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Effect of Breast Cancer Awareness Education on Breast Self-Examination Practices among Women in Nigeria

Abstract

Breast cancer is an important public health concern among women in Nigeria and may contribute substantially to illness, disability, and premature mortality. Early recognition of breast abnormalities and timely access to appropriate healthcare can improve opportunities for diagnosis and treatment. Breast self-examination is one approach through which women may become more familiar with the normal appearance and feel of their breasts and may notice unusual changes that require professional assessment. However, limited awareness of breast cancer risk factors, warning signs, appropriate breast health practices, and the importance of timely healthcare-seeking may reduce women's engagement in breast self-examination. Breast cancer awareness education provides an opportunity to improve women's knowledge of breast cancer and encourage appropriate breast health practices. Against this background, this study investigates the effect of breast cancer awareness education on breast self-examination practices among women in Nigeria. The study will be anchored on the Health Belief Model, Social Cognitive Theory, and Health Belief and Behavioural Change perspectives. The Health Belief Model explains how women's perceptions of susceptibility to breast cancer, perceived severity, perceived benefits of breast health practices, perceived barriers, self-efficacy, and cues to action may influence breast self-examination practices. Social Cognitive Theory emphasizes observational learning, self-efficacy, behavioural modelling, reinforcement, and environmental influences in shaping women's adoption of breast health practices. Behavioural change perspectives provide an additional framework for understanding how increased awareness, confidence, and perceived personal relevance may translate into preventive health practices. Collectively, these theoretical perspectives provide a suitable framework for explaining how breast cancer awareness education may influence breast self-examination practices among women in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise women aged 18 years and above residing in selected urban, semi-urban, and rural communities across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, communities, households, and eligible women. Breast cancer awareness education will be assessed using indicators such as exposure to educational sessions, frequency and duration of education, knowledge of breast cancer risk factors, warning signs and symptoms, importance of early detection, appropriate breast health practices, awareness of breast self-examination, knowledge of how and when to perform breast self-examination, awareness of clinical breast examination, knowledge of mammography and other screening services where appropriate, and awareness of available healthcare and referral services. Breast self-examination practices will be assessed using indicators such as whether participants perform breast self-examination, frequency of examination, consistency of practice, knowledge and application of appropriate examination techniques, examination of both breasts and relevant surrounding areas, recognition of unusual breast changes, documentation or monitoring of changes where applicable, and timely reporting of suspicious findings to qualified healthcare professionals. Data will be collected using structured questionnaires, breast cancer knowledge assessment tools, breast self-examination practice checklists, demonstration-based assessments, and pre-test and post-test assessments where a quasi-experimental intervention is adopted. Descriptive statistics will be used to summarize participants' demographic and socioeconomic characteristics, breast cancer awareness, previous exposure to health education, and breast self-examination practices. Inferential statistical techniques, including chi-square tests, paired and independent t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of breast cancer awareness education on breast self-examination practices. Where a quasi-experimental design is adopted, breast self-examination practice scores before and after the educational intervention may be compared with those of a comparison group to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that breast cancer awareness education has a significant positive effect on breast self-examination practices among women in Nigeria. Women exposed to structured and practical breast cancer awareness education are expected to demonstrate improved knowledge of breast cancer warning signs and greater engagement in appropriate breast self-examination practices than women without comparable exposure. Education may improve women's confidence in recognizing normal breast characteristics, identifying unusual changes, understanding the appropriate role of breast self-examination, and seeking professional assessment when abnormalities are detected. Demonstrations and practical education may further improve women's ability to perform breast self-examination correctly and consistently. However, fear of breast cancer, embarrassment, cultural beliefs, misinformation, limited access to healthcare services, lack of privacy, low perceived risk, and uncertainty about appropriate screening practices may reduce the effectiveness of education alone. The study therefore expects accessible, culturally appropriate, practical, and sustained breast cancer awareness education, supported by accessible clinical evaluation and referral services, to contribute significantly to improved breast self-examination practices among women in Nigeria. The study is expected to contribute to the literature on breast cancer awareness, breast self-examination, breast cancer prevention, early detection, women's health, reproductive health, health education, cancer screening, health promotion, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, state ministries of health, hospitals, primary healthcare centres, healthcare professionals, cancer-control organizations, women's health organizations, community health workers, development partners, and policymakers regarding strategies for improving breast cancer awareness and early detection. The study will also provide evidence-based recommendations for expanding community-based breast cancer education, strengthening practical breast-health education, improving awareness of breast cancer warning signs, promoting timely healthcare-seeking, strengthening referral systems, and integrating breast cancer awareness into routine women's health and community health programmes across Nigeria.

Keywords: Breast cancer awareness education, breast self-examination practices, women, breast cancer, early detection, cancer prevention, women's health, health education, breast health, health promotion, Nigeria, public health.