To Assess the Effectiveness of Video-assisted Teaching on Knowledge Regarding Male Breast Cancer among Adult Males

Introduction: As the healthcare programs focus on the relatively higher incidence, women have a fair level of awareness of breast cancer. Breast of male hence ignored in the community. Studies from India have shown that medical care is often taken in an advanced stage because of lack of awareness, and the aggressive nature of breast cancer in Indian men and seen at quite an early age. Video-assisted knowledge teachings about awareness of male breast cancer among adult males would improve their understanding and exploration of the perceptions and opinions of Indian male cancers. Aim: To determine the effectiveness of video-assisted education on male breast cancer knowledge among adult males in the city of Wardha. Methods and Materials: One group pretest and posttest design with a quantitative research approach has been used in this interventional study design. This study has been carried out in community set up. Sample size was100. Validated Pretested predesigned structured questionnaires were used. In Microsoft excel sheet, data collected was entered. SPSS-software Original Research Article Gadhave et al.; JPRI, 33(52A): 12-25, 2021; Article no.JPRI.75793 13 was used to perform the statistical analysis. Frequencies and percentages for categorical variables have been presented. Results: The pre-test findings show that 15(15%) of the adult males had a poor level of knowledge score, 50(50%) had average knowledge and 31(31%) of them had good knowledge and 4(4%) of them had found a very good level of knowledge. After video-assisted teaching in the post-test 3(3%) had a good knowledge score and 97(97%) had very good knowledge, thus it shows that after the post-test the knowledge score was increased. The Mean value of the pre-test is 9.32 and the post-test is 23.14 (p-value is 0.001), the calculated t-value is 35.47. Hence it indicates that Teaching aided with video was effective. The post-test score was significantly associated with population variables such as occupation and bad habits. The post-testing knowledge score with demographic variables such as age, religion, family type, education, marital status, dietary pattern, and area of residence was not significantly linked. Conclusion: The study shows that the expected teaching on male breast cancer has helped adult males to gain a better understanding of the nature of the disease and to take measures to prevent male breast cancer.


INTRODUCTION
Male breast cancer is a rare disease that represents 1% of all breast cancer cases. While extensive literature on female breast cancer is epidemiologically available, relatively little knowledge exists about male breast cancer.
In every country, cancer is a leading cause of death and a significant impediment to increasing life expectancy. 1 According to World Health Organization (WHO) estimates, cancer is the first or second leading cause of death before the age of 70 in 112 of 183 countries in 2019,2 and third or fourth in another 23 countries [1].
Male breast cancer (MBC) is extremely uncommon, accounting for only 1% of all breast cancer diagnoses. MBCs have a higher proportion of oestrogen receptor (ER)-positive subtypes than female breast cancers (FBCs) (>95 percent MBC vs 75 percent FBC), implying that MBCs are a more homogeneous group of tumours than FBCs. Family history and genetic susceptibility are important risk factors, despite the lack of data on the aetiology of MBC. Inherited mutations in BRCA2 are responsible for approximately 10% of cases. In contrast, BRCA1 mutations are found in a small number of cases, suggesting that the underlying genetic etiologies of MBC and FBC are different [2,3].
The incidence of MBC has increased between 0.86 and 1.06 per 100,000 people over the past 26 years [2].
Because of the comparatively higher prevalence of female breast cancer and the focus of health programs, there is a high level of awareness.
On the other hand, male breast cancer is less prevalent in the community and is often ignored [3]. Indian studies show that medical attention is most often sought in the advanced stage As a consequence of ignorance and that breast cancer is aggressive in Indian men and is seen at a relatively young age [4].
The etiology of breast cancer is unclear in men, but the levels of hormones can play a significant part in disease development. An increased risk for breast cancer has been constantly associated with testicular abnormalities like undescended inguinal hernias, orchiectomy, orchitis, and infertility.
Male breast cancer has increased by 26 percent over the past 25 years, as in breast cancer [5].
No studies to assess Indian perceptions of this disease have been conducted previously [6,7].
In this regard, a study was performed to investigate the efficiency of the education of male breast cancer in Indian men with video support.

MATERIALS AND METHODS
A pre-experimental pre-test, the post-test research design were used in this study. The study was conducted from 23 rd March 2021 to 10th April 2021 and the setting was selected in the community area of Wardha city. By using the purposive sampling technique, 100 adult males were selected based on the calculation. The study participants were informed and the purpose of the study was explained. The inclusion criteria were: adult males in the selected area who are willing to participate in the study and who can understand and write English and Marathi. Study participants those were attended a similar type of study and were health professionals excluded from the study. Demographic variables were collected in terms of age, religion, type of family, education, marital status, and dietary pattern, area of residence, occupation, and bad habits.

Cochran Formula for Sample Size
A semi-structured questionnaire, which is attached in Annexure 1, has 26 multiple choice questions and these were classified in different areas, such as Meaning, incidence, causes, and risk factors, male breast self-examination, Medical management, lifestyle management, and preventive measures. The questionnaire was prepared based on the existing literature and clinical experiences of handling male patients having breast cancer. Each correct answer carries one mark and the total score is 26. The prepared tool was validated by twelve experts, out of the ten were from the nursing department, one was from the Department of surgery and one was from the physiology department. Reliability analysis was done by the Spearman-Brown prophecy formula and was 0.90, hence the tool was found reliable, valid, and feasible. The interview technique was processed for 100 samples was planned to gather demographic information and the knowledge structured questionnaire on male breast cancer including medical management, lifestyle management, Complications, and prevention of male breast cancer. On the first day of the data collection, a pretest was conducted on a knowledge questionnaire regarding male breast cancer. The questionnaire was administered, each sample requires meantime 30 minutes to complete the structured questionnaire. Following the pretest, intended video-assisted teaching was carried out on knowledge and breast examination with sufficient audiovisual aids in a quick and clear understandable way for the study participant utilizing PowerPoint presentation with live video of self-breast examination. The post-test was conducted with the same questionnaire. Based on the 26 questions each study participant was asked individually for his answers with the same questionnaire. As collected, the responses were arranged in tabular form to conduct statistical analyzes which are mentioned in the following sections.
The steps of methodology including statistical analysis are described in [ Table 1, Fig. 1] as follows:

Statistical Analysis
The collected data were coded, tabulated, and analyzed by using descriptive statistics (mean percentage, standard deviation) and inferential statistics. The significant difference between pre and post-test readings was tested by using students paired and unpaired t-test, the association of knowledge with demographic variables was done by one way ANOVA test and Pearson's correlation coefficient.

RESULTS
The above Table 1 shows that the Majority of the 34 % samples were from the age group of above29-38years, 27 % samples were from the age group of 39-48 years, 13 % samples were from the age group of above or equal to 49 years,25 % samples were Buddhist,7% were Muslims,3%were Christian. The majority of the 59 % samples were living in a joint family,35 % were from a nuclear family, and 6%were living in the extended family. Majority 47%were completed higher secondary education,28% secondary,14% were primary and 10% posted graduation. As per occupation majority, 35% were laborers, 27% were farmers,15% were in the private sector,4% government servants and2% doing other work. The majority 71% were married, 29% were unmarried. The majority 79% were mixed dietary patterns and 21% were vegetarian. As per bad habits 27% of tobacco chewers,15% Alcoholic,13% smokers, 2% drug adductors, and 43% were not having any bad habits. As per source of knowledge36% an internet/social media,16% through television,(% through radio and 14% through newspapers and 25% through other resources The above Table 2 shows that (15%) had a poor level of knowledge score, (50%) had an average level of knowledge score,(31%) had a good level of knowledge score, and (4%) had a very good level of knowledge score and none of them have excellent knowledge. The minimum score was 2 and the maximum score was 17, the mean score was 9.32 ± 3.32 with a mean percentage score of 35.84% The above Table 3 shows that none of them had a poor, average, and a good level of knowledge score, (3%) had a very good level of knowledge score, and (97%) had an excellent knowledge score. The minimum score was 19 and the maximum score was 26, the mean score was 23.14±1.40with a mean percentage score of 89%.

Fig. 1. Schematic presentation of one group pre-test and post-test design for the present study
The effectiveness of structured teaching program was analyzed as follows: Hypothesis: H0: There will be no significant difference between knowledge score regarding male breast cancer among adult male H1: There will be no significant difference between knowledge score regarding male breast cancer among adult male The above Table 4 shows that there is a significant difference between pre-test and posttest knowledge scores interpreting effective video-assisted teaching on knowledge regarding male breast cancer among male adults. The mean value of the pre-test is 9.32and the posttest is 23.14 and standard deviation values of pre test are 9.32 ± 3.32 and post test is 23.14±1.40. The calculated t-value is 35.47 and the p-value is 0.001. Hence it is statistically interpreted that the planned teaching on knowledge regarding male breast cancer among adult males was effective. Thus the H1 is accepted and H0 is rejected in this study.
The association between some selected demographic variables and post-test knowledge score was calculated and shown in [ Table 5]. Illustrate that association between occupation and bad habits shows that calculated 'p-value was less than the acceptable level of significance i.e. 'p'=0.05. Thus, there was a significant association between demographic variables occupation and bad habits and post-test knowledge score. However, other demographic variables such as age, religion, education, type of family, education, marital status, type of diet, and source of knowledge Illustrate that calculated 'p-value was more than the acceptable level of significance i.e. 'p'=0.05. Thus, there was no significant association between demographic variables such as age, religion, education, type of family, education, marital status, type of diet, source of knowledge, and post-test knowledge score.

DISCUSSION
The study was conducted to assess the effectiveness of video-assisted teaching on knowledge regarding male breast cancer among adult males It was aimed to improve the knowledge of adult males regarding male breast cancer.
The mean post-test score of 23.14 (SD=1.40) was higher than the mean pre-test score of 9.32 (SD=3.32) these scores indicate that the videoassisted teaching was effective. The significant difference between the 2 tests was tested by using paired 't' test the level of significance was set at the computed value (p<0.001) indicated that there was a significant difference in the knowledge of adult males about male breast cancer.
A study of the male's cancer of the breast awareness in Indian expatriates in the Middle East by Salati SA. has been carried out. A crosssectional survey with a random sample of Indian males expatriates in the Al-Qassim region of Saudi Arabia, Male breast cancer awareness has been examined with a self-designed questionnaire. Results indicate that 81% of study participants were poorly aware of breast cancer in the male. This community should be given special attention in raising the issue of men's breast cancer [8]. In this study, only 44% (44 out of 100) were aware that men, too, had breasts such as women (even though small), and 66% were uncertain or believed otherwise. Of the 100 subjects, 81 were unfamiliar with the common characteristics of male breast cancer. Those subjects virtually don't know about the concept for breast selfexamination, as it was heard of only 4 out of 100 (4%). These are worrying figures, as lack of awareness shows that the presentation of cancer patients is delayed. But many recent studies have also shown that other population groups have a similar unsatisfactory picture.
In a study conducted by male graduate students at the Management and Science University, Malaysia, a significantly high percentage found misunderstandings regarding male breast cancer.  Almost 80 percent of participants had not realized that men could develop breast cancer, but, while everyone was at greater risk due to their positive family history, all reported never discussing the disease with their providers. This study offers much-needed insights into male breast cancer consciousness and knowledge [10, 11,12].
Our study focused on finding the efficacy of video-assisted knowledge education in male breast cancer among adult males in which knowledge scores were taken as the main indicator. The other limitation was though our tool assessed knowledge regarding male breast cancer the scores were self-reported, so an increase in the score had definitely shown knowledge increase but how far it was transformed into a change in practices could not be evaluated. Another limitation of our study was due to resource constraints the individual-level data could not be compared pre-intervention and post-intervention; we had to use aggregate data to compare scores.

CONCLUSION
Women are prevalent with breast cancer and can develop in men, though it is rare. Society seems unaware of the possibility for men to develop breast cancer that partly contributes to late diagnosis in men. Nurses must raise awareness about potential breast cancer in men, associated risk factors, and prevention methods. The detection of breast cancer can be assisted by a simple screening method, such as breast selfexamination. This test can be carried out quickly and easily independently, which can lead to early detection. The present study concludes that In pre-test and after video-assisted training, male adult knowledge about breast cancer is not adequate; the awareness of male adults is improved after teaching. Video support is, therefore, effective in enhancing male breast cancer knowledge of adults, helps them to consider the complications of cancer of the male breast, and to take the appropriate measures to recognize at earlier and prevent male breast cancer.

FUTURE RECOMMENDATION
The level of awareness is poor and strategies must be developed to improve this. In this respect, careful use of social media and television can be helpful. These findings provide a starting point for developing evidence-based, gender-based, health promotion and disease prevention interventions for men. There are still misconceptions concerning male breast cancer and male breast self-examination, so special attention should be given to educating men on the subjects of male breast cancer and male breast self-examination (MBSE).

CONSENT
The written informed consent dully signed individually by them was obtained.

ETHICAL APPROVAL
We