The practice of breast self-examination and associated factors among female healthcare professionals working in selected hospitals in Kigali, Rwanda: a cross sectional study | BMC Women’s Health

The present study was conducted to assess the prevalence of BSE and its associated factors among female healthcare professionals working in selected district hospitals in Kigali, Rwanda.

There are four important findings in this study. The first finding was the low level of BSE practice. The second findingwas more than 50% of female healthcare professionals didn’t mention the commonly known risk factors of breast cancer. The third finding revealed that almost half of the participants felt that they are unable to detect breast cancer by themselves. The last finding showed only attitude as a predicator to practice BSE.. Attitude was the only statistically significant predictor for BSE practice.

In this study, less than half of female healthcare professionals, 94 (42.5%) reported ever performing BSE, yet regular performers were only 33.0%. The main reasons for not practicing BSE was fear of being diagnosed with breast cancer followed by lack of technical knowledge to perform BSE. Similar prevalence of regular BSE practice was observed in prior study conducted among female healthcare professionals in Oromia region of Ethiopia, 32.6% [27]. However, the prevalence of BSE practice in this study was lower than previous studies done in Saudi Arabia, Ethiopia, Eritrea, Turkey, Nigeria and Morocco [17, 18, 20, 28,29,30,31,32]. The possible explanations for this difference could be differences in educational level of participants, size and composition of the samples, access to information and possible increased breast cancer awareness campaigns. For example, most of the respondents were holders of bachelor degree and the proportion of doctors was higher in the study done by Heena in Saudi Arabia [17].

The magnitude of breast self-examination practice in this study was higher compared to a study done in North West Ethiopia [22]. The study participants being young and living in relatively rural area might have an impact in the magnitude of BSE practice in Ethiopia.

Moreover, the prevalence of BSE practice in this study was higher compared to the study done among secondary students in Nyarugenge district in Kigali, Rwanda which was less than 24% and a study among women attending health facilities in Kayonza district, Rwanda 28% [33, 34]. This difference is mainly due to differences in the composition and educational level of the participants.

The study has found out that the knowledge level of female healthcare professionals about risk factors of breast cancer was low, with median score of 46.2%. This result is comparable with other similar studies [17, 18]. The main risk factors unknown by the female healthcare professionals were nulliparity, old age at first pregnancy, early menache, and late menopause. Even though it is difficult to control these risk factors, women should be aware of these homone related risk factors in order to teach the general public.

Attitude is a key factor in influencing the health behaviours. Almost half of the participants mentioned that they are unable to detect a breast mass by themselves using BSE. This showed low self-efficacy of the study participants in practing BSE. This might be due to low level of knowledge and inadequate training observed in the study. Self-efficacy is one of the predicator variables to practice BSE [35].

The study found out that there was no statistically significant association between the overall total knowledge score and BSE practice among female healthcare professionals. This finding was in agreement with a prior study conducted among female healthcare professionals in Nigeria [31]. However, knowledge of BSE and BC was significantly associated with BSE practice in studies conducted among healthcare professionals in Ethiopia [19, 27, 36] and Turkey [37]. This finding supports the idea that knowledge doesn’t necessarily change the persons’ health behaviors.

Female doctors had statistically significant higher knowledge level than nurses and other healthcare professionals with median score of 74.3% compared to 62.9% for nurses and 58.6% for other professions. This finding is supported by prior studies conducted in Morocco among healthcare professionals [32]. The knowledge level of female healthcare professionals in this study was much higher than a study done in Saudi Arabia [17]. This might be due to lack of updated courses and focus on BC.

Female healthcare professionals who received training on BSE on either the job or school had higher knowledge score than those without training. However, it is only one quarter of the study participants claimed to attend the training on BSE. This might be due to less focus given in the curriculum of nursing. To go into the cause of low training attendance, further studies with qualitative approach is required.

Holders of Bachelor degree (A0) had statistically significant higher total knowledge score than advance diploma (A1). This is in consistent with a prior study done in Oromia region of Ethiopia [27].

Participants’ attitude towards BSE and BC was significantly associated with BSE practice. This finding was supported by prior studies done in Turkey [38]. However, this is in contrary to the results obtained in studies carried out in Nigeria [32] and Morocco [32] where attitude was not associated with practice.

There was statistically significant differences in the total attitude scores among the different professions. Doctors had a higher attitude score than nurses and other professions with median scores of 86.8, 72.6, and 73.7% respectively. However, the attitude score didn’t differ significantly among the different level of education.

The multivariate analysis has shown that attitude towards BSE and BC as the only significant predictor variable to perform BSE. This finding was supported by prior studies done in Ethiopia [19].

In addition, knowledge and attitude had a positive linear relationship with r = 0.186, p = 0.005.

There were certain limitations in the study. The first was the practice of BSE was assessed by self-reporting by the respondents. This might not provide the actual facts as some respondents might not adequately remember the timing and frequency of practice. The second limitation was that respondents were female healthcare professionals working in the district hospitals, this result may not reflect those working in the health centers and private institutions. Despite this limitation, the study identified important gaps in knowledge and practice of BSE among healthcare professionals in Kigali, Rwanda.