KNOWLEDGE, PERCEPTION AND UTILISATION OF PROSTATE CANCER SCREENING SERVICES AMONG SECONDARY SCHOOL MALE TEACHERS IN IBEJU-LEKKI LOCAL GOVERNMENT AREA, LAGOS STATE

ABSTRACT

Prostate cancer (PC) is the most commonly diag Inosed cancer among Nigerian men; yet screening for early detection of the disease is not a common practice. Few studies have documented prostate cancer screening practices and its antecedents among Nigerian men. This study therefore investigated the knowledge and perception of PC and utilisation of prostate cancer screening services among secondary school male teachers in Ibeju-Lekki Local Government Area (ILGA), Lagos State.

A descriptive cross-sectional survey was conducted among 338 consenting male teachers out of a total of 395 in all secondary schools in ILGA. A validated self-administered semi-structured questionnaire used for data collection included a 39-point knowledge and 34-point perception scales, questions on perceived susceptibility, screening practices and willingness to undertake PC screening. Knowledge scores ≤13, 13-26 and ≥26 were classified as poor, fair and good respectively. Perception scores ≤16 and ≥16 were categorised as negative and positive perception respectively. Data were analysed using descriptive statistics, t-test, Chi-square test and logistic regression at p=0.05.

Respondents’ mean age was 33.5±7.3 years, 60.4% were Christians, 80.8% were Yoruba and 48.8% were married. Many (61.5%) respondents had bachelor degree. Most (60.9%) respondents had heard about PC and only 27.5% recognised PC as leading cause of cancer-related death among Nigerian men. About a quarter of respondents (25.7%) correctly identified location of the prostate gland, and 47% knew it affects only men. Almost half (48.2%) and 44.1% identified alcohol and tobacco use as main risk factors. More (52.4%) respondents correctly affirmed swelling of the prostate gland as the main symptom of prostate cancer and 55.9% knew surgery/radiotherapy prevent prostate cancer progression. About one-third (34%) identified regular exercise as a risk-reduction strategy for PC. Mean knowledge score was 13.4±9.0; respondents with poor, fair and good knowledge of PC were 52.7%, 36.1% and 11.2% respectively. Mean perception score was 13.8±8; respondents with negative and positive perception towards PC were 60.7% and 39.3% respectively.  Most 92.3% respondents did not perceive themselves susceptibility to PC. Few (1.5%) reportedly had prostate condition, while only 23.1% perceived PC as very serious. Majority (79.6%) had never heard about PC screening. Only a few (1.2%) had utilised PC screening services. Major barriers to utilisation were insufficient knowledge about PC (59.2%) and 58.0% were willing to utilise the screening service in the future. There was a significant difference in mean knowledge scores of respondents from private schools 15.5±9.8 compared with those from public schools 11.3±7.5. There was also a significant association between respondents’ educational qualification and PC-related knowledge, Respondents that had good knowledge were one time less likely to have poor PC-related knowledge, (OR: 0.1, 95% CI: 0.0-0.3) and one time less likely to have negative perception towards PC, (OR:0.6, 95% CI: 0.4-0.8). 

Prostate cancer-related knowledge and perceived risk of susceptibility were low, although most respondents were willing to utilise the screening services in the future. Health education interventions such as enlightenment campaign, training and seminars would be useful in addressing these gaps.

Keywords:Prostate cancer knowledge, Perception, Susceptibility, Utilisation of screening services

Word count:488

TABLE OF CONTENT

Section Page

Title page i

Dedication ii

Abstractiii

Acknowledgev

Certification vi

Table of Contentvii

List of Figuresx

List of Tablesxi

Glossary of Abbreviationsxii

CHAPTER ONE: INTRODUCTION1

1.1 Background information1

1.2 Statement of the problem2

1.3Justification and rationale of the study4

1.4 Research Questions5

1.5 General objectives of the study5

1.6 Specific objectives5

1.7 Hypothesis6

CHAPTER TWO: REVIEW OF THE LITERATURE7

2.1 Cancer of the Prostate7

2.2 Risk and predisposing factors for prostate cancer11

2.3 Causes of Prostate Cancer15

2.4 Health promotion intervention for Prostate cancer17

2.4.1 Primary prevention: lifestyle adjustments18

2.4.2 Primary prevention through screening for early detection of the disease19

2.4.3Screening tests / method21

2.4.4Risk associated with screening22

2.4.5PSA Test (Prostate-Specific Antigen)22

2.4.6DRE (Digital Rectal Examination)23

2.4.7Trans Rectal Ultrasound (TRUS)23

2.4.8Prostate Biopsy24

2.4.9Other imaging tests24

2.5Tumour Characteristics and Tumour Grade24

2.5.1High-Grade Cancer25

2.5.2Tumour Stage25

2.6Secondary prevention:  Treating Prostate Cancer26

2.7Tertiary prevention:  Management of prostate cancer28

2.8 Incidence and prevalence of prostate cancer 29

2.9 Prostate cancer awareness32

2.10 Knowledge of Prostate Cancer, risk factors, sign and symptoms33

2.11Perception towards Prostate Cancer34

2.12Perceived risk factors and perceived susceptibility towards prostate cancer36

2.13Prostate cancer screening awareness38

2.14Utilisation of prostate cancer screening services and future willingness 

to utilise the screening services39

2.15 Factors influencing the prostate cancer screening40

2.16Benefits for undertaking prostate cancer screening41

2.17 Barriers/hindering factors to utilisation prostate cancer screening services42

2.18 Conceptual framework42

2.14.1 Health Belief Model (HBM)42

CHAPTER THREE: METHODOLOGY46

3.1 Research Design46

3.2 Independent and dependent variables46

3.3 Description of study location46 

3.3.2 Location and Size47

3.3.3 Description of the study site48

3.4 Study Population48

3.5 Sampling procedure49

3.6 Instrument development50

3.7 Validity and reliability50

3.8 Methods of data collection51

3.9 Data processing and Analysis51

3.10 Ethical consideration52

3. 11 Limitation of study52

CHAPTER FOUR: RESULTS53

4.1 Socio-Demographic Characteristics of the Respondents54

4.2 Awareness on prostate cancer and related knowledge57

4.3 Knowledge on prostate cancer59

4.4 Perception of prostate cancer68

4.5 Perceived risk factors and perceived susceptibility towards prostate cancer71

4.6 Awareness on prostate cancer screening and utilisation of the services79

4.7 Willingness to utilise prostate cancer screening services in the future81

4.8 Suggested ways for improving teachers’ participation in prostate cancer screening   87

4.9 TEST OF HYPOTHESES90

4.9.1 Hypothesis one90

4.9.2 Hypothesis two93

4.9.3 Hypothesis three97

4.9.4 Hypothesis four101

4.9.5 Hypothesis five107

4.9.6 Hypothesis six109

CHAPTER FIVE: DISCUSSION111

5.1 Socio-demographic characteristics of the respondents111

5.2 Knowledge on prostate cancer111

5.3 Perception of prostate cancer 113

5.4 Perceived risk factors and perceived susceptibility towards prostate cancer114

5.5 Utilisation of prostate screening services114

5.6 Willingness to utilise prostate cancer screening services in the future115

Conclusion 116

Health education implication117

Recommendation118

Suggestion for further studies118

REFERENCES119

Appendix 1128

LIST OF TABLES

page

Table 4.1Socio-Demographic Characteristics of the Respondents54

Table 4.2Location of prostate gland60

Table 4.3Response on predisposing risk factors63

Table 4.4Response on Sign and symptoms associated with prostate cancer65

Table 4.5Response on treatment and prevention modality 67

Table 4.6Response on Perception of prostate cancer69

Table 4.7Response on Perceived risk factors of prostate cancer 72

Table 4.8Response on Signs and symptoms experienced by the respondents75

Table 4.9Response on perceived susceptibility towards prostate cancer77

Table 4.10Perceived susceptibility towards prostate categorization78

Table 4.11Respondents’ Sources of information on prostate cancer screening80

Table 4.12Respondent’s influencing factors to undertake prostate cancer screening82

Table 4.13 Respondents’ reasons to undertake prostate cancer screening83

Table 4.14 Reason why respondents won’t undertake screening85

Table 4.15Respondents’ Factors Prevent Undertaking Screening86

Table 4.16Respondents’ Suggested ways for improving teachers’ participation 

in prostate cancer screening88

Table 4.17 Differences in the mean knowledge score on prostate cancer 

between male teachers in private secondary schools and male 

teachers in public secondary schools.91

Table 4.18Logic regression to explore the strength of the association 

between respondents’ prostate cancer related knowledge and school type92

Table 4.19Relationship between prostate cancers related knowledge and

perceived susceptibility towards prostate cancer94

Table 4.20Logic regression to explore the strength of the association between 

prostate cancers related knowledge and perceived 

susceptibility towards prostate cancer96

Table 4.21There is no significant relation between prostate cancers related 

knowledge perception of prostate cancer98

Table 4.22Logic regression to explore the strength of the association 

between respondents’ prostate cancers related knowledge and 

perception of prostate cancer100

Table 4.23 Relationship between demographic variables (age, discipline, highest 

education qualification and position in school) and related prostate 

cancer knowledge.103

Table 4.24 Logic regression to explore the strength of association between 

variables (discipline, highest education qualification and position 

in school) and related prostate cancer knowledge106

Table 4.25 Relationship between perceived susceptibility to prostate 

cancer and willingness to utilise prostate cancer screening services108

Table 4.26Relationship between demographic variables (ages, marital status, 

years in service and income) of the respondents and willingness 

to utilize prostate cancer screening services110