CHAPTER ONE

Introduction

Background to the Study

Prostate cancer, an adenocarcinoma of the male prostate gland, is increasingly becoming an

important health burden among men in the World; Prostate cancer is the second commonest

cause of cancer related death in men worldwide (Ferlay, et al., 2013; Lozano, et al., 2014).

Globally, it is estimated that 1,111,700 men were newly diagnosed for prostate cancer

(Morlando, Pelullo, & Di Giuseppe, 2017). According to the American Cancer Society,

220,800 was the incidence estimated in 2015 (Smith et al., 2015). It has been revealed that

Prostate cancer statistics increase due to risk factors such as old age, inadequate diet, obesity,

tobacco use, poor economy, lack of physical inactivity, alcohol consumption, and ethnicity

(Ogunsanya, 2019). An estimated 0.9 million cases and 0.26 million deaths of prostate cancer

occur annually in the world (Ferlay et al., 2013). Furthermore, Prostate cancer is the number

one cancer in both incidences and mortality in Africa, constituting 40,000 (13%) of all male

cancer incidences and 28,000 (11.3%) of all male cancer-associated mortalities (Ferlay, et al.,

2013). A study about incidence of prostate cancer in Africa was conducted and results show

that in 16 African countries the Prostate Cancer incidence rate were 22-23.97 per 100,000 of

the population, while about 19.5 per 100,000 was reported as median incidence rate (Adeloye,

et al., 2016). The disease is still growing, as well as urbanization, population growth and

positive change regarding life expectancy in Africa (Adeloye,et al., 2016). According to the

Rwanda demographic survey, prostate cancer mortality was 1.5/100,000 of the population,

while 320 patients have been operated on in 2014 (RDHS, 2014-2015). Prostate cancer is noted

as one of the important cause of morbidity and mortality among men in Rwanda and according

1
to The International agency for Research on Cancer (2018), 31.9% /100,000 populations, with

24.4%/100,000 mortality rate. For many years, screening for early detection of prostate cancer

has been an important intervention tool in health. In 2014, WHO reported that in Rwanda,

among the 2700 cancer deaths, 16.3% was caused by prostate cancer (WHO, 2014). In East

Africa, prostate cancer ranks third in both incidence and mortality, and leads to an estimated

9,000 (9% of all male cancers) cases and 7,300 (8.5% of all male cancer) deaths annually

(Ferlay, et al., 2013). It is important to note that PC incidences increased by 64.5% between

1990 and 2010 (Lozano, et al., 2014).

Knowledge of prostate cancer and prostate cancer screening plays an important role in cancer

screening utilization (Baty BJ, Kinney AY, Ellis SM. 2013). Researchers have found a

correlation between knowledge and screening behaviours (Danigelis NL, Roberson NL,

Worden JK, Flynn BS, Dorwaldt AL, Ashley JA, et al. 2014 A large international survey

carried out in Europe and the USA on general public awareness of prostate cancer in 2013

showed that there was a lack of awareness of prostate cancer. In Nigeria quite a few studies

have been done on knowledge, attitude and practices of prostate cancer and prostate cancer

screening. These studies report a low level of awareness of prostate cancer and prostate cancer

screening. A cross sectional study done in 2009 on a native African urban population showed

that 78.8% had never heard of prostate cancer and 5.8% had heard of PSA. The study also

showed that none of the respondents had taken the screening test.

Prostate cancer screening is an attempt to diagnose prostate cancer in asymptomatic men. The

principles of screening for prostate cancer are measurement of serum prostate specific antigen

(PSA) and digital rectal examination (DRE). However, the debate about testing for prostate

cancer using PSA and DRE continues. The majority of reviews indicate that evidence of

benefit from screening for prostate cancer using serum PSA is inconclusive. It is also unclear
2
how PSA can be most effectively used in the detection of prostate cancer. However, large

population-based studies have shown increased survival benefits in the early treatment of

prostate cancer when compared with no active therapy in men with moderately and poorly

differentiated disease. Some evidence has also shown that the recent decline in cancer

mortality observed in several countries was due to early detection. (Ebuchi O.M. Otumu IU

2014) The majority of Ugandan men are simply not aware of prostate cancer and do not take

early urinary symptoms seriously, therefore 60-80% present with very advanced prostate

cancer. Although much emphasis has been placed on cancer in women in Uganda, especially

breast and cervical cancer, little attention has been given to the cancers affecting men.

Currently, there is no formal program targeting prostate cancer which may explain the lack of

awareness about prostate cancer among the population. These changes have been accompanied

by an increased demand for the earlier detection of prostate cancer through screening on the

assumption that earlier treatment reduces mortality. However, the effectiveness of population

screening in reducing mortality from prostate cancer remains unproven and must await the

outcome of randomised controlled trials currently in progress or planned both in Europe and

the US. In the meantime, it is the potential for harm that has led some to question whether even

a randomised trial is ethical. The difficulty arises from the recognition that many more men

will die with prostate cancer, often undiagnosed as shown by autopsy studies, than will die of

the disease, suggesting that the natural history may encompass latent or very slow-growing

disease. This is compounded both by the uncertainty surrounding the effectiveness of radical

treatment compared with surveillance, and by the morbidity which may be caused by this

treatment.

For a screening test to be useful, certain conditions must be met: firstly the screening test must

be valid. The validity is measured by its ability to distinguish between subjects with the

3
condition and those without. The validity of a screening test is determined by its sensitivity and

specificity. These vary with the screening test, not the population. A good screening test

preferably will have a high sensitivity and specificity and must be rapid, simple and ideally

noninvasive and acceptable for the population screened. Sensitivity is defined as the proportion

of men with a positive test result of those who truly have the disease. Specificity is defined as

the proportion of men with a negative test result of those patients who are known to be free of

the disease. A positivity criterion can influence the sensitivity and specificity of a test. If the

positivity criterion is moved up (e.g. a PSA cut-off value for the indication of prostate biopsy)

the specificity increases but the sensitivity decreases. The number of false-positives would

decrease, but the number of false-negatives (those with the disease, but missed by the given

test) increases. Also to be considered in the evaluation of a screening test is the positive

predictive value (PPV), which reflects the possibility that if the test is positive, the patient has

the disease in question. To calculate the true sensitivity the underlying prevalence of the

disease should be known. This is not the case for prostate cancer. Therefore, sensitivity is

based on the number of positive biopsies in the screened population as a "gold standard".

Sensitivity defined in this way is termed "relative sensitivity" (Terris MK, Wallen EM, Stamey

TA 2017). Next to the sensitivity of a screening test the specificity is of great importance in a

population based screening program, simply because all those with a positive screening test(s)

need further workup (i.e. prostate biopsy), which may cause unnecessary damage, mental stress

and costs.

In view of the well documented knowledge and practice of prostate cancer screening test, the

challenges that have confronted medical doctors and health workers is the proper knowledge of

the practice of prostate cancer among elderly men attending general outpatient. Therefore this

research will be conducted to determine the knowledge and practice of prostate cancer

4
screening test among men attending outpatient department in University of Port Harcourt

Teaching Hospital.

Statement of the Problem

In developing countries, prostate cancer is the second most common malignancy causing death

among men (Ghaoor, Schuyten and Bener, 2017). One of the major factors responsible for the

high morbidity and mortality is later presentation (Ekwere and Egbe, 2018). Most prostate

cancer patients arrive at the hospital with the advanced disease (Eke and Sapire, 2018) and the

cost of treating advanced prostate cancer is very high especially in the Nigerian economy with

poor health facilities

Nigeria has a 5-year prevalence rate of 28 per 100,000 (Ferlay et al., 2015). The Cancer

Association of Nigeria has projected that one in eight men (1/8) in Nigeria will develop

prostate cancer during their lifetime, with most men being diagnosed after the age of 50.

Statistics from CAN also show that prostate cancer has been on the increase with 126 and 311

cases reported in 2006 and 2012 respectively (Haidula, 2014). Hence men may be at risk,

mostly, older men are more affected and since knowledge and awareness of the prostate cancer

risk factors and practice of digital rectal examination for cancer prevention is limited

(Adebamowo and Adekunle, 2018), creating awareness and education are therefore essential

pre-requisites in the efforts aimed at reducing the rate of prostate cancer especially in the

developing countries continues to increase than in countries in western Europe (Zeeger, 2017).

There is a need to find out what adult men know and do concerning screening practices for

detecting prostate cancer.

Elderly men from age of 50 years and above in developing countries may be aware of the risk

factors of prostate cancer, but may not intentionally engage in the screening. Therefore, the
5
researcher seeked to find out what the knowledge and practice of men that come to outpatient

department in University of Port Harcourt Teaching Hospital were, about prostate cancer

screening.

Purpose of the Study

The purpose of the study was to determine the knowledge and practice of prostate cancer

screening test among men attending outpatient department in University of Port Harcourt

Teaching Hospital.

Objectives of the Study

The main objective of the study is to access the knowledge and practice of prostate cancer

screening test among men attending outpatient department in University of Port Harcourt

Teaching Hospital.

Specifically, this study seeks to:

1. Assess the level of knowledge of prostate cancer screening test among men attending

Outpatient Department in University of Port Harcourt Teaching Hospital.

2. Identify the determinants of attitude of men attending Outpatient Department in University

of Port Harcourt Teaching Hospital.

3. Identify practices towards prostate cancer screening test among men attending Outpatient

Department in University of Port Harcourt Teaching Hospital.

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Research questions

1. What is the level of knowledge of prostate cancer screening test among men attending

Outpatient Department in University of Port Harcourt Teaching Hospital?

2. What are the attitudes of men towards prostate cancer screening test in Outpatient

Department in University of Port Harcourt Teaching Hospital?

3. What are the self-reported practices of prostate cancer screening test among men attending

Outpatient Department in University of Port Harcourt Teaching Hospital?.

Significance of the Study

The results of this study will help reveal the level of knowledge and practice of prostate cancer

screening test as well as factors that influence the practice of prostate cancer screening among

men attending outpatient department in University of Port Harcourt Teaching Hospital. It also

will aid those with plan to implement programmes for men that attend outpatient department to

know the aspects to emphasize during health education, which in turn will help men to be

appropriately equipped with knowledge that will help them for prevention and early

management of prostate cancer as well as attending prostate cancer screening.

The findings from this study will provide information that will be of help to professionals and

institutional workers to improve/promote specific knowledge levels and practice of screening

test on prostate cancer and calls for encouraging behavioural changes toward avoiding risks for

the development of prostate cancer among elderly men. Finally, this study will provide a

volume of literature on issues of knowledge and practice of prostate cancer screening test

among men thus it serves as a reference material to other researchers in the field of nursing

practice.

7
Scope of Study

The study focused on the knowledge and practice of prostate cancer screening test and

determination of factors that may influence the practice of prostate cancer screening test among

men attending outpatient department in University of Port Harcourt Teaching Hospital.. This

study was delimited to all adult men aged 40 years and above, that attends Outpatient

Department of University of Port Harcourt Teaching Hospital.

Operational Definition of Terms

Knowledge: It refers to the awareness or familiarity gained through experience.

Knowledge about prostate cancer screening test: It is defined as the awareness or familiarity of

prostate cancer.

Men: These are men at the age of 40 years and above

Practice: It is the actual application or use of a method of doing something.

Prostate cancer: It is a type of cancer that affects the male prostate gland.

Screening test: A procedure done to detect potential health diseases especially in people who

do not have symptoms of the disease.

The factors that influence the practice of prostate cancer screening: These are those conditions

that impede or facilitate the practice of prostate cancer screening.

8
 CHAPTER TWO

Literature Review

This chapter presents the review of literature related to the study under the following

subheadings: Conceptual review, theoretical review, empirical review and summary of

literature review.

Conceptual Framework

Prostate is a walnut sized gland which is part of the male reproductive system. It is located

beneath the urinary bladder and in front of the rectum. The function of the prostate is to make

fluid which nourishes and protects sperm cells in the semen. The activity and growth of the

prostate is regulated by a hormone called androgen (testosterone) produced by the testicles

(Prostate, 2013). Many men who are diagnosed with prostate cancer are asymptomatic,

however symptoms include urinary problems, blood in urine, pain in the hips, groin, pelvis,

spine, and difficulty urinating and when ejaculating (“Prostate Cancer Prevention and Early

Detection Prostate cancer risk factors,” n.d.). In a study conducted by reviewing other prostate

cancer studies on clinical features of suspected prostate cancer in primary care, it was reported

that although urinary tract symptoms are one of the predictors for prostate cancer, they were

not highly predictive. Instead, a biochemical test such prostate specific antigen (PSA) testing

or digital rectal exam (DRE) provide better indication of the disease (Young et al., 2015)

Like all the other cancer types, the origin of prostate cancer is unknown.Regardless, there may

be certain factors that dispose men to being at risk of prostate cancer. These factors include

age, race, and family history of prostate cancer, certain prostate changes (Prostatic

9
Intraepithelial Neoplasia) and some type of genome. However, having a risk factor does not

mean that one will necessarily get prostate cancer (Zhou & Magi-Galluzzi, 2018).

Cancer incidences and mortality rates vary worldwide. In the United states prostate cancer is

the most common malignancy affecting men and is the second leading cause of cancer deaths

(Bashir, 2015). However, prostate cancer differs between geographical and different ethnic

groups. Chu et al. (2016) reported that the rates of prostate cancer vary about 8 times within

Sub-Saharan Africa, with the lowest rate reported in West Africa and highest rates reported in

the East. With the economy in Africa improving and increasing adoption of western style of

living, it is likely that an increase in the incidence rate of prostate cancer in Africa will occur

with time as projected (Rebbeck 2013)

In a study conducted on prostate volume and prostate adverse features, prostate cancer size and

location were said to be of importance in diagnosis. Prostate cancers located in small glands

are more aggressive than those located within larger glands (Briganti et al., 2017). Detection

and treatment are very important when it comes to prostate volume.

Prostate cancer is a disease of the prostate gland that presents as either asymptomatic disorder

(Persec et al. 2013 ) or a systemic malignancy (Bambury& Gallagher, 2014). It is marked by a

disruption of the prostate architecture causing abnormal structure of the prostate and an

increase in Prostate Specific Antigen (PSA) (Lawrentschuk & and Pera, 2022) .

The risk factors for prostate cancer include age, sex, lifestyle, diet, race and family history of

PCa with age being highlighted as significantly common. Almost two out of every three

prostate cancer cases are found in men over 40 years of age. Symptoms of prostate cancer

include difficulty in urinating, frequent urination and blood in urine which are not usually

10
present especially in the early stages of the disease, hence the importance of screening

(Prostate Cancer UK, 2014).

Prostates specific antigen screening test is used as a biomarker to test for the prostate cancer

marker. If the PSA results are elevated with persistent increase in the results, it is an indication

of cancerous prostate cells (Duffy, 2015). However, the first step in screening for prostate

cancer is Digital Rectal Examination (DRE) (Loeb &Catalona, 2019). Treatment choices play

a very important role depending on the stage of the prostate cancerous cells (Prostate Cancer

UK, 2014).

The elements of the approach to controlling prostate cancer are similar to that of other non-

communicable diseases (NCDs) which include prevention, detection, diagnosis, treatments and

rehabilitation. Living a healthy lifestyle such as avoiding smoking, exercising regularly and

weight control offer opportunities for reducing the risk of developing prostate cancer (Cuzick

et al., 2014).

Early detection comprises early diagnosis in symptomatic population and screening in

asymptomatic population, for at risk individuals (Of, Health, Of, & Services, 2022). Increasing

awareness of the signs and symptoms of cancer contributes to detection of the disease in less

advanced stages (knowledge acquisition) and insight into the usefulness of participation in

screening activities for early diagnosis. This will add to timely detection of the disease and

efficient management that can save lives. Early detection can then lead to careful assessment

of clinical signs and symptoms, testing for prostate specific antigen and assessment for digital

rectal exams so that the choice of treatment: drug therapy, surgery, radiation, vasectomy or

surveillance can be initiated.

11
Prostate cancer screening

Being the most commonly diagnosed cancer in men does raise concerns for screening;

however, most cases are slow-growing, which never becomes clinically evident, and data have

suggested that many men die of other causes before cancer becomes advanced, thus making

routine screening controversial. There are different recommendations regarding when and

whom to screen for prostate cancer. All of these measures incorporate prostate specific antigen

testing as the primary screening tool. Apart from subtle differences, the primary focus of all

these recommendations is to help the patient make an informed decision regarding whether or

not to undergo screening after being explained the benefits and risks of screening as well as

taking into considerations the patient’s values and preferences in the decision making.

PSA and role of other adjunctive pre-biopsy tests.

Prostate Specific Antigen is a glycoprotein secreted by prostatic secretory epithelium and

seminal vesicles and is the most abundant protein in seminal plasma. Some amount normally

leaks into the blood. In case of any trauma or prostatic disease or any condition which disrupts

the microarchitecture of the gland, PSA diffuses into extracellular space, which is then drained

by the lymphatics into the bloodstream, thereby raising the prostate specific antigen value in

such men. Otherwise, the amount of PSA produced on per cell basis by malignant cells is less

than normal prostatic cells or in benign prostatic hyperplasia. PSA level increases in malignant

as benign conditions of the prostate like benign prostatic hyperplasia, prostatic inflammation or

infection, perineal trauma, or sexual activity. Hence raised PSA level is not specific for

prostate cancer. Furthermore, a normal PSA value does not rule out prostate cancer. Despite

the lack of specificity, PSA remains the single most widely recruited test for early detection of

prostate cancer. The normal value of PSA is considered to be less than or equal to 4 ng/ml.

However, serum PSA levels increases with age, plus PSA levels rise at a faster rate in older

12
men. Hence various age-specific ranges have been defined in an attempt to reduce the detection

of less advanced tumors in the older age group and increase the detection of potentially curable

tumors in the younger age group. These age-specific ranges are as follows:

• 40 to 49 yrs: 0 to 2.5ng/ml

• 50 to 59 yrs: 0 to 3.5ng/ml

• 60 to 69 yrs: 0 to 4.5ng/ml

• 70 to 79 yrs: 0 to 6.5ng/ml

Apart from age, studies have shown that certain medications also affect the value of PSA

levels. A few of these are Statins, Thiazide diuretics, Non-steriodal anti-inflammatory drugs, 5-

alpha-reductase inhibitors. All of them are known to decrease PSA levels. Hence any rise in

PSA levels while a patient is on these medications should raise the suspicion of prostate

cancer. Therefore this must be kept in mind before ignoring a normal PSA value.

Apart from PSA, a digital rectal exam (DRE) is also sometimes used to aid screening, but it has

low sensitivity and specificity. A DRE checks for the consistency, size, and texture of the

prostate gland.

Issues of Concern

Although the widespread availability of PSA screening in 1992 did lead to an increase in the

number of prostate cancers detected and a 44 % reduction in mortality as suggested by

simulation models, calculations suggest that screening does not improve quality-adjusted life

years (QALYs), even if there is a reduction in mortality. For prostate cancer screening, there is

a high potential for overdiagnosis. Overdiagnosis means screening of a condition that would

13
not have been clinically evident in the lifetime of the patient. The prevalence of prostate cancer

detection at autopsies of men that died due to other causes is higher than the lifetime incidence

of prostate cancer in the population. Per data from studies, 23 to 50 % of prostate cancers are

overdiagnosed. Many of the screening-detected prostate cancers are likely to have early-stage

cancer, which probably wouldn’t have even caused any clinical problems in the patient’s

lifetime. But this initial screening leads the patient to undergo further confirmatory testing and

aggressive treatment. These, apart from causing a myriad of adverse effects, also bring in

anxiety and cancer-related psychological effects for the patient.

Clinical Significance

The goal of screening is to reduce prostate cancer-specific morbidity and mortality by early

detection of high-risk and localized cancers, which can be successfully treated. Screening has

shown to offer a small potential reduction in the chance of dying from prostate cancer in some

men. Studies have demonstrated that in men aged 55 to 69 yrs, PSA based screening can

prevent 1 prostate cancer-related death when screened for over ten years per 1000 men

screened. Screening programs may prevent 3cases of metastatic prostate cancer per 1000 men

screened. But current results from screening trials show no reduction in the all-cause

mortality. There is inadequate evidence whether the benefits of screening are more in high-risk

individuals aged 55 to 65 yrs and whether earlier screening of such high-risk men is beneficial.

But for men aged 70+, there is adequate evidence consistent with no benefit of PSA-based

screening for prostate cancer.

One of the major concerns regarding prostate cancer screening is overdiagnosis, which

involves overtreatment of low-grade prostate cancer and decreasing the quality of life of the

patient by adding treatment-associated side effects and psychological harm when in reality,

14
cancer would not have caused any clinical problems in the patient. This outcome can be

overcome by active surveillance (monitoring). Active surveillance is one of the management

strategies in which a super select group of low-grade cancer patients are under close

monitoring and followed through their disease course with the expectation to intervene only if

cancer progresses. This approach will lead to the avoidance of treatment-associated side effects

in such patients. This monitoring is only achievable by cumulative efforts and coordination of

care amongst the interdisciplinary team members.

Theoretical review

Theory of Planned Behaviour

The theory of planned behavior, postulates that people are motivated to change based on their

perception of norms, attitudes, and control over behaviors. Each of these factors can either

increase or decrease a person’s intent to change his or her behavior. The theory shows several

important constructs that are involved in these value expectancy theories: attitude, subjective

norm, perceived behavioral control, intention, and behavior (Montano & Kasprzyk, 2018). The

theory of planned behavior explains how behavioral intention determines behavior, and how

attitude toward behavior, subjective norms, and perceived behavioral control influence

behavioral intention. According to the theory, attitudes toward behavior are shaped by beliefs

about what is entailed in performing the behavior and outcomes of the behavior. Beliefs about

social standards and motivation to comply with those norms affect subjective norms. The

presence or lack of things that will make it easier or harder to perform the behaviors affects

perceived behavioral control. Thus a chain of beliefs, attitudes and intentions drive behavior.

15
Application of the theory

The Theory of Planned Behavior is an expectancy-value theory. Expectancy value theories

assume that human behavior is rationally guided by logical thought processe. Consistent , a

person’s behavior is determined by their attitude towards the outcome of that behavior and by

the opinions of the person’s social environment.

Based on the TPB (Ajzen & Fishbein, 2013), intent to seek prostate cancer screening is a

function of three determinants: attitude, subjective norms, and perceived behavioral control.

Therefore, the prostate cancer screening practices of elderly men could be explained and

predicted by whether or not an individual is favorable to obtaining prostate cancer screening

tests, whether or not the individual feels socially pressured to obtain or not obtain prostate

screening tests, and whether or not the individual feels in control of obtaining prostate cancer

screening tests. The application of the TPB and related measures will not only contribute to

understanding the complex concept of culture, but also will serve to explain and predict health-

related practices and behaviors by quantifying specific cultural variables.

The theory postulates three conceptually independent determinants of intention. First, the

attitude of elderly men toward prostate cancer screening explains the degree to which they have

a positive or negative valuation of prostate cancer screening. Second, subjective norm refers to

the perceived social pressure experienced by elderly men to participate or not participate in

prostate cancer screening. Third, the antecedent of intention is the degree of perceived

behavioral control, or the degree of ease or difficulty in prostate cancer screening participation

experienced by men. In addition, perceived behavioral control is assumed to reflect past

experience as well as anticipated barriers and obstacles to prostate cancer screening.

16
Empirical Review

The low levels of knowledge and practice among African populations have been documented in

Nigeria, Uganda, and Ghana. In Nigeria, low levels of knowledge and practice were observed among

men in a rural community in the Inkene local government district (Eo et al., 2014). A similar finding

was reported in a qualitative cross-sectional study conducted in Ibadan, South West Nigeria. The

study recommended for the creation of community awareness programs on prostatic diseases in the

community (Atulomah et al., 2016).

A hospital based study in Nigeria however, reported a contrasting result. In this study 74.1% of the

men were reported to be aware of the existence of prostate cancer except that their participation in

screening activities was low. A similar hospital based study conducted in Kenya, Nairobi indicated a

low perception of men regarding cancer of the prostate (Paul, 2014).

In Uganda, the level of awareness about prostate cancer among men was also low, as was their

participation in screening activities (Atulomah et al., 2016); (Nakandi et al., 2013). The study revealed

that 59.4% of the men had heard about prostate cancer and as few as 9% knew about serum prostate

specific antigen (PSA) testing. Consequently, only 3.5% had ever undergone a serum PSA test

(Ellison et al., 2014). A study conducted in Ghana reported prostate cancer awareness level of 54.1%

among participants ( Binka et al., 2015). These results cumulatively indicate that in Africa, knowledge

and practice with regards to prostate cancer is low and requires strategies for improvement.

There is a clear need for health promotion interventions designed to increase awareness and improve

prostate cancer practice. To prepare men to make a decision to be tested, Information Education and

Communication (IEC) materials should be provided earlier to facilitate the diagnosis of prostate cancer

(Brooks, Wolf, Smith, Dash, &Guessous, 2013). Particularly, men in the risk age groups must be

targeted to receive information so they can be evaluated early for detection and management. On the

17
other hand, younger men under the age of 40 and men at average risk should receive this information

early so that detection rates improve, to save lives.

Summary of Literature Review

This chapter gave an overview of prostate cancer. It also discussed gaps, similarities and

contradictions on studies conducted on knowledge and practices of prostate cancer screening tests in

other regions.

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 CHAPTER THREE
Research Methodology

This chapter discusses the research design and the method which was used to answer the objectives of

the study. It covers the research design, sampling, data collection instrument, the reliability, validity

and procedure for data collection as well as analysis. The ethical consideration and the rights of the

participants have also been explained in this chapter.

Research Design

A quantitative approach using a cross sectional descriptive design was used for this study. This was

appropriate to ensure all respondents had an equal chance of being selected for the study and allow the

inference of the findings to the entire population under study (Elsayir, 2014);(Dicker, Coronado &

Koo, n.d).

Eligible men attending Outpatient Department In University of Port Harcourt Teaching Hospital were

recruited for the study. The descriptive study survey allowed orderly collection of data. The cross

sectional approach involves the collection of data at a point in time and be considered suitable for the

phenomenon being studied.

Research Setting

The research setting for this study is University of Port Harcourt Teaching Hospital (UPTH). It is a

tertiary institution located at Alakahia, Obio Akpor LGA. It is situated between Alakahia Primary

School and University of Port Harcourt. UPTH is a research, training and service centre for health

professionals and health care needs of all age groups are met. It consists of so many units namely

Accident and Emergency, Outpatient Department, Immunization unit, Labour ward, Eye clinic and

19
 Administration to mention but few. It is headed by a Chief Medical Director and other subordinates

in sub units.

Target Population.

The population for the study are men attending the Outpatient Department (OPD) in UPTH. They

consisted of a uniform mix of patients from both rural and urban areas since patients from both

locations do come to the targeted health facility. Men attending UPTH at the Outpatient Department

who were eligible and willing to participate. Men with prior diagnosis of prostate cancer were not part

of the study. Men with debilitating medical or health issues, mentally unstable and speech disabled

were excluded. Men who were critically ill were also excluded.

Sample Size

The sample size was calculated using the Taro - Yamane (1967) simplified formula for finite

population proportions using the following parameters: Population size: 240, Expected frequency:

50%, Confidence level: 95%.

n= _N___

1+N (e) 2

Where:

n = sample size

N = population size

e = level of precision at a 95% confidence level (0.05)

n = ___ 240______

20
 1+297 (0.05)2

n= ___240________

1 + 240(0.0025)

n = ____240___

1 + 0.6

n = __297__

1.6

n = 150.

Therefore based on the above sample size calculation, a sample size of 150 men attending Parklane

hospital was used.

Sampling Technique

The study employed a simple random sampling technique for obtaining respondents for the distribution

of questionnaires. This approach confers a degree of confidence on the representative nature of the

chosen sample by minimizing researcher bias.

Instrument for data collection

A self-structured questionnaire designed based on WHO guidelines on conducting Knowledge,

Attitudes and Practice surveys as well as UNESCO questionnaire guidelines (“A guide to developing

knowledge, attitude and practice surveys”) was used. The questionnaire was in English and consisted

of closed-ended questions. Three sections namely Section A, B and C made up the questionnaire.

21
Section A consisted of questions on socio-demographic characteristics such as age, current residence,

religion, education, major occupations, marital status, smoking and alcohol status, earnings per month

as well as family history of cancer. Section B captured knowledge questions on prostate cancer risk,

signs and symptoms, complications and treatment options. Section B also captured question on sources

of information where the participants heard about prostate cancer. Section C captured information on

prostrate cancer practices such as PSA screening and DRE, duration when the tests were done and

reasons for not having a PSA or DRE exam done.

Validity of Instrument

The validity of a test is the extent to which the test measures the variables under the study. It ensures

accuracy and correct interpretation of the results of the study. In this study validity was achieved by

cross-checking, inspecting and scrutinizing the information entered in the questionnaires to ensure that

the data collected was accurate, relevant, complete, consistent and homogeneous.

Validity was well ensured by verification of the men’s passports (health cards with basic information

on their medical history) to ensure that they have never been diagnosed with prostate cancer. Validity

was also enhanced as adjustments were made to the questionnaire as a result of pretesting the data

collection tool.

Reliability of Instrument

Reliability is the consistency of a measure that ensures consistency of a test. In this study, in order to

establish the reliability of the instrument, a test retest technique was used to ascertain the reliability of

the instrument. The questionnaire was pilot tested using 10 men attending Outpatient Department In

UPTH by the researcher to find out unclear and ambiguous questions which were reworked and

removed. The pilot testing of the questionnaire helped to estimate the time that could be taken to

22
respond to the questionnaire which was an average of 10 minutes. After two weeks, the questionnaire

was re-administered to the same group, which were collected after response. Reliability coefficient of

0.80 was obtained.

Method of data collection

The researcher with the letter from the Department of Nursing Science, obtained permission to carry

out the study from the hospital administration. The data was collected by the researcher. The

researcher administered the questionnaires to the selected men present at the OPD between 10am and

4pm. The questionnaires was collected on the spot. This ensured a high return rate and avoided the

problems usually associated with the posting of instrument and to offer explanation where and when

necessary. The data collection lasted for 3 weeks.

Method of Data Analysis

Data Analysis was done using Expanded Program on Immunization (E.P.I) info 7. Data obtained was

summarised in frequencies and percentages using data analysis tool. Knowledge levels was

determined using a series of 10 questions on risk factors, signs and symptoms, prevention, treatment

and complications of prostate cancer.

Practice was assessed by calculating frequencies and percentages of those who had a PSA or DRE

done, and the number of times it was done.

Ethical Consideration

Approval for this study was obtained from the University and a permit was obtained from the

management of University of Port Harcout Teaching Hospital. Approval through a consent letter was

obtained prior to the commencement of this study. Before participation in the study, individual

informed consent was obtained from each participant, this was to ensure that participation in the study

was voluntary. Confidentiality, privacy and anonymity was assured to the respondents with respect to

23
the information they have shared. This enabled them to give the necessary assistance on the collection

of data. The researcher ensured that there was no risk involved in participating in this study.

24
 CHAPTER FOUR

Results

This chapter describes the data analysis, findings and interpretation of the results. The data analysis

was guided by the research questions. The statistics are presented in frequencies, tables and

percentages. Relationships between variables were identified using frequencies and percentages. A

total of 150 questionnaires were administered and all copies were properly filledand returned.This put

the response rate at 100%.

Table 1: Demographic data of the respondents

Demographic Variables Frequency Percentage

(150) (%)
Age
29-39 30 20
40-50 60 40
51-61 40 26.6
61 and above 20 13.3 Table 1:
Current Residence
Town 60 40 shows the
Village 90 60
demographic
Marital Status
Single 30 20 characteristics
Married 60 40
Seperated 30 20 of the
Divorced 15 10
Cohabiting 15 10 respondents.
Religion A total of 150
Christianity 90 60
Islam 15 10
men
Others 45 30

participated in
Education
Primary 80 53.3
Secondary 40 26.6 this data
Tertiary 15 10
None 15 10 collection

Occupation procedure.
Farming 30 20
Business 45 30
25
Teaching 40 26.6
Unemployed 15 10
Others 20 13.3
Results revealed that 60(40%) of the respondents were within the age range of 40-50, 40(26.6%) were

50-61 years old, 30(20%) were within the age range of 29-39, while 20(13.3%) were 61 and above.

90(60%) of the respondents lived in the village while 60(40%) resided in town. Furthermore, 60(40%)

of the respondents were married, 30(20%) were single, while 30(20%) were separated, 15(10%)

divorced and cohabiting. There were 90(60%) Christian respondents, 15(10%)Muslims and 45(30%)

other religions. The distribution of the respondents by their education levels showed that 80(53.3%)

had acquired at least a primary education, 40(26.6%) had secondary education while 15(10%)

respondents had tertiary and no education respectively. By occapation levels, the distribution showed

that 45(30%) were business men, 40(26.6%) had teachings jobs. 30(20%) were farmers while 15(10%)

were unemployed, 15(10%) were classified under others.

Table 2: Level of knowledge of Prostate Cancer Screening Test

Items Strongly Agree Neutral Disagree Strongly

agree disagree
I know about prostate cancer 24 31 _ 45 50
(16%) (20.7%) (30%) 33.3%)
I can identify what prostate cancer is 12 15 3 40 80
(8%) (10%) (2%) (26.7%) (53.3%)
All men must have prostate cancer 4 16 _ 120 10
26
 (2.6%) (10.6%) (80%) (6%)
The only way to suspect prostate cancer is 25 40 15 20 50
through screening (16.7%) (26.7%) (10%) (13.3%) (33.3%)

I can identify the early warning signs of prostate 12 15 1 120 10

cancer (8%) (10%) (0.6%) (80%) (6%)

Early detection can increase survival 75 45 _ 10 20

(50%) (30%) (6%) (13.3%)

Prostate cancer can be treated 16 30 4 25 75

(10.6%) (20%) (2.6%) (16.7%) (50%)

There are ways in which PCa can be treated 17 30 3 30 70

(11.3%) (20%) (2%) (20%) (46.7)

Prostate cancer screening should be done 45 60 _ 15 30

regularly (30%) (40%) (10%) (20%)

Table 2 shows findings on the level of knowledge of prostate cancer screening test among men

attending Outpatient Department in University of Port Harcourt Teaching Hospital. Respondents who

strongly disagreed about their knowledge of prostate cancer were 50(33.3%), 45(30%) disagreed while

31(20.7%) and 24(16%) agreed and strongly agreed having an idea of what it is respectively.

120(80%) of the respondents disagreed that all men must have prostate cancer while 16(10.6%) agreed

. 30(20%) which is less than half of the respondents knew the warning signs of with the majority

120(80%) and 10(6%) disagreed and strongly disagreed respectively. Seventy five respondents

75(50%) strongly agreed that early detection could increase chances of survival while 20(13.3%)

strongly disagreed. Respondents who strongly agreed that PCa can be treated were only 16(10.6%).

Thirty 30(20%) respondents could identify ways to treat PCa with 35 (46.7%) stating drug therapy, 15

(20%) mentioning radiation and 8 (10.7%) stating vasectomy as means of treatment. 60(40%) of the

respondents agreed that PCa screening shouhld be done regularly while 45(30%) strongly agreed.

27
30(20%) strongly disagreed to it. 40(26.7%) and 25(16.7%) agreed and strongly agreed that the only

way to suspect prostate cancer is through screening, while 50(33.3%) strongly disagreed to it.

Table 3: Attitude towards prostate cancer screening test

Attitude Statements Strongly Agree Neutral Disagree Strongly

agree disagree

Prostate cancer is only a problem for males of 10 60 _ 40 40

advancing age (6%) (40%) (26.6%) (26.6%)
It is important to screen for prostate cancer 60 40 _ 35 15

28
 (40%) (26.6%) (23.3%) (10%)
Prostate cancer screening would be painful 50 35 5 15 45
(33.3%) (23.3%) (3.3%) (10%) (30%)
Going through prostate cancer screening is 46 45 _ 48 11
embarrassing (30.7%) (30%) (32%) (7.3%)
Prostate cancer screening will aggravate the 7 30 _ 68 45
disease (4.7%) (20%) (45.3%) (30%)
Going through prostate cancer screening is 52 70 1 15 12
necessary for good health (34.7%) (46.7%) (0.7%) (10%) (8%)
Prostate cancer screening is beneficial and will 42 63 _ 20 25
settle any ambiguities (28%) (42%) (13.3%) (16.7%)
Regular examination for PCa is expensive 66 71 _ 10 3
(44%) (47.3%) (6%) (2%)
If recommended I would go to screen for PCa 17 105 _ 20 8
(11.3%) (70%) (13.3%) (5.3%)
If found out that I have PCa, I would accept any 48 78 4 15 5
treatment given (32%) (52%) (2.6%) (10%) (3.3%)

Table 3 represents the responses obtained for the attitudes of the patients towards prostate cancer

screening test in University of Port Harcourt Teaching Hospital. From the findings, 26.6% strongly

disagreed that prostate cancer was a problem for males only in advanced age while 40% agreed. 80%

strongly agreed that its important to screen for prostate cancer while 10% strongly disagreed.

35(23.3%) agreed prostate cancer screening would be painful while 10% disagreed. 60.7% believed

that going through prostate cancer screening could be embarassing. 20% agreed that prostate cancer

screening will aggrevate the disease while 45.3% disagreed. 46.7% agreed that going through prostate

cancer screening is necessary for good health. 42% agreed and 28% strongly agreed that PCa

screening is beneficial and will settle any ambiguities while 13.3% and 16.7% disagreed and strongly

disagreed respectively. 70% of the respondents agreed that if recommended, they would go to screen

for PCa while 13.3% disagreed. 52% agreed and 32% strongly agreed that if diagonized of prostate

cancer, would accept any treatment given.

29
Table 4: PROSTATE CANCER SCREENING PRACTICES

Strongly Agree Neutral Disagree Strongly

ITEMS agree disagree

I have undergone a screening test. 27 _ _ 13 110

If Yes, what is the type of screening test

undergone

Digital Rectal Examination(DRE) 18 _ _ _ _

Prostate Specific Antigen(PSA) 6 _ _ _ _

Cannot remember 3 _ _ _ _

Reasons for screening for prostate cancer

Routine check 8 _ _ _ _

Had symptoms of it 5 _ _ _ _

Wife/friend suggested it 3 _ _ _ _

Doctor recommended it 11 _ _ _ _

Reasons for not screening for PCa

Don’t know of it 95 _ _ _ _

Might be painful 3 _ _ _ _

Might be expensive 7 _ _ _ _

Don’t want to know the outcome 6 _ _ _ _

It is not necessary 5 _ _ _ _

Doctor has never recommended it 7 _ _ _ _

I did routine PCa screening

Last 3- 4 months 12 _ _ _ _

6 months ago 10 _ _ _ _

Last 12 months 5

30
Out of 55 respondents who have heard about prostate cancer, 27(18%) have had an exam done. The

PSA test had been done on 6(4%) with 18(12%) having done a rectal examination. The respondents

gave the following reasons for having an examination done: recommended by a doctor 11(9.1%),

routine check 8 (5.3%), wife/friend suggested it 3 (1.6%) and sick 5 (3.3%).

Out of the 123 respondents who haven’t done the prostate cancer screening test, 95(63.3%) gave

reasons of not knowing about it. 3(2%) stronly agreed that it might be painful, 7(4.7%) strongly agreed

it might be expensive. 6(4%) strongly agreed that their reasons for not screening was because they

didn’t want to know the outcome of the test, while 5(3.3%) strongly agreed that the test was not

necessary. 7(4.7%) haven’t done the test because a doctor hasn’t suggested it. Some of the participants

indicated to have undergone the examination in the past 3 - 4 months: 12(8%). 10(6.7%) respondents

reported to have had it done 6 months ago while 5(3.3%%) reported 12 months ago.

CHAPTER FIVE

Discussion of Findings

This chapter, which concludes the study, briefly summarizes the findings relationship with other

studies/ literature review. It also focuses on implications of findings to nursing, limitations of the

31
study, summary, conclusion and makes recommendations and suggestions for practice and further

research.

Key Findings

Level of knowledge of Prostate Cancer Screening Test

The findings revealed a low level of knowledge of prostate cancer as demonstrated by the results

where 122(81.3%) of the respondents did not know what prostate cancer was. However, 120(80%)

respondents were positive that early detection could increase chances of survival. The result obtained

in this study correspond with Andreas, (2019) &Atulomah et.al, (2020) whose reports quoted that

there is low level knowledge about prostate cancer in Nigeria. The findings from the questionnaire

respondents does not correspond to interviewee’s as only four out of the eleven participants

interviewed reported having knowledge of prostate cancer. Most of the respondents reported that they

do not know anyone that has had prostate cancer before. The findings of this study are in line with

Ajape, Babata, and Abiola (2020) whose findings revealed that none of their respondents have seen or

cared for someone with prostate cancer. The findings from this study also corroborate with the

interviewee’s responses were all the participants’ stated that they do not know any one that has

prostate cancer.

Attitude towards prostate cancer screening test

From the findings, majority of the respondents (53.2%) did not believe prostate cancer was a problem

for males only in advanced age while 66.6% were positive that it is important to screen for prostate

cancer.This figure corresponds to the research done by Oladimeji et al., (2020) among Nigerian men

that showed that 22.5% of the Nigerian men were aware of prostate cancer screening with positive

attitudes of over 50%. Significantly, the results presented here showing that uptake of prostate cancer

screening was associated with advancing age from 10.3% in 40–44-year age group to 57.1% in the
32
participants aged 65 years and above. In a similar study, done in a rural community of Ogun State in

Southwestern Nigeria the level of awareness of prostate cancer among the participants was 39.2 %

(Ogundele, 2020). This is slightly higher than the awareness rate in our study despite the fact that this

study took place in an urban setting. Knowing the level of awareness about a disease condition is

important for both the government and health care workers for the purpose of planning and

organization of health care delivery to the group of people affected or to people at risk of developing

the disease condition

Prostate Cancer Screening Practices

Findings revealed that only 27(18%) of the respondents had undergone a screening test, and the major
reason for not screening PCa was that they do not know of it (63.3%). This study revealed that
although some respondents were aware of prostate cancer screening, few had taken the test. Because
there is insufficient scientific evidence for the justification of screening in all men, informed decision
making should guide a decision to obtain screening for prostate cancer. This means that men should
talk with their doctors to learn the nature and risks of prostate cancer, understand the benefit and risks
of screening and decide whether prostate cancer screening is right for them(Ross et al., 2020).

Implication of Study to Nursing

According to the current study, knowledge from these findings will help to influence nursing care to

patients and the general public. It will also provide excellent guide for research priorities for health

policy activities. This implies that it will help to address cultural beliefs and perception towards men’s

health. The findings of this study indicated that prostate cancer and screening knowledge alone may

not prompt men to participate in screening and counseling, therefore it is expected that nurses should

use their skills to encourage men to screen, as this will help promote cancer prevention programs and

promoting healthy living. This is so because with deep understanding of the knowledge, attitude and

33
cultural beliefs of the population, nurses can use this type of information to plan education, prevention

and screening programs.

Limitations of the Study

This study was limited to men attending outpatient in University of Port Harcourt Teaching Hospital,

Rivers State,which may limit the generalization of the findings to other health facilities in the state and

in Nigeria as a whole. A small number of respondents reported having been screened for PCa,

therefore statistical tests could not be performed as the numbers were very minimal. The researcher

encountered some limitations among the respondents as some of them needed assistance in

understanding and filling the research instrument. Some of the respondents were reluctant to fill the

questionnaire because they claim they did not have time for it. The researcher also incurred huge

financial expenses in carrying out this research.

Summary

The primary objective of the study was to assess the knowledge and practice of prostate cancer screening

test among men attending outpatient in University of Port Harcourt Teaching Hospital, Rivers State. A

cross-sectional descriptive survey design was used and 150 respondents were used. A self-structured

questionnaire was developed according to the objectives of the study to guide in the generation of

information. Socio-demographic characteristics of the respondents and the research question were

analyzed using simple frequency and percentage. The findings revealed a low level of knowledge of

prostate cancer as demonstrated by the results where 122(81.3%) of the respondents did not know what

prostate cancer was. However, 120(80%) respondents were positive that early detection could increase

chances of survival. From the findings, majority of the respondents (53.2%) did not believe prostate

cancer was a problem for males only in advanced age while 66.6% were positive that it is important to

34
screen for prostate cancer. Findings revealed that only 27(18%) of the respondents had undergone a

screening test, and the major reason for not screening PCa was that they do not know of it (63.3%).

Conclusion

The study has showed that the practice of prostate cancer screening among men attending outpatient in

University of Port Harcourt Teaching Hospital is low; however, most of the men are willing to

undertake prostate cancer screening and know more about the disease. More efforts are needed to

encourage adult males who are at risk to go for voluntary screening and counseling as early detection

and good knowledge have been shown to improve the disease outcome. These findings indicate that

public health programmes should create awareness and improve knowledge of prostate cancer among

men across all socio-economic groups. This could result in an improvement in attitudes which may

eventually help screening participation. These programmes should provide clarity on healthy lifestyles

to prevent cancer and highlight the health benefits of early screening, detection and treatment,

screening and treatment options and the peculiarities of each to inform health-seeking choices.

Recommendations

The following recommendations are made based on the findings of the study;

1. Firstly, voluntary and regular prostate cancer screening should be recommended for adult

males, including those in the high-risk bracket. There is need for increased awareness of the

factors that predispose participants to the disease. The significance and relevance of these

findings to and its accuracy in diagnosing prostate cancer cannot be overemphasized.

2. Secondly, there is need for health education among younger males because it’s a potential

channel to create awareness to young males about prostate cancer and cancer in general.

35
 3. As screening was very low, a programme could be developed as part of a routine to screen men

who are at a risk age of developing PCa. Women could also be involved in speaking to their

spouses on the importance of early screening as has been recommended in several reports.

4. The Ministry of Health could work together with the UPTH health team to include PCa

awareness and screening as part of priority diseases and start at community level with health

extension workers sharing information on PCa knowledge, screening modalities, the

importance of early detection and treatment options available using especially identified

sources (radio and TV) and other sources.

5. Lastly, there is a need for health stakeholders to initiate policies and programs in clinics,

research councils and schools that will encourage youths and adults into action towards

screening and counseling services.

Suggestion for Further Studies

The following areas are suggested for further research: there is need for sustained local research

regarding risk factors (e.g., family history, genetics, etc.) for prostate cancer; that may improve further

understanding of prostate cancer and the uptake of prostate cancer screening in Rivers state and

Nigeria as a whole. Also, in view of the findings in this study, it is suggested that further studies

should be done using more geographical areas since only one area was used.

36
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40
 APPENDIX A

MADONNA UNIVERSITY ELELE, RIVERS STATE, NIGERIA

FACULTY OF HEALTH SCIENCES

DEPARTMENT OF NURSING SCIENCE

P.M.B 48, Elele, Rivers State.

Our Ref……………………………… Office of: Head of Department

GEMMA B.GALOA RN, MAN

Your Ref …………………………… Tel: +234 9159814309

Email:gemma440913@gmail.com

TO WHOM IT MAY CONCERN

The bearer AKA KOSISOCHUKWU LILIAN is a bona-fide student of this University. She is
carrying out a Research on KNOWLEDGE AND PRACTICE OF PROSTATE CANCER
SCREENING TEST AMONG MEN ATTENDING OUTPATIENT DEPARTMENT IN
UNIVERSITY OF PORT HARCOURT TEACHING HOSPITAL as part of the requirement for
the award of Bachelor of Nursing Science.

She is asking for permission to obtain data from your community. Kindly accord her the necessary
assistance, please. All information / data shall be treated as strictly confidential. At the end of the
study the finding shall be communicated to you.

Yours faithfully,

MRS. GEMMA B. GALOA

HOD

41
 APPENDIX B

INFORMED CONSENT

Madonna University,

Department of Nursing Science

Elele Campus,

Rivers State.

Dear Respondents,

The researcher is a final year student of the above-mentioned school, carrying out a research

on the Knowlegde and practice of prostate cancer screening test among men attending outpatient

department in University of Port Harcourt Teaching Hospital Port harcourt. The questionnaire is

purely for academic research and it is meant for the improvement of healthcare delivery.

You are requested to kindly and carefully answer the questions, information is confidential and your

names are not needed.

Thanks for your cooperation.

Yours faithfully,

Aka Kosisochukwu Lilian.

42
 APPENDIX C

QUESTIONNAIRE

Instructions: Please Tick (√)where appropriate and supply answers accurately where applicable.

Section A: Socio-Demographic Characteristics

1. Age

2. Current Residence
Town [ ] Village [ ]

3. Religion
Christianity [ ] Islam[ ] Others [ ]

4. Education

Primary [ ] Secondary [ ] Tertiary[ ] Others [ ]

5. Major Occupations

Business [ ] Unemployed [ ] Teacher/Lecturer [ ] Farmer[ ]

Unemployed[ ] Others [ ]

6. Marital Status

Single [ ] Married[ ] Divorced [ ] Cohabiting[ ] Separated[ ]

7. If married, Number of wives

Two [ ] One[ ] More than two [ ]

8. Do you smoke?

Yes [ ] No [ ]
9. If yes,

1-4 cigarettes daily [ ] >5 cigarettes daily[ ] >10 cigarettes daily [ ].

43
10.Do you take alcohol?

Yes [ ] No [ ]
11. If yes,

Which class? (Please give a Tick(√) to all that apply)

Beers[ ] Wines [ ] Spirits [ ]

12. Amount?

1 glass daily[ ] 1-5 glasses daily More than10 glasses daily [ ]

Section B: Knowledge about Prostate Cancer (PCa)

Knowledge is defined as having information on prostate cancer. Information include what the
signs and symptoms are, prevention and treatment modalities for prostate cancer
Instructions:Please give a Tick(√) to the appropriate answer

14. I have you heard about prostate cancer?

Strongly agree[ ] Agree [ ] Disagree [ ] Strongly disagree [ ]

15. If yes, which source of information told you about prostate cancer?

Instructions: Please Tick (√)to all that apply

Male dinners [ ] Church [ ] Health [ ] Internet [ ] Textbook [ ] Family and Friends

[ ] Professional [ ] Others, Specify [ ]
16. What is prostate cancer?

Scrotum cancer [ ] Cancer of the male reproductive organ[ ]

Inflammation of the prostate gland [ ] Cancer of the prostate gland [ ] Inability to urinate[ ]

Don’t Know [ ]

17. What are the risk factors associated with prostate cancer (Please Tick(√) all that apply)
44
Family history [ ] Race [ ] Age [ ] Dietary fat intake[ ] Sexual activity [ ] Occupation[
] Cigarette[ ] Smoking[ ] Don’t Know[ ]

18. Can risk factors for developing prostate cancer be reduced?

Strongly agree [ ] Agree [ ] Strongly disagree [ ] Disagree [ ]

19. If you agree, by which way?

Improved sex education[ ] Better health care [ ] Periodic medical check-up[ ]

Condom usage [ ] Abstaining from sex [ ] Dietary Control [ ] Don’t know [ ]

20. What are the early warning signs of prostate cancer?

Pain in groin[ ] Fever [ ] Difficulty in urinating [ ] Uneasy feelings [ ]

Don`t know [ ]

21. Early detection of prostate cancer increase survival?

Strongly agree [ ] Agree [ ] Strongly disagree [ ] Disagree [ ]

22. Prostate cancer be treated?

Strongly agree [ ] Agree [ ] Strongly disagree [ ] Disagree [ ]

23. If positive, how can prostate cancer be treated? (please Tick(√) all that apply)
Surgical means [ ] Drug therapy [ ] Radiation [ ] Surveillance [ ]
Vasectomy [ ] All of the above Don`t know [ ]

22. What are the complications of prostate cancer?(Please Tick(√) all that apply)
Impotence [ ] Loss of life [ ] Urinary incontinence [ ] Cystitis/urethritis [ ]
dementia [ ] Don’t know [ ]

Section C: Prostate Cancer Practices

45
Defined as having ever been tested for prostate cancer by any common screening methods: PSA
testing, Direct Rectal examination

23. I have done a prostate cancer screening test

Strongly agree[ ] Agree [ ] Disagree [ ] Strongly disagree [ ]

24. I have had a PSA Test done?

Strongly agree[ ] Agree [ ] Disagree [ ] Strongly disagree [ ]

25. I have had a Rectal Exam done?

Strongly agree[ ] Agree [ ] Disagree [ ] Strongly disagree [ ]

26. If any of the above tests is positive, when did you have it?

3-4 months ago [ ] 6 months ago [ ] 12 months ago [ ]

27. If positive, what was the reason for having a PSA / Rectal exam done?

Routine check [ ] Recommeded by a doctor [ ] Sick [ ] Wife/friend suggested it [ ]

28. If negative, why not?

Afraid [ ] Not necessary[ ] Expensive [ ] I don’t want to know the outcome[ ]

No medical Aid [ ] I don’t know of it [ ]

APPENDIX D

46
 LETTER OF ATTESTATION

Our ref……………………………

Your ref ……………………………

Date……………………………

TO WHOM IT MAY CONCERN

The bearer AKA KOSISOCHUKWU LILIAN (NSC/18/1126) is a bona-fide student of this

University. She is carrying out research on KNOWLEGDE AND PRACTICE OF PROSTATE
CANCER SCREENING TEST AMONG MEN ATTENDING OUTPATIENT DEPARTMENT,
aspart of the requirements for the award of Bachelor of Nursing Science.

The student is permitted to obtain data from this establishment. Kindly accord her the necessary
assistance, please.

All information / data shall be treated as strictly confidential. At the end of the study the finding shall
be communicated to you.

Yours faithfully,

MRS GLORIA OGAN,

HNS.

APPENDIX E

47
 RELIABILITY TEST RESULTS

Table showing respondents’ results

S/N X Y XY X^2 Y^2

1 28 34 952 784 1156

2 44 50 2200 1936 2500

3 25 28 700 625 784

4 15 21 315 225 441

5 30 50 1500 900 2500

6 30 40 1200 900 1600

7 50 40 2000 2500 1600

8 25 31 775 625 961

9 46 42 1932 2116 1764

10 22 28 616 484 784

TOTAL 315 364 12190 11095 14090

Using Pearson’s correlation coefficient formula

n (∑xy)-(∑x) (∑y)
48
 √n (∑x^2)-(∑x) ^2*n (∑y^2) - (∑y) ^2

= 10 (12190) – (315)(364)
______________________________________
√10 (11095)-(315)2 * 10(14090) - (364)2

= 121900– 114660
_______________________________
√110950– 99225 * 140900- 132496

= 7240
__________________
√11725 * 8404

= 7240
__________________
√98536900

= 7240
___________ 9619.61 = 0.7526

Therefore the instrument for data collection is strongly reliable, with coefficient of 0. 75.

APPENDIX F

APPROVAL

To the Research Committee

49
Department of Nursing
Madonna University

Student’s Name: AKA KOSISOCHUKWU LILIAN

Registration number: NSC/18/1126

The Research Project titled:

KNOWLEDGE AND PRACTICE OF PROSTATE CANCER SCREENING TEST AMONG MEN

ATTENDING OUTPATIENT DEPARTMENT IN UNIVERSITY OF PORT HARCOURT
TEACHING HOSPITAL

of which I have mentored has been reviewed, corrections have been made and is recommended for

submission/ presentation, in particular (please check) for:

Research Proposal (Chap 1-3) for pre-council exams

Complete Research Project (Chap1-5) for council exam

Others (Internal or External Defence) for BNSc degree

Remarks (if any) _________________________________________

_______________________________________________________

Name of Supervisor: Dr. Abdurrahman Muhammad Sani

(Signature over printed name)

Date: __________________________

50