|Year : 2015 | Volume
| Issue : 2 | Page : 215-226
Effect of video-based teaching module on knowledge about testicular cancer and testicular self-examination among male undergraduate students
Chinomso Ugochukwu Nwozichi
Department of Adult Health Nursing, School of Nursing, Babcock University, Ilishan Remo, Ogun State, Nigeria
|Date of Web Publication||16-Dec-2015|
Chinomso Ugochukwu Nwozichi
Department of Adult Health Nursing, School of Nursing, Babcock University, Ilishan Remo, Ogun State
Source of Support: None, Conflict of Interest: None
Introduction: Testicular cancer (TC) is the most common neoplasm affecting males between 15 and 35 years of age and testicular self-examination (TSE) has been recommended for its early detection and treatment. Aim: This study evaluated the effect of video-based teaching module (VBTM) on knowledge about TC and TSE among male undergraduate students of a selected college in Bangalore. Materials and Methods: A preexperimental (one group pretest-posttest) study design was adopted, and a purposive sampling technique was used to select 87 participants. Tool for data collection was a self-developed structured questionnaire which was used to assess participants' knowledge of TC and TSE before and after the educational intervention (VBTM). Data collected were analyzed with SPSS 17.0 presenting them in descriptive and inferential statistics. Results: Findings showed that the pretest knowledge score of participants was very poor, and the rate of TSE practice was also very low. Participants' pretest awareness was associated with their attempt/practice of TSE (P = 0.001). After the intervention, there was a significant increase in participants' knowledge. Majority (54%) and 32 (36.8%) had very good and good knowledge, respectively, after the intervention. There was a highly significant difference between the overall pretest knowledge level (mean = 12.66, standard deviation [SD] = 4.62) and posttest knowledge level (mean = 25.7, SD = 3.62) at P ≤ 0.001. Conclusion: VBTM used in this study was effective in improving the knowledge of TC and TSE among male undergraduate students.
Keywords: Effect, self-examination, testicular cancer, video-based teaching module
|How to cite this article:|
Nwozichi CU. Effect of video-based teaching module on knowledge about testicular cancer and testicular self-examination among male undergraduate students. Arch Med Health Sci 2015;3:215-26
|How to cite this URL:|
Nwozichi CU. Effect of video-based teaching module on knowledge about testicular cancer and testicular self-examination among male undergraduate students. Arch Med Health Sci [serial online] 2015 [cited 2020 Jan 28];3:215-26. Available from: http://www.amhsjournal.org/text.asp?2015/3/2/215/171909
| Introduction|| |
Testicular cancer (TC) is the most common neoplasm affecting males between the age of 15 and 35 years. Globally, the incidence of TC is increasing rapidly. Even though it has a good prognosis, TC is the leading cause of death in young men aged 15 and 44 in westernized countries.  According to the National cancer Institute report, there are an estimated 221,020 men currently living with TC in the United States.  A meta-analytical study which reviewed 441 studies on incidence of TC between 1980 and 2002 reported that there was a clear trend toward an increased incidence of TC in the last 30 years in majority of the developed countries in North America, Europe, and Oceania.  Another review conducted in Europe made it known that since the second world war, TC incidence has been increasing nearly in all European countries with the highest rates in Denmark and Germany. 
The incidence is lower among men of Indian Origin, but they present at a later stage with higher mortality. Indian men may be less aware of the risk factors and have decreased knowledge. Yet, limited research has addressed TC among young men in India and other developing countries. TCs form 1% of all malignancies in men in India. Although uncommon, they affect men in the prime of their lives, being the most common solid tumor in young adults; with the potential to adversely impact their lives-both in terms of longevity and quality.  Although the prevalence of TC is low compared to other forms of cancer, there are a number of reasons it definitely deserves attention. It is important to look beyond the plain prevalence rate and see who at the risk group is and use the years of potential life loss to measure the need to give it attention. We would realize that TCs rise to the top of male cancers in terms of mortality. The prognosis also depends largely on early detection. Unlike breast self-examination for women, limited attention has been paid to the importance of men performing testicular self-examination (TSE) as a strategy to ensure early detection and treatment of TC which is the main reason why the mortality rate is high. To detect TC at an early stage, it is, therefore, important that young men are informed about the prevalence, how to identify the most common early symptoms and the practice of TSE.
A number of studies have supported that awareness about TC is an important prerequisite for the performance of TSE, which indicated that proper knowledge about TC may be sufficient for the performance of TSE among young men. In contrast to this view, a cross-sectional survey conducted at a university in Turkey found that despite half of the students reporting awareness of TC, very few (5.9%) stated they have received information about TSE.  This corroborates the findings of other studies that argued that knowledge and awareness of TC and TSE may not necessarily bring about practice of TSE. Ward et al.  in their comprehensive survey of health behavior among adolescent boys who participated in a community-based youth organization in America, reported that nearly 73% of the participants had heard about TC, but only 10.3% performed TSE correctly.
Poor knowledge about TC and TSE among students has been reported in several studies. A report of a survey conducted among senior high school students in Sweden showed that most students had never heard of TC or TSE and most frequently reported source of information was the media.  Kedzierewicz et al.  conducted a survey among French soldiers and found that there was a need for special educational programs to enhance the knowledge of the people on issues related to TC and TSE. In their study, Kedezierewicz and his team reported that 85.8% of the soldiers declared they would be delighted if they were exposed to a short educational course on TC and TSE.
Educational programs with the use of appropriate instructional materials are very effective in health education and promotion. The content of the educational programs should be comprehensive enough to provide relevant and accurate details on the subject matter. Analyzing the need for complete information to be presented to the people especially regarding TC and TSE, an old study conducted by Cummings et al. reported that most participants knew about TC and its related symptoms, however, overwhelming majority did not know TC is most likely to occur in their age group.  Participants may probably have got their information from sources and methods that are not comprehensive and effective for health teaching. The more accurate the information about TC and TSE, the more likely participants performed TSE.
Video-based teaching programs have been sought to offer a promising alternative in delivering the intended content that may not be effective using other traditional print-based illustrations.  However, even when contents can be delivered through other methods, video-based teaching provides a unique opportunity to present, teach, and internalize information; they are also excellent medium for focusing the learner's attention on specific details based on the materials.
There has been reported evidence that the use of video-based teaching modules (VBTM) has enriched the educational curriculum in a range of teaching fields and also in the discipline of health education that are based on science and those related to the human anatomy and physiology. , Therefore, VBTM can be judiciously applied in enhancing the knowledge of young men about TC and TSE because it has been confirmed to link audio and visual together in order to provide a multisensory experience for the learners.  Kozma  reported in his argument that simultaneously processing of auditory and visual information might aid learning. Thus, video might be preferable for learning because it can expose the learner to events that cannot be easily demonstrated. , Many other studies have supported the effectiveness of video technology in enhancing learners' knowledge. More recent study reported that video allows learners to view actual objects and realistic scenes, to see a sequence in motion, and to listen to narrations.  Considering it from the learners' perspective, VBTM can be a more effective medium than text or traditional lecture method because it enhances learners' satisfaction and motivation during the learning process. , In fact, from the economic point of view, Jung  pointed out that video-based teaching programs are cost effective due to its reusability.
Among the various technologies currently available for health teaching, health education, and health promotion programs, video technology is suitable for context-based learning because it conveys the information or knowledge in a more interesting way and allows the portrayal of complicated context.  Since the information on TC and TSE are very vital and needs an effective method of delivery, It is, therefore, necessary to evaluate how effective VBTM would be when applied in teaching young men about TC and TSE. Million-Underwood and Sanders  as stated earlier, found a significant positive correlation between knowledge of TSE procedures and the percentage of self-reported TSE practice. Accurate information may increase the likelihood of young men performing TSE. However, when the information provided are not complete or the method used to deliver the information is inappropriate, it may cause more harm than good as clients tend to assess their initial symptoms based on the existing knowledge. To explain the harm of inadequate information, one of the TC survivors in Chapple et al. study  explained his reason for not seeking early help. He stated "my testicle was larger than it should be, very, very firm, it was like a rock, but no pain, no sensation, nothing. And I thought; well, may be it's just something that will go away on its own, so I just carried on with life." This client probably had information about TC, but due to possible incomplete information or an inappropriate source, he did not see the need to seek help early with the knowledge that his signs were not indicative of TC. This points out the need to adopt an effective method during health teaching.
The use of VBTM in enhancing knowledge of young men about TC and TSE has not received much attention in the literature, hence, the researcher aimed to evaluate the effect of VBTM in enhancing knowledge about TC and TSE among male undergraduate students in a selected college at Bangalore.
| Materials and Methods|| |
A preexperimental (one group pretest posttest) study design was adopted. The study was conducted after approval from the research ethical committee of Dayananda Sagar College, Bangalore.
Sample and sample technique
The samples for this study consisted of male undergraduate students of Dayananda Sagar College. A purposive sampling technique was used to select 87 participants. Participants were given an adequate explanation about the purpose of the study, after which they signed the consent form indicating a voluntary participation.
Description of the video-based teaching module
A VBTM was constructed by the researcher based on specific contents relevant to the purpose of the study with the assistance of simulation experts and a urologic oncologist. There was also an inclusion of relevant videos from YouTube. The first draft of the VBTM was presented to other experts and based on their suggestions; the final draft of a 58 min VATM was developed.
Tool for data collection
The tool for data collection was a self-developed structure questionnaire which consisted of two parts: Part A elicited the sociodemographic data of participants, part B assessed participants' knowledge of TC and TSE based on the content of the VBTM constructed. Part B was further subdivided into four sections as follows:
Section I consisted of 8 knowledge questions on general information about TC, section II consisted of 7 knowledge questions on causes, risk factors, and types of TC, section III consisted of 10 knowledge questions on clinical manifestations, treatment and complications of TC while section IV contained 10 knowledge questions about TSE (Appendix).
The tool was subjected to the pilot study, and reliability was estimated using split-half test and Spearman-Browns prophecy formula yielding reliability scores of 0.86 and 0.88 respectively.
Procedure for data collection
Participants were taken through a process of orientation to familiarize them with the motive of the study and how to remain cooperative throughout the study period.
The pretest took place after the orientation phase. This process assessed participants' knowledge of TC and TSE prior to the introduction of the educational intervention.
Following the pretest, all participants received an interactive introduction lecture, after which the VBTM was introduced in one episode followed by an interactive closing lecture.
After a period of 7 days, participants were asked to complete the posttest questionnaire which was identical with the pretest tool to assess their knowledge about TC and TSE after the educational intervention.
| Method of Data Analysis|| |
Data collected were analyzed using SPSS 17.0 (Chicago IL, USA) presenting both descriptive and inferential statistics. Participants' sociodemographic characteristics were presented in frequency and percentage table while Chi-square and Student's t-test was used to determine the association and significant difference in participants' pretest and posttest knowledge levels. P ≤ 0.001 was considered significant.
Participants' knowledge levels were categorized as follows
Less than 40% was very poor knowledge; 40-49% was poor Knowledge; 50-59% was moderate knowledge; 60-79% was good knowledge; 80 and above was very good knowledge.
| Result|| |
The mean age of the participant was 20.76 years.
As shown in [Table 1], majority of the participants (40.2%) were in their 1 st year in college, Hindu by religion (70.1%), declared family income of less than Rs. 20,000. 42.5% of the participants declared father's educational background as secondary education and the majority resided in the rural areas. Only 25 participants (28.7%) reported family history of cancer. Majority (82.8%) had no previous awareness about TC while 88.5% were not aware of TSE. The highest reported information source was the media.
[Figure 1] shows the majority (52.9%) of participants had poor knowledge level about TC and TSE before the educational intervention.
[Table 2] shows the pretest and posttest knowledge scores in all sections. A statistically significant difference was observed in all sections. The overall pretest mean score was 12.66 (standard deviation [SD] = 4.62) while the posttest mean score was 25.7 (SD = 3.62) all significant at P ≤ 0.001.
[Table 3] shows an association between pretest knowledge levels and sociodemographic variables such as annual family income (P = 0.001), family history of cancer (P = 0.001), and previous awareness of TSE (P = 0.001).
|Table 3: Association between pretest knowledge score with selected demographic variable|
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[Table 4] shows a statistically significant association between participants' pretest and posttest knowledge levels (P < 0.001).
|Table 4: Association between overall pretest knowledge level and overall posttest knowledge level|
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[Table 5] shows a significant relationship between previous awareness about TSE and practice/attempt of TSE (P = 0.001).
| Discussion|| |
Participants were eager to commit themselves to the teaching program and made positive comments about the opportunity to accurately perform TSE as recommended. They reported that the training program with specific and direct feedback on knowledge and skills motivated them to improve themselves and increase their confidence with regards to practice of TSE. Prior to the introduction of the teaching module, majority reported no previous knowledge of TC and TSE and their overall knowledge level was poor. There was a similar finding in a previous study among male university students in Turkey where majority (88%) had no knowledge of TC and TSE.  In the same vein, Rudberg et al.  reported in their study among senior high school males in Sweden that most of the students had never heard of TC and TSE. However, the most reported source of information was the media which is also in line with the findings of this present study where 80% (n = 10) reported media as the major information source. There seems to be a higher level of knowledge about TC and practice of TSE observed in a cross-sectional study conducted by Peter et al.  and also a comprehensive survey of health behaviors among adolescents who participated in a community youth organization in America reported a higher knowledge level of TC but only 10% performed TSE. 
Among participants who were aware of TSE (n = 10), 90% reported an attempt or actual practice of TSE. This explains the assumption that knowledge or awareness about TC and TSE could result into positive intention to practice TSE. This corroborates the findings of Million-Underwood and Sanders  who found a positive correlation between knowledge of TSE procedures and the percentage of self-reported TSE practice. An accurate information is a predictor to actual practice of TSE. This was also supported by another study. 
| Effectiveness of Video-Based Teaching Module|| |
This study and a number of other studies have identified that the media is usually the source of information about TC and TSE. Health care personnel who are supposed to be the leading health information providers are not doing enough especially to improve peoples' knowledge about TC and TSE probably due to lack of knowledge or inability to utilize appropriate methods and technology to do so. When compared to the level of attention given to female breast examination, health workers are less committed to educating the males about the importance of TSE. Tichler et al.  found out in their study that 84% of military physicians have never taught their soldiers the importance of TSE whereas, 51% taught female soldiers breast self-examination. Findings from this study have revealed that VBTM is an effective method to teach about TC and TSE. It was observed in this study that there was a significant enhancement of participants' knowledge of TC and TSE after the educational intervention. As compared to the preintervention knowledge, no participants had very poor or poor knowledge after the intervention. Based on the findings of this study, it is evident that VBTM is a potent method which could be adopted by health teachers and educators to enhance knowledge of young men about TC and TSE.
Data from the current study have provided an objective illustration that VBTM is very effective in health teaching. A similar result was reported by El-Sayed and team who found video-based lectures to be more effective than the traditional methods of teaching.  On the other hand, participants from this present study expressed that the use of video improved their understanding of the subject matter and had a positive impact on their motivation as well as concentration during the period of intervention. Data from this study corroborate other studies where different quantitative methodologies were employed, adding to the evidence that VBTM is appropriate in health teaching. ,,, Some previous studies have identified learner's satisfaction as a merit of this method in various disciplines. El-Sayed and team reported its usefulness in teaching human anatomy and physiology,  Kalwitzki et al. reported its effectiveness in teaching pediatric dentistry,  Coolen et al. argued that video-assisted real-time simulation is an effective training method for acute pediatric emergency.  Furthermore, in the field of oncology, interactive videos are used effectively in improving the outcomes among breast cancer patients. 
Video-based teaching module promotes retention and recall, hence it was applied effectively in various health teaching programs such as cardiopulmonary resuscitation program,  lobectomy program,  and another program which aimed at assisting parents of children with behavioral and developmental problems. 
Never before has health education and promotion been more important that it is today, healthcare professionals including doctors, nurses as well as public health officers can participate in advancement of health promotion not only to the mainstream but to the forefront of their practice. Oncology nurses should be actively involved in the prevention as well as management of cancer cases.  Therefore health education requires strategies that have evidence of providing the motivation they need in order to maintain compliance.
| Limitations|| |
This study was limited by the small sample size and also the fact that it was conducted in a single educational institution. There was no control to measure the difference with other method. The teaching module was administered only in an episode. In addition, the follow-up did not measure the extent to which the knowledge gained was retained and applied by the participants. There is a need to replicate this study on a larger sample size across more than one institution.
| Conclusion|| |
Findings from this study have revealed that the overall knowledge of TC and TSE before the intervention was very poor among male undergraduate students. However, without an effective method, health teaching may not have any significant effect on the people. The present study has found VBTM to be highly effective in enhancing the knowledge of TC and TSE and probably motivate male students to practice self-examination of their testicles. It is therefore recommended that health educators should adopt VBTM in conveying health-related information to the people, and further studies should be conducted using different settings to compare the results of the present study.
| Acknowledgement|| |
I appreciate the support of Professor Ezekiel Ajao, Dr (Mrs) Ojewole, Mrs P.E. Ahuchuba and the entire management of Babcock University, Nigeria.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]