Improving Breast Health Literacy Through an Innovative Breast Cancer Awareness Campaign Using the Know Your Lemons (KYL) Materials in Malaysia
Authors: Islam T. , Su T.T. , Musthaffa S. , Din N. Abdullah , Rahman Z. , Mohamed K.N. , Kaur S. , Beaumont C.E. , Crawford-Gray K. , Filza J. , Shaheera F. , Taib N.A. 
Published: September 2018

Background: Breast cancer (BC) is the most common cancer in Malaysia but has the worst survival in the Asia Pacific region. Main drivers identified in previous research include late-stage disease at presentation, poor adherence to treatment and sociocultural barriers. Factors affecting late presentations include lack of awareness on basic symptoms of BC and poor access to early detection. Although BC awareness campaigns have been done, Hadi et al., showed low BC awareness among university students in Malaysia. This is an evaluation of the “Show You Care, Be Aware” campaign that was done in University of Malaya, Kuala Lumpur in October 2017. The campaign was carried out using KYL materials through use of posters, awareness booths and public forums. The materials contain information on the normal breast, 12 symptoms of BC, information on breast self examination (BSE), screening and diagnostic (detection) pathways in Malay and English language. Aim: To evaluate the campaign effect on breast health literacy. Methods: A quasi-experimental research was conducted. The KYL materials were forward and backward translated by 2 native bilingual individuals. The context and content of the translation was ensured to be accurate and fitted into the KYL design. A total of 679 participants participated in the study. A self-designed questionnaire was used to assess effectiveness of the materials. Educational intervention sessions were provided in the form of KYL materials (leaflets, posters and banners) displayed in awareness booths in the campus. Discussion on leaflets and questions and answers, and practical demonstrations of BSE dummy were done. The questionnaire was administered through face to face interview. The data were analyzed via SPSS 20; descriptive and Wilcoxon matched paired signed rank test was performed. Results: 72% (n=492) of our participants were Malay, 19% (n=119) Chinese and 10% (n=68) Indians and others. Majority of our participants were female (94.2%), age 30 or below (61%), single (62.9%), had college or university education (85.7%). Most of our participants, 96.2% stated that the language used in the KYL materials were clear and understandable; 95.3% thought materials were attractive and 89.2% found them acceptable in Malaysian culture. 52.7% preferred Malay materials, 40.4% English and 6.5% in both Malay and English. The materials improved perceived knowledge on the process of detecting BC (96.5%). 92.8% agreed or strongly agreed that they felt more confident in recognizing the symptoms of BC themselves. There was an increase in self reported knowledge of BC; mean scores before and after exposure to KYL materials were 2.83 versus 4.30 respectively ( P < 0.001). Conclusion: Health education using KYL materials promoted breast cancer awareness, confidence in detecting symptoms and knowing processes of diagnosis among urban and educated Malaysians. Future research in lower educated and rural communities in Malaysia is warranted.