br On the basis of an expected prevalence of
On the basis of an expected prevalence of 25% of them having poor knowledge from a study previously conducted in the region,14 a 95% level of confidence, and an 80% power, a total sample size of 288 women 18 years of age was generated. After adding a 10% increment to the sample size of 288 to compensate for the potential nonresponse from participants, the total sample size reached 317
women. All the five health care centers in Ghail Bawazir District were included in the study. A sampling technique based on proportional allocation was employed to recruit the participants from the five centers according to the flow rate of attendance in those centers in the last 3 months. In each PHCC, all adult women were deemed eligible for the study with the following criteria: a) age range from 18 to 60 years; b) no previous history of BC; and c) attending the center for routine primary care services or accompa-nying a patient. The distribution of the sample size in each of the five centers was as follows: 102, 82, 77, 33, and 23 women from centers A, B, C, D, and E, respectively. Moreover, the first enrolled woman was selected randomly, and then, every fourth women entering the PHCC was asked to participate in the study. The same process was repeated for two randomly selected days per week in each health center.
Data Collection Tool
A questionnaire was used as an instrument for data collection and consisted of 67 questions. Questions in this questionnaire were derived from valid and reliable questionnaires in the English language retrieved from previous studies conducted in other pop-ulations.15 Furthermore, the questionnaire was reviewed by experts in the field for relevance, clarity, and appropriateness of the terms used and internal consistency of the questions. Back-to-back Ara-biceEnglish Bafilomycin-A1 of the questionnaire was performed by a professional translator to ensure consistency of the translated terms and to correct all discrepancies. The final questionnaire in the Arabic language was further tested on a group of women (n ¼ 21) who were not included in the study.
Participants were invited by the investigator (female family doctor) to personal interviews using the pretested validated ques-tionnaire. The questionnaire was designed to contain four main parts. The first part included questions related to women’s socio-demographic status [age ( 30, 31-40, and >40 years), marital status (married or unmarried), educational level (have no formal education for a woman who never attended school and formal education for a women who had ever received some type of formal education such as primary school, secondary school, diploma, or undergraduate and post graduate higher education), and working status (working and housewife/nonworking)]. The second part of the questionnaire was subdivided into two sections. Section 1 included 10 items related to knowledge of BC risk factors such as family history of BC, obesity, the use of oral contraceptive pills (OCPs) and hormonal replacement therapy (HRT), delayed maternal age (>30 years), nulliparity, age at menarche, age at menopause, exposure to ionizing radiation, older age, and lack of physical activity. Section 2 included eight items. The participants were asked to tick all items Staggered cuts were aware of as correct for risk factors, namely, family history of BC, obesity, HRT and OCPs, having the first child at age 30 years or older, nulliparity, age of menarche, age of menopause, ionizing radiation, increasing with age, and lack of exercise, which were scored as one for correct answer “Yes” and zero for “No” and “I don’t know”. By adding the response to each item, a knowledge scale based on knowledge of BC risk factors was constructed. The lowest possible scale score is zero if no symptoms were known, and the highest possible scale score was 10 if all the risk factors were known. The other section included
Women Attending PHCC in Ghail Bawazir District, Yemen
eight items related to knowledge of BC warning signs, and the items were scored as one for correct answer “Yes” and zero for “No” and “I don’t know.” These signs comprised breast lump, dumpling of the breast, bloody nipple discharge, pulling of the nipple, change in the shape and size of the breast, change in the shape and size of the nipple, redness or ulceration of the breast skin, and peau d’orange appearance of the breast skin. A similar approach as that of the above mentioned was used to assess the level of knowledge of BC warning signs, where the lowest possible scale score is 0 if no signs were known and the highest possible scale score was 8 if all the risk factors were known.
The third part is related to knowledge and awareness of BC screening methods, which include questions about the common screening methods (mammography, clinical breast examination (CBE), and breast self-examination (BSE)), as well as assessing the source of information about BC. The last part includes questions regarding activities practiced by the women for screening methods (mammography, CBE, and BSE), which was assessed by asking four questions for each method (have heard about this method, how many times to do it, regularity in practice, purpose for performance, and reasons for not practicing the BC screening method). To score the responses to these questions, a correct answer was allocated a value of “one” and a wrong answer was allocated a value of “zero.”