JHE 5 (2) (2020) 61-65

Journal of Health Education

http://journal.unnes.ac.id/sju/index.php/jhealthedu

Husband’s Permission as A Determinant for Breast Cancer Screening

among Women of Childbearing Age
Oluwatobi Daniel Nofiu

DOI: http://dx.doi.org/10.15294/jhe.v5i2.38565

University of Maiduguri Borno State, Nigeria

History Article Abstract

Submitted 3 May 2020 Background: Breast screening reduces breast cancer-associated morbidity and mor-
Revised 9 August 2020 tality, a means to early detection, also increases the chances for successful treatment
Accepted 27 September 2020 and cure of the disease. This study was conducted to assess the husband’s permis-
sion as a determinant of breast cancer screening among women of childbearing age
Keywords in The Southwest zone, Nigeria.
breast cancer screening; deter-
Method: Ex-post facto research design was used for this paper. A total sample of
minant; husband’s permis-
sion; southwest zone Nigeria; 768 women of childbearing age in The Southwest zone, Nigeria from a popula-
women of childbearing age tion of 8,261,284 were selected through multi-stage sampling procedures of simple
random sampling, proportionate, and systematic sampling techniques. Out of the
768 copies of the questionnaire distributed, 762 were valid for analyses. Inferential
statistics of a one-sample t-test was used to test the data collected at 0.05 level of
significance.
Results: The results revealed that husband’s permission is a determinant of breast
cancer screening among women of childbearing age was significant with a t-value
of 4.921 and a p-value of 0.001 at 0.05 level of significance.
Conclusion: It was concluded that the husband’s permission was a determinant of
breast cancer screening among women of childbearing age in The Southwest zone,
Nigeria. Based on the conclusion, it was recommended that husbands should be en-
couraged and enlightening on breast cancer and its screening in other to allow their
wives to go for screening by governmental and non-governmental organizations
through mass media, community, and town campaign of breast cancer screening.

How to Cite
Nofiu, O. D. (2020). Husband’s Permission as A Determinant for Breast Cancer
Screening among Women of Childbearing Age. JHE (Journal of Health Education),
5(2), 61-65.


Corresponding Author: p-ISSN 2527-4252
Bama Road, Maiduguri, Borno State, Nigeria e-ISSN 2528-2905
E-mail: [email protected]
 Oluwatobi Daniel Nofiu / Journal of Health Education 5 (2) (2020) 61-65

INTRODUCTION solami et al. 2019). Research from Tabrizi (2018)

found significant relationships among these fac-
Breast cancer is a common cause of can- tors with breast cancer such as income, meno-
cer-related deaths in most developing countries. pause status, a history of breast cancer in close
Breast cancer is the most frequently diagnosed relatives, beliefs, inaccessibility, knowledge, cues
neoplastic disease in women around menopause to action, emotions, self-care, and life priorities
often leading to a significant reduction of these (P<0.05) (Tabrizi, et al., 2018). Breast-feeding ap-
women’s ability to function normally in everyday pears to be protective against breast cancer, and
life (Kamińska, et al., 2015). Breast cancer is the null parity is associated with an increased risk of
type of cancer that develops from breast tissue; it developing breast cancer. Prolonged use of oral
is mostly common in women and it is one of the contraceptive pills, hormonal therapy, and being
most studied diseases, largely because of its high overweight or obese have been found to increase
mortality (second to lung cancer) (Oguntunde, breast cancer risk among menopausal women
et al., 2017). Breast cancer is a metastatic cancer (Jago, et al., 2014).
and can commonly transfer to distant organs such Breast screening reduces breast cancer as-
as the bone, liver, lung and brain, which mainly sociated morbidity and mortality, a means to ear-
accounts for its incurability (Sun, et al., 2017). ly detection, also increases the chances for suc-
Female breast cancer is a major global pub- cessful treatment and cure of the disease (Chor, et
lic health problem with an estimated 1,384,155 al., 2014), but also improves chances of survival
new cases worldwide and over 459,000 related and lessens the need of invasive treatment. Ensu-
deaths annually (Adebimpe, et al., 2018). Studies ring availability of early diagnostic and screening
have shown a steady increase in the incidence of services and taking immediate steps have been re-
breast cancer in Nigeria from 15.3 per 100,000 garded as the two main strategies for warranting
in 1976 to 33.6 per 100,000 in 2015 to 52.1 per improvement in the prognostic outcome (Abulk-
100,000 in 2012 (World Health Organization, hair, et al., 2010). The assumption is that early
2016). The incidence of breast cancer is increa- detection will improve outcomes. A number of
sing in the developing world due to increased life screening tests have been employed, including
expectancy, increased urbanization and adoption clinical and self-breast exams, mammography,
of western lifestyle (World Health Organization, genetic screening, ultrasound, and magnetic reso-
2013). Various factors also affect the incidence of nance imaging.
breast cancer, of which genetic factors, environ- Determinants are threat to women’s health
mental factors, and lifestyle are the most impor- and well-being, and health indicators in Nigeria
tant ones, and also many factors such as parities, are unfavorable to mothers. No matter how equip-
lactation, and exercise play important roles in ped a health facility is, it is the level of patronage
reducing the risk of this disease (Momenimova- that makes the difference to good health of both
hed & Salehiniya, 2019). mother and child. Thomas et al. (2012) noted that
Breast cancer causes are unknown; thus role of husbands in encouraging or obstructing
it is considered as a disease primarily associated women’s access to screening may be an important
with some risk factors. Multiple risk factors for issue in traditional. Men allow their women to go
breast cancer are well-established; these include for breast screening while some reported otherwi-
breast density, reproductive (parity and age at first se (Kinnon, 2018). Other men indicated that they
birth), menstrual (menopausal status and age at are not comfortable, especially if the test is being
menarche), and modifiable lifestyle factors such performed by a male health care worker. Additio-
as body mass index (BMI), hormone replacement nally, Estrada, et al. (2014) noted that husband’s
therapy (HRT) use and alcohol consumption (Ho permission contribute to underuse of breast can-
et al. 2020). These factors are simply being a fe- cer screening methods among women.
male, getting older, family history of breast can- The researcher gathered information that
cer especially a first-degree relative, early menar- women with symptoms of late stage of breast
che at the age of 12 and under, late menopause cancer disease, such as a breast reddish, swollen,
after the age of 55 years, and having the first child tender breast, but refusing to go to the clinic/hos-
after the age of 30 years. pital. From consultation with women, many of
Previous studies have reported that there them did not want to go for check-up because of
are several common factors present in women their husband’s. Some thought it was a mere infec-
diagnosed with breast cancer, such as their ages, tion of the breast that could be easily cured with
ages at menarche and menopause, family histo- drugs. These generated a lot of questions as to
ries, lifestyles and oral contraceptive usage (Al- whether these women are aware about the health

62
 Oluwatobi Daniel Nofiu / Journal of Health Education 5 (2) (2020) 61-65

consequences of not attending clinics/ hospitals cancer screening among women of childbearing
for breast cancer screening. There were different age. My husband did not allow me because health
screening of early diagnosis of breast cancer such care center is far from where I live has a mean of
as Breast Self-Examination, physical examinati- 3.7894 and standard deviation of 1.5796, my hus-
on by a medical doctor and mammography. This band did not allow me to go for breast checkup
has therefore, prompted the researcher to assess has mean of 3.2134 and standard deviation of
whether husband’s permission is a determinant 1.3013, my husband did not allow me because of
of breast cancer screening among women of the personnel in the hospital are not friendly has
childbearing age in The Southwest zone, Nigeria a mean of 3.6815 and 1.5362 while my husband
did not allow me because of the Fear of breast
METHODS cancer has a mean of 3.5103 and standard devia-
tion of 1.3109. It was revealed that the aggregate
The research design adopted for this study mean 3.5131 is greater than 2.5 constant mean.
was ex post facto research design. The sample size Therefore, husband’s permission determines
of this study was 768 women of childbearing age breast cancer screening among women of child-
between the ages of 18-49 years as suggested that bearing age in The Southwest zone, Nigeria.
in a population of 1,000,000 and above, a sample
size of 384 can be used in a study (Research Ad- Table 1. Mean scores of responses on the hus-
visor 2006). However, the researcher doubled the band’s permission and breast cancer screening
figure to have a wider coverage of respondents for among women of childbearing age
the purpose of generalization of findings to the Item Mean Standard
target population. A multi-stage sampling techni- Devia-
que that involves a simple random sampling, tion
proportionate sampling and systematic sampling
My husband did not allow
techniques was used for this study. The first sta-
me because health care
ge involved the use of simple random sampling 3.7894 1.57957
center is far from where
technique to select five (5) states from six (6) exis-
I live
ting states which are Ekiti, Lagos, Ondo, Osun
and Oyo by writing all the name of States on a My husband did not allow
pieces of paper, folded and dropped in a contai- me to go for breast check 3.2134 1.30132
ner, shuffled it, and the selection was made in or- up
der to get equal chance of selection. My husband did not allow
The instrument that was used in collecting me because of the person-
3.6815 1.53618
data for this research was a researchers’ structu- nel in the hospital are not
red questionnaire. In order to establish the face friendly.
and content validity of the instrument, the questi- My husband did not allow
onnaire was vetted by five (5) jurors from Depart- 3.3707 1.47334
me because of my age
ments of Human Kinetics and Health Education
My husband did not allow
and Nursing Sciences, Ahmadu Bello University,
me because of the fear of 3.5103 1.31097
Zaria. The comments, observations, corrections
breast cancer.
and suggestions were incorporated and a final
draft of the questionnaire was prepared and used Aggregate Mean 3.5131 1.44028
for pilot study. Descriptive statistics of means
and standard deviation was used to answer the Table 2 reveals that husband’s permission is
research questions, thus, any response that has a a determinant of breast cancer screening among
mean aggregate of 2.5 and above was accepted as women of childbearing age. This is because the
positive and any response that has a mean score one-sample t-test calculated value is 4.921 greater
of less than 2.5 was negative or not accepted. One than the t-critical is 1.972 at degree of freedom
sample t-test was used to test the formulated hy- 761 with probability value 0.001 is less than 0.05
potheses at 0.05 alpha level of significance level of significance. Thus, this result shows that
the sub-hypothesis (null) which states that “Hus-
band’s permission among women of childbearing
RESULTS AND DISCUSSIONS
age in The Southwest zone, Nigeria is not signifi-
cant determinant for breast cancer screening” is
Table 1 reveals the mean and standard
therefore rejected.
deviation on the responses of the respondents
Studies of African American and others
whether husband’s permission determine breast

63
 Oluwatobi Daniel Nofiu / Journal of Health Education 5 (2) (2020) 61-65

have found positive associations between subjec- (2012) that role of husbands in encouraging or
tive perceptions of support for breast and cervi- obstructing women’s access to screening may be
cal cancer screening (eg, having friends or fam- an important issue in traditional societies (Tho-
ily who encouraged screening) and actual cancer mas, et al., 2012). In this survey, only 4% of wo-
screening behaviors (Mouttapa et al., 2016). The men reported that their husbands ever opposed
perceived receipt of social support is believed to their desire to screen, while > 2/3rd of husbands
be a motivator for multiethnic women to get rou- were clearly supportive. Husband’s positive sup-
tine cancer screenings. Mouttapa (2016) findings port as well as educational level were determi-
of a relationship between PI women perceived nants of women’s participation in breast cancer
social support and Pap testing behaviors are screening activities. In results, women who per-
consistent with their prediction and the sugges- ceived a positive spousal attitude (versus a neutral
tion that enhancing the quality of women’s social one) were significantly more likely to ever-obtain
networks, specifically their relationship with their a mammography. Spousal support was the only
husband/ male partner, may facilitate cancer variable which appeared to affect regular adhe-
screening efforts above and beyond the impact rence to yearly mammography. Recognizing the
of traditional cancer prevention strategies (eg, in- importance of support from spouses, that men to
creasing knowledge of cancer risk factors). encourage women for screening. Most men ap-
In the Middle East, socio-cultural factors preciated the importance of regular breast cancer
influence women’s view of breast cancer scree- screening in promoting women’s health and in
ning. For example, in Saudi Arabia, men directly early detection of breast cancer. They felt they
influence women’s decision making with regard had an important role in encouraging the women
to healthcare services and their own perceptions in their lives to participate in breast cancer scree-
of self-care (Al-Dasoqi et al., 2017). Arab men ning activities, but were adamant that any exami-
perceive that their opinions and support are a nation must be performed by a female health care
major factor influencing female family members’ professional (Donnelly et al., 2017).
participation in breast cancer screening, it is im-
portant that any program instituted to increase Table 2. One sample t test on husband’s permis-
such screening participation be aimed at both sion as a determinant of breast cancer screening
men and women (Donnelly et al., 2017). among women of childbearing age
As with many countries in the Std. De- t- P-
world, Arabs in Qatar characteristically are adhe- Mean df
viation value value
rent to patriarchal customs and traditions (Don-
Ag- 3.51 1.44 4.92 761
nelly et al., 2017). Nevertheless, the fear that a
gregate 0.001
woman’s breasts may be exposed and palpitated
mean
by a male health care professional can be a cont-
ributing factor in the reluctance of women to par- Con- 2.50 0.001
ticipate in such screening activities or in getting stant
mean
their husbands’ or fathers’ approval for breast
t (761) = 1.972, P < 0.05
examinations (Donnelly et al., 2017).
Breast cancer may have direct conse-
Kinnon (2018) revealed that some men al-
quences on the husband. For instance, distress
low their women to go for breast screening while
was found to be distributed among husbands of
some reported otherwise. Other men indicated
the women diagnosed with breast cancer, even
that they are not comfortable, especially if the test
though it was not as much of the patients‘ distress
is being performed by a male health care worker.
themselves (Yusoff, et al., 2012). However, some
Men believed that breast cancer preventive prac-
studies reported that spouses (regardless of gen-
tices must be performed in a similar context of
der) had more distress than patients (Yusoff et al.,
women’s religious and cultural background (Al-
2012).
Dasoqi et al., 2017). Hence, there is an urgent
The result also revealed that husband’s
need to pay more attention to spreading aware-
permission is a determinants of breast cancer sc-
ness among men, as they are associates, and they
reening among women of childbearing age with
need to be armed with proper awareness (Ade-
t value of 4.921 and p-value 0.001 < 0.05. This
bimpe et al., 2018). It is being agreed that breast
means that the husband’s permission is one of the
cancer is a disease that presents spouses with the
determinants of breast cancer screening among
new environment of life, mostly in relation to the
women of childbearing age. The finding of this
marital satisfaction, communication and inter-
study is in line with the study of Thomas et al.

64
 Oluwatobi Daniel Nofiu / Journal of Health Education 5 (2) (2020) 61-65

personal support (Yusoff et al., 2012). Further- Q., Tan, K. W., ... & Li, J. (2020). Incidence
more, husbands’ breast cancer knowledge plays of breast cancer attributable to breast density,
a significant role in wives’ attitudes and practices modifiable and non-modifiable breast cancer
risk factors in Singapore. Scientific reports, 10(1),
related to breast cancer (Adebimpe et al., 2018).
1-11.
Jago, R., Thompson, J. L., Sebire, S. J., Wood, L., Pool,
CONCLUSION L., Zahra, J., & Lawlor, D. A. (2014). Cross-
sectional associations between the screen-time
From the results and findings of this paper, of parents and young children: differences by
it was concluded that husband’s permission was parent and child gender and day of the week.
a determinant of breast cancer screening among International Journal of Behavioral Nutrition and
Physical Activity, 11(1), 54-60.
women of childbearing age in The Southwest
Kamińska, M., Ciszewski, T., Łopacka-Szatan, K., Miotła,
zone, Nigeria. It was therefore recommended P., & Starosławska, E. (2015). Breast cancer risk
that husbands should be encourage and enligh- factors. Przeglad menopauzalny= Menopause re-
tening on breast cancer in other to allow their view, 14(3), 196–202.
wives to go for screening by governmental and Kinnon, J. B. (2018). Breast cancer: The increasing
non-governmental organizations through com- threat to young black women. Women’s Health
munity and town campaign of the importance of Section. Ebony, 1(1), 1-7.
breast cancer screening. Besides, governmental Momenimovahed, Z., & Salehiniya, H. (2019). Epide-
and non-governmental organizations should put miological characteristics of and risk factors for
breast cancer in the world. Breast Cancer: Targets
more effort in making breast cancer screening and Therapy, 11(1), 151-64.
free consultation in town and communities. Mouttapa, M., Park Tanjasiri, S., Wu Weiss, J., Sablan-
Santos, L., DeGuzman Lacsamana, J., Quitu-
REFERENCES gua, L., ... & Tupua, M. (2016). Associations
between women’s perception of their hus-
Abulkhair, O. A., Al Tahan, F. M., Young, S. E., bands’/partners’ social support and Pap screen-
Musaad, S. M., & Jazieh, A. R. M. (2010). The ing in Pacific Islander communities. Asia Pacific
first national public breast cancer screening pro- Journal of Public Health, 28(1), 61-71.
gram in Saudi Arabia. Annals of Saudi medicine, Oguntunde, P. E., Adejumo, A. O., & Okagbue, H. I.
30(5), 350-357. (2017). Breast cancer patients in Nigeria: data
Olalekan, A. W., Oluwaseun, F. A., & Oladele, H. A. exploration approach. Data in brief, 15(1), 47–57.
W. (2018). Prevalence and knowledge of Salmo- Research Advisor. (2006). Excel Compatible Sample
nella infections among food handlers: Implica- Size Table. Retrieved March 14, 2018 (www.
tions for school health in Southwestern Nigeria. researchadvisor.com).
Sahel Medical Journal, 21(2), 99–103. Sun, Y. S., Zhao, Z., Yang, Z. N., Xu, F., Lu, H. J., Zhu,
Alsolami, F. J., Azzeh, F. S., Ghafouri, K. J., Ghaith, Z. Y., ... & Zhu, H. P. (2017). Risk factors and
M. M., Almaimani, R. A., Almasmoum, H. A., preventions of breast cancer. International jour-
... & Tashtoush, S. H. (2019). Determinants of nal of biological sciences, 13(11), 1387–1397.
breast cancer in Saudi women from Makkah Tabrizi, F. M., Vahdati, S., Khanahmadi, S., & Bar-
region: a case-control study (breast cancer jasteh, S. (2018). Determinants of breast cancer
risk factors among Saudi women). BMC public screening by mammography in women referred
health, 19(1), 1554-15560. to health Centers of Urmia, Iran. Asian Pacific
Chor, J. S. Y., Lam, H. C. Y., Chan, A., Lee, H. M., Journal of Cancer Prevention: APJCP, 19(4), 997–
Fok, E., Griffiths, S., & Cheung, P. (2014). So- 1003.
cioeconomic disparity in breast cancer detection Thomas, D. B., Gao, D. L., Ray, R. M., Wang, W. W.,
in Hong Kong–a high income city: retrospective Allison, C. J., Chen, F. L., ... & Li, W. (2002).
epidemiological study using the breast cancer Randomized trial of breast self-examination in
registry. PloS one, 9(10), e107630. Shanghai: final results. Journal of the National
Al Dasoqi, K., Zeilani, R., Bawadi, H., & Al Dasoqi, Cancer Institute, 94(19), 1445-1457.
A. (2017). Perspectives and Attitudes of Jorda- World Health Organization. (2013). Breast Cancer:
nian Male College Students on Breast Cancer Prevention and Control. Fact Sheet No. 297.
Screening. Journal of Cancer Education, 32(1), Retrieved (http://www.who.int/mediacentrre/
24-30. factsheets/fs297).
Donnelly, T. T., Al-Khater, A. H., Al-Bader, S. B., Al- World Health Organization. (2016). The World Health
Kuwari, M. G., Abdul Malik, M. A., Al-Meer, Report 1996: Fighting Disease, Fostering Develop-
N., & Singh, R. (2017). Perceptions of Arab ment: Executive Summary. Geneva.
men regarding female breast cancer screening Yusoff, N., Reiko Yap, K. M., & Ahmad, A. (2012).
examinations—Findings from a Middle East Husbands’ experience with their wives’ breast
study. PloS one, 12(7), e0180696. cancer: a qualitative study. Malaysian Journal of
Ho, P. J., Lau, H. S. H., Ho, W. K., Wong, F. Y., Yang, Public Health Medicine, 12(1), 31-38.

65