RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.

A STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO ASSISTED TEACHING AWARENESS PROGRAMME ON BREAST CANCER AND

BREAST SELF EXAMINATION AMONG ARTS COLLEGE STUDENTS IN SELECTED COLLEGES, AT BANGALORE.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

SUBMITTED BY:

Mrs. MINI KUMARI.RI YEAR M.Sc. NURSING

MEDICAL SURGICAL NURSINGSRI SHARADA COLLEGE OF NURSING

BANGALORE- 560061.

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1. NAME OF THE CANDIDATEAND ADDRESS

Mrs. MINI KUMARI.RI YEAR M.Sc NURSING,

SRI SHARADA COLLEGE OF NURSING,BANGALORE-560061.

2 NAME OF THE INSTITUTION SRI SHARADA COLLEGE OF NURSING,UTTARAHALLI MAIN ROAD,

BANGALORE-560061.

3 COURSE OF STUDY AND SUBJECT

MASTERS DEGREE IN NURSINGMEDICAL SURGICAL NURSING

4DATE OF ADMISSION TO COURSE

01/10/2011.

5 TITLE OF THE STUDY A STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO ASSISTED TEACHING

AWARENESS PROGRAMME ON BREAST CANCER AND BREAST SELF EXAMINATION

AMONG ARTS COLLEGE STUDENTS IN SELECTED COLLEGES, AT BANGALORE.

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6. BRIEF RESUME OF THE INTENDED WORK:

INTRODUCTION:

“To acquire knowledge one must study; but to acquire wisdom, one must observe”

-Marilyn vos savant.

Breast cancer is also known as breast carcinoma. It is the fifth most common cause of cancer deaths after lung, stomach, liver and colon cancers. Even though breast cancer rates are low in Asian countries, the incidence of breast cancer in India is rising at an alarming rate and has become the second most common cancer affecting Indian women.1

Breast cancer is any kind of malignant growth in the breast tissue. The major risk factors for breast cancer are family history of breast cancer, menarche before 12 years of age, menopause after 55 years of age, obesity, excessive exposure to the ionizing radiations before 30 years of age, hormonal dysfunction, stress, nulli parity or first child after 30 years of age.2A woman’s risk for developing breast Cancer in her life time is 1 in 8.the risk by 39 years is 1 in 209 and it increases to 1 in 24 by 59 years.3

According to American Cancer Society about 1.3 million women will be diagnosed with Breast Cancer annually in worldwide, about 4,65,000 will die from this disease.4In India, the incidence of breast Cancer is increasing with an estimated 80,000 new cases were diagnosed annually and one in 22 women is likely to suffer from Breast Cancer during her life time.5

Breast Self Exam is a screening method used in an attempt to detect early Breast Cancer. The method involves the woman herself looking at and palpates her Breast with the pad of fingers to feel for lumps, distortion or swelling.6 Regularly examining her own breasts allows a woman to become familiar with how her breast normally look, feel and help her more readily detect any changes it may occur such as new lumps, thickness, new dimples, crease or folds, changes in shape or size, red or hot areas, orange peel texture, fluid leaking from nipple etc.

Breast self Examination should be performed once in each month beginning at 20 years age and continue each month throughout a woman’s life

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time. It’s preferable to do Breast Self Examination for menstruating women on the same day of each month 7-10 days after the first day of the period. For menopause and pregnant women choose the same day of every month. Schedule once in each year if examination done by the nurse or Doctor.7, 8

A study conducted on knowledge and attitude of breast self examination in 300 women aged 24-54 years in southern Iran by using interview schedule. The study result shown that53.3% women performed Breast Self Examination, 5.6% of women did Breast Self Examination correctly, and they learned it from medical personnel, their relatives, television, books, radio, journals and pamphlets.9

6.1. NEED FOR THE STUDY:

According to 2006 Indian Council of Medical Research data, one in every 30 women in Indian metros will develop breast cancer as compared to one in 70 rural women. The experts predicted the incidence of breast cancer would be double in next 10years.10

In India Breast Cancer is the first leading site of cancer in 4 out of 5 urban registries- Bangalore, Mumbai, Delhi and Bhopal. In Chennai it is the second leading site of cancer. In the hospital based registry in regional center for Cancer Research and Treatment at Kidwai Memorial Institute of Oncology about 500 cases of breast cancer are registered annually.11

Nanda Kumar reported that, the Bangalore the 4 th in the highest number of breast cancer cases in the country, after Delhi, Mumbai and Chennai, according to national cancer Registry programme , Bangalore in 2007, Breast cancer is higher due to the dietary shifts from low fat foods to high fat diet and passive reproductive life.12

Breast cancer cases have doubled in India in the last two decades. The number of women estimated to be dying of breast cancer every year has also been steadily raising. 48,170 women died due to breast cancer in 2007 and the number reached 50,000 in 2010. Delhi recorded an estimated 810 deaths due to breast cancer in 2010 compared to 779 in 2009 and 749 in 2008.Experts say women now marry late and give birth to fewer children have increased breast cancer rates in India.13

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Breast Self Examinations aid in the detection of Breast Cancer are considered optional by the American Cancer society.14 80% of breast cancers diagnosed clinically are found by the woman herself.8 American national organizations, institutes and commercial bodies provided lot of information and training on breast self examination.15 Some private health institutes and commercial non health related organizations also developed breast self examination training websites and videos.16, 17

Breast Cancer organization believes that Breast Self Examination is a useful and essential screening strategy used in combination with regular physical exams by a doctor and mammography.18

The first stage of Breast tumors were detected 53.8% by routine physical examination, 37.7% by self examination and only 27% detection were accidental. And breast cancer mortality might reduced by 18.8% to 24.4% through self examination or routine physical examination.19

A population based case control study on patterns and predictors of Breast cancer detection methods in 1619 women with newly diagnosed breast cancer under 45 years of age was conducted in united states by using interview and medical record. Results shown that 71% cancers were identified by self detection, 9% were identified by routine clinical breast examination and 20% by routine mammography. So the researcher concluded that breast self examination helps in early detection of any breast problem especially breast cancer. So the researcher emphasize the need for Breast Self Examination awareness campaigns are a key measure for early diagnosis of Breast Cancer patients.20

Breast Cancer affects so many lives today especially in developing countries like our India. So it is vital for the women to know about the breast cancer, risk factors and early detection methods such as clinical breast examination, breast self examination and mammography. The Video Assisted teaching programme will improve significantly the knowledge and practice of Breast Self Examination in women. The Young Arts college students may show more interest to know more about the Breast Self Examination and they will effectively communicate their acquired knowledge to their mother, sisters, other college students and other women in the society. So the researcher felt

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the need to educate students through Video Assisted Teaching in a selected arts college, Bangalore.

6.2. REVIEW OF LITERATURE:

a) Literatures related to knowledge about breast self examination in women:

A descriptive study was conducted on knowledge and practice on Breast Self Examination as a method of early detection among 100 antenatal clinic attendees in South Eastern Nigeria. Data collected by using a structured questionnaire. The results shown that 78% of the respondents practiced breast self-examination regularly, but only 34% of them knew the reason for practicing breast self-examination. This means that the knowledge about breast self-examination practice were mostly ineffective. Only 3% of the respondents knew about a mammogram. 97% of the respondents had heard of cancer of the breast. So Breast self-examination was positively associated with educational level attained.21

                   A descriptive co relational study was conducted to identify knowledge levels and performance frequency of breast self-examination and variables related to breast cancer screening behaviors among 103 Muslim female workers in Turkey. Result showed that 26.2% of the women had adequate knowledge about Breast Self Examination and 4.3% performed Breast Self Examination. And higher health motivation, higher perceived self-efficacy of BSE, marital status, and familial breast cancer history were significantly associated with BSE performance.22

A cross sectional study was conducted to determine the level of knowledge and attitude about breast self examination and mammography among 244 women aged 20-64 in rural area of western turkey. The samples selected by cluster sampling. Four trained doctors collected the data by face to face interview between January and February 2005. The study results shown that23.4% of them had no knowledge about breast cancer, 27.9% had no concept about breast self examination. Only 10.2% performed monthly breast self examination regularly.76.6%reported that they heard about breast cancer, but only 56.1% of them had sufficient knowledge about it. Television or radio programs were the main source of information about breast cancer, and 23.4% sample mentioned health professionals were mentioned as a source of

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information.23

b) Literatures related to effectiveness of education and training programme on breast cancer and or breast self examination:

An experimental study to assess the effectiveness of breast self examination training programme on knowledge attitude and practice in 122 working women was conducted in Egypt. Data collected by using self administered questionnaire, attitude rating scale and observation checklist. Results shown that only 10.6% and 11.5% of the total sample had satisfactory knowledge about breast cancer and breast self examination, respectively.39.3% have negative attitude towards breast cancer and breast self examination. 91.8% mentioned lack of knowledge, 50% of responses were fear and worries to discover breast cancer. After the training programme implementation, a remarkable improvement in participants’ level of knowledge, attitude and practice was observed. Public health programme teach and encourage the women to regularly examine their breast and to seek early treatment for any detected lesions.24

    One group pretest/posttest design was conducted a study to evaluate the effectiveness of a community-based health education program via a mobile van to promote the awareness of breast cancer and breast self-examination practice among 777 women in Hong Kong by using self-administered questionnaire before and after a breast health education program.53.7% were aware of breast health and breast diseases and 48.6% knew about the breast screening methods before the intervention. After intervention it was found that women who had received instruction on BSE practice, and those who were aware of breast screening methods, breast health, and breast diseases were more likely to practice Breast self Examination. 93.3% told that they are willing to practice Breast Self Examination regularly and 92% are willing to pass the acquired Breast Self Examination knowledge to their relatives and friends in the posttest.25

A quasi-experimental study was conducted to assess the effectiveness of structured teaching programme on knowledge and performance ability of breast self examination among 40 women (20 in experimental group and 20 in control group) in selected rural communities of Ludhiana, Punjab. Structured questionnaire and check list were used for data

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collection. The data analyzed by mean, standard deviation, ‘t’ test and Chi-square test and Co-efficient correlation. The study result shown that there is no statistically significant different between pre-test Breast self examination knowledge score of experimental group (12.30) and control group (13.65) (T=1.20NS)and Breast Self Examination performance ability score of experimental group (3.25) and control group (2.85) (t=1.19NS).There was statistically significant increase in post-test knowledge Breast Self Examination score of experimental group (27.85) at 0.001 level. (t=16.52) and in Breast Self Examination performance ability score of experimental group (17.4) at 0.001 level (t=34.54).26

A quasi experimental study was conducted among 250 students from different university departments excluding health departments were chosen randomly.200 students took part in education session, however only 180 students were contacted one month after training session.32 students took part in individual instruction and 148 students took part in the group education. The data collected by questionnaire and Champion Health Belief Scale.the study result shown that the knowledge of breast self examination came from radio and television (36.9%), other people(20.2%), doctors(13.1%) and nurses(9.5%).only 5.6% students performs doing breast self examination and the first reason for not doing breast self examination is lack of knowledge about it. All students pre education mean score was 15.4±10.7 and post education mean score was 38.0±8.7. And also found that students instructed in groups by peers showed higher degree of breast self examination knowledge when compared with those taught as individually.27

A study conducted to evaluate the effectiveness of peer education model in teaching breast self examination among late adolescence female students attending second class of Buca Educational faculty of Dokuz Eylul University. 15 volunteer students received breast self examination training by the researcher and qualified as peer educators. Then this each one reached 10peers and conveyed the information about breast self examination. The Maurer evaluation forms for regular breast self examination practice and skills were used and evaluated with 100 points. Paired ‘t’ test , students t test, McNemar test, Pearson correlation test used for statistical analysis. The study result shown that the students average point of knowledge on breast self examination before training was 43.0± 11.7, it became 88.9±8.15 after a week and 86.9±9.69 after four weeks. Similarly the practice of practicing

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breast self examination increased from 2.6% to 66% and breast self examination practice skills became 91.5±7.25 at four weeks(r=0, 70).28

c) Literatures related to effectiveness of Multimedia and Video assisted teaching:

A study conducted on Development of Web-based multimedia content for a physical examination and health assessment course. The multimedia content was developed based on Jung’s teaching and learning structure plan model, using 5 processes as Analysis Stage, Planning Stage, Storyboard Framing and Production Stage, Program Operation Stage and Final Evaluation Stage. Consultation with the experts in context, computer engineering, and educational technology was utilized in the development of these processes. Web-based multimedia content is expected to offer individualized and tailored learning opportunities to maximize and facilitate the effectiveness of the teaching and learning process.29

A quasi-experimental research, pre and post test without control group design with experimental approach was conducted to assess the effectiveness of Video assisted teaching programme on the knowledge among 248 nurses on neonatal resuscitation. The samples were selected by cluster sampling technique in PHC’s of Salem district. Data collected by using closed ended questionnaire and observational checklist. Data were analyzed by descriptive and inferential statistics. The overall pre-test mean knowledge score was 28.13±7.55 (42.61%) whereas in post-test it was 57.71±3.94 (87.44%) revealing 44.83% enhancement of knowledge score. Highly significant difference was found between the total knowledge scores of pre and post test and area wise score values of pre and post test (P<0.01) revealing effectiveness of Video assisted teaching programme.30

Thirty-three studies reviewed for the use of television as a patient-education process. Eleven studies randomized subjects and had a control group. While there are many different conditions addressed by the studies as methodological problems there are consistencies in the results that suggest the medium has a role to play and reported as achieving their objective of knowledge gain, skill training, or behavior change. Video presentation alone was as effective as any other presentation method and was more effective than only written information.31

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A quasi- experimental Pretest and Posttest control group design used to assess the effectiveness of video assisted teaching (VAT) on needle stick injury on knowledge and attitude of staff nurses in Hassan. 60 staff nurses selected as sample by non probability purposive sampling technique. Demographic data, structured knowledge & attitude questionnaire and video assisted teaching (VAT) for data collection used for data collection .data analyzed by using Chi-square with Yates correction and Fisher exact test. The study result shown that overall mean knowledge scores (pre test=13.53, post test= 26.66) and mean attitude scores are (pre test= 43.39, post test= 74.92). Knowledge (43.90%) and attitude (54.60%) scores of staff nurses were less before administration of VAT. The overall post-test mean percentage of knowledge and attitude was higher (88% and 83.2%) in experimental group than in control group (37.86% and 54.6%) respectively, where ‘t’ value were knowledge (t=26.67 at p<0.001) and attitude (t=16.32 at p<0.001). The finding signifies that the video assisted teaching was effective to enhance the knowledge and to mould attitude.32

d) Literatures related to effectiveness of Video assisted teaching in Breast Self Examination:

A quasi experimental study was conducted to assess the effectiveness of video demonstration programme on knowledge and intentions about breast self examination technique among 255 ninth grade girls. A pretest was conducted to determine the knowledge about breast cancer and breast self examination. Displayed a 50 minutes video demonstration programme about breast self examination technique. After intervention delayed post test conducted later between 5-6 weeks in 211 girls. The study result shown that the experimental group participated in video demonstration programme increase in their knowledge score than the control group. The experimental group girls reported performing breast self examination from the past month as well and they have a higher intention to perform breast self examination in future.33

A health education intervention study by using video slides on LCD and flip charts in 30 sessions (20-25 subjects in each session) about Breast Self Examination was conducted from March to August 2010 among 250 women beneficiaries’ in Ahmadabad Municipal Corporation. Data collected by using questionnaire about various aspects of breast cancer. The study result

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shown that there was a significant increase in knowledge about breast self examination after 3 months of the intervention from 26.8% to 90.8% and in knowledge about mammography from 14.8% to 89.2%. The study concludes that there was not only improve the knowledge also improves the breast self examination practices.34

STATEMENT OF THE PROBLEM:

“A Study to assess the Effectiveness of Video Assisted Teaching Awareness Programme on Breast Cancer and Breast Self Examination among Arts College Students in selected Colleges at Bangalore”.

6.3. OBJECTIVES OF THE STUDY 1. To assess the knowledge of arts college students regarding Breast cancer

and Breast Self Examination (BSE) in terms of pretest scores. 2. To assess the effectiveness of video assisted teaching compare the pre and post test Knowledge scores. 3. To find out the association between the knowledge of the arts college

students with their selected demographic variables.

OPERATIONAL DEFINITIONS: Assess: In this study it refers to measure the knowledge level of arts college students, observed by structure knowledge questionnaire.Effectiveness: It is the significant increase in knowledge about Breast cancer and breast self examination, which is determined by comparing the pre and post test knowledge scores.Video assisted teaching (VAT): In this study it refers to an instructional programme about Breast cancer and Breast self examination organized and administered through videos designed for educating the arts college students.Breast Cancer: In this study it refers to the malignant growth in the breast tissue.Breast self examination (BSE):

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In this study it refers to the process in which the breast and their accessory structures are observed and palpated to assess the abnormalities.

Arts college students: It refers to the participants those who are studying in other than science,

medical, Para medical, or other professional colleges.

HYPOTHESIS: H1: The post test knowledge scores of arts college students after administration of Video assisted teaching will be significantly higher than their pretest knowledge Scores.H2: There will be a significant association between knowledge of arts college students with their selected demographic variables.

ASSUMPTIONS:1. The arts college students may have less knowledge regarding Breast cancer and Breast Self Examination.2. The arts college students will be expressing their willingness to learn.3. The a will teach their mothers and other college students.

RESEARCH VARIABLES:

Independent variable: Video assisted teaching on Breast cancer and Breast Self Examination.

Dependent variable: knowledge scores about Breast cancer and breast self Examination.

Extraneous variables: socio demographic variables such as Age, Education, Type of family, area of residence, Religion, socio Economic status, age at menarche, menstrual history and source of information.

DELIMITATION: 1 . The s tudy w i l l be l imi ted to selected arts college students in Bangalore. 2. The study will measure only the knowledge of arts college students towards Breast Cancer and Breast Self Examination.

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3. The size of the sample was only 50 subjects. 4. Individual Brest Self Examination will not be done by the investigator.

7. MATERIALS AND METHODS:

7.1. SOURCE OF DATA: Data will be collected from the students of selected arts colleges in Bangalore.

7.2. METHOD OF COLLECTION OF DATA

Research Approach: Quantitative approach.

Research Design: Pre- experimental study. One group pretest posttest design.

Study Setting: The study will be conducted in selected arts colleges of Bangalore. Population: Arts college students in Bangalore. Sample: Students studying in the selected arts college, Bangalore.

Sample Size: The sample consist of 50 arts college students.

Sampling Technique: Non-probability convenient sampling technique will be used.

SAMPLING CRITERIA:

Inclusion criteria:1. Students studying in the selected college, at Bangalore.2. Students are willing to participate in study. 3. Able to understand or read and write Kannada or English

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Exclusion criteria: 1. Students are on vacation. 2. Students having visual or hearing sensory deprivation. 3. Students who attended the similar programme already. 4. Those who will not willing to participate in the study.

DATA COLLECTION TOOL AND INSTRUMENT:

Structured questionnaire consist of two sections Part A - Demographic variables Part B - Knowledge questionnaire on Breast cancer and Breast Self Examination.Video Assisted Teaching programme regarding Breast cancer and breast self Examination.

DATA ANALYSIS METHOD The data analysis will be done using descriptive and inferential statistics. 1) Descriptive statistics: mean percentage, frequency and standard deviation. 2) Inferential statistics: It includes paired t-test and Chi-square test.

Data Collection Method:

              The objectives of the study will be explained and the data will be collected after getting permission from the concerned authorities of selected arts college in Bangalore. The researcher herself will collect the data by using structured knowledge questionnaire in pre test. Post test will be conducted for all the participants after the video assisted teaching intervention regarding Breast cancer and Breast Self Examination.

7.3 DOES THE STUDY REQUIRE ANY INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?

Yes, the video assisted teaching is used as an intervention among arts college students at selected arts college in Bangalore.

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7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?

Yes .Ethical clearance and Permission will be obtained from, The research committee of Sri Sharada College of Nursing. Authorities of selected arts college in Bangalore. Informed concerned will be obtained from study participants.

ETHICAL COMMITTEE:

TITLE OF THE TOPIC A Study to assess the Effectiveness of Video Assisted Teaching Awareness Programme

on Breast Cancer and Breast Self Examination among Arts College Students

in selected Colleges at Bangalore.

NAME OF THE CANDIDATE Mrs. Mini Kumari.R

COURSE AND THE SUBJECT Master of Science in Nursing.Medical Surgical Nursing

NAME OF THE GUIDE Mrs.K.Padmavathi M.Sc(N)Head of the Department

Department of Medical Surgical NursingSri Sharada College of Nursing, Bangalore.

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ETHICAL COMMITTEE Approved

MEMBERS OF THE ETHICAL COMMITTEE:

1. Prof. B.Maheshwari Bai M.Sc(N) Principal& Head of the Department Department of Mental Health Nursing Sri Sharada College of Nursing, Bangalore – 61.

2. Mrs. K.Padmavathi M.Sc(N) Vice Principal &Head of the Department Department of Medical Surgical Nursing Sri Sharada College of Nursing, Bangalore– 61.

3. Mrs. B.Ramasundari M.Sc(N) Head of the Department Department of Child Health Nursing Sri sharada College of Nursing, Bangalore – 61.

4. Dr.Ganga Boriah Statistician Department of community medicine Kempe Gowda Institute of Medical Science, Bangalore.

5.Dr.K.C.Tharun M.S Chairman, Vishwabharathi hospital Pvt Ltd, Sri Sharada Nursing College, Bangalore-61.

8. LIST OF REFERENCES:

1. Chandrasekharan S. There is life after Breast Cancer: a breast cancer alert every women should read. Woman’s Era 2010 January 2; 37(867):118-20.2. Black M.J. Textbook of Medical Surgical Nursing, Sixth edition. WB Saunders co. Philadelphia: 1011-1012.3. Brunner and Suddharth, “Text book of medical surgical nursing, 8 th edition, Lippincott, Philadelphia. 1296- 1297.

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4. Breast cancer cases deaths per year in US and in world. www.imaginis.com.5. Breast cancer statistics. www.breastcancer.org.6. Breast self examination. www.wikipedia.com7. Breast self examination. www.breastcancerpreventionfund.org.8. The importance of breast self examination. www.mta.ca.com.9. Simi A, Yadollahie M, Habibzadeh F. Knowledge and attitudes of breast self examination in a group of women in Shiraz, Southern Iran. Post grad Med J 2009 June; 85(1004):283-710. World health organization report 297, cancer, WHO 2006.11. American Cancer Society cancer facts and Figures, 2005-2006.12. Nanda Kumar. National Cancer Registry Programme. The times of India Feb 2007.13. Breast cancer cases on the rise. www.articles.indiatimes.com14. The importance of breast self exams. www.cyfairhospital.com15. Breast self examination training through the use of multimedia: a bench mark multimedia development methodology for bio medical applications. www.dtic.mil.com.16. The komen foundation. www.komen.org.17. The memorial sloan - kettering cancer center. www.learnbse.com.18. Breast self exam. www.breastcancer.org.19. Estimated Effect of Breast Self-Examination and Routine Physician Examinations on Breast-Cancer Mortality. www.newenglandjournalofmedicine.org.20. Coates RJ, Uhler RJ, Brogan DJ, Gammon MD, Malone KE, Swanson CA, Flaqq EW et al. Patterns and predictors of the breast cancer detection methods in women under 45 years of age (United States). Cancer causes control 2001 June; 12(5):431-42.21. Onwere S, Okoro O, Chigbu B, Aluka C, Kamanu C, Onwere A. Breast self examination as a method of early detection of breast cancer: knowledge and practice among antenatal clinic attendees in South Eastern Nigeria .Pak J Med Science 2009 Jan-Mar; 25 (1 ):122-5.

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22. Avci IA. Factors associated with Breast self examination practices and beliefs in female workers at a Muslim Community. Euro J Oncol Nurs 2008 April;12(2):127-33.

23. The knowledge and attitudes of breast self-examination and mammography in a group of women in a rural area in western Turkey. www.biomedcentral.com.

24. Patient education and counseling. www.dx.doi.org.

25. Chan S, et al .community based outreach program to improve breast health awareness among women in Hong Kong. Public health Nursing 2007 May-June; 24(3):265-73.

26. Breast self examination abstract. www.scribd.com.27. Ayla akka et al. The effect of peer education on university students knowledge of breast self examination and health beliefs. The journal of breast health 2009; 5(3):135-39.28. Arzu Tuna Malak, Aklime Dicle. Peer education model in teaching breast self examination. Asian Pacific Journal of Cancer Prevention 2007; 8: 481-84.29. Oh Pj, Shin SR, Jungttle. Development of web-based multimedia. Taehan Kanho Hakhoe Chi 2004 October; 34 (6): 994-1003.

30. Tamizharasi K. Effectiveness of video assisted teaching programme on neonatal resuscitation for the nurses working in rural salem, Tamilnadu.Asian journal of nursing education and research 2012;2(1). www.anvpublication.org.

31. Television as a patient education tool: A review of its effectiveness. www.sciencedirect.com.

32. Kumar Mahendra. To assess the effectiveness of video assisted teaching on needle stick injury regarding knowledge and attitude of staff nurses working in selected hospitals of Karnataka. International Journal of Nursing Education 2010;2(2):25-27.            

33. Ogletree et al. A study on knowledge and intentions of ninth grade girls after a breast self examination programme. www.google.com.

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34. Bala D V, Hemant Gameti. An educational interventional study of breast self examination in 250 women beneficiaries of urban health centers of west zone of Ahmadabad. Health line 2011 July-December; 2(2):46-49.

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9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

11.1 NAME AND DESIGNATION OF GUIDE.

Mrs. K. Padmavathi M. Sc(N)Vice Principal& HOD

Department of Medical Surgical NursingSri Sharada College of Nursing, Uttarahalli,

Bangalore

11.2 SIGNATURE OF THE GUIDE.

11.3 CO – GUIDE (IF ANY)

11.4 SIGNATURE OF THE CO-GUIDE

11.5 HEAD OF THE DEPARTMENT

Mrs. K. Padmavathi M. Sc(N)Head of the Department

Department of Medical Surgical NursingSri Sharada College of Nursing, Uttarahalli,

Bangalore11.6 SIGNATURE OF THE

HEAD OF THE DEPARTMENT

12.1 REMARKS OF THE PRINCIPAL

12.2 SIGNATURE OF THE PRINCIPAL