ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE OF CANCER PREVENTION POLICIES AMONG STAFF OF FEDERAL ACADEMIES IN NORTH-CENTRAL AREA, NIGERIA
Abstract
This study was conducted to assess knowledge, attitude and practice of cancer prevention strategies among staff of Federal universities in North Central Zone,Nigeria. To achieve this purpose, ex-post facto research design was used. A total of 756 staff from seven federal universities in north central zone Nigeria with a population of twenty-five thousand three hundred and sixty-one 25,361 were selectedthrough multi-stage sampling procedures of simple random, stratified, proportionate and accidental. The instrument used for the study was pilot tested with the use of Spearman-Brown Split Half, Gutman Split Half and Cronbach Alpha and 0.839, 0.813 and 0.859 were obtained respectively. Out of the 756 copies of questionnaire distributed, 752 were valid for analyses. Inferential statistics of one sample t-test, Pearson Product Moment Correlation (PPMC), regression analysis and independent sample t-test were used to test the data collected. The results revealed that the staff of Federal Universitiesare knowledgeable about cancer prevention strategies, have good attitude towards cancer prevention strategies, however, are poor in practice with Pvalues of 0.021, 0.001, 0.11 respectively, demographic characteristics had influence on knowledge, attitude and practice of cancer prevention strategieswith p=0.000 and lastly there was no significant difference between male and female in their knowledge with p=0.11, attitude p=0.29 and practice p=0.31 towards cancer prevention strategies all at 0.05 level of significance. Based on the results, the following conclusions were drawn; Staff in Federal Universities of North-central Zone, Nigeria are knowledgeable about cancer prevention strategies, their attitude towards cancer prevention strategies is good, Cancer prevention strategies practiceis poor among staff in Federal Universities of North-central Zone.knowledgeof cancer prevention strategies translated into positive attitude towards cancer prevention strategies butknowledge of cancer prevention strategies do not influence practice of cancer prevention strategies among staff in Federal Universitiesof North-central Zone, Nigeria. Based on the conclusion, it was recommended that concerned Government and non-Governmental agencies and Ministry of Health should double efforts in ensuring that Federal University staff are provided adequate intervention programmes and Health Education on improved practice of cancer prevention strategiesand development of practices that will bridge the gap that exist between knowledge and practice on one hand and attitude and practice of cancer prevention strategies among Federal University staff in North-central Zone, Nigeria
TABLE OF CONTENTS
Cover page i
Title Page ii
Declaration iii
Certification iv
Dedication v
Acknowledgements vi
Abstract viii
Table of Contents ix
List of Abbreviations x
List of Tables xi
List of Figures xv
List of Abbreviations xvi
Operational Definition of Terms xvii
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study 1
1.2 Statement of the Problem 5
1.3 Purpose of the Study 7
1.4 Research Questions 8
1.5 Research Hypotheses 9
1.6 Significance of the Study 10
1.7 Basic Assumptions 11
1.8 Delimitations of the Study 11
CHAPTER TWO: REVIEW OF RELATED LITERATURE
2.1 Introduction 13
2.2 Concept of Cancer 14
2.2.1 Prevalence of Cancer 17
2.2.2 Types of Cancer 21
2.2.4 Cancer prevention strategies 29
2.2.5 General Symptoms of Cancer 31
2.2.6 Predisposing Factor for Cancer 35
2.3 Theoretical Framework 46
2.4 Knowledge of Cancer prevention 50
2.5 Attitude towardsCancer prevention 57
2.6 Practice ofCancer prevention 62
2.7 Age and Cancer prevention 66
2.8 Religion and Cancer prevention 70
2.9 Gender and Cancer prevention 71
2.10 Level of Education and Cancer prevention 72
2.11 Summary 75
CHAPTER THREE: METHODOLOGY
3.1 Introduction 77
3.2 Research Design 77
3.3 Population of the Study 78
3.4 Sample and Sampling Procedure 79
3.5 Research Instrument 81
3.6 Validity of the Instrument 82
3.7 Pilot Study 82
3.8 Procedure for Data Collection 83
3.9 Procedure for Data Analyses 84
CHAPTER FOUR: RESULTS AND DISCUSSION
4.1 Introduction 86
4.2 Results 86
4.4 Discussion 112
CHAPTER FIVE: SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
5.1 Summary 119
5.2 Contribution to Knowledge 122
5.3 Conclusions 123
5.4 Recommendations 124
5.5 Suggestions for future Research 125
References 126 Appendixes 136 LIST OF TABLES
Table 1: Population Distribution of Academic and Non-Academic staff 78
Table 2: Sampled Number of Respondents from Selected Federal Universities in Northcentral Nigeria 80
Table 3: Demographic Characteristics of the Respondents 86
Table 4: Mean and Standard deviation on the knowledge of cancer prevention strategies
among staff of Federal Universities 88
Table 5: Mean and Standard Deviation on the attitudes towards cancer prevention
strategies among staff in Federal Universities 90
Table 6: Mean and Standard Deviation on practices ofcancer prevention strategies among
staff in federal universities 92
Table 7:Mean Scores of responses on the influence of Knowledge on Attitude of Cancer prevention strategies among Staff of Federal Universities in North-central
Zone 93
Table 8:Mean Scores responses on influence of Knowledge on Practice of Cancer prevention strategies among Staff of Federal Universities in
North-central Zone 94
Table 9: Mean scoresof responses on the Influence of Level of Education on Knowledge, Attitude and Practice of Cancer prevention strategies 95
Table 10: Mean Scores of responses on the Influence of religion on Knowledge, Attitude
and Practice ofCancer prevention strategies 96
Table 11: Mean Scores of responses on the Influence of age on Knowledge, Attitude and
Practice ofCancer prevention strategies 96
Table 12: Mean scoresof responses difference between Male and Female Staff of Federal Universities in Their Knowledge towards Cancer prevention strategies 97
Table 13: Mean scores of responses on Difference between Male and Female Staff of Federal Universities of North-central Zone, Nigeria in their Attitude towards
Cancer prevention strategies 98 Table14:Independent t-test Statistics on Difference between Male and Female Staff of
Federal Universities of North-central Zone, Nigeria in their Attitude towards
Cancer prevention strategies 99
Table 15: One sample t test on knowledge of staff in federal universities about cancer prevention strategies 100
Table 16: One sample t test on attitude of staff in federal universities of North Central zone, Nigeria towards cancer prevention strategies 101
Table 17: One sample t test on cancer prevention strategies practices among staff of federal universities 102
Table 18: Pearson Product Moment Correlation statistics on Knowledge of cancer prevention strategiesand attitude towards cancer prevention strategies 103
Table 19: Pearson Product Moment Correlation statistics on Knowledge of cancer prevention strategiesand practice ofcancer prevention strategies 104
Table 20: Multiple regression analysis oninfluence of level of education on knowledge,
attitude and practice ofcancer prevention strategies 105
Table 21: Multiple regression analysis oninfluence of religious on knowledge, attitude and
practice ofcancer prevention strategies 106
Table 22: Multiple regression analysis oninfluence of age on knowledge,attitude and
practice ofcancer prevention strategies 107
Table 23: Independent t-test analysis on difference between male and female staff of federal universities in their knowledge towards cancer prevention
strategies108
Table 24: Independent t-test analysis on difference between male and female staff of federal universities of North-central zone, Nigeria in their attitude towards
cancer prevention strategies 109
Table 25: Independent t-test statistics on difference between male and female staff of federal universities of North-central zone, Nigeria in their attitude towards cancer prevention strategies 110
LIST OF FIGURES
Fig. 1 Mammography image of the Breast 22
Fig. 2 Image of Ovarian Cancer 25
Fig. 3 Skin Cancer 26
Fig 4 Researcher‟s Developed Conceptual Framework 45 LIST OF ABBREVIATIONS
ACS – America Cancer Society
CRC – ColoRectal Cancer
WHO – World Health Organization
PSA – Prostate-Specific Antigen
HBM – Health Belief Model
HDI – Human Development Index
HPV – Human Papilloma Virus
N.C.I – National Cancer Institute
BMI – Body Mass Index
OPERATIONAL DEFINITION OF TERMS
For thepurpose of this study, the following terms are operationally defined:
Staff means academic and non-academic staff of Federal Universities in North central
Zone, Nigeria
Cancer prevention strategies is avoidance of risk factors among staff of Federal
Universities in North-central Zone, Nigeria.
Knowledge of Cancer prevention strategies is theunderstanding and know-how about avoidance of the risk factors of Cancer.
Attitude towards Cancer prevention strategiesare the believes held by staff of federal University in North central Zone, Nigeria and feelings towards avoidance of risk factors
Practice of Cancer prevention strategies the actual exhibition of the knowledge of risk factors and avoiding the risk factors by staff of federal University in North central Zone, Nigeria
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Cancer is a major public health concern affecting all categories of individuals worldwide. It is believed that cancer is the second most common cause of death in developed countries and among the three leading causes of death in developing countries including Nigeria. In the light of the above, Qalawa, Mohamed and Eltay(2013),asserted that cancer is now the second leading cause of death, after cardiovascular diseasesworldwide, approximately 10 million people are diagnosed with cancer annually and more than 6 million die of the disease every year.
It will be of interest to understand this health condition known as cancer, which according to America Cancer Society (2014), starts when cells in any part of the body begin to grow out of control, the word cancer is an umbrella term that refers to about 200 diseases that share two common characteristics which are; an uncontrolled growth of cells and the ability to invade and damage normal tissues either locally or at distant sites in the body.In addition, World Health Organisation (WHO) (2012), also described cancer as a generic term for a large group of diseases that affect any part of the body, hence, malignant tumour is often used to describe cancer. A defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and spread to other organs. This process is referred to as metastasis which is the major cause of death from cancer patient.
There are many types of cancer, but they all arethe uncontrollable growth of abnormal cells. WHO (2012), reported the commonest cancers in Africanmales are prostate (13.7% of all cancers), liver (11.5%), Kaposi‟s sarcoma (8.7%),oesophagus (6.2%) and Non-Hodgkin lymphoma (6.2%) cancer,whereas, in females the commonest cancers are cervix (23.8%), breast (21.3%), liver (4.7%) and Kaposi sarcoma (3.8%) cancers.WHO report (2012)revealedthat 24.6 million people live with cancer worldwide. Estimated cancer incidence in Africa is between 70-100/100,000 population. As at 2005, the commonest cancer in men is Kaposi sarcoma (15.5%) with cancer of the cervix representing 22.2% of all cancers among women. Most cases present at advanced stages when curative measures may be unsuccessful (Parkin, Whelan, Ferlay, Treppo, &Thomas 2015). WHO (2012) report shows that prostate cancer and liver cancer had taken the lead with 13.7% and 11.5% respectively whereas Kaposi sarcoma represent only 8.7% of all cancer cases, the incidence rate of cervical cancer in Nigeria is 25/100,000.
Quite a number of risk factors have beenmentioned byNnodu, Erinosho, Jamda, Olaniyi, Adelaiye and Lawson (2010) as modifiable factors such as use of tobacco, age, unhealthy diet, infectious agents like Human Papilloma Virus (HPV), hepatitis B virus, helicobacter bacterium, ultra violet radiation, physical inactivity, occupational exposures, food contaminants such as aflatoxin, ionizing radiation, and obesity. Nonmodifiable risk factors include ageing, ethnicity, heredity, sex, immunosuppression andreproduction. This simply means that modifiable risk factors could be prevented.
The National Institute for Occupational Safety and Health has identified more than 130 substances as potential occupational carcinogens.Thousands of chemical substances are in use but have never been evaluated for possible carcinogenicity.
Workplace hazards, working conditions, and personal risk factors may interact to contribute to chronic diseases such as cancer among working adults. In addition, for potentially large numbers of workers, the workplace could be an effective place to use comprehensive strategies that protect and promote health for adults at midlife and at older ages. However, primary prevention strategies policies that reduce exposure to known carcinogens have been found to reduce cancer risk (e.g., eliminating exposure to asbestos to reduce lung cancer) (Loeppke, Schill&Chosewood, 2013).
According to a study in America on knowledge of cancer risk and survival conducted byBreslow, Sorkin, Frey and Kessler (2011) it wasrevealed that majority of respondents used for the study were unable to identify major cancer risk factors when exposed to a list of risk factors. Approximately two-thirds did not recognize that age increased the risk for breast and colon cancer, that diet increased the risk for colon cancer, or that multiple sex partners increased the risk for cervical cancer. In a related version, a study conducted in Nigeria by Nnodu,Erinosho, Jamda, Olaniyi, Adelaiye and Lawson (2010) on the Knowledge, Attitude and Practice of Cervical cancer, revealed that respondents were asked if they know of cervical cancer and human papilloma virus. The the outcomes indicate that very small proportions know about these diseases and overwhelming majority of the respondents said that cervical cancer and human papilloma virus could not be prevented. This revelation is an indication that the knowledge of cancer was low.
Attitudes are the beliefs held by people and feelings towards concept and body of knowledge, it is an important factor towards the prevention strategies of cancer as well as avoiding risk factors that could prone an individual to the deadly disease. In a study conducted in SouthAfrica byRamathuba, Ratshirumbi andMashamba(2013), the majority of the women who participated in the study (82.7%) reported that if they noticed any change in their breast, they would consult the medical doctor, while 14.0% said that they would consult the traditional doctor and 3.3% would consult the prophet. The issue of religious and cultural belief might play a significant role in the health-seeking behaviour (attitude) of the staff in North Central-zone, Nigeria.
According to Azubuike and Okwuokei (2013),practice of primary prevention strategies of cancer has a very strong association with knowledge and practice of early detection strategies. The study showed that not all who knew about the preventive strategies practiced it, which also revealed that there is a very strong indication that practice increases as level of knowledge increases. Additionally, Azubuike and Okwuokei (2013), posited that there is an existing association between the knowledge of cancer risk factors and practice of preventive strategies. Suggesting that knowledge of the risk factors seems to be a motivation to practice. Furthermore, previous study by Haji-Mahmoodi, Montazeri, Jarvandi, Ebrahimi, Haghighat and Harirchi(2012) has also identified relationship between knowledge and practice of preventive procedures. However, the commonest reason reported for not practicing any of the preventive procedures was the feeling that one cannot get breast cancer, followed by lack of awareness and forgetfulness and then avoidance of fear and anxiety. Specifically,the feeling that one cannot get breast cancer‟ indicates disbelief and superstition. Disbelief and misconception about cancer has been reported as contributory factor to late reporting of signs and symptoms (Haji-Mahmoodi et al 2012). North-centralZone, Nigeria is one of the six geo-political zones of the country. The zone is the most unique region in the country consisting of seven (7) states including the Federal Capital Territory (FCT). The zone has combinations of several ethnic groups that can be referred to as a little representation of the entire country. North Central Nigeria zone consist of; Kwara
(Yoruba),Kogi state (Igbira, Yoruba, &Igala), Abuja (Gbwari), Nasarawa state (Hausa),
Niger state (Hausa, Nupe&Fulani), Plateau State(Beerom, Ganang, Afizere), Benue State (Tiv&Idoma). This shows a fair distribution of ethnic groups in Nigeria. Thereby creating a research population that is capable of generalization.These facts necessitate a study on assessment of knowledge, attitude and practice of cancer prevention strategiesStrategies among staff of Federal Universities in North-central zone, Nigeria.
1.2 Statement of the Problem
The high rate of death in the world is worrisome, the trend as revealed in many literatures including W.H.O. (2012), shows that cancer accounts for 12.5% of all deaths in the world. Cancer rank highest in terms of economic loss of all the fifteen (15) leading causes of death in the world. In Africa, home for large percentage of developing countries is not left out of the scourge of cancer. Reports have shown that 650,000 indigenous Africans run the risk ofdying from cancer out of 965 million diagnosed.
The pathetic situation is that African women‟s diagnosis and deaths are higher than women in developed countries. This is evident in the report of Parkin, Sitas, Chinrenje, Stein, Abratt, et al. (2012) which revealed that 12.5% of all death cases in the world are caused by cancer and it is estimated that if the trend continues, additional 16 million diagnoses will occurby 2020.
The researcher observed through numerous literatures that substantial proportion of all cancers is attributable to carcinogenic exposures in the environment and the workplace, and is influenced by activities in all economic and social sectors. Many of these exposures are involuntary but can be controlled or eliminated through enacting and enforcing proactive strategies for prevention strategies. The prevention strategies of cancers of environmental and occupational origin reduces cancer incidence and mortality and is highly cost effective; in fact, it is not just socially beneficial because it reduces medical and other costs, but because it averts the suffering of many human beings.Unfortunately,emphases are not on prevention strategies of cancer through avoidance of risk factors.
According to W.H.O. (2012),some years back, cancer was thought to be rare in Africa and cancer was seen as a disease of the developed country where cancer is only second to cardiovascular diseases in the causes of death. Based on researcher‟s observation, the alarming increase in the incidence of cancer is mainly due to infectious conditions including the HIV/AIDS pandemic, tobacco use, harmful use of alcohol, improper diet, physical inactivity, environmental pollution and a general increase in life
expectancy predominantly among elites who aremostly found in the Ivory Tower.However, evidences have shown that knowledge of the above predisposing factors is poor. The increasing rate of cancer diagnosis in the country at large and the region in particular can be traced to the level of knowledge of cancer, attitude towards prevention strategies of cancer and practice of avoidance of the predisposing factors.
The high cases of cancer in North-Central Nigeria cannot be far away from the lack of knowledge of predisposing factors such as age, alcohol, sedentary lifestyle, Human Papiloma Virus, obesity, exposure to radiation and so on as stated by Nnodu, et al (2010) and a perceived low level of knowledge, poor attitude towards early reporting of signs and symptoms and poor practice of prevention strategies of cancer. Specifically, a study conducted in North-Central and South-West on knowledge and believes towards cervical cancer shows that; all of the women in the selected focused group had no knowledge of cervical cancer. Meanwhile, most of the participants in Abuja who are
Muslim women had heard about cervical cancer, but no knowledge of risk factors. However, in Ondo state, none of the women in the group of a FGD had ever heard of cervical cancer. Based on the forgoing, it is believed that a gap of adequate knowledge, negative attitude and poor practice exist in the North central geo-political zone of Nigeria. In light of the above,theresearcher assessed knowledge, attitude and practice of cancer prevention strategies among staff of Federal Universitiesin North Central Zone, Nigeria.
1.3 Purpose of the study
The purpose of this study was to assess and identify possible existing gaps in knowledge, attitude and practices of cancer prevention strategiesamong of staff of Federal
Universitiesin North-central Zone, Nigeria Specifically, the study intended to assess:
- Knowledge of cancer prevention strategies among staff of Federal Universities in
North-central Zone, Nigeria.
- The attitude towards cancer prevention strategies among staff in Federal Universities of North-central Zone, Nigeria
- The practice of cancer prevention strategies among staff in Federal Universities of
North-central Zone, Nigeria.
- Whether knowledge of cancer prevention strategies influences attitude towards cancer prevention strategies among staff in Federal Universities of North-central
Zone, Nigeria
- Whether knowledge of cancer prevention strategies influences practice of cancer prevention strategies among staff in Federal Universities of North-central Zone, Nigeria
- Whetherdemographic characteristic of respondents (religion, level of education and age) influence their knowledge, attitude and practice of cancer prevention strategies among staff in Federal Universities of North-central Zone, Nigeria
- Whethergender differences exist among staff of Federal Universities in Northcentral Zone, Nigeria in their knowledge, attitude and practice ofcancer prevention strategies
1.4 Research Questions
The study was proposed to answer the following specific researchquestions:
- What is the knowledge of cancer prevention strategies among staffof Federal
Universitiesin North-central Zone, Nigeria?
- What are the attitudes towards cancer prevention strategiesamong staff in Federal
Universities of North-central Zone, Nigeria?
- What are the practices of cancer prevention strategies among staff in Federal
Universities of North-central Zone, Nigeria?
- Will knowledge of cancer prevention strategies influence attitude towards cancer prevention strategies among staff in Federal Universities of North-central Zone, Nigeria?
- Will knowledge of cancer prevention strategies influence practice of cancer prevention strategies among staff in Federal Universities of North-central Zone, Nigeria?
- Will demographic characteristic of respondents (religion, level of education and age) influence knowledge, attitude and practice ofcancer prevention strategies among staff in Federal Universities of North-central Zone, Nigeria?
- Does gender differ in theirknowledge, attitude and cancer towards cancer prevention strategies in Federal Universities of North-central Zone, Nigeria?
1.5 Research Hypotheses
On the basis of the research questions, one major and seven (7) sub-hypotheses were formulatedto guide study.
1.5.1 Major Hypothesis
There is no significant knowledge, attitude and practices of cancer prevention strategies among staff in Federal Universities of North-central Zone, Nigeria
1.5.2 Sub-Hypotheses
- Staff in Federal Universities of North-central Zone, Nigeria are not significantly knowledgeable about cancer prevention strategies
- The attitude of staff in Federal Universities of North Central zone, Nigeria towards cancer prevention strategiesis not significant
- Cancer prevention strategies practices by thestaff in Federal Universities of North-central Zone, Nigeria is not significant
- There is no significant influence of knowledge of cancer on attitude towards cancer prevention strategies among staff in Federal Universities of North-central Zone, Nigeria
- There is no significant influence of knowledge of cancer on practice of cancer prevention strategies among staff in Federal Universities of North-central Zone,
Nigeria
- There is no significant influence of demographic characteristics of respondents (level of education, religion and age) on knowledge, attitude and practice of cancer prevention strategiesin Federal Universities of North-central Zone,
Nigeria
- There is no significant difference between male and female staff of Federal Universities of North-central zone, Nigeria in their knowledge, attitude and practice of cancer prevention strategies
1.6 Significance of the Study
The results of this study are significant in the following ways: –
Adequate information on the level of knowledge for the prevention strategies of cancer among staff will help the public health professionals to bridge the gap of lack of adequate knowledge, through intervention programmes that will raise level of awareness, improve health of the staff of Federal Universities and prevent the manifestation of cancer.
The study would be useful to Health Educators to design mechanism that will mitigate the likely negative attitudes towards the prevention strategies of cancer among staff of Federal Universities inNorth Central Nigeria. The findings of the study should help Public Health Educators to collaborate with ministry of labour and productivity to encourage positive practices of cancer prevention strategies among staff ofFederal Universities North-central Nigeria.
The study would raise awareness on a number of preventive strategies that can help in reducing cases of cancer through effective health promotion methods among staff of Federal Universities in North Central Nigeria. The study will also reveal the distribution of cancer awareness along age range, gender,religious background, place of work and level of income. Through effective intervention programme, the result of this study will correct some wrong impressions and misconceptions of cancer prevention strategies among Staff ofFederal Universities North-central Nigeria.
1.7 Basic Assumptions
Based on research evidence, the following assumptions were made
- The knowledge of cancer prevention strategies among Staffof Federal Universitiesin North-central Nigeria may aid the reduction in the prevalence of cancer in the region.
- Knowledge of predisposing factors would improve the prevention strategies of cancer among Staffof Federal Universitiesin North-central Nigeria.
- Right attitude towards predisposing factors could help cancer prevention strategies among Staffof Federal Universitiesin North-central Nigeria.
- Practice of Immunization against Human Papilloma Virus (HPV) would help prevent cancer among Staffof Federal Universitiesin North-central Nigeria.
- There would be a significant relationship between age and Knowledge, Attitude and Practice of Cancer Prevention strategies among Staffof Federal
Universitiesin North-central Nigeria
1.8 Delimitations of the Study
This study was delimited to:
- Only Federal University Staff of the seven North Central States of Nigeria.
- Knowledge of Cancer prevention strategies among staff of Federal Universities in North-central Zone, Nigeria.
- Attitude towards cancer prevention strategies among staff ofFederal Universities in North-central Zone, Nigeria.
- Practice of cancer prevention strategies among staff of Federal Universities in
North Central States of Nigeria
- Demographic variables of Age, level of income, Educational qualification and gender („s) relationship with Knowledge, Attitude and Practice of Cancer Prevention strategies inFederal Universities of North-central Zone, Nigeria.
- Gender differences in Knowledge, Attitude and Practice of Cancer Prevention strategies
- Cancer prevention strategies is predicated on knowledge and avoidance of risk factors.
ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE OF CANCER PREVENTION POLICIES AMONG STAFF OF FEDERAL ACADEMIES IN NORTH-CENTRAL AREA, NIGERIA