|Year : 2022 | Volume
| Issue : 1 | Page : 20-24
Effectiveness of posters in enhancement of knowledge about cancer among outpatients and caregivers: A quasi-experimental study
Sadhana Sudhir Kulkarni1, Bhavna Pramod Joshi2, Prabha Pandurang Nayak3, Vasanti Prabhakar Kelkar3
1 Department of Emergency Medicine, MGM Medical College, Aurangabad, Maharashtra, India
2 Department of Community Medicine, MGM Medical College, Aurangabad, Maharashtra, India
3 Department of Anaesthesiology, MGM Medical College, Aurangabad, Maharashtra, India
|Date of Submission||06-Feb-2022|
|Date of Decision||31-Mar-2022|
|Date of Acceptance||06-Apr-2022|
|Date of Web Publication||20-Apr-2022|
Bhavna Pramod Joshi
Department of Community Medicine, MGM Medical College, N-6, CIDCO, Aurangabad, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: Noncommunicable diseases are posing serious public health threats in developed as well as developing countries. Cancer has become one of the leading health problems. The lack of knowledge about cancer in the general public is a major hurdle in its prevention, early detection, and treatment. Out of various media, display of posters is a simple and cost-effective way of mass education. Hence, the effectiveness of posters in imparting knowledge regarding cancer needs to be evaluated. Materials and Methods: After ethical clearance, a quasi-experimental study was undertaken among 314 outpatients and caregivers in waiting area of outpatient department of a tertiary health-care institute. Individuals aged 18 years and above, who could read, write, and understand Marathi language, participated in the study. Written informed consent was obtained. Each of the participants was asked to fill a pretested, structured questionnaire before their entry into display area of posters. Self-paced observation of posters was allowed, after which posttest questionnaire was administered. Totally 255 completely filled forms were considered for analysis. Data were analyzed using SPSS v25.0, and Chi-square values were calculated. Results: Of the 255 participants, 175 (68.6%) were males and 80 (31.3%) were females. The number of correct responses marked increased in posttest as compared to pretest for all 13 items. The difference was found to be statistically highly significant (P ≤ 0.0001) for 9 and significant (P = 0.012, 0.005) for 2 of the total 13 items in the questionnaire. Conclusions: This study provides evidence that posters can be used as an effective tool for health communication regarding cancer among outpatients and caregivers in outpatient department.
Keywords: Cancer, caregivers, knowledge, posters, quasi-experimental
|How to cite this article:|
Kulkarni SS, Joshi BP, Nayak PP, Kelkar VP. Effectiveness of posters in enhancement of knowledge about cancer among outpatients and caregivers: A quasi-experimental study. Oncol J India 2022;6:20-4
|How to cite this URL:|
Kulkarni SS, Joshi BP, Nayak PP, Kelkar VP. Effectiveness of posters in enhancement of knowledge about cancer among outpatients and caregivers: A quasi-experimental study. Oncol J India [serial online] 2022 [cited 2022 Sep 30];6:20-4. Available from: https://www.ojionline.org/text.asp?2022/6/1/20/343574
| Introduction|| |
Among all noncommunicable diseases, cancer is responsible for substantial mortality and morbidity around the globe. The number of new cases of cancer reported globally in the year 2020 was close to 20 million, with death toll of over 9 million. By 2040, a 47% rise in cancer burden worldwide is expected, cases to cross 28.4 million figures. This increase will be larger in developing countries (64% to 95%) as compared to developed ones (32% to 56%). The Asian countries account for nearly one-half of all cases and more than half of all deaths due to cancer. In India, there were an estimated 1.39 million cancer cases in 2020, which is expected to rise to 1.56 million by 2025.
However, there is a hope of reducing morbidity and mortality due to cancer. In India, the top five cancers, namely breast, cervical, oral cavity, lung, and colorectal, which account for 47.2% of all cancers, can be prevented, screened for and/or detected early, and treated at an early stage. Creating awareness and imparting knowledge regarding early signs and symptoms can go a long way in alleviating suffering from cancer.
The World Health Organization suggests that national policies and programs should focus on raising awareness, reducing exposure to cancer risk factors, and ensuring that people are provided with the information and support they need to adopt healthy lifestyles.,,
For the purpose of creating awareness, every year, February 4 is observed as World Cancer Day at behest of the Union for International Cancer Control. This day is an opportunity to end the injustice of preventable suffering from cancer. The initiative aims at raising worldwide awareness, improving education, and catalyzing personal, collective, and government action. Research literature confirms that low health literacy is one of the important social determinants of health associated with cancer-related disparities. The present study was undertaken to probe into an effective media for imparting knowledge about cancer.
Various measures such as articles in newspaper, magazines, television and mass media campaigns, posters and leaflets, and didactic lectures for masses have been practiced to impart knowledge about cancer. There is evidence to support further investment in research to build and identify best practices in materializing the use of social media in cancer prevention and treatment.
Of all these various media, posters are relatively inexpensive. They also present an effective way to catch and hold the attention of viewers. Images used in posters are more evocative than spoken words, increasing the probability of a viewer remembering the information. Posters can be studied by the viewers in a self-paced manner, allowing better comprehension.
There are many Indian studies assessing awareness about cancer.,, However, empirical evidence regarding the effectiveness of educational media in imparting cancer-related knowledge is scarce.
With this background, the present study was carried out in outpatient department (OPD) waiting area of a tertiary health-care institute (TCI), with the aim to investigate the scope of posters as a medium of information, education, and communication (IEC) about cancer.
The aim of this study was to evaluate the effectiveness of posters in increasing cancer-related knowledge among outpatients and caregivers in waiting area of OPD of TCI.
- To assess the level of knowledge regarding causes, symptoms, prevention, and treatment of cancer among study participants
- To impart knowledge about cancer with the help of posters
- To comparatively evaluate the level of knowledge regarding cancer before and after observation of posters.
| Materials and Methods|| |
The waiting area of OPD offers a unique opportunity for delivering health-related messages. Hence, to avail this opportunity, the present study was envisaged to be carried out among outpatients and their caregivers in the waiting area of OPD of a TCI. Based on the aim and objectives of the present study, a quasi-experimental study design was chosen. It was because a single-group pretest–posttest was planned to be implemented. Logistically feasible sample size was decided to be the number of participants, aged 18 years and above, met within duration of cancer awareness week during OPD hours. Ethical clearance was obtained from the Institutional Ethical Committee for Research on Human Subjects (ECRHS), letter number MGM-ECRHS/2018/11. Necessary administrative permissions were also obtained.
The study was conducted between January 15, 2019 and March 15, 2019. During the 1st month, the educational posters and questionnaires were prepared by the investigators. The posters included pictures, text and graphical information regarding cancer epidemiology, etiology, prevention, and treatment. The posters were prepared in Marathi language. Content of these was validated with the help of five subject experts and their suggestions were incorporated.
For data collection, a structured questionnaire, translated and back-translated in Marathi, was prepared. The questionnaire carried 13 items testing knowledge regarding epidemiology, causes, risk factors, prevention, and treatment of cancer. Additional two questions regarding perception were included in posttest. All the questions of questionnaire are mentioned at the end of the materials and methods. The questionnaire was scrutinized by five subject experts for content validity. This questionnaire was then pretested in twenty patients and caregivers, who were not included in the final analysis. The data obtained thus were subjected to Kuder–Richardson's formula, and the reliability of the questionnaire was confirmed.
The data collection was done during February 04, 2019–February 09, 2019. The outpatients and caregivers 18 years of age and above, who could read, write, and understand Marathi language, as well as willing to participate, were included in the study. Written informed consent was obtained from each participant after explaining to them the nature and purpose of the study. Privacy and confidentiality were ensured. The participants were asked to fill the demographic data and self-administered pretest questionnaire in the waiting area. After collecting the questionnaires from them, they were led to a separate display area in the vicinity of OPD. In this area, the posters prepared by the investigators were displayed. The participants were allowed to observe the posters in a self-paced manner. After leaving the display area, the participants were asked to fill the posttest questionnaire.
After data collection was done over 6 consecutive days, the total number of participants reached was 314. Over the next 3 weeks, data analysis and report compilation were done. The data of 255 participants who filled up both pre- and posttest forms completely were entered in Microsoft Office Excel 2007 and were analyzed using IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp. Data were presented in tabular and graphical form. Chi-square test was applied to test the significance of difference. P < 0.05 was deemed to be significant.
| Sample Questionnaire|| |
Section A: Identification and demographic information
Section B: Information regarding whether oneself or family member ever being afflicted by cancer
Section C: Knowledge assessment
- Cancer is seen only in old persons.
a) True, b) False, c) I don't know
- Cancer is caused by which of the following habits?
a)Smoking, b) Eating tobacco, c) Alcohol use, d) All of the above, e) I don't know
- Who is at risk of getting cancer because of smoking?
a)Person who smokes, b) Person who smokes and people in vicinity, c) None of above, d) I don't know
- Can a person get cancer by coming in contact with another cancer patient?
a)Yes, b) No, c) Don't know
- In India, which cancer is the most common among females?
a)Breast, b) Cervical, c) Lung, d) Oral Cavity, e) Don't know
- In India, the most common cancer seen in males is
a)Oral cavity/Lung, b) Kidney, c) Prostate, d) Stomach, e) Don't know
- What are the symptoms of cancer
a)Rapidly growing swelling, b) Passing blood in urine/stool, c) Weight loss, d) All of the above, e) I don't know
- Do females need to self-examine their breasts every month?
a)Yes, b) No, c) I don't know
- What is the method of treatment for cancer?
a)Medicine, b) Radiation, c) Surgery, d) All of the above, e) Don't know
- Which is the most important factor related to the cure of cancer?
a)Early diagnosis and treatment, b) Medicines, c) Healthy diet, d) Regular exercise, e) Don't know
- Is there any medicine for relieving cancer pain?
a)Yes, b) No, c) I don't know
- Can morphine be used for reducing cancer pain?
a)Yes, b) No, c) I don't know
- Cancer is incurable.
a)True, b) False, c) I don't know
Section D: Questions on perception
- Do you feel the knowledge you obtained today through posters is adequate?
a)Yes, b) No, c) I don't know
- The fear you had about cancer, is it less now?
| Results|| |
Of the 314 participants, only 255 participants had filled the demographic data and questionnaires completely before and after visiting poster exhibition. These 255 completely filled forms were analyzed.
The mean age of the 255 participants in the study was found to be 32 years (standard deviation ± 13.69 years) with a range of 18–78 years. There were 175 (68.6%) males and 80 (31.4%) females. The educational status of the participants is shown in [Table 1].
|Table 1: Gender-wise distribution of participants with respect to educational status|
Click here to view
Of all the 255 participants, 9 (3.5%) reported that either they themselves or their relative was suffering from cancer.
Knowledge of participants was very low with regard to symptoms of cancer (correct responses 27.1% pretest, 32.5% posttest). The knowledge about possibility of relief of pain in cancer was low before poster exhibition (32.5% pretest). However, it was increased after poster exhibition (77.6% posttest), as shown in [Table 2].
|Table 2: Pre and posttest responses to questions and significance of difference between the two|
Click here to view
Correct responses were found to be more in posttest as compared to pretest. The difference was found to be significant for 11 of the 13 items (84.6%), as shown in [Table 2].
In [Figure 1], it can be observed that in posttest, there was an increase in number of participants choosing “all of above” option rather than individual habits as being responsible for cancer causation. The difference between pre- and posttest responses of participants was statistically significant (P = 0.005).
|Figure 1: Distribution of responses with respect to habits causing cancer|
Click here to view
Of all the participants, 219 (85.9%) felt that they had gained adequate knowledge about cancer after observing the posters.
The information in the posters helped to reduce undue fear of cancer in 182 (71.4%) participants.
| Discussion|| |
Posters are relatively inexpensive and may present an effective way to catch and hold the attention of viewers. The present study was undertaken to probe into effective media for creating awareness about cancer.
In our study, knowledge about symptoms of cancer is found to be 27.1% in pretest, whereas it was 32.5% posttest after poster observation, and the difference was found to be statistically significant (P < 0.0001). A similar study was conducted in Turkey by Erkin et al. in 2018. They also employed a quasi-experimental study design to investigate the effectiveness of photographs and posters in early detection of skin cancer among nursing students. They found that there was a significant linear increase in the scores for knowledge of symptoms (F = 7.874, P < 0.001) postintervention. This is in line with the findings of the present study.
A survey was reported from Southeast Europe regarding the media of health information about cancer. It was conducted among 2100 female patients of the Serbian Railways Medical Centre in 2013 by Cvijović et al. The authors found that majority of the women (71%) were aware of possibility of preventing breast and cervical cancers because of posters at health institutions. This study corroborates the use of posters as media of health information regarding cancer as does the present study. In our study, knowledge about “need of breast self-examination” improved after poster observation (P < 0.0001).
In a special article published in 2017, Simmons et al. emphasize the use of plain language in disseminating cancer-related information for its prevention. The authors observed that reduction in medical jargon and use of linguistically and culturally appropriate health education was necessary for successful community interventions. These were proven to be effective in education regarding cervical, skin, and breast cancer. On a similar account, for the purpose of the present study, the posters and questionnaire were designed in regional local language. Furthermore, the language used in posters as well as questionnaire was simple and devoid of medical jargon.
A study conducted among 60 general practitioners of the Picardy region in northern France in 2012 investigated the role of posters displayed in waiting area of OPD in health promotion. Gignon et al. concluded after this study that posters are an effective vehicle for health education on topics such as antismoking campaigns, family planning, and promotion of physical activity. The present study provides evidence that posters are useful in health education about cancer as well.
Gobind and Ukpere conducted a mixed-methods study at a university of higher education in South Africa. They evaluated the effectiveness of posters in creating awareness about HIV/acquired immunodeficiency syndrome in 2014. The study concluded that posters had a positive impact on the level of awareness of the participants. Similarly, the results of the present study support that poster is an effective medium in cancer-related knowledge dissemination.
In a systematic review of 2016, involving 11 studies employing interventions for testicular cancer awareness and screening, Saab et al. observed that IEC posters were one of the effective interventions that improved awareness and screening of testicular cancer. The present study also corroborates that poster can be used to improve knowledge about cancer.
85.8% of participants agreed that they gained knowledge and 71.4% of participants reported that posters helped to reduce undue fear about cancer. The feedback strongly supports that the posters played a valuable role in imparting education about cancer.
However, it was observed in this study that knowledge regarding symptoms of cancer was very low, both in pretest and posttest. Further probe in this unmet need is required.
| Conclusions|| |
The results of the present study show that posters in local and simple language can be an effective tool of health communication regarding cancer. Posters can play a major role in enhancing knowledge about cancer.
We express our gratitude to Dean, MGM MCH, Aurangabad, for support in conduction of this study. We are thankful to the resident doctors and faculty of the Department of Anaesthesia for extending their help during poster exhibition.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al
. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209-49.
India: National Institute of Cancer Prevention and Research, Indian Council of Medical Research; c2021. Available from: https://www.cancerindia.org.in
. [Last accessed on 2021 Oct 15].
Prochaska JJ, Coughlin SS, Lyons EJ. Social media and mobile technology for cancer prevention and treatment. Am Soc Clin Oncol Educ Book 2017;37:128-37.
Elangovan V, Rajaraman S, Basumalik B, Pandian D. Awareness and perception about cancer among the public in Chennai, India. J Glob Oncol 2017;3:469-79.
Ray K, Mandal S. Knowledge about cancer in West Bengal – A pilot survey. Asian Pac J Cancer Prev 2004;5:205-12.
Kumar YS, Mishra G, Gupta S, Shastri S. Level of cancer awareness among women of low socioeconomic status in Mumbai slums. Asian Pac J Cancer Prev 2011;12:1295-8.
Harris AD, McGregor JC, Perencevich EN, Furuno JP, Zhu J, Peterson DE, et al.
The use and interpretation of quasi-experimental studies in medical informatics. J Am Med Inform Assoc 2006;13:16-23.
Allen M. Reliability, Kuder-Richardson formula. In: The SAGE Encyclopedia of Communication Research Methods. California, Unites States: SAGE Research Methods; 2017. Available from: https://dx.doi.org/10.4135/9781483381411.n493
. [Last accessed on 2020 Jul 18].
Erkin Ö, Ardahan M, Temel AB. Effects of creating awareness through photographs and posters on skin self-examination in nursing students. J Cancer Educ 2018;33:52-8.
Cvijović J, Kostić-Stanković M, Krstić G, Stojanović L. Marketing communication in the area of breast and cervical cancer prevention. Vojnosanit Pregl 2016;73:544-52.
Simmons RA, Cosgrove SC, Romney MC, Plumb JD, Brawer RO, Gonzalez ET, et al.
Health literacy: Cancer prevention strategies for early adults. Am J Prev Med 2017;53:S73-7.
Gignon M, Idris H, Manaouil C, Ganry O. The waiting room: Vector for health education? The general practitioner's point of view. BMC Res Notes 2012;5:511.
Gobind J, Ukpere WI. The use of posters in disseminating HIV/AIDS awareness information within higher education institutions. Mediterr J Soc Sci 2014;5:739-47.
Saab MM, Landers M, Hegarty J. Promoting testicular cancer awareness and screening: A systematic review of interventions. Cancer Nurs 2016;39:473-87.
[Table 1], [Table 2]