Impact of a Health Education Program on Breast Self-Examination Awareness among Female College Students

R Siva et al | DOI: 10.65188/nurexus.1046

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Journal of MedVerse Research & Practice

ISSN: 3107-4278

Impact of a Health Education Program on Breast Self-Examination

Awareness among Female College Students

Dr. Siva R

, Dr. Kavitha D

Postgraduate, Professor

Department of Community Medicine, Madras Medical College, Chennai

Email: sivar1998@gmail.com

Submission Date: 22.09.2025

Accepted Date: 18.10.2025

Published Date: 31.10.2025

DOI: 10.65188/nurexus.1046

article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits

unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Abstract

Background: Breast cancer is the most common malignancy among women globally and a leading cause of cancer-

related mortality in India [1–4]. Early detection significantly improves prognosis, and Breast Self-Examination (BSE)

is an affordable, non-invasive method that empowers women to identify breast changes promptly [5–8]. However,

awareness and regular practice remain inadequate among young women [7–10].

Objectives: To assess the effectiveness of a structured health-education intervention in improving knowledge and

attitude regarding breast cancer and BSE among female college students.

Methods: A pre-post interventional study was conducted among 150 female students in a private engineering college

in Chennai from July to September 2024. Participants were selected through simple random sampling. Baseline

knowledge and attitude were assessed using a pre-tested questionnaire. A structured 45-minute educational session in

Tamil, incorporating videos, flip-charts, and demonstrations, was delivered to groups of 30 students. The same

questionnaire was administered immediately after the session. Data were analysed using STATA, and changes in

proportions were assessed, with p < 0.05 considered statistically significant.

Results: The mean age of participants was 18.34 ± 1.22 years. Before intervention, only 76 percent had heard of

breast cancer, and 29.3 percent knew about BSE. Correct knowledge of BSE steps was as low as 3.3 percent.

Following the intervention, awareness of breast cancer increased to 93.5 percent, and knowledge of BSE rose to 82.7

percent. Correct understanding of BSE steps improved markedly to 89.3 percent. Attitude also improved

significantly, with notable increases in confidence and willingness to perform BSE. All improvements were

statistically significant (p < 0.0001).

Conclusion: The structured educational intervention effectively enhanced knowledge and attitude regarding breast

cancer and BSE among college-going women. Incorporating skill-based breast health education into college health

programs can promote early detection practices and contribute to reducing the breast cancer burden in the

community.

Keywords: Breast cancer, Breast self-examination, Health education, College students, Early detection, Awareness

Introduction

Breast cancer remains the most commonly diagnosed malignancy among women worldwide, with more

than 2.3 million new cases and approximately 685,000 deaths reported in 2020, according to the World

Health Organization [1]. It has surpassed lung cancer as the leading cancer globally, comprising nearly 11.7

percent of all cancer diagnoses [2]. In India, breast cancer represents the foremost cause of cancer-related

illness and mortality among women, with an estimated 178,361 new cases and 94,408 deaths recorded in

2020 [3,4]. The high disease burden in the country is associated with late presentation, insufficient

awareness, and inadequate screening coverage. Early detection plays a pivotal role in improving prognosis,

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and breast self-examination (BSE) continues to be recognized as an affordable, non-invasive, and

accessible screening approach that enables women to identify breast changes at an early stage [5,6]. Despite

this, evidence indicates that knowledge and regular practice of BSE are suboptimal, particularly among

young women, including college students [7,8].

Persistent gaps between awareness and actual practice have been attributed to cultural barriers,

misconceptions, fear, and inadequate guidance [9,10], emphasizing that information alone is insufficient to

change behaviour [11,12]. Research suggests that repeated, structured, and skill-based educational

interventions are essential to enhance technique, improve attitude, and build confidence toward BSE

practice among young women [13,14,15]. College-going females represent a key target population, and

findings from a recent quasi-experimental study in South India demonstrated significant improvement in

both knowledge and BSE practice following structured health education, underscoring its effectiveness in

shaping preventive health behaviours [16]. Health education not only improves awareness but also

challenges misconceptions and stigma surrounding breast cancer, promoting an enabling environment for

early detection. Assessing the impact of such interventions among college women is therefore crucial, as

strengthening knowledge and practice of BSE in this demographic can contribute to early diagnosis and

ultimately reduce the burden of breast cancer in the community.

Materials & Methods

The present study was conducted among female students of a private engineering college located within the

premises of our medical college in Chennai. A pre-post intervention study design was adopted, and

participants were selected through simple random sampling. Data collection took place over three months,

from July to September 2024. Based on findings from a previous study reporting only 17 percent awareness

of breast self-examination (BSE) among college-going women [3], the sample size was calculated using

Open Epi software with 5 percent absolute precision, 95 percent confidence level, an expected 20 percent

improvement following intervention, and a 10 percent non-response rate, yielding a final sample size of

150.

Institutional Ethics Committee approval was obtained before the study, along with formal written

permission from the college administration. First- and second-year B.Tech and MBA students who were

available during the study period and provided voluntary informed consent were included. To inform tool

development and educational content, two focus group discussions were held with a representative group of

female students. Health education sessions were conducted in batches of 30 students in a campus hall. Each

session began with an introduction explaining study objectives, followed by written informed consent. As a

symbolic gesture to promote breast cancer awareness, participants were given pink ribbons and informed

about their significance. A structured self-administered questionnaire was used to assess baseline

knowledge and attitude regarding BSE.

The intervention consisted of a 45-minute educational session delivered in Tamil using PowerPoint slides,

flip books, and instructional videos, covering breast anatomy, symptoms and risk factors of breast cancer,

and the steps of BSE. The session was facilitated by a trained faculty member and a postgraduate student

from the Department of Community Medicine. Immediately after the session, the same questionnaire was

re-administered to assess changes in knowledge and attitude. Before the conclusion of the two-hour

program, participants received informational pamphlets detailing the step-by-step procedure of BSE for

future reference.

Ethical approval for the present study was obtained from the Institutional Ethics Committee of Madras

Medical College, Chennai (Ref No: MMC/EC/2024/73518). A detailed Participant Information Sheet was

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provided to all participants, and written informed consent was obtained prior to their enrollment in the

study.

Results

Table 1: Socio-demographic characteristics of the study subjects (n=150)

S. No

Variable

n (%)

Age

18.34 ± 1.22 (Mean ± SD)

Course studying

B. Tech

144 (96)

MBA

6 (4)

Year of course

I year

24 (16)

II year

90 (60)

III year

36 (24)

Education of the mother

Illiterate

7 (4.7)

Primary school

24 (16)

High school

64 (42.7)

Pre-university

29 (19.3)

Graduate

17 (11.3)

Post graduate

8 (5.3)

Any other

2 (1.3)

The study included 150 participants with a mean age of 18.34 ± 1.22 years, indicating that the sample

comprised predominantly young adults. Most respondents were pursuing B. Tech (96 percent), while a

smaller proportion were MBA students (4 percent). With regard to the academic year of study, 16 percent

were in the first year, 60 percent in the second year, and 24 percent in the third year. The educational status

of the participants’ mothers varied, with 4.7 percent being illiterate, 16 percent having completed primary

education, and 42.7 percent having completed high school. Additionally, 19.3 percent had pre-university

education, 11.3 percent were graduates, and 5.3 percent were postgraduates, while 1.3 percent reported

other educational qualifications. Overall, the participants represented a young academic population with

varied maternal educational backgrounds.

Table 2: Knowledge on Breast Cancer and Breast Self- Examination (BSE) among the study

subjects before and after the intervention, (n=150)

Variable

Before

intervention

n (%)

After

intervention

n (%)

p value*

Ever heard of breast cancer

114 (76)

140 (93.5)

<0.0001

Ever heard of causes of breast cancer

64 (42.5)

132 (88)

<0.0001

Mentioned correct causes of breast cancer

10 (6.7)

125 (83.5)

<0.0001

Ever heard of symptoms of breast cancer

43 (28.7)

126 (84)

<0.0001

Mentioned correct symptoms of breast cancer

23 (15.3)

136 (90.7)

<0.0001

Early detection of breast cancer possible

65 (43.3)

126 (84)

<0.0001

Mentioned BSE as a method for early

detection of breast cancer

6 (4)

68 (45.3)

<0.0001

Breast cancer is a curable disease if detected

86 (57.3)

119 (79.3)

<0.0001

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early

Ever heard of Breast Self-Examination

44 (29.3)

124 (82.7)

<0.0001

Mentioned correct purpose of BSE

27 (18)

127 (84.7)

<0.0001

Mentioned correct steps of BSE

5 (3.3)

134 (89.3)

<0.0001

Before the intervention, awareness levels regarding breast cancer and Breast Self-Examination (BSE) were

relatively low among participants, with only 76 percent having ever heard of breast cancer and just 42.5

percent aware of its causes. Knowledge of correct causes and symptoms was particularly poor, reported by

only 6.7 percent and 15.3 percent, respectively. Awareness of early detection was also limited, with 43.3

percent recognizing that breast cancer can be detected early and only 4 percent identifying BSE as a

method for early detection. Similarly, just 29.3 percent had heard of BSE, 18 percent understood its

purpose, and only 3.3 percent knew the correct steps. Following the intervention, a substantial improvement

was observed across all knowledge indicators. Awareness of breast cancer increased to 93.5 percent, and 88

percent reported knowledge of its causes. Knowledge of correct causes rose dramatically to 83.5 percent,

and awareness of symptoms improved to 84 percent, with 90.7 percent identifying correct symptoms.

Understanding of early detection increased to 84 percent, and recognition of BSE as a screening method

improved to 45.3 percent. Furthermore, awareness of BSE increased to 82.7 percent, while correct

knowledge of its purpose and steps rose to 84.7 percent and 89.3 percent respectively. All improvements

were statistically significant (p < 0.0001), indicating the intervention was highly effective in enhancing

knowledge and awareness related to breast cancer and BSE among participants.

Table 3: Attitude towards BSE among the study subjects before and after the intervention,

(n=150)

S.No

Variable

Before

intervention, n

(%)

After

intervention, n

(%)

value*

I will feel comfortable in performing

Breast Self-Examination

56 (28)

105 (52.5)

<0.0001

I will consult a doctor if I find some

changes in my breasts

86 (43)

179 (89.5)

<0.0001

I will feel comfortable sharing with

friends/family about any changes in my

breasts

82 (41)

133 (66.5)

<0.0001

I feel confident in doing Breast Self-

Examination

47 (23.5)

175 (87.5)

<0.0001

The table presents the change in participants’ attitudes and intentions related to Breast Self-Examination

(BSE) before and after a health education intervention. Each statement reflects a positive behavioral or

attitudinal outcome toward breast cancer awareness and self-examination practices. The percentages

indicate the proportion of participants who agreed with each statement. All four variables show a

statistically significant improvement after the intervention (p < 0.0001), meaning the changes are highly

unlikely to be due to chance.

Discussion

The current study demonstrated a significant improvement in breast cancer awareness among female

college students following a structured health education session, with awareness levels increasing from

76% pre-intervention to 93.5% post-intervention. These findings are consistent with those of Yadav et al.

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[17], who reported an increase in awareness from 64.8% to 91.2% among nursing students in Nagpur, and

Thanushree et al. [18], who observed a rise from 58% to 89.3% among university students in Karnataka. In

contrast, Saha et al. [19] reported that only 16.6% of rural women in South India had ever participated in a

breast cancer education program, highlighting persistent gaps in community-level awareness initiatives.

Knowledge regarding breast cancer symptoms and risk factors also improved significantly in the present

study, with correct responses increasing from 6.5% and 15.5% to 83.5% and 90.5%, respectively. These

findings align with studies by Gore et al. [20] in Maharashtra and Mukherjee Das et al. [21] in Delhi, both

of whom documented substantial gains in knowledge following educational interventions. Awareness of

breast self-examination (BSE) increased from 29.5% to 82.5% in this study, comparable to improvements

reported by Jadhav et al. [22] in Tamil Nadu and Mainaz et al. [23] in rural Karnataka. Similarly, Patel and

Vyas [24] reported notable improvement in BSE awareness among college students in Ahmedabad.

Correct knowledge regarding the purpose and steps of BSE increased sharply from 18% and 3% pre-

intervention to 84.5% and 89% post-intervention, respectively. These findings are consistent with earlier

studies by Vijayalakshmi et al. [25] and Sowmini et al. [26], who also reported significant improvements

following structured demonstrations and teaching sessions.

Attitudinal changes were evident in the present study, with comfort and confidence to perform BSE

increasing from 28% and 23.5% to 52.5% and 87.5%, respectively. Similar improvements in self-efficacy

were reported by Nidhi et al. [27] among undergraduate students in Gujarat. Health-seeking intentions also

improved substantially, with willingness to consult a doctor increasing from 43% to 89.5%, consistent with

findings by Gawande and Kulkarni [28]. Strengths of this study include its focus on young female college

students—an ideal target group for early breast cancer awareness—use of context-specific educational

content, and inclusion of a two-month follow-up to assess BSE practice.

One limitation of the study is that awareness was assessed immediately after the intervention, which may

have inflated post-test scores. However, sustained improvements in awareness are supported by broader

public health efforts. Mitra et al. [29] reported strong commitments in Puducherry toward non-

communicable disease control through NCD clinics, healthcare workforce training, and community

awareness programs. Under the National Health Mission, Tamil Nadu [30], initiatives such as “Screen to

Win” and “Makkalai Thedi Maruthuvam” have been implemented to improve cancer screening access.

Despite these efforts, screening uptake remains suboptimal due to poor compliance and limited follow-up.

Kalaiarasi et al. [31] reported that although Tamil Nadu has a relatively higher breast cancer screening rate

of 5.5%, women aged 20–24 years are significantly less likely to undergo screening compared to those aged

35–49 years, underscoring the importance of early awareness initiatives such as the present study.

Conclusion

This study demonstrates that a structured health education session on breast self-examination significantly

improves the knowledge and attitudes of young female college students. The observed improvement

reflects a positive shift in health-seeking behavior and utilization of health services among participants.

Empowering young women through context-specific awareness programs can play a vital role in reducing

breast cancer-related morbidity and mortality. However, further research with follow-up assessments is

required to determine whether these improvements lead to sustained behavioral changes, particularly the

regular practice of breast self-examination. Extending this program to female students across diverse

academic streams can facilitate early detection of breast cancer and promote wider dissemination of

knowledge and positive attitudes within the community. As this was our first initiative to educate students

outside health-related disciplines under the STS project, plans include expanding the program to other

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institutions, along with follow-up assessments to evaluate improvement in breast self-examination

practices.

Conflict of Interest: Nil

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