utilizing the researcher-made questionnaire of Breast Self-Examination Checklist as the main instrument for data gathering.

There were (30) respondents involved in the study. The study was conducted in Beatriz D. Durano Memorial National High School, P.G Almendras St. Lapu-

Lapu Suba Danao, City.

Two standardized tools were utilized in this study.

Part I was a 10 items researcher made questionnaire that determines the Level of Knowledge in Performing Breast Self-Examination, which answers have corresponding value: 5= Exceptional Understanding; 4= Good Understanding; 3= Moderate Understanding; 2= Basic Understanding; 1= No Understanding.

Part II of the questionnaire is the Breast Self-Examination Checklist to determine the Level of Skills. A 16 items checklist, which ratings have corresponding values 5= Excellent; 4= Very Good; 3= Good; 2= Fair; 1= Poor. There were no numbers that are closer to 1 that would indicate that the respondents got scores closer to 5.

FINDINGS

Among thirty (30) study participants 80 percent ages 15-16 which comprises 24 study participants, 20 percent ages 17-18 which comprises 6 study participants, while there were none for the age range of 19-20. And 100 percent or (30) all of the respondents are single.

The average mean of Level of Knowledge is 2.8 and interpreted as “Moderate

Understanding”, while in the Level of Skills is 3.61 and interpreted as “Very

Good”.

The Level of Knowledge and Skills among the 4th year Female High School Students with an obtained r value of 0.025 and the critical r value was 0.3494, the obtained t value of 0.132 and a critical t value of 2.048 which made the researchers to accept the hypothetical statement of null hypothesis.

This indicates that the computed value is less than the tabular value therefore

the researchers accepted the null hypothesis in which states that there is

no significant relationship between Level of Knowledge and Skills in Performing

Breast Self-Examination.

CONCLUSIONS

In the findings of the study, the researcher here aimed to conclude that:

There is no significant relationship between Level of Knowledge and Skills in Performing Breast Self-Examination among 4th Year Female High School Students of Beatriz D. Durano Memorial National High School.

Therefore, the students’ knowledge does not affect her skills in performing Breast

Self-Examination.

RECOMMENDATIONS

Since the result of the study denotes no significant relationship between Level of Knowledge and Skills in Performing Breast Self-Examination among 4th Year Female High School Students of Beatriz D. Durano Memorial National High School, Year 2013 the researchers would like to propose a Health Teaching Program in Breast Self-Examination.

This Health Teaching Program in Breast Self-Examination consists of information on how to properly perform the Breast

Self-Examination with exact knowledge.

The research study has already reached its scope and limitation, the researchers gathered data regarding Level of Knowledge and Skills in order to formulate the Health Teaching Program in Breast Self-Examination and to evaluate effectiveness of the study.

Further studies recommended by the researchers to the following:

1. The Level of Knowledge, Skills and

Practice in Performing Breast Self Examination.

2. The Knowledge, Attitude and

Practice in Performing Breast Self Examination.

3. The Compliance to regimen in

Breast Cancer Patients.

4. The Effectiveness of Breast Self-

Examination in Detecting Early Signs of Breast Cancer.

5. The Effectiveness of Breast Cancer Control Program of the Philippines.

ACKNOWLEDGMENT

This research would not have been possible without the guidance and the help of several individuals who in one

way or another contributed and extended their valuable assistance in the preparation and the completion of this

study.

First and foremost, to God Almighty, who has generously provided knowledge and heavenly wisdom to the researchers

for further understanding of the research study and for his guidance and blessings he showered upon us all. The researchers brings back the glory and

honor to our God.

To the loving parents and family, of the researchers whose encouragement, supervision, prayers, moral and financial support in formulating the study aided

the researchers in the completion of the study. Without their support, the researchers cannot hurdle all the

obstacles and challenges in the making of this research.

To Mr. Kelly Thomas B. Tadena, RN, MAN, adviser of their research study for his invaluable assistance, comments and

suggestions that helped improve this research and for the motivation and encouragement which enable the

researchers to pursue in making this research.

To Dr. Herminia O. Fernandez, RN, RM, MAN, Dean College of Nursing for her concerns, comments, suggestions and for her approval in conducting this

research.

To Dr. Alberto A. Jumao-as Jr., Vice President for Academics for his

concerns, for the additional knowledge regarding the research topic and approval that made this research

possible.

To Principal Mary Ann Ramos, for allowing the researchers to conduct their research study in Beatriz D.

Durano Memorial National High School without her approval this research

would have not been possible.

To Dr. Don Roel G. Arias, panelist, for his assistance and suggestions which

aided the researchers in the completion of this study.

To Mr. Dennis T. Perez, for his assistance in the statistical treatment

and the completion of this study.

To Mr. Emardy Barbecho, for the support and for helping check the

grammar used in this study.

To the understanding and cooperative Level 4 Female High School

Students of Beatriz D. Durano Memorial National High School, for

their cooperation and honesty in answering the questionnaire which

serves as the data for the success of this study.

To their classmates and friends for the words of encouragement and for making this research study a helpful material that could be used for future

endeavours.