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Asian Journal of Engineering, Social and Health
Volume 3, No. 12 December 2024
Volume 4, No. 12 December 2024 - (2691-2700)
p-ISSN 2980-4868 | e-ISSN 2980-4841
https://ajesh.ph/index.php/gp
Effectiveness of Video Education in Enhancing Knowledge and
Attitudes Toward Breast Self-Examination (BSE) Among Rural Women:
A quasi-experimental
Rini Mutahar1*, Asri C Adisasmitha2, Arie Kusumaningrum3,
Yeni4, Dian Safriantini5, Rini Anggraini6
1,2 Universitas Indonesia, Indonesia
3,4,5,6 Universitas Sriwijaya, Indonesia
Emails: rini_mutahar@fkm.unsri.ac.id
ABSTRACT
In Indonesia, especially in rural areas far from health access, breast cancer is one of the leading causes of
death in women. Breast self-examination (BSE) is a simple and relatively easy method to detect breast
cancer early, but unfortunately, knowledge and practice of BSE among rural women are still relatively low.
This study aims to determine how much influence multimedia learning videos have on the knowledge and
attitudes of women of childbearing age about BSE in rural areas. This study used a quasi-experimental
design with two stages before and after treatment. This study involved sixty postmenopausal women aged
over 30 who lived in Ogan Ilir Regency. Two villages were randomly selected as the intervention and
control groups, each consisting of 30 people. The intervention group received education using local
language video media (Palembang), while the control group received education using the lecture method.
The study results showed a significant difference in increasing BSE knowledge in the intervention group
(average pre-test 5.79; post-test 8.07; p <0.0001) compared to the control group. On the other hand, the
intervention group's attitude score decreased slightly after the intervention (25.79 to 23.32; p = 0.021).
However, there was a significant difference in knowledge change favoring the intervention group over the
control group (p=0.043). For video-based education, it has been shown that knowledge about BSE
increases among rural women, but attitudes remain essentially unchanged. Other community approaches
and psychological support are crucial to ensure long-lasting positive attitudes towards BSE practices.
Keywords: Breast Cancer, Breast Self-Examination (BSE), Video Intervention.
INTRODUCTION
Breast cancer is a significant health problem and one of the leading causes of death in
Indonesia. Based on GLOBOCAN data (2018), the population breast cancer is the type of cancer
that causes the most significant number of deaths among Indonesian females, which is 17 per
100,000 population (Bray F., 2018). The delay in the detection of breast cancer, which is an issue
in rural areas in Indonesia, is a significant reason for high death rates, implying a lack of
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information and poor facilities. A study done by the authors observed that in villages, it is difficult
for more women to be accompanied for screening, hence leading to advanced and complicated
diagnoses of breast cancer that lead to more deaths (Icanervilia et al., 2023). Moreover, as
reported in 2020, only 11.3% of women aged between 30 and 50 years old in Ogan Ilir Regency,
South Sumatra, had a screening for breast and cervical cancer (Dinkes Kabupaten Ogan Ilir, 2021).
It is demonstrable that there is a more significant disparity in countries, especially in the
engagement and prevention of the disease (Setyarini & Rahaningtyas, 2018)
Breast Self-Examination (BSE) is a method that makes early breast cancer detection easier
for women, not only because it is inexpensive. This method can allow women to check the
palpation change in their breasts for lesions or lumps, which might be early signs of malignancy.
BSE has excellent potential in cancer screening, notably in regions that lack health services (Naz
et al., 2024). However, BSE practice and knowledge are still considered low, especially for rural
women (Usman et al., 2020) and women of low socioeconomic status in the age range of 20-50
years (Kristina & Salsabila, 2020). For instance, 7.14% of women in Tamil Nadu, India, carried out
BSE regularly before an educational intervention, increasing to 64.7% after education was
presented to the women (Nisha & Murali, 2020). Like in Tamil Nadu, Nigeria has also experienced
a similar situation where roughly 75.1% of women from the rural area had very low BSE
knowledge (Hanson et al., 2017).
One of the most effective ways of improving the level and rate of adoption of BSE is through
multimedia education, e.g., video materials. It is believed that video materials contain sight and
sound and are more effective and easier to remember and understand than the traditional media
of books and lectures (Xu et al., 2023). For instance, in Bihar, India, it has been reported that
video-related work increased women's knowledge three times within three months after the
training (Sinha & Sharma, 2024). Of great interest, research undertaken in Iran stated that
teaching women BSE through videos is as efficient as doing it through direct Interviews (Karimian
et al., 2022). This method is suitable in Indonesia, especially considering the rural areas with very
low infrastructure and health service coverage.
However, implementing health education programs in rural areas is more adverse because
of the absence of facilities or low literacy levels in health matters (Icanervilia et al., 2023). In this
case, approaches that involve local health workers or caders within the community to expose
such programs can be a Permanent alternative. In addition, a visualization of the content is more
helpful to students because it has become possible for them to learn the subject matter at the
most appropriate time and place using electronic devices. In this manner, women would practice
self-breast examinations regularly and improve their self-detection skills. Although some studies
have already shown the beneficial aspects of video-based clinics in enhancing women's breast
examinations, there is a void in analyzing the effectiveness of such clinics on women in rural
Indonesia in terms of their socio-cultural and resource circumstances. This research fills that gap
by assessing the impact of multimedia and educational videos specific to the rural communities
Effectiveness of Video Education in Enhancing Knowledge and Attitudes Toward Breast Self-Examination
(BSE) Among Rural Women: A quasi-experimental
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Volume 3, No. 12 December 2024
of Indonesia. It also investigates the involvement of community-based health cadres who act as
enablers, a new strategy that is not practiced much in other studies.
Based on the above background, the objective of this research is to assess multimedia-
based educational videos on the knowledge and attitude of rural women towards SADARI. The
benefit of this study is anticipated to influence evidence-based recommendations for health
promotion planning, particularly in resource-poor settings. Additionally, the benefits of this
research may also guide the design of practical, affordable, and sustainable interventions
targeting women in rural settings that can, in turn, help reduce breast cancer death rates due to
early screening.
RESEARCH METHOD
Research Design and Sample Selection
This research used a quasi-experimental design with two stages: pre-test and post-test. The
research sample consisted of 60 women of childbearing age over 30 years who lived in Ogan Ilir
Regency. Participants were divided into two groups (Intervention and Control) each consisting of
30 people. The selection of villages for the intervention and control groups was carried out
randomly.
Data Collection
Data were collected through a structured questionnaire distributed in a Google Form.
Before participating, all respondents were asked to provide written consent (informed consent).
The questionnaire was divided into three main sections: demographics, knowledge, and
attitudes. The demographic section recorded information on name, age, occupation, education
level, number of children, and family history of cancer. The knowledge section contained ten
questions about symptoms, risk factors, prevention methods, and breast self-examination (BSE).
The attitude section contained ten questions with a Likert scale focused on attitudes towards
breast cancer screening.
Intervention
The research began with a pre-test for all participants. After the pre-test stage, the
intervention was carried out simultaneously in both groups. The intervention group received two
animated educational videos about breast cancer and BSE, each five minutes long, with a
narrative in the local language (Palembang). This animated video, created by the author, was
given to participants who had completed the pre-test. The main information of each video is
described in Table 1. The control group received education through a lecture method. After two
weeks, all participants took part in the post-test stage using the same questionnaire as in the pre-
test stage.
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Table 1. The Main Information for BSE Intervention Video
Sections
Titles
Sub-titles
The First Video
(Theoretical)
Introduction to breast cancer
Definition, prevalence, symptoms and types
of breast cancer
Prevention of breast cancer
Healthy lifestyles to prevent breast cancer
Types of breast cancer
screening
BSE, clinical breast examination and
mammography
The Second Video
(Practical)
Introduction to BSE
Definition of BSE
Practical
BSE steps
Statistical Analysis
Descriptive statistics were used to summarize the frequency distribution of variables. For
inferential analysis, the independent t-test was used to compare the results between the
intervention and control groups. In contrast, the paired t-test was used to measure differences
between the pre-test and post-test groups. In all tests, the significance threshold was set at 0.05
Ethics Approval Code.
This study was approved by the Health Research Ethics Committee, Faculty of Public Health
Sriwijaya University, with Ethical Approval No: 400/UN9.FKM/TU.KKE/2024.
RESULTS AND DISCUSSION
Result
This research involved a total of 30 participants in each group, namely the intervention
group and the control group. In the control group, there was a decrease in the number of
participants to 23 people, while in the intervention group, the number of remaining participants
was 28 people.
Table 2 shows that the majority of respondents had a high school education or equivalent,
namely 80% of respondents for intervention group and 36.7% respondents for control group. The
majority of respondents were housewives, namely 100% respondents for intervention group and
76.7% respondents for control group. The majority of 93.3% respondents for intervention group
and 96.7% respondents for control group did not have a family history of cancer. The analysis of
demographic characteristics between the two test groups showed no difference in demographic
characteristics between the intervention and control groups (p value> 0.05).
Table 2. Respondent Characteristics (Baseline)
Variable
Control Group
(n=30)
n (%)
P value
Education
Primary School
Junior High School
Senior High School
4 (13.3)
9 (30)
11 (36.7)
0.904
Effectiveness of Video Education in Enhancing Knowledge and Attitudes Toward Breast Self-Examination
(BSE) Among Rural Women: A quasi-experimental
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Variable
Control Group
(n=30)
n (%)
P value
Higher Education
6 (20)
Respondent Occupation
Housewife
Teacher
Lecturer
Trader
23 (76.7)
5 (16.7)
1 (3.3)
1 (3.3)
0.388
Family History of Cancer
Yes
No
1 (3.3)
29 (96.7)
1.000
Mother's Age, mean (SD)
Number of Children, Mean
(SD)
34.20 ± 10.043
3.04 ± 1.020
0.703
0.96
Table 3 shows the changes in the mean knowledge and attitude scores in the intervention
and control groups before and after the intervention. In the intervention group, the mean score
of knowledge increased significantly from 5.79 ± 1.641 in the pre-test to 8.07 ± 1.585 in the post-
test (p < 0.0001). In contrast, in the control group, the mean score of knowledge also increased,
from 5.35 ± 2.269 in the pre-test to 6.91 ± 2.37 in the post-test (p < 0.0001). However, this
increase was smaller than the intervention group, indicating that the lecture method was not as
effective as educational videos in increasing knowledge
In the attitude variable, the intervention group showed a significant decrease in the mean
score, from 25.79 ± 3.436 in the pre-test to 23.32 ± 2.790 in the post-test (p = 0.021). In contrast,
in the control group, attitude scores showed a small increase from 32.61 ± 4.459 in the pre-test
to 32.91 ± 5.16 in the post-test, although this change was not statistically significant (p = 0.711).
Table 3. Difference in Mean Knowledge and Attitude Scores in the Intervention
and Control Group Before and After Intervention
Variable
Group (n)
Pre-Test
Post-Test
P Value
Mean ± SD
Mean ± SD
Knowledge
Intervention (n=28)
5.79 ± 1.641
8.07 ± 1.585
<0.0001
Control (n=23)
5.35 ± 2.269
6.91 ± 2.37
<0.0001
Attitude
Intervention (n=28)
25.79 ± 3.436
23.32 ± 2.790
0.021
Control (n=23)
32.61 ± 4.459
32.91 ± 5.16
0.711
Based on Table 4, it is known that there is no difference between the knowledge of the
intervention group and the knowledge of the control group before receiving the Intervention. At
the same time, the attitude shows a significant difference. After 2 weeks of Intervention, a
significant difference was obtained between the knowledge of the intervention group and the
control groups' knowledge. The analysis results also showed a difference between the attitudes
of the intervention group and the attitudes of the control group after 2 weeks of Intervention.
Rini Mutahar, Asri C Adisasmitha, Arie Kusumaningrum, Yeni, Dian Safriantini, Rini Anggraini
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Table 4. Difference in Mean Knowledge and Attitude Scores Between Intervention and
Control Groups Before and After Intervention (n=51)
Variable
Pre-Test
(Intervention)
Pre-Test
(Control)
P value
Post-Test
(Intervention)
Post-Test
(Control)
P value
Mean ± SD
Mean ± SD
Mean ± SD
Mean ± SD
Knowledge
5.79 ± 1.641
5.35 ± 2.269
0.428
8.07 ± 1.585
6.91 ± 2.37
0.043
Attitude
25.79 ± 3.436
32.61 ± 4.459
<0.0001
23.32 ± 2.790
32.91 ± 5.16
<0.0001
Based on Table 5, the intervention media in the form of video is quite effective in changing
respondents' knowledge and attitudes compared to lecture media. The average change in
knowledge in the intervention group was higher than the control group (2.29 and 1.57,
respectively). In the attitude variable, there was also a higher change in attitude in the
intervention group compared to the control group. There was a significant difference in the
average between attitudes in the intervention and control groups.
Table 5. Difference in Mean Changes in Knowledge and Attitude Between the Two Groups
Variable
Intervention (n=28)
Control (n=23)
P value
Mean ± SD
Mean ± SD
Knowledge
2.29 ± 2.016
1.57 ± 1.647
0.175
Attitude
-2.46 ± 5.32
0.30 ± 3.89
0.043
Discussion
This research highlights the effectiveness of video-based education in both knowledge
improvement and attitude change regarding breast self-examination (BSE). It can be seen from
Table 3 that in the intervention group, the mean knowledge score improved significantly from
5.79 ± 1.641 in the pre-test to 8.07 ± 1.585 in the post-test (p < 0.0001). Similarly, the control
group also showed an upward trend change in knowledge scores, from 5.35 ± 2.269 to 6.91 ±
2.37 (p < 0.0001), but this increment was lesser than that of the intervention group. These results
imply that video education is superior to lecture methods in content delivery. Sinha & Sharma
(2024) also posit that video interventions increase knowledge retention better and faster through
attractive and easy-to-use multimedia approaches.
Table 3 also depicts a comparable trend where the mean attitude score of the intervention
group decreased from 25.79 ± 3.436 in the pre-test to 23.32 ± 2.790 in the post-test (p = 0.021).
The control group displayed no changes in attitude scores, a minimal increase from 32.61 ± 4.459
to 32.91 ± 5.16 (p = 0.711). The observed decline in the mean score changes in attitude in the
intervention group might be attributed to heightened anxiety or fear after they were given
complete knowledge of the risks associated with breast cancer. This situation is in concordance
with the findings of (Dewi et al., 2019), who argue that increased awareness of cancer risk may
yield some backward effects, which are negative feelings, if this awareness is not well managed
via psychosocial interventions. Table 4 shows that before the intervention, there was no
Effectiveness of Video Education in Enhancing Knowledge and Attitudes Toward Breast Self-Examination
(BSE) Among Rural Women: A quasi-experimental
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Volume 3, No. 12 December 2024
significant difference in knowledge between the intervention and control groups (p = 0.428),
while attitudes showed a significant difference (p < 0.0001). After two weeks of intervention, the
intervention group showed a significantly higher knowledge score than the control group (p =
0.043). For the attitude variable, the difference between the two groups remained statistically
significant, with the control group maintaining a higher mean score than the intervention group
(p < 0.0001). These findings indicate that video-based education, while increasing knowledge,
may require other means, such as support and motivation, to change or strengthen an
individual’s emotions.
As shown in Table 5, the mean change in knowledge score was also higher in the
Interventional group (2.29 ± 2.016) than in the control group (1.57 ± 1.647), though the difference
was not significant (p = 0.175). However, in the attitude variable, the interventional group had a
negative mean change (-2.46 ± 5.32). In contrast, the control group experienced a small
intervention mean change, which was positive (0.30 ± 3.89), and the difference was statistically
important (p = 0.043). From this, it can be inferred that video-based interventions are insufficient,
especially when designed to provide the requisite information. However, they do not address
additional measures, such as support for attitude change. In addition, in the experimental group,
the diminished positive attitudes after participation in the study point to anxiety that is likely to
be associated with the receipt of information on cancer risk. This is relevant to the findings of
(Dewi et al., 2019), who said that cancer education. However, it increases awareness and may
also increase anxiety if it is not supplemented with much-needed psychiatric help.
This research revealed that educational video-based Intervention significantly improved
women's knowledge of breast self-examination (BSE) in rural areas. Educational videos are an
effective tool for delivering health information in a way that is easy to understand, quickly
accessible, and appropriate for communities with limited health facilities (Kay, 2012). These
results support the findings of (Sinha & Sharma, 2024) research, which showed an increase in
knowledge of up to 100% after an educational video intervention in a rural community in Bihar,
India. (Baby, 2022) discovered that a video-assisted breast self-examination education program
was beneficial for women in certain rural areas.
Strenght and Limitation
This research approach employs the local language of the video, namely the Palembang
language, which is one of the major strengths. Considering the cultural aspects by using a local
language fosters a greater understanding of the educational materials among participants and
enhances the participants’ confidence in the information provided (Lott et al., 2021). Research
shows that when communicating with people, they are likely to understand better when
communicating with people familiar with the same language. The research has also supported
these findings (Nisha & Murali, 2020), which illustrates the significance of local language and
context in enhancing people’s acceptance and comprehension of health interventions in rural
communities.
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With a community-based approach involving local health cadres, this program can be
adopted globally in other villages in Indonesia, particularly South Sumatra Province. In many
rural areas, health promotion is primarily accomplished by posyandu caders and village midwives
(Solikhah et al., 2018) and this educational video program can be incorporated into normal
routine activities at posyandu or posbindu. Utilizing devices such as mobile phones or tablets,
which are readily available, can enable the communities to acquire a BSE education on their own
time and in their preferred location (Bower et al., 2014). Also, for maximum effect, the video
content can be modified to fit the region's language and cultural context, thus making it easier
for people to accept and comprehend.
This research used a quasi-experimental study with pre-test and post-test, which allows
direct evaluation of the impact of the Intervention on changes in knowledge and attitudes.
Therefore, this design gives a better understanding of the optimal effectiveness of educational
videos during a short period. Furthermore, a community-oriented strategy, which includes local
health workers, is another advantage that enhances the sustainability of the education program
and supports its sustainability (O’Donovan et al., 2020). As per the study of (Hanson et al., 2017),
the involvement of health cadres contributes to the success of interventions in places with less
developed strategies.
However, this study also has several areas for improvement. First, it is a quasi-experimental
design that lacks control over external variables, such as the social culture’s impact on the
attitudes and behaviors surrounding BSE. The video intervention hampered interaction between
the study participants and a live facilitator who could address their questions and apprehensions
(Occa & Suggs, 2016), as pointed out by (Karimian et al., 2022), who recommended the use of
face-to-face interventions in enhancing health literacy, the video provided just standby
information. Second, the measurement duration of only two months after the intervention
somehow made this study all but avoid measuring the long-term effects on BSE sociocultural
practices. The findings of this research should reflect whether the knowledge gained and retained
will serve its purpose of fostering BSE practice, which was another limitation that was evident in
other studies that sought to assess a changed behavior after a longer time frame that was
relatively prolonged (Sinha & Sharma, 2024).
CONCLUSION
According to the evidence from this study, a video-assisted education strategy enhanced
the understanding of breast self-examination (BSE) women, especially among rural women who
speak the local idiom and narrate using local concepts. Nevertheless, a slight decline in attitude
scores suggested a need for support to begin holding positive beliefs and emotions toward BSE.
The engagement of community health aides and mental cadre is critical for reinforcing favorable
attitudes and assisting the respondents in coping with distress regarding the risk of having breast
cancer. These findings suggest adopting video-assisted health education programs with the
Effectiveness of Video Education in Enhancing Knowledge and Attitudes Toward Breast Self-Examination
(BSE) Among Rural Women: A quasi-experimental
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dimensions of community supervision to enhance the practice of BSE. Further studies should
focus on assessing the effectiveness of the combined intervention over a more extended period
and consider an in-stage approach as well as a community perspective to reduce the
effectiveness. This study provides valuable insight into the promotion of awareness and
prevention of breast cancer in rural settings.
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Rini Mutahar, Asri C Adisasmitha, Arie Kusumaningrum, Yeni, Dian Safriantini, Rini Anggraini
(2024)
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