Assessing the knowledge, Attitudes and Barriers Regarding Health Promotion of Breast Cancer Among Community Pharmacists

Figures & data

Figure 1. A detailed questionnaire of this study.

(A) Sociodemographic and practice variables. (B) Knowledge test on the prevalence, risk factors, signs and symptoms, screening methods and treatment of breast cancer. (C) Pharmacists belief statements with regard to providing advice to patients on breast cancer. (D) Barrier to providing breast cancer health promotion to patients visiting the pharmacy.

Table 1. Sociodemographic and practice variables of the pharmacists who took part in the study (n = 605).

Variable	n	%
Age (years)
<30	327	54.0
≥30	278	46.0
Sex
Male	265	43.8
Female	340	56.2
Marital status
Never married	273	45.1
Married/divorced/widowed	332	54.9
Education
BSc Pharmacy	415	68.6
Pharm.D	147	24.3
Postgraduate pharmacy education (MSc or PhD)	43	7.1
Place from where the academic degree was obtained
Jordan	526	86.9
Other	79	13.1
Experience (years)
<5	255	42.1
5 to <10	229	37.9
≥10	121	20.0
Attended an educational program on breast cancer
Yes	360	59.5
No	245	40.5
Approximate patients with breast cancer interacted with per month (n)
<3	382	63.1
≥3	223	36.9
Perceived knowledge of breast cancer
Poor–Fair	211	34.9
Good–Excellent	394	65.1
Average working h per week (n)
<40	245	40.5
≥40	360	59.5
Average patients interacted with per day (n)
<50	272	45.0
≥50	333	55.0
Female patients visiting the pharmacy (%)
<20	81	13.4
20–49%	302	49.9
≥50	222	36.7
Pharmacists working in the pharmacy at any one shift (n)
1	234	38.7
2 or more	371	61.3
Respond to patient inquiries related to breast cancer warning signs and symptoms and breast cancer early detection and screening tests
Rarely	217	35.9
Often	388	64.1
Provide patients with advice or counseling on breast cancer screening and early detection
Rarely	208	34.4
Often	397	65.6
Provide patients with breast cancer educational materials or self-assessment quizzes
Rarely	272	45.0
Often	333	55.0
Refer patients to special breast cancer screening programs organized by hospitals or cancer organizations
Rarely	277	45.8
Often	328	54.2

Table 2. The groups and categories for knowledge, attitude and barrier points.

Group	Categories	n (%)	Mean (standard deviation)	Median (interquartile range)	Minimum	Maximum
Knowledge	Less than 50%	464 (76.7)	8.2 (2.9)	8.5 (6–10)	-1.5	12.5
	More than or equal 50%	141(23.3)	15.3 (1.6)	15.5 (14–16)	13	20.5
	Total	605	9.8 (4.1)	9.5 (7–12.5)	-1.5	20.5
Attitude	Negative	36 (6%)	-11.7 (8.5)	-11.5 (-16.5 to -3.5)	-28	-1
	Neutral	8 (1.3%)	00	00	00	00
	Positive	561 (29.7%)	17.46 (5.9)	17.0 (14–19)	1	28
	Total	605 (100%)	15.49 (9.4)	17.0 (13.0–21.0))	-28	28
Barrier	Barrier Dominant	251 (41.5%)	5.7 (4.3)	4 (2.0–9.0)	1	18
	Neutral	63 (10.4%)	0	0	0	0
	Not Barrier Dominant	291 (48.1%)	-5.0 (3.1)	-5.0 (-7.0 to -2.0)	-18	-1
	Total	605 (100.0%)	-0.15 (6.1)	0.0 (-5.0 to 3.0)	-18	18

Table 3. Responses of the community pharmacists on the 26-item knowledge test on the prevalence, risk factors, signs and symptoms, screening methods, and treatment of breast cancer.

Question	Standard answer (true, false)	Correct answer		Incorrect answer		Did not know
		n	%	n	%	n	%
Prevalence of breast cancer
Breast cancer is the most common form of cancer among women.	T	529	87.4	52	8.6	24	4.0
Breast cancer should not be of concern for patients younger than forty years of age.	F	235	38.8	337	55.7	33	5.5
Risk factors
Use of hormone replacement therapy is one of the risk factors for developing breast cancer.	T	466	77.0	76	12.6	63	10.4
Late onset menstrual period is one of the risk factors for developing breast cancer.	F	88	14.5	425	70.2	92	15.2
Old age increase risk of breast cancer.	T	494	81.7	69	11.4	42	6.9
There is no relationship between cigarette smoking and breast cancer.	F	253	41.8	305	50.4	47	7.8
Family history of breast cancer is a risk of breast cancer.	T	497	82.1	59	9.8	49	8.1
Use of oral contraceptive decrease risk of breast cancer.	F	196	32.4	326	53.9	83	13.7
There is no relationship between size of breast and risk of breast cancer.	F	117	19.3	401	66.3	87	14.4
Breastfeeding increase risk of breast cancer.	F	257	42.5	283	46.8	65	10.7
Signs and symptoms
Nipple discharge can be a warning sign of breast cancer.	T	459	75.9	74	12.2	72	11.9
Painless breast lump under armpit is not sign of breast cancer.	F	226	37.4	316	52.2	63	10.4
Change in breast shape is a sign of breast cancer.	T	508	84.0	60	9.9	37	6.1
Pain in breast region and dimpling are signs of breast cancer.	T	466	77.0	88	14.5	51	8.4
Screening methods
Appropriate early screening for breast cancer reduces breast cancer mortality.	T	493	81.5	72	11.9	40	6.6
Breast self-examination is one of the methods that are used to detect the presence of breast cancer.	T	494	81.7	65	10.7	46	7.6
To detect the presence of breast cancer, women over the age of twenty and under the age of forty should do a breast self-examination at least once per year.	F	76	12.6	485	80.2	44	7.3
To detect the presence of breast cancer, women aged forty years and above should do a monthly breast self-examination, an annual clinical breast examination and a biannual mammogram.	F	48	7.9	507	83.8	50	8.3
Mammography is painful.	F	183	30.2	303	50.1	119	19.7
Mammography is safe.	T	415	68.6	92	15.2	98	16.2
Breast self-examination is recommended for women aged 35 and below and should be done once a month.	T	465	76.9	91	15	49	8.1
Treatment
Total mastectomy is the surgical option of choice for patients diagnosed with early-stage breast cancer.	F	167	27.6	353	58.3	85	14
Patients with invasive breast cancer that is estrogen receptor positive should receive adjuvant endocrine therapy.	T	416	68.8	72	11.9	117	19.3
Tamoxifen is the adjuvant endocrine therapy of choice for premenopausal patients with invasive breast cancer.	T	465	76.9	47	7.8	93	15.4
The treatment of breast cancer is a long and painful process.	T	403	66.6	115	19	87	14.4
Treatment of breast cancer affects fertility.	F	126	20.8	373	61.7	106	17.5

Table 4. Responses of the pharmacists on the belief statements with regard to providing advice to patients on breast cancer.

Statements	Sum agree	%	Neutral	%	Sum disagree	%
I should be involved in breast cancer health promotion activities in the pharmacy	512.0	84.6%	59	9.8%	34	5.6%
Integrating breast cancer health promotion into my daily practice as a community pharmacist is important	473.0	78.2%	96	15.9%	36	6.0%
I feel confident and prepared to provide breast cancer health promotion	429.0	70.9%	124	20.5%	52	8.6%
Discussing breast cancer awareness with my female patients in the pharmacy is beneficial and can save their lives	494.0	81.7%	85	14.0%	26	4.3%
Providing counseling of dispensed medications to breast cancer female patients in the pharmacy is my responsibility as a pharmacist	470.0	77.7%	99	16.4%	36	6.0%
Distributing breast cancer educational materials is important in the pharmacy	497.0	82.1%	84	13.9%	24	4.0%
It is important to discuss breast cancer with my female patients to encourage breast cancer early screening and detection	487.0	80.5%	80	13.2%	38	6.3%
There is enough evidence to suggest that the pharmacist can influence patients to adopt breast cancer screening practices	468.0	77.4%	97	16.0%	40	6.6%
Inviting healthcare professionals to provide breast cancer education to the female patients in the pharmacy is important	461.0	76.2%	106	17.5%	38	6.3%
Providing breast cancer counseling to my patients can improve my professional state and increase my professional satisfaction	491.0	81.2%	78	12.9%	36	6.0%
Providing breast cancer counseling is an effective use of my time	485.0	80.2%	84	13.9%	36	6.0%
If I have access to patient education materials related to breast cancer, I am more likely to provide breast cancer health promotion to my female patients	481.0	79.5%	93	15.4%	31	5.1%
Patients would like me as a pharmacist to counsel them on breast cancer screening and early detection	465.0	76.9%	103	17.0%	37	6.1%
Patients appreciate my effort as a pharmacist to counsel them on breast cancer	457.0	75.5%	118	19.5%	30	5.0%

Table 5. Barrier to providing breast cancer health promotion to patients visiting the pharmacy.

Statements	Sum agree	%	Neutral	%	Sum disagree	%
Patients do not ask for breast cancer health promotion	172	28.4%	146	24.1%	287	47.4%
Patients do not appreciate the pharmacist's role as a breast cancer health promoter	116	19.2%	147	24.3%	339	56.0%
Patients will be offended if I offer them breast cancer counseling	142	23.5%	158	26.1%	305	50.4%
I am not reimbursed for providing breast cancer health promotion	139	23.0%	197	32.6%	269	44.5%
Availability of enough personnel in the pharmacy to provide breast cancer health promotion to patients visiting the pharmacy	227	37.5%	196	32.4%	182	30.1%
Having enough time to provide breast cancer health promotion to patients visiting the pharmacy	311	51.4%	136	22.5%	158	26.1%
Having enough space to provide breast cancer health promotion to patients visiting the pharmacy	310	51.2%	164	27.1%	131	21.7%
Have access to breast cancer educational materials	343	56.7%	156	25.8%	106	17.5%
The pharmacy manager does not support my role as a breast cancer health promoter	215	35.5%	159	26.3%	231	38.2%

Table 6. Associations between sociodemographic and practice variables of the pharmacists and scoring 50?% or more in the knowledge test.

Knowledge score
Variable	n	%	<50%		≥50%		χ^2 Test	p-value	Association strength
			n = 464	%	n = 141	%
Age (years)
<30	327	54.0	240	73.4%	87	26.6%	4.335^a	0.037	0.085
≥30	278	46.0	224	80.6%	54	19.4%
Sex
Female	340	56.2	244	71.8%	96	28.2%	10.553^a	0.001	0.13
Male	265	43.8	220	83.0%	45	17.0%
Marital status
Never married	273	45.1	196	71.8%	77	28.2%	6.7	0.009	0.07
Married/divorced/widowed	332	54.9	268	80.7%	64	19.3%
Education
BSc Pharmacy	415	68.6	308	74.2%	107	25.8%	5.431^a	0.066
Pharm.D	147	24.3	123	83.7%	24	16.3%
Postgraduate pharmacy education (MSc or PhD)	43	7.1	33	76.7%	10	23.3%
Place from where the academic degree was obtained
Jordan	526	86.9	391	74.3%	135	25.7%	12.548^a	<0.001	-0.14
Other	79	13.1	73	92.4%	6	7.6%
Experience (years)
<5	255	42.1	167	65.5%	88	34.5%	31.912^a	<0.001	0.23
5 to <10	229	37.9	198	86.5%	31	13.5%
≥10	121	20.0	99	81.8%	22	18.2%
Attended an educational program on breast cancer
Yes	360	59.5	294	81.7%	66	18.3%	12.297^a	<0.001	0.14
No	245	40.5	170	69.4%	75	30.6%
Approximate patients with breast cancer interacted with per month (n)
<3	382	63.1	275	72.0%	107	28.0%	12.834^a	0.000	0.15
≥3	223	36.9	189	84.8%	34	15.2%
Perceived knowledge of breast cancer
Poor–Fair	211	34.9	155	73.5%	56	26.5%	1.896^a	0.168	0.06
Good–Excellent	394	65.1	309	78.4%	85	21.6%
Average working h per week (n)
<40	245	40.5	178	72.7%	67	27.3%	3.762^a	0.052	0.08
≥40	360	59.5	286	79.4%	74	20.6%
Average patients interacted with per day (n)
<50	272	45.0	193	71.0%	79	29.0%	9.104^a	0.003	0.12
≥50	333	55.0	271	81.4%	62	18.6%
Female patients visiting the pharmacy (%)
<20	81	13.4	62	76.5%	19	23.5%	24.535^a	<0.001	0.2
20–49%	302	49.9	208	68.9%	94	31.1%
≥50	222	36.7	194	87.4%	28	12.6%
Pharmacists working in the pharmacy at any one shift (n)
1	234	38.7	137	58.5%	97	41.5%	70.306^a	<0.001	0.34
2 or more	371	61.3	327	88.1%	44	11.9%
Respond to patient inquiries related to breast cancer warning signs and symptoms and breast cancer early detection and screening tests
Rarely	217	35.9	163	75.1%	54	24.9%	0.472^a	0.492
Often	388	64.1	301	77.6%	87	22.4%
Provide patients with advice or counseling on breast cancer screening and early detection
Rarely	208	34.4	159	76.4%	49	23.6%	0.011^a	0.916
Often	397	65.6	305	76.8%	92	23.2%
Provide patients with breast cancer educational materials or self-assessment quizzes
Rarely	272	45.0	176	64.7%	96	35.3%	39.735^a	<0.001	0.26
Often	333	55.0	288	86.5%	45	13.5%
Refer patients to special breast cancer screening programs organized by hospitals or cancer organizations
Rarely	277	45.8	194	70.0%	83	30.0%	13.228^a	<0.001	0.15
Often	328	54.2	271	82.6%	57	17.4%

Figure 2. The receiver operating characteristic curve analysis, Area under the curve for multivariate regression analysis of the association between sociodemographic and practice variables with scoring 50% or more in the knowledge test.

ROC: Receiver operating characteristic.

Table 7. Multivariate regression analysis of the association between sociodemographic and practice variables with scoring 50?% or more in the knowledge test.

Variables in the equation	Subcategories	β	SE	Wald	Sig.	ODDs Ratio	95% CI for odds ratio
							Lower	Upper
Education	Postgraduate education	Reference		5.456	0.065
	BSc Pharmacy	-0.712	0.351	4.087	0.043	0.492	0.247	0.979
	Pharm.D	-0.921	0.407	5.159	0.023	0.396	0.178	0.881
Experience (years)	≥10	Reference		13.694	0.001 ^†
	<5	0.372	0.308	1.460	0.227	1.451	0.793	2.655
	5 to <10	-0.690	0.323	4.560	0.033	0.501	0.266	0.945
Female patients visiting the pharmacy (%)	≥50	Reference		4.849	0.089
	<20	-0.276	0.365	0.569	0.450	0.759	0.371	1.553
	20%–49%	0.358	0.258	1.933	0.164	1.431	0.864	2.370
Pharmacists working in the pharmacy at any one shift (n)	2 or more	Reference
	1	1.338	0.247	29.353	0.000 ^†	3.812	2.349	6.186
Attended an educational program on breast cancer	No	Reference
	Yes	-0.504	0.214	5.528	0.019 ^†	0.604	0.397	0.920
Provide patients with advice or counseling on breast cancer screening and early detection	Rarely	Reference
	Often	-1.187	0.263	20.349	0.000 ^†	0.305	0.182	0.511
Provide patients with breast cancer educational materials or self-assessment quizzes	Rarely	Reference
	Often	0.831	0.250	11.031	0.001 ^†	2.295	1.406	3.746

† Statistically significant predictors.