Faculty of Education and Languages

NBHS 1203

.Nursing Research and Statistics

Name:R.D.S.D.Y.GUNARATHNA.

Rg no: OUM17108

Email: [email protected]

0716461216

Tutor’s name: Mr. Sameera Liyanaarachchi

Learning center: IIHS, Walisara, Sri Lanka

 RESEARCH PROPOSAL

KNOWLEDGE, ATTITUDE AND PRACTICE REGARDING SELF BREAST EXAMINATION

AMONG WOMEN OF IBBAGAMUWA MOH AREA.

“Across- sectional Descriptive Study”

By R.D.S.D.Y. GUNARATHNA

OUM 17108

0716461216

[email protected]

Bachelor (Hons) Nursing Science

International Institute of Health Sciences-Learning Center for OUM

Supervisor: Mr. Sameera Liyanaarachchi.

2018 Semester.

1
Contents
Chapter 1:....................................................................................................................................................4
Introduction.............................................................................................................................................4
1.1 Background....................................................................................................................................4
1.2 Justification....................................................................................................................................7
1.3 problem statement........................................................................................................................8
1.4 Research question.........................................................................................................................9
1.6 Objectives....................................................................................................................................10
Chapter 2:..................................................................................................................................................11
Literature review...................................................................................................................................11
Chapter 3...................................................................................................................................................15
Methodology.........................................................................................................................................15
3.1 Study design................................................................................................................................15
3.2 Study population.........................................................................................................................15
3.3 Sample size..................................................................................................................................15
3.4 Study setting...............................................................................................................................15
3.5 Sampling technique....................................................................................................................15
3.6 Sampling criteria.........................................................................................................................16
3.6. Ethical consideration..................................................................................................................17
Chapter 4.....................................................................................................................................................1
4.1. Work Schedule..................................................................................................................................1
4.2. Budget for Survey.............................................................................................................................1
Chapter 5:....................................................................................................................................................2
References...................................................................................................................................................2
Chapter 6 Annexure :..................................................................................................................................3
6.1 Questioner.........................................................................................................................................3
6.2 Ethical clearance Letter 1...................................................................................................................8
6.3 Ethical clearance Letter 2...................................................................................................................9

2
Chapter 1:

Introduction

1.1 Background

Breast self-examination (BSE) is a simple, very cost effective, non-invasive detection means
used to detect breast cancer at early stage. It should be done for all women older than 35
years. Cancer is a major public health problem in many parts of the world. Breast cancer is a
malignant tumor that starts from the cells of the breast. It occurs mostly in women, but
sometimes men can also be affected.[ CITATION Ari15 \l 1033 ]
An evaluated 231,840 new cases and 40,290 deaths of breast cancer are expected to occur
among women in the US during 2015. In 2013, an estimated 232,340 new cases and 39,620
deaths from breast cancer are expected to occur in women. Breast cancer is one of the most
commonly diagnosed cancers around the globe, which accounts for 1.7 million (11.9%) in
2012, and there were 6.3 million women alive who had been diagnosed with breast cancer in
the past 5 years. many women miss early detection and treatment opportunities due to lack of
information and knowledge of early detection of breast cancer.[ CITATION Des18 \l 1033 ]
The detection and treatment of reproductive organ cancers (ROCs), particularly breast cancer,
is low. Inspite of its prevalence, ROCs are not managed as a major public health problem at
any levels of health care delivery system. Nationwide, there is no organized ROC prevention,
education, screening, or curative care program. A Little is known about the scale of the
problem, which makes it all the more difficult to formulate policies and/or develop practical
strategies for dealing with it. Sri Lanka has a free public health care system, although private
health systems which run parallel make a substantial contribution. The burden of cancer care
rests almost exclusively with the public sector due to high cost of cancer care which is
beyond the affordability of most average Sri Lankans . Hence, studying the incidence patterns
of breast cancer is important for the government to make policy decisions on allocating funds
and other resources for early detection and treatment of breast cancer.[ CITATION Inf \l
1033 ]

Generally, there has been a steady increase in the incidence of breast cancer over the study
period, although a slight drop in the incidence is observed in 2007 . This is likely to be due to
a change in criteria adopted by the NCCP for cases to be included in the cancer registry. Prior

3
to 2007 all invasive as well as in-situ neoplasms (ductal and lobular carcinoma in-situ) were
included in the registry, while from 2007 onwards only invasive neoplasms are included.
Exclusion of in-situ cancers post-2007 may have contributed to an underestimation of the
actual increase in breast cancer incidence.

The observed increase in incidence is likely to be due to many factors which include
improvement of the coverage of the national cancer data, increase in diagnosis due to breast
cancer screening and a true increase in the incidence.[ CITATION Kus17 \l 1033 ]

Since breast cancer is serious, an important factor in the prognosis of breast cancer is early
detection of the disease. Breast self-examination (BSE) is one of the simple, quick, and cost-
free procedures for early detection of breast cancer among women. In developing countries,
breast self-examination is the recommended method because it is easy, convenient, private,
safe and doesn’t require equipment. Several studies proposed it because there is a difference
among women who practice BSE and those not.[ CITATION Kus17 \l 1033 ]

This study is important in providing information toward BSE practice among female. Better
documenting BSE practice would be useful to governmental and non-governmental
organization in the design of implementations aimed at effective prevention of breast cancer,
and it may also prompt other researchers and policy makers to carry out a huge extensive
research in this particular area being as baseline data. This study is also considered vital
because BSE can be a simple means through which early detection of a breast disease could
be made. Assessing BSE practice will be helpful over scarce diagnostic service.

Many developing countries including Sri Lanka does not have a national breast cancer
screening program. This probably is one reason for the higher proportion of advanced breast
cancers at diagnosis observed in Sri Lanka, compared with developed countries. On the other
hand, lack of a national screening program has likely contributed to the lower breast cancer
incidence in Sri Lanka compared with the developed countries.[ CITATION Muk18 \l 1033 ]

Since 1985, Sri Lanka National Cancer Control Program (NCCP) has been collecting
nationwide cancer data. Over this period, the coverage has moderately increased, and as of
2014 it is estimated to include over 80% of all cancers diagnosed in the country . NCCP data
include all cancers treated at national cancer treatment centres and data from other major
private and government hospitals, and pathology laboratories. As adjuvant treatments in the

4
public sector are instituted almost exclusively through national cancer treatment centres, the
overall coverage for breast cancer is likely to be greater than 80%.

Over the decades, there has been some debate over just how valuable breast self-examination
is in detecting breast cancer early and increasing the likelihood of survival. For example, a
2008 study of nearly 400,000 women in Russia and China reported that breast self-
examination does not have a meaningful impact on breast cancer survival rates and may even
cause harm by prompting unnecessary biopsies (removal and examination of suspicious
tissue). Because of the ongoing uncertainty raised by this and other studies, the American
Cancer Society no longer recommends breast self-exam as a screening tool for women with
an average risk of breast cancer.[ CITATION sal19 \l 1033 ]

Breastcancer.org still believes that breast self-examination is a useful and important screening
tool, especially when used in combination with regular physical exams by a physician,
mammography, and in some cases ultrasound and/or MRI. Each of these screening tools
works in a different way and has strengths and weaknesses. Breast self-exam is a convenient,
no-cost tool that you can use on a regular basis and at any age.

Breast self -examination is a kind of examination made by each woman and it is cost
effective, painless, easy to apply, safe, and non invasive procedures without special material
or tool requirements. It is an important noticing way of breast cancer which takes five
minutes to apply . Breast cancer awareness improves the outcome of breast cancer treatment

Breast self- examination is useful for women’s awareness of warning signs and symptoms of
breast cancer like redness of the breast skin, changes in the size of the breast or nipple, a
breast lump, pain in the breast or armpit, lump under the armpit, nipple rash, changes in the
shape of the breast or nipple, bleeding or discharge from the nipple, pulling of the nipple,
dimpling of the breast skin and changes in the position of the nipple.

Breast self -examination is also important to increase breast health awareness which helps to
allow for timely detection of anomalies for those who do not have access to health facility
and advanced laboratory investigations for diagnosing breast cancer.

It is known that clinical breast examination, Mammography, Ultrasound and Magnetic

resonance imaging are breast cancer screening methods and Mammography, Ultrasound and

5
magnetic resonance imaging methods of breast cancer screening are not available in study
area. Using mammography instead of magnetic resonance imaging did not significantly
increase screening sensitivity. The sensitivity of magnetic resonance imaging method of
screening of breast cancer was higher than mammography and ultrasound.

Early identification of breast cancer through breast self -examination and diagnosis plays an
important role in reducing its morbidity and mortality. But most of women do not perform
breast self- examination in low income countries because of lack of awareness and lack of
knowledge of breast self- examination.

The incidence of breast cancer has been increasing in different regions of the world. The
expected incidence rate of breast cancer is similar in different countries. However, breast
cancer mortality rate is much higher in low income countries than well developed countries
due to lack of early screening methods and treatment of breast cancer.

Worldwide, breast cancer is the second common cancer next to lung cancer and the fifth
cause of cancer mortality. The incidence rate of breast cancer in North Africa and Sub-
Saharan Africa (SSA) was 29.3 per 100000 and 22.4 per 100000 respectively. This incidence
rate also indicated that breast cancer was increased between 2000 to 2015. According to
breast cancer estimate in 2018, about 626,679 of women died from breast cancer in the world
which accounted a crude mortality rate of 13 per 100.000 women ].[ CITATION Muk18 \l
1033 ]

About 10,000 Ethiopian women have already faced breast cancer and thousands of more
patients are unreported as most women living in rural areas seek treatment from traditional
healers before getting support from health facility.

Female health facility workers should be role model and they should educate the community
to create awareness of early detection of signs and symptoms of breast cancer using breast
self- examination. But health workers have not considered breast self- examination as a
support for standard breast cancer screening method. Moreover, they had low practice of
breast self examination.

The findings of this study would be useful for better documentation of practice of breast self
-examination of females working in public health facilities to design interventions aimed at

6
reducing breast cancer mortality through increasing community awareness and improving
early diagnosis and treatment of the disease.

1.2 Justification

Breast cancer is curable if it is detected early. Improvements in early detection and

treatment of the breast cancer have leaded a growing number of survivors. Outcomes for
breast cancer vary depending on the cancer type, extent of disease, and person's age. Survival
rates in the developed world are high. If government and nongovernmental organization and
institute establish many cancers controlling programs, breast cancer still considered a major
health problem among female in the developing counties.[ CITATION Egg17 \l 1033 ]

The maintenance of all rounded health and quality of life are major concerns since side
effects of cancer treatment may arise and can result in significant long term physical and
psychological disabilities.

Breast Cancer is the commonest cancer among women in the world. Women play many
roles in the society. women is an important person in the society. In the family, she protects
her family members and she do things more for the home setup. Breast cancer can lead to
many social issues.

Recent studies have shown a general lack of knowledge and awareness regarding breast
cancer risk and risk education. Previous studies have also indicated that people knowledge
and education were shown to be correlated with risk of developing the condition. Breast
cancer is the most common cancer among females, and represents a major global health
problem. Almost 70% of women with breast cancer are aged over 50 years, and only 5% are
younger than 40 years old. Approximately 700,000 cases are reported annually worldwide, of
which 57% of these cases present in developing countries. The global incidence of breast
cancer is rising, particularly in developing countries that formerly had a low incidence. the
incidence of breast cancer is increasing in the developing world due to increased life

7
expectancy, increased levels of urbanization and the adoption of western lifestyles.
According to a recent report by the World Health Organization, the largest increase in cancer
incidence over the next 15 years will be in Middle Eastern countries. The mortality rate from
all types of cancer in the Middle East is currently 70%, compared to 40-55% in western
countries. Furthermore, by the year 2020, the number of new cancer cases diagnosed each
year is estimated to increase by 40%. Urgent interventions are, therefore, needed to raise vast
awareness of all cancers in this region in order to improve the rates of early detection and
increase the chance of curative treatment.[ CITATION Des18 \l 1033 ]

Studies led to a dramatic change in how breast cancer is defined and now treated. Back in the
1980s it was assumed that all breast cancers were the same.  But laboratory studies began to
indicate that breast cancer was not a single disease. Researchers found that there were sub-
types of breast cancers that could be identified by their differing expression levels of genes
("molecular profiling"). This became important because identifying the sub-type of breast
cancer can be used to predict how a patient will respond to a particular treatment. This
finding drastically changed how breast cancer is treated. Instead of assuming a larger tumor
will be more likely to metastasize and treating bigger tumors more aggressively, it is now
recognized that the different types of breast cancer need to be treated with different therapies.

There are many cancer care associations in Sri Lanka. Such as Cancer care association,
National cancer care program. The main objectives are of the campaigns are: Encourage all
women over 30 years to screen themselves for Breast Cancer immediately.
Create awareness of symptoms in order for women to take immediate remedial action.
Raise funds to purchase mobile mammography machines for rural Sri Lanka.

Breast cancer is the second leading cause of cancer deaths in women today and is the most
common cancer among women. .Breast cancer is the most common cancer among Malaysian
women. There is a marked geographical difference in the worldwide incidence of breast
cancer, with a higher incidence in developed countries compared to developing countries.

According to Malaysia cancer statistic (data and figure – 2006) found that the incidence of
breast cancer case according to age between 0-9 years is 1 case, for to age 10-19 years – 6

8
cases and 20-29 years is 78 cases. It is show increase in cases and it happening to all groups.
Because of that, it is very important for someone to detect early sign and symptom of breast
cancer. All groups should know how 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.

Breast self-examination (BSE) is a low-cost, low risk procedure that can be repeated at
frequent intervals, and has been advocated as a self-performed screening procedure.

Breast cancer is easier to threat the earlier it is found. There is evidence that women who
correctly practice Breast Self Examination (BSE) monthly can detect a lump in the early
stage of its development, and early stage of its development, and early diagnosis has been
reported to influence early treatment and to yield a better survival rate. Unfortunately ,
despite the benefit of regular BSE ,a few women actually examine themselves , in fact ,
majority does not even know how to do BSE and opinion conflict about the value of BSE
men who correctly practice Breast Self Examination (BSE) monthly.[ CITATION sal19 \l
1033 ]

Breast self-examination is simple screening method for the detection of early breast cancer in
women. Its purpose is important in case of a prompt reporting of breast symptoms which are
important early detection messages for women of all ages, and to make women familiar with
both the appearance and the feel of their breasts as early as possible. There is evidence that
women who correctly practice Breast self- examination monthly are more likely to detect a
lump in the early stage of its development, and early diagnosis has been reported to influence
early treatment and to yield a better survival rate.

9
1.6 Objectives

General objective

The study aimed to assess the level of BSE knowledge, attitude, and practice among women
in selected MOH area.

Specific objectives

1. To assess women’s level of knowledge on breast examination

2. To assess practices and problems of women regarding breast examination
3. To assess attitude regarding breast cancer, and early diagnosis.

10
Chapter 2:

Literature review

A research about Breast Self-Examination and breast cancer awareness in women in

developing countries: a survey of women in Buea, Cameroon done by Mary Atanga Bi Suh,
Julius AtashiliEmail author, Eunice Asoh Fuh and Vivian Ayamba Eta,A cross-sectional
survey was conducted in a volunteer sample of 120 consenting women in Buea, Cameroon.
Data were collected using a structured questionnaire self-administered by study participants.
A descriptive cross sectional study has conducted in Buae. The population is primarily served by
the Buea Regional Hospital, an intermediate level health facility which has a radiology department as
well as a radiologist but no mammography equipment or any system for systematically screening
women for breast cancer. There is no oncologist and women diagnosed with breast cancer need to
be referred to Douala or Yaounde which are respectively approximately 35 and 160 miles from Buea.
Findings was indicated that the practice of BSE while perceived as being important is not frequently
practiced in these women in Buea, Cameroon. Considering the substantial role that can be played by
BSE in such settings with limited prevention methods (mammography is unavailable) combined with
the high burden of breast cancer, these findings suggest an urgent need for interventions to
implement and re-enforce existing cancer awareness and cancer screening programs. Health
education campaigns will be needed to elucidate the public on the causes, risk factors and
prevention of breast cancer. These education and information sessions would also need to dispel
myths such as that witchcraft playing a role in the genesis of breast cancer while also inculcating the
substantial role of genetics and unknown factors. Further studies need to explore what interventions
could be best used to improve the uptake and practice of BSE and other methods for early breast
cancer detection.[ CITATION Des18 \l 1033 ]

Mehregan Hahi Mahmoodi conducted a cross-sectional study on female health care workers
in Tehran, Iran to examine the knowledge of breast cancer, and the attitude and practice
towards BSE. In the study finding, 75% of the women knew about the prevalence of breast
cancer 27% knew that breast pain is not a symptom of breast cancer. Regarding attitude
toward BSE, 63% believed that BSE is not difficult and 72% agreed that BSE is time
consuming or troublesome. Only 6% of the women performed BSE monthly on a regular
basis. 50% performed occasionally and 44% never practiced BSE. The researcher also found

11
that women more than 50 years of age, with higher education and professional status, positive
personal history about breast problems and those who had more knowledge about BSE were
more likely to practice BSE than other female health worker.[ CITATION Egg17 \l 1033 ]
A research about knowledge and attitudes of breast self-examination and mammography in a
group of women in a rural area in western Turkey was done by Pınar Erbay Dündar, Dilek
Özmen,Beyhan Öztürk,Gökçe Haspolat, Filiz Akyıldız, Sümeyra Çoban, and Gamze
Çakıroğlu. Breast cancer appears to be a disease of both the developing and developed
worlds. Among Turkish women, breast cancer is the second leading cause of cancer-related
deaths. The aims of this cross-sectional study were to determine levels of knowledge about
breast cancer and to evaluate health beliefs concerning the model that promotes breast self-
examination (BSE) and mammography in a group of women aged 20–64 in a rustic area of
western Turkey. 244 women were recruited by means of cluster sampling in this study. The
questionnaire consisted of sociodemographic variables, a risk factors and signs of breast
cancer form and the adapted version of Champion's Health Belief Model Scale (CHBMS).
Bivariate correlation analysis, Chi square test, Mann-Whitney U test and logistic regression
analysis were performed throughout the data analysis. In this cross-sectional study, the data
was collected from the rural area of Manisa, a city located in the western region of Turkey.
The total study population consisted of 1,829 women aged between 20–64 years living in the
Muradiye Health District in Manisa. The aim of the study was to reach at least 236 women
with a 99.9% confidence level and 0.50 prevalence by using the Epi info 2000 statistical
software. Cluster sampling method was performed proportional to the percentage of the three
neighbourhood populations in Muradiye District. A total of 24 clusters were selected. It was
decided that each cluster would consist of 10 houses and the first house of the cluster was
selected randomly. After the first initially selected house, every subsequent forth house was
selected (i.e 1st, 5th, 9th etc). For the women who were absent, the visits were repeated once.
And if they weren't found on these second visits either, the neighbouring house was included
in the study. As a result, 244 women were interviewed. When the visits were made to the
selected houses, it was found that, in some houses, more than one female occupant aged 20–
64 (daughters, mother-in-laws, aunts etc.) resided at the given address. The response rate of
the study surpassed 100%, since all of the women aged 20–64 living in the selected houses
were incorporated in the study. Although the advancement in age is a risk factor in breast
cancer, women over 65 were not included in this study, due to a perceived risk of inadequate
perception. Four trained intern doctors from the medical faculty collected the data in face-to-
face interviews between January and February 2005. They made clear the confidentiality,
12
benefits, risks, and future implications of the research. Data was then collected from those
who verbally consented to participate. The study was ethically approved by the Manisa
Province Health Directorate.According to the women's responses 23.4% of them had no
knowledge about breast cancer, 27.9% had no concept of BSE, 89.3% had never had a
mammography and 75.0% had never had CBE. 27.9% of the women participants, expressed
no previous knowledge of mammography. Only 5.1% of them, had had an annual
mammography or over a two year period .Although 72.1% of the participants reported having
a knowledge of BSE, only 40.9% of the women in the practiced group ever indicated having
practiced BSE in the previous 12 months. In this BSE practice group, while 29.5% stated they
had examined themselves irregularly, only 10.2% stated that they performed BSE on a
regular monthly basis. A total of 59.1% of the participants indicated they had never
performed BSE. 10.6% of the study group stated that they had had mammography tests and
25.0% had CBE.[ CITATION Egg17 \l 1033 ]

A majority of the sample (76.6%) reported that they had heard or read about breast cancer,
but only 56.1% of them had sufficient knowledge of it. TV/ radio programs were identified as
the main source of information on breast cancer by 39.3% of the participants. Health
professionals were mentioned as a source of information by 23.4% of the sample.

13
Chapter 3

Methodology

3.1Studydesign
Descriptive cross-sectional study.

3.2 Study population

The population of the present study comprised women of are participating well women clinic
in Ibbagamuwa MOH area.

3.3 Sample size

Sample size for this study will be 100 women..

3.4 Study setting

The study was conducted among the randomly selected women, over 35 years who are
participating suwanari clinic in MOH.

3.5 Sampling technique

The present study aimed to assess the knowledge,attitude and practices of self breast
examination.

14
3.6 Sampling criteria

a. Inclusion criteria
1. The study subjects will be included in the study only from MOH, Ibbagamuwa
2. The study subject will be those who are in over 35 years
3. The study subject will be only female
4. The study subjects will be those who are willing to participate in the study.

b. Exclusion criteria
1. The study subject who are not willing to participate in the study..
2. Women who are in other MOH.

Data Analysis

All data coded, entered and analyzed by using SPSS 20 version.

15
3.6. Ethical consideration

The approval for the proposal was granted by the Ethical Review Committee,

Ethical clearance and approval to conduct this research will be obtained from the Research
Ethics International Institute of Health Science (IIHS), Welisara, Sri Lanka. And the
permission was obtained from the Director of the National Hospital Sri Lanka. The informed
consent had been obtained from each participant about the purpose of this study. Privacy,
confidentiality and anonymity of the subjects were ensured during data collection. Collected
data was processed and saved with password on personal computer. The processing and
analysis were carried out only by the investigators and used only for the above study. Saved
data in the personal computer also deleted.

16
 Work Schedule

Month November November December

Decembe
r
Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Finalize the
research
proposal and
literature
review

Ethical clearance

Pre-test

Data collection

Data entry and

preliminary data analysis

Data analysis

Report finalization
 4.2. Budget for Survey
Budget for survey

Activities Number of Per day Total price

days (Rs)
(Rs)

Transport 10 100 1000

Stationery and Materials

Materials Quantity Unit price (Rs) Total

price (Rs)

Pens 100 10 1000

Papers 500 4 2000

Data card (internet 20 100 2000

usage)

Print out 500 10 5000

Photocopies 500 4 1000

Total 11500

Item Price

Budget for survey Rs:1000

Budget for stationery and materials Rs:11500

Total Rs:12500

2
Chapter 5:

References
Ariyaratne, M. e. (2015, 7 14). Knowledge, Attitudes and Practices of Hand Hygiene among Final Year
Medical and Nursing Students at the University of Sri Jayewardenepura. Retrieved from
Scholar bank: http://dr.lib.sjp.ac.lk

Desta M, A. T. (2018). Knowledge, practice and associated factors of infection prevention among
healthcare workers in Debre Markos referral hospital, Northwest Ethiopia . BMC Health
services research, 1-10.

Eggimann, P. P. (2017, may 19). Infection control in ICU. Retrieved from research gate:
https://www.researchgate.net

Infection control. (2019, july 27). Retrieved from wikipedia: https://en.wikipedia.org

Jain, M. D. (2012, february 13). Infection control practices among doctors and nurses in a tertiary
care hospital. Retrieved from Annals of tropical medicine and public health:
http://www.atmph.org

Jayathikala, K. (2017). Infection prevention and control in Sri Lankan hospitals in relation to WHO
guidline. Sri Lankan Journal of Infectious Diseases, 2-9.

Mukhopadhyay C. (2018). Infection control in intensive care units. indian journal of respiratory care,
14-21.

Nofal M, e. a. (2017). Factors influencing compliance to the infection control precautions among
nurses and physicians in Jordan: A cross-sectional study. Journal of infection prevention, 182-
188.

Saleem O. (2019). Knowledge and Practices of Nurses in Infection Prevention and Control within a
Tertiary Care Hospital. Retrieved from Annel of medical and health science research:
https://www.amhsr.org

Shah, N. a. (n.d.). Towards changing healthcare workers' behaviour: a qualitative study exploring
non-compliance through appraisals of infection prevention and control practices. Journal of
hosptal infection.

Shah, N. e. (2015). Towards changing healthcare workers’ behaviour: aqualitative study exploring
non-compliance throughappraisals of infection prevention and control practice. Journal of
Hospital Infection, 126-134.

Sodi, K. S. (2013, august 6). Knowledge of infection control practices among intensive care nurses in a
tertiary care hospital. Retrieved from pub med: https://www.ncbi.nlm.nih.gov

Yassi A, e. a. (2017). Determinants of Healthcare Workers’ Compliance with Infection Control

Procedures. pubmed, 44-52.

3
Chapter 6 Annexure :
6.1 Questioner

Please put your answers in box using (√) mark

Demographic data

1. Age
a. 35-40
b. 41-50
c. 51-60
d. Above 60

2. Level of education

a. Up to grade 08
b. Up to O/L
c. Up to A/L
d. Diploma/Bachelor

2. Have you a family history of breast cancer ( to mother, father or blood relationship )
a. Yes
b. No

3.Mariatal status

Single

Married

4
 Divorced

Widowed

6.How long have you participate wellwomen clinic

Less than 1 year

1-5 year

6-10 year

More than 10 years

5. Can you confidently do a complete self breast examination (SBE) on your own?
I. Yes, I know all the steps of SBE
II. No adequate knowledge
III. No idea
6. how often do you examine

I. Monthly
II. Within 1-3 month
III. Not frequent

5
Section 2

2. Attitudes

Statement Strongly Agree Uncertain Disagree Strongly

Agree disagree
BSE will be embarrassing to me

Doing BSE is wasting time

Doing BSE makes me feel

unpleasant
If there is lump, I prefer to get
treatment from a traditional healer

Feel uncomfortable, can't do BSE

once in a month

All women should do BSE

I really care about my breasts

Avoid BSE because I worry about

having breast cancer

I'm not afraid to think about the

breast cancer
Always search for information
regarding BSE from the internet,
magazine, and newspaper

2.Practices
 Never Sometime Often Usuall Alway
s y s
Do BSE once a month

learning the correct method of BSE

. Discuss the importance of BSE with

friends
. Have been taught on BSE by health staff

If notice any breast abnormality, directly

go to public health care

Comments…………………………………………………………………………………………………
………………………………………………………………………………………………………………
………………………………………………………………………

Date of data completion :( DD/MM/YYYY) …………….../………. /……………

Signature of Data Collector: …………………………………………………

2
INFORMATION SHEET

I am R.D.S.D.Y. Gunarathna, working as a nursing officer at Lady Ridgeway Hospital for

children. I would like to invite you to take part in the research titled regarding“. Knowledge,
attitude and practices regarding self breast examination of women in Ibbagamuwa MOH area

1. Your participation in this study is voluntary. You are free to not to participate at all or to
withdraw from the study at any time. There will be no loss of your work or personality or
position to which you are otherwise entitled. If you decide not to participate or withdraw
from the study you may do so at any time.

2. The gathering of data would be done through a questionnaire without any discomfort to
you. There are no actual or potential risks involved.

3. Confidentiality of all records is guaranteed and no information by which you can be

identified will be released or published. These data will never be used in such a way that you
could be identified in any way in any public presentation or public action without your
expressed permission.

4. You may withdraw your consent to participate in this study at any time with no effect
position or loss of benefits. Please notify it to the investigator as soon as you decide to
withdraw your consent.

5. If you have questions about any of the information please feel free to ask.

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 CONSENT FORM

To find out the : “. Knowledge, attitude and practices regarding self breast examination of
women in Ibbagamuwa MOH area

To be completed by participant. (Please complete the whole sheet by yourself).

1. Have you read the information sheet?

Yes / No

2. Have you had satisfactory answers to your entire question?

Yes / No

3. Have you received enough information about the study?

Yes / No

4. Have you had an opportunity to discuss this study and ask any question?

Yes / No

5. Do you understand that you are free to withdraw from the study at any time without
having to give reasons and without affecting your future?

6. Yes / No All personal details will be treated as strictly confidential. Do you give your
permission for these individual to have access to your records?

Yes / No

7. Have you had sufficient time to come to your decision?

Yes / No

8. Do you agree to take part in this study?

Yes / No

9. Who explained the study to you?

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 Participants’ signature: ------------------------------------- Date: -----------------------

Name----------------------------------------------------------------------------------------------

To be completed by the investigator

I have explained the study to the above volunteer and she / he has indicated her / his
willingness to take part.

Signature of investigator: ---------------------------------------------Date: ---------------------------

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6.2 Ethical clearance Letter 1

ETHICAL AND ADMINISTRATIVE CLEARANCE

Chairperson,

Ethical review committee,

International Institute of health science,

No 704, Negombo Road,

Welisara,

Sri Lanka.

10/08/2019

Dear Sir,

REQUESTING ETHICAL CLEARANCE

I am R.D.S.D.Y. Gunarathna, a nursing student at IIHS, I am hoping to conduct a research

on, Knowledge, attitude and practices on self breast examination of women in Ibbagamuwa
MOH area, part of an academic requirement.

I would be grateful if you could review my proposal (herewith) in view of granting ethical
clearance for the study. There are no significant ethical issues and all participants include in
the study are voluntary and have consented to it. All information disclosed will be private and
confidential with hundred percent anonymity.

Thank you!

Your faithfully,

R D S D Y Gunarathna.

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6.3 Ethical clearance Letter 2

Medical Officer,

MOH,

Ibbagamuwa,

01/06/2020.

REQUEST FOR PERMISSION TO CONDUCT RESEARCH IN MOH

IBBAGAMUWA, SRI LANKA

Dear Dr.

I am R D S D Y Gunarathna student of International Institute of Health Sciences (IIHS) in

Welisara. The research I wish to conduct for my Bachelor of nursing Study, “Knowledge,
attitude and practices on self breast examination of women in Ibbagamuwa MOH in Sri
Lanka “involves under the supervision of Mr. Sameera Liyannaarachchi., part of an academic
requirement.

I am hereby seeking your consent to my study.

I have provided you with a copy of my research questioner which includes copies of the
measure and consent and assent forms to be used in the research process, as well as a copy of
the approval letter which I received from the IIHS. If you require any further information,
please do not hesitate to contact me on (0716461216, [email protected]).
Thank you, time and consideration, in this matter.

Thank you!

Yours sincerely,

R D S D Y Gunarathna

International Institute of Health Science.

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