Determinants of self-breast examination practice among women attending family planning clinic at chuka level 5 hospital, Kenya

Abstract

Breast cancer remains a significant global public health issue. In 2022, globally, there were approximately 20 million new cases of cancer and 9.7 million cancer-related deaths, with female breast cancer ranking second in incidence. Breast cancer is a growing public health issue in sub-Saharan Africa. In Kenya, it is the most common cancer among women, accounting for about a quarter of all female cancer cases. However, due to limited access to screening, low awareness, and frequent misdiagnosis, many cases are detected at advanced stages. Self-breast examination (SBE) is a simple, cost-effective method to promote early detection, yet its uptake remains low in many Kenyan regions. This analytical cross-sectional study aimed to identify factors influencing SBE practice among women attending the family planning clinic at Chuka Level 5 Hospital. A total of 129 women were selected using systematic random sampling, while healthcare providers were selected through convenience sampling. Data was collected using a researcher-administered questionnaire for the women and interview guides for key informants. A pre-test was conducted at Embu Level 5 Hospital to ensure validity and reliability of the tools. Quantitative data was analyzed using SPSS v29. Descriptive statistics were used to describe the characteristic of study participants. Chi-square tests, and regression analysis were used to determine the predictors of SBE (p < 0.05). Qualitative data from healthcare providers was analyzed thematically. Ethical approval was obtained from Chuka University ethical review committee and research permit was obtained NACOSTI. Study participants signed an informed consent and confidentiality was maintained throughout the study. The mean age of the women was 26.03 years, majority lived in rural areas (54.3%, n = 69) and identified as Catholics ((47.2%, n= 60). Over half had tertiary education (55.9%, n=71), and majority were in formal employment (27.6%, n=35). Among six healthcare providers (HCPs), the average age was 41.17 years and most were nurses (50%, n=3). They had an average of 12.5 years of experience and majority held diploma or degree qualifications (33.3%, n=2). SBE was practiced by 66.1% (n=84) of the women, though only 52.4% did so monthly, and less than half (47.6%) performed it at the recommended time after menstruation. Some of the barriers to regular practice included lack of knowledge, forgetfulness, and fear of detecting a lump. Participants with tertiary education were 0.247 less likely to perform SBE as compared to those with primary education (AOR= 0.247, 95% CI 0.101 – 0.608, p = 0.002). In addition, farmers were significantly 4.48 times more likely to perform SBE as compared to those in formal employment ((AOR = 4.48, 95% CI 1.31 – 15.29, p=0.017). While most participants (92.9%) had heard of SBE, only 67.7% had received practical instruction. Majority of the participants, (38.6%) had good knowledge level. Participants with primary education were significantly about 6 times more likely to have poor knowledge level; AOR = 5.635, 95% CI; 0.945 – 33.584, p = 0.038. On cultural factors, most participants rejected religious or cultural discouragement of SBE. Women who agreed that their family encourages them to practice SBE were significantly 0.4 times less likely not to perform SBE compared to those who disagreed (AOR – 0.345, 95% CI; 0.148 – 0.806, p – 0.014). Identified themes include low prevalence of SBE practice, knowledge gaps, barriers to SBE, low trust in SBE and educational efforts from the HCPs. More than half of the women practice SBE. However, more health messages should be shared to those in formal employment and the highly educated to encourage the practice of SBE within the region. The county government should continue to implement community outreach programs in the county.