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Nursing
Cancer Self-Screenings: The Attitudes and Knowledge Base of
College Students
Rohit Aula and Codi Rhear
Problem
There has existed a deficit in knowledge about college students’ awareness of and
attitudes toward cancer self-screenings. Specifically, concurrent examination of
college students’ perceptions of each of the gender-specific cancer self-screenings
was not found in the literature.
Purpose
The intent of this study was to determine whether or not college students
have been properly educated on the aspects of need and methodology of cancer
self-screenings. Further, the study sought to assess college students’ adherence to
the performance of cancer self-screenings.
Aims and Significance
The three goals of the study were to assess college students’ level of
knowledge of cancer self-screenings, to determine college students’ adherence to
performance of cancer self-screenings, and to compare the level of awareness and
knowledge base between the two genders.
It was determined that the major contributing factor of cancer self-screening non-performance is a lack of knowledge, regarding the need to perform cancer
self-screenings and the method in which to do so. Also, it is well established that
early detection for any disease process facilitates more positive outcomes. Determining the knowledge level of college students, and any deficiencies therein, will
help guide interventions that further encourage routine cancer self-examinations,
potentially resulting in favorable outcomes.
Literature Review
The purpose of reviewing published literature was to examine existing
knowledge and findings related to cancer self-screenings among college students.
The search yielded no literature that reflected research on cancer self-screenings
among college students that involved both males and females. Though, published
studies were found that separately considered each gender and their specific cancer self-examination.
In Ankara, Turkey, a cross-sectional study performed by Yavan, Akyüz,
Tosun, and İyigün (2010), considered women aging from 17 to 65, to assess their
breast cancer risk perception and attitudes toward screening tests. The rates of the
women who conducted breast self-exam (BSE) regularly was barely over 20 percent, and the reason that accounted for 50.8 percent of women not performing
BSE was, “Do not know how to perform” (p. 199). Ceber, Turk, and Ciceklioglu (2010)
found that an experimental group receiving an educational program on breast cancer was “significantly more likely to feel confident and motivated” (p. 2363).
Rudberg, Nilsson, Wikblad, and Carlsson (2005) determined that there
was a great need for educating men about testicular cancer and how to perform
testicular self-examinations, and that school nurses for middle and high schools
were not providing this information, due to a lack in their own knowledge base.
In another 2005 study, McCullagh, Lewis, and Warlow found that men, who were
provided with information about testicular-self examinations and taught how to
perform them, were more likely to do routine self-screenings.
Parallel examination of male and female college students’ perceptions of
and adherence to each of the gender-specific cancer self-screenings was deemed
to be deficient in existing knowledge, which motivated the construction of this proposed research.
Research Question
How familiar with gender-respective cancer self-screenings are college
students and how well do they adhere to performance?
Theoretical Background
The theoretical background for this study was based upon the Health Belief Model (HBM). The fundamental idea of the HMB centers on the understanding that an individual will be moved to take a health-related action, if that person
deems that a harmful health condition can be prevented by such a preemptive action. (Becker, 1974). The HBM provides a framework that is especially effective when
developing health education strategies, as it focuses on stirring people to action by
using their innate will to avoid unhealthful outcomes. (Becker, 1974).
Extrapolating the principle behind the HBM, individuals will participate in
cancer self-examinations if they consider that screenings will help them avoid unfavorable outcomes, namely undetected malignancies. Accordingly, the initiative
that this study set out to achieve was to determine the level of knowledge individuals, particularly college students, maintain regarding cancer self-examinations, in
order for educational programs to be properly developed.
Design
The study was performed following a quantitative descriptive design using
structured non-disguised questionnaires that explored participants’ knowledge of
their gender-specific cancer self-examinations. Brief questionnaires were provided
in person, having the participants complete the questionnaires in the presence of
the researchers increased the completion rate and generated veracious responses.
Sampling Procedure and Characteristics
The sample used for the study was gathered at LaGrange College Plaza
using convenience sampling, until the target of at least 50 males and 50 females
Rohit Aula and Codi Rhear
was reached. The two fundamental inclusion criteria included: being a LaGrange
College student and being between 17 and 23 years of age, the age-range of traditional college students. The only noteworthy exclusion criterion was being a nursing major, as these individuals would be informed about breast and testicular selfexaminations through their curriculum.
Data Collection Strategies / Instruments
One of the researchers found in the review of literature was contacted regarding the usage of the instrument she featured in her study. Dr. Barbara Powe of
the American Cancer Society was contacted for permission to use the Breast Cancer Perceptions and Knowledge Survey (BCPKS), a 12-item survey instrument with
the response format limited to “agree” or “disagree.” This BCPKS instrument, used
by Powe, Underwood, Canales, and Finnie (2005), focused on “perceptions about
the causes of breast cancer, risk factors, and efficacy of screening and treatment”
(p. 259). The reliability of this tool was validated reflecting a Kuder-Richardson reliability of 0.78. Authorization was given to use Dr. Powe’s BCPKS instrument. For the
males, the researchers constructed an instrument mirroring the BCPKS instrument
to measure an individual’s level of knowledge and familiarity with performing testicular cancer self-screenings, recognizing the inherent limitation of such an instrument’s validity.
Each of these instruments included two initial demographic items addressing age and race. The following 12 questions were formulated to elicit only “agree”
or “disagree” responses. Employing this question format enhanced the brevity of
such a questionnaire, increasing the willingness and compliance of participants.
Consistent with the scoring of the BCKPS, an “agree” response represented a score
of “1” and a “disagree” response earned a score of “0.” High “knowledge scores” indicated that the individuals had a high level of knowledge about cancer self-screenings. Conversely, a low “knowledge score” indicated that individuals had a low level
of knowledge regarding cancer self-screenings. In addition to the demographic
items and the 12 items of the BCKPS and analogous male version, two questions
were included addressing education regarding self-examinations and adherence
to performing screenings.
Ethical Considerations
In order to follow moral code, efforts were taken to ensure that human
rights were protected. Addressing the right of self-determination, participants were
given frank information about the purpose of the study and how the information
they provide would be used, before they consented to take part in the research.
Also, the participants completed the questionnaires without providing their names,
ensuring that all information supplied was confidential. When questionnaires were
distributed, a cover sheet was clearly displayed that provided information about
the study and the researchers, ensured confidentiality, and included the statement:
“Your completion of this questionnaire implies consent to participation in this
study.”
Retrieving and Storing Data
After participants completed the questionnaires, they returned them to
the researchers, in person. The researchers compiled completed questionnaires
and separated them by gender.
Analysis
Data analysis and scoring were performed according to the guidelines established by Dr. Powe. Data were analyzed using percentages, measures of central
tendency, and scoring to derive meaning from the responses provided by the participants.
For each question, total “agree” responses were counted and divided by
the total participants of that gender to calculate a percentage of “agree” responses,
for that particular question. The same procedure was performed for the “disagree”
responses to arrive at a percentage of “disagree” responses, for each question. This
was performed in order to detect common incorrect responses to specific questions, which provided information about knowledge deficiencies regarding certain
subjects. Also, scoring questionnaires in terms of calculating “knowledge scores”
was executed. The sum of each participant’s “knowledge score” was divided by the
total participants for that gender to arrive at a “mean knowledge score” for each
gender.
Regarding teaching, the percentage of males and the percentage of females who had been taught how to perform cancer self-screenings were calculated. The same procedure was performed to calculate percentages of each gender’s
performance of regular self-screenings. Comparisons between the two genders
were made, considering the response percentages, “mean knowledge scores,” percentages of those taught cancer self-screenings, and percentages of those who
regularly perform them.
Lastly, statistical analyses were performed using the IBM SPSS (Statistical
Package for the Social Sciences) to determine if there was a significant difference
between the male and female knowledge scores, as well as if being taught how
to perform BSE or TSE was independent of the incidence of performance. These
analyses were respectively carried out using the Independent-Samples T Test and
Chi-Square Test of Independence functions.
Results
Out of a total possible “knowledge score” of 12, the mean “knowledge
score” for males was 8.3, and the mean “knowledge score” for females was 9.1. An
independent-samples t test comparing the mean knowledge scores of the male
and female groups found a significant difference between the means of the two
groups (t(93) = 2.691, p = 0.008). The mean knowledge score of the female group
was significantly higher (m = 9.10, sd = 1.505) than the mean knowledge score of
the male group (m = 8.30, sd = 1.413).
When asked about teaching and performance, 34.0% of males reported
that they had been taught how to perform testicular self-examinations (TSE) and
Rohit Aula and Codi Rhear
21.3% responded that they actually perform TSE. Approximately, seventy percent
of females reported that they had been taught how to perform breast self-examinations (BSE) and 32.6% responded that they actually perform BSE. The data indicate
that more females than males are familiar with their gender-respective cancer selfscreening and adhere to performance.
It was determined that if more than 45% of the participants incorrectly
answered a statement on the questionnaire, this reflected a significant deficit in
knowledge regarding the subject of that item, thus the statement was deemed a
“significant item.” There were three items from the testicular cancer questionnaire
that met this criterion. There were 78.7% of male participants who incorrectly disagreed to the item, “Being hit in the testicles can cause testicular cancer.” For the
item, “Testicular cancer is most common in older men than younger men,” 61.7%
incorrectly agreed. The last “significant item” for the male participants was worded,
“Men who have had an undescended testicle have a higher risk for testicular cancer,” and 48.9% incorrectly disagreed.
The questionnaire for the female participants revealed two “significant
item” statements. One hundred percent incorrectly disagreed with the statement,
“One of the best ways to find cancer early is by checking the breasts every month
(breast self examination).” The second item that 45.8% incorrectly disagreed with
was worded as follows: “A woman who eats foods high in fat and very little fruits
and vegetables may be more likely to get breast cancer.”
These “significant item” statements provide two insights. The first exposes
where the knowledge deficits exist with gender-specific cancer self-screenings. The
second reveals areas where teaching needs to be improved in cancer education.
A chi-square test of independence was calculated comparing the frequency of responses to the items: “Have you ever been taught how to perform a TSE/BSE” and
“Do you regularly perform TSE/BSE?” A significant interaction was found (χ2(4) =
113.517, p < .05). Individuals were more likely to perform cancer self-examinations
if they had been previously taught.
Limitations
Since no instrument related to knowledge of testicular cancer self-screening was found in the literature, an instrument had to be created by mirroring the
BCPKS to measure an individual’s level of knowledge and familiarity with performing testicular cancer self-screenings. This may have limited the validity of the findings for this portion of the study. The need for testing of these items was recognized.
The third item of the BCPKS, “One of the best ways to find cancer early is by
checking the breasts every month (breast self examination),” was considered to be
potentially misleading. The fact that the questionnaire was designed to determine
women’s knowledge of breast self-examinations could lead the participants to accept this statement as true, when in reality the best method of detecting cancer
early is mammography.
Discussion
The results of this study suggest that a need exists to further educate both
male and female college students on their respective gender-specific cancers and
self-examinations. A related study performed by Powe, Underwood, Canales, and
Finnie (2005) also found that further teaching is indicated regarding breast cancer
and BSE. This study examined the knowledge of college students (including nursing students) using the BCPKS instrument. The mean knowledge score of the 159
participants in this study was calculated to be 7.48 (p. 262). The variation of mean
knowledge scores between the two studies could be attributed to both studies using random samples and varied inclusion criteria.
Implications for Clinical Practice
It was determined that the major contributing factor of cancer self-screening non-performance is a lack of knowledge, regarding the need to perform cancer
self-screenings and the method in which to do so. Also, it is well established that
early detection for any disease process facilitates more positive outcomes. Findings from this study exposed college students’ misconceptions and deficiencies in
knowledge, and will be able to help direct interventions that further encourage
routine cancer self-examinations, resulting in earlier detection and treatment of
gender-specific cancers.
References
Becker, M. H. (1974). The health belief model and personal health behavior. Health Education Mono
graph, 2(4)
Ceber, E., Turk, M., & Ciceklioglu, M. (2010). The effects of an educational program on knowledge of
breast cancer, early detection practices and health beliefs of nurses and midwives. Journal
of Clinical Nursing, 19(15-16), 2363-71.
McCullagh, J., Lewis, G., & Warlow, C. (2005). Promoting awareness and practice of testicular self-examination. Nursing Standard, 19(51), 41-9.
Powe, B. D., Underwood, S., Canales, M., & Finnie, R. (2005). Perceptions about breast cancer among
college students: Implications for nursing education. Journal of Nursing Education, 44 (6),
257-265.
Rudberg, L., Nilsson, S., Wikblad, K., & Carlsson, M. (2005). Barriers identified by Swedish school nurses
in giving information about testicular cancer and testicular self-examination to adolescent
males. The Journal of School Nursing, 21(1), 17-22.
Yavan, T., Akyüz, A., Tosun, N., & İyigün, E. (2010). Women’s breast cancer risk perception and attitudes
toward screening tests. Journal of Psychosocial Oncology, 28(2), 189-201.
Rohit Aula and Codi Rhear
Appendices
Current knowledge about college students’ awareness of and attitudes
toward cancer self-screenings is lacking. The intent of our study is to determine
whether or not college students have been properly educated on the aspects of
need and methodology of cancer self-screenings, and their adherence to perform
them.
Rohit Aula and Codi Rhear