Knowledge, Perception and Awareness of Benign Prostrate Hyperplasia Among Men of Age 20-50 Years - Essay Example

To Explore and Assess the Knowledge, Perception and Awareness of Benign Prostrate Hyperplasia (BPH) Among Men of Age 20-50 Years Institution affiliation Date Abstract The research aims at assessing the knowledge, perception and awareness of benign prostate hyperplasia (BPH) among men of age 20-50 years. In the recent past, the incidences of benign prostatic hyperplasia have been on a rampant increase. Therefore, the research seeks to assess the causes of that change, whether men have been aware of the condition and what they are doing towards primary and secondary prevention. The research will be a qualitative study conducted among men of between ages 20 years to 60 years. Data collection will occur with the help of a questionnaire. In analyzing the data, SPSS program and the Microsoft Excel are in use. The report will then be detrimental to the department and the relevant authorities for the sake of health promotion. The relevant health departments will be informed of the findings for the sake of incorporation in their departments. Key words: Benign Prostatic Hyperplasia, Awareness, Knowledge, Prostate cancer, Primary prevention, Health Education Introduction In men, the urine flow is through the urethra. Enlargement of the prostate gland is likely to blocks urine flow. The urethra narrows, therefore, forcing the urethra to contract forcefully to push urine through. The bladder muscles thicken, becomes stronger and sensitive over time; it, therefore, begins to contract in the presence of a small amount of urine due to its increased sensitivity causing need for frequent urination With time, the bladder muscles become ineffective to pressing out urine due to the narrowed urethra so urine tends to remain in the bladder, and it is completely not emptied. It in the end puts an individual at risk of developing urinary tract infections. Bladder stones, blood in urine, incontinence and acute urinary retention are a few serious problems that can develop over time. Benign prostatic hyperplasia is a histologic diagnosis referring to the multiplication of smooth muscle and epithelial cells within the prostatic transition zone. The etiology of BPH is unknown; however, there is a similarity between BPH and the embryonic morphogenesis of the prostate. The lower urinary symptoms have resulted from the enlarged gland. Direct bladder outlet obstruction has resulted to voiding symptoms. The prevalence and severity of lower urinary tract symptoms in aging male population are progressive, and it is, therefore, important the diagnosis in the healthcare of the patient and a large society. Despite the lack of enough information to explain the pathophysiology, BPH is treatable through surgical and medical treatment (Bird et al., 2013, pg. 347). Background Information Prostate gland is located within the male reproductive system. The gland is just below the bladder and in front of the rectum. During ejaculation, the prostate gland produces a fluid that helps in carrying sperms. Naturally, the prostate gland grows as a man matures. It grows through two periods of man growth. The first period takes place during puberty where the gland doubles in size (Banks, 225). At the age of 25 years, the gland starts its second phase of growth, which may result to BPH. BPH is a disease that is associated with slow progression, but begins early. Usually it begins as a small nodular hyperplasia. It later evolves into a microscopic nodular enlargement that later may cause a clinical effect to an individual. It is the most common urologic disease affecting a bigger percentage of about 25% of elderly males (Coyne et al., 2013, pg. 235). BPH and lower urinary symptoms are common in elderly males (Kramer, 2005, pg. 1210). By age 60, approximately 50% of all men suffer from prostatic hyperplasia; 80% of males by age 90. Despite the fact that prostate gland grows during most of a man’s life it usually does not cause problems. Problems will only result when the enlarging prostate gland exert pressure on the bladder that lie just above the gland (Duncan & Goldacre, 2011, pg. 43). The gland tissues multiplies are causing it to enlarge this has an effect on the surrounding layer of tissues that stop expanding hence pressing the urethra, this results to irritability (Rosen et al.,2009, pg. 565. The most common benign tumor in men is BPH; in regular medical practice, there is under detection of the condition because men do not go for regular medical checkups and due to the fear of men bringing up their problems to the physicians (Spickett & Robertson, 2010, pg. 18). Research shows that the prostatic hyperplasia incidence is most common in elderly and aging men, thus, the incidence of prostatic hyperplasia increases with age (Çapik & Gözüm, 2012, pg. 76). The condition is associated with urinary tract infection symptoms that have an impact on the quality of an individual’s life by interfering with daily activities and sleep patterns. Most BPH presents with voiding difficulties due to obstruction (Sarma & Wei 2012, pg. 250). The cause of BPH is unclear, but for it to occur there must be a normal level of testosterone. Research has shown that men having low levels of the hormone testosterone before puberty have low chances of developing benign tumor (Mirone et al., 2011, pg. 1010). Hypothesis, therefore, have been put forward to explain BPH develops to an individual: (1) BPH occurs during an abnormal increase in clonal proliferating cells and mature cells (2) occurs through an abnormal increment in the number of stem cells and (3) it can also occur due to a decrease in the rate of cell death of the mature parent cells. Justification of Study Continuing high morbidity from preventable cancer and tumor related conditions are still high in high-income countries. It prompts the need for assessing the factors hindering effective BPH screening among adults from 20 years of age, since prevention is a key element of curbing the number of people being affected. Such can occur through early identification by screening the population at risk. The total number of patients with benign prostatic hyperplasia is of significant importance in assessing compliance of the male population to the screening services being offered in various hospitals (Emberton, 2010, pg. 1430). With intensive monitoring and screening strategies to enhance compliance to screening services, it is expected that the people being affected by BPH will be detected in early stages making it easy to manage the condition. Study reveals that a large percentage of male patients do not seek for medical assistance because of lack of enough information & awareness concerning BPH and their health. They also have intense fear of exposing what they are going through (Marberger, 2010, pg. 120). Literature Review Various key words such as benign prostatic hyperplasia, awareness, knowledge and prostate cancer were used in searching out for research academic materials. The exclusion criteria gave rise to several journals that were crucial. After detailed search of the articles related to the topic of study, the following were some of the articles that did provide essential information: Author Study aims Methods sample Results Mirone. Et al., 2011 Evaluating the current benign prostatic hyperplasia treatment: impact on sexual function and management of related sexual adverse events Qualitative study There was an evidence of close relationship between BPH and sexual dysfunction. Meryn, 2010 A study to evaluate whether men are aware of their prostate health Qualitative study Primary prevention which forms the basis of routine checkup was seen as the core gateway to prevention of late awareness of the condition Marberger, 2010 The study seeks to find out the challenges that accompany current management and treatment of BPH Qualitative study The main challenges that were noted to affect the management were late diagnosis of the disease, inability of men to detect early symptoms, and failure to seek early medical treatment Çapık, & Gözüm, 2012 Study to evaluate how web education and reminders of health belief have on knowledge levels and early diagnosis behaviors of prostate cancer screening Qualitative study The education did provide positive impact to the behavioral change of the individuals. There was an increase in the screening rates of the patients from 9% to 19%. Banks, Mayor & Meryn, 2010 The study seeks to raise awareness so that men can seek for medical care rather than having a perception that it is a normal disease of the old age Quantitative study There is a deficit in the education levels and awareness concerning the condition. Therefore, there is a need to create an environment where men can ask questions about the condition and receive clear responses for hence enhancing awareness Benign prostatic hyperplasia is among the prevailing conditions that affect most men during the aging process. Increasing age and a consequent increase in male hormones play a big role in hyperplasia of the gland and the continuous prostate enlargement. BPH has been considered as a common condition in which male patients seek medical attention. In recent times, many factors led to an increase in the total number of men who received treatment for lower urinary tract symptoms (McVary 2010, pg. 126). According to the data released by Cancer (2011) Research Institute in United Kingdom, the rates of prostate cancer remains high, and continues to escalate day by day. It accounts for close to 25% of all the cancer cases in men. The rates of incidence and occurrence remain higher in London and lower in the northern parts of the country. The report also does indicate that the prevalence of the condition is rampant among the men above 50 years of age. Prostate cancer screening is not common in the European countries regions and the overall rates of awareness remains very low. The economically disadvantaged people stand the highest risk of having the condition. Prostate cancer stars off with the enlargement of the prostate gland, also known as benign prostatic hyperplasia, followed by the elevation of the serum prostate specific antigen (Meryn, 2010, pg. 106). Screening of the prostate enlargement should be done at an early age for the sake of early treatment (Lane et al, 2010, pg. 3098). Table 1: Number of new cases of prostate cancer in year 2011 in Europe England UK Cases 41,736 Crude Rate 134.3 AS Rate 104.7 AS Rate - 95% LCL 103.7 AS Rate - 95% UCL 111.3 There are many challenges affecting the poor coverage on the knowledge and awareness of BPH and prostate cancer. Men have a poor perception and attitude towards exposure of the condition in public. Research shows that there is a relationship between stigma and prevalence of the condition (Lyratzopoulos et al., 2010, pg. 340). There is a belief that the condition is closely related to deterioration sexual functioning hence, men are silent in unleashing it to the public. The populations of low social- economic status also have a dire problem in their health seeking behavior. They lack funds for medical care; hence, screening is close to impossible (Chapple et al., 2011, pg. 350). In a longitudinal study that was conducted by Juliao et al (2012, pg. 36), 6975 men underwent rectal examination to determine the age-prostatic gland enlargement distribution. The study showed that the prevalence increased by 35% from 8% recorded between 40-49 years to about 43% that was recorded between 70-79 years. A study conducted by Kirby & Fitzpatrick (2010, pg. 902) did show that the rates of awareness of BPH is very low in London, hence there is a need to come up with a strategy to increase the awareness. Research Questions What is the knowledge on BPH (signs, prevention and treatment) among male residents of age 20 to 60 years? Are the male residents of the area aware of BPH? Research Objectives Broad Objective To assess and explore the knowledge, perception and awareness of BPH among residents of the area aged 20 to 60 years. Specific Objectives to assess the level of knowledge(signs, prevention and treatment) of BPH to determine the level of awareness of BPH among male residents to determine factors that influence medical checkup on BPH among male residents to assess the attitude of male residents towards seeking medical assistance/ screening on BPH to assess perception of males on the condition Methodology Research Design The study design will be a qualitative study. The design of the study will assess the knowledge and awareness of BPH among the male residents. Study Population The study populations will be males who are above 20 years of age to 60 years old. Inclusion Criteria any male resident above 20 years to 60 years of age who will be present at the time of study and who gives informed consent to participate in the research. Exclusion Criteria Male residents below 20 years and above 60 years of age will be excluded. Any male resident who is within the age bracket who refuses to participate in the research will not be included in the study. Also excluded from the study will be women because the study will majorly be concerned with the condition-affecting males. Not included in this study will also be those males’ residents who will not be present at the time of study and those who will not consent to the study. Sampling Technique The respondents (sample size) will be selected using systematic random sampling technique. A random starting point will be identified, and the first male resident within the age bracket for the study will be selected as a result. Then every fifth male resident between 20 to 60 years of age will be picked thereafter to give a sample of 100 who qualifies for the study. Sample Size Determination The respondents qualifying for the study were selected using systematic random sampling technique. The sample size was determined by the sample size standard formulae: N = (Fischer et al, 1998) Where: N = desired sample size (if the target population is greater than 10,000) p = the proportion of the target population estimated to have a particular characteristics being measured taken as 10% z = Standard normal deviation which is 1.96 at 99 % level of confidence. q = one – p = 1-0.5 = 0.5 d = Degree of accuracy desired is 0.05 (Fischer et al, 1998) {1.96 x 1.96 x 7 x (1 – 7) N = 100 .052 3.8416 x 0.07 x (1-0.07) n= .0025 n (Sample) = 100.3 the minimum sample size was, therefore, be 100. Study Variables The dependent variables: Knowledge on BPH, attitude towards BPH diagnosis and screening services the independent variables: Age, level of education, and beliefs. Data Collection Procedures Study Instruments A researcher administered questionnaire will be utilized to collect data. There will also be pencils to be used to fill the questionnaires. The questionnaire will be given to every identified respondent in the study area after an informed consent has already been obtained. Detailed interview with male respondent within the study age bracket who cannot read or write will be used to obtain information from them. Identification cards and birth certificates will be used to verify the age of the youths who will be having a desire to participate in the research (Welman, Kruger & Mitchell, 2005, pg. 66) Validity The questionnaire will be developed in English for ease of understanding and will be pre-tested St. Mary’s Hospital following which the post pre-tested questionnaire will be reviewed and validated to ascertain the suitability of the tool used (Moule & Goodman, 2009, pg. 55). Study Limitations the financial constraints due to typing, printing, travelling, and time unavailability will be the major limitations in study that will need proper adjustments to ensure a successful study. It will be difficult in some cases for the sake of obtaining information from the respondents. They may not know the names of the vaccines, drugs and the medical terminologies, but great assistance will be made available for the sake of data clarification. Pretesting the data collection tool will be pretested in St. Mary’s Hospital by giving 10 men (10% of sample size, 10/100 x 100= 10) within the age bracket to fill. It will test the efficiency and effectiveness to collect the required data to meet the set objectives. Adjustments will be then done to ensure validity and reliability of the data collected in using the questionnaire in the actual study. Data Collection Process It will include administration of questionnaires. The researcher-administered questionnaires will be appropriate to ensure that the male residents who cannot read or write can express their opinion by asking them the questions through an interpreter as the researcher fills the questionnaires. The researcher will explain to the respondents on the procedure for the respondents to give informed consent. The respondents will be expected to give informed consent first for them to fill the questionnaires. After giving informed consent, the researcher will carefully explain to the mother on how to fill the questionnaire and assist the respondents in the case of any difficulty. After completion, the researcher will thank the respondents for the cooperation and the support (Gerrish & Lacey, 2010, pg. 45) Data Management and Analysis Data categorization and coding will be carried out during preparation of questionnaires. Each day data that will be collected will be entered, coded and keyed into variables using Statistical Package for Social Sciences SPSS version 12 – computer software and Microsoft excel. Quantitative data will be analyzed using SPSS version 12 and Microsoft Excel - computer software. Ethical Considerations The researcher will obtain a letter of introduction from the school. Informed consent will be obtained from male residents within the age bracket of the study by a clear explanation of the study objectives and allowing them to sign a consent form from an informed point of view. Confidentiality and respect will be maintained throughout the research process the respondent will not be allowed to write their names on the questionnaires instead numbers will be used for questionnaire identification. Significance of the Study The findings of the research shall provide a large- sample and long-term information that will be used to identify the knowledge gap in the population. Out of this study, the researcher will be able to learn through the process of research writing; identify the concerned stakeholders in cancer and benign tumors awareness and programs and will able to discover the reasons behind male population at risk do not go for medical checkups. It will be aimed at improving the awareness and knowledge of the male population at risk in the market. Because the research is a large community based study, it include a broad range of the male population this, therefore, suggests that the result will be strong in terms of being generalized and applied to other men in other societies. The same study outcomes will be of great importance to the country in in creating awareness to the population. The same policies will be passed on to the policy makers at the Department of Health to use this information and implement. The other researchers, the program managers, program implementers and the residents with the intentions of improving their awareness and community health issues will also be notified of the findings. References Banks, I., Mayor, S. And Meryn, S., 2010. Talking prostates. Journal of Mens Health, 7(3), pp. 221-226. Bird, S.T., Delaney, J.A., Brophy, J.M., Etminan, M., Skeldon, S.C. And Hartzema, A.G., 2013. Tamsulosin treatment for benign prostatic hyperplasia and risk of severe hypotension in men aged 40-85 years in the United States: risk window analyses using between and within patient methodology. BMJ: British Medical Journal, 347. Cancer Research Institute, http://www.icr.ac.uk/ Çapik, C. And Gözüm, S., 2012. The effect of web-assisted education and reminders on health belief, level of knowledge and early diagnosis behaviors regarding prostate cancer screening. European Journal of Oncology Nursing, 16(1), pp. 71-77. Coyne, K.S., Sexton, C.C., Bell, J.A., Thompson, C.L., Dmochowski, R., Bavendam, T., Chen, C. And Quentin Clemens, J., 2013. The prevalence of lower urinary tract symptoms (LUTS) and overactive bladder (OAB) by racial/ethnic group and age: Results from OAB‐POLL. Neurourology and urodynamics, 32(3), pp. 230-237 Chapple, C.R., Montorsi, F., Tammela, T.L., Wirth, M., Koldewijn, E. And Fernández Fernández, E., 2011. Silodosin therapy for lower urinary tract symptoms in men with suspected benign prostatic hyperplasia: results of an international, randomized, double blind, placebo-and active-controlled clinical trial performed in Europe. European urology, 59(3), pp. 342-352 Djavan, B. et al., 2012. The urologist view of BPH progression: Results of an international survey. European Urology, 41, pp.490–496 Duncan, M.E. And Goldacre, M.J., 2011. Mortality trends for benign prostatic hyperplasia and prostate cancer in English populations 1979–2006. BJU international, 107(1), pp. 40-45. Emberton, M., 2010. Medical treatment of benign prostatic hyperplasia: physician and patient preferences and satisfaction. International journal of clinical practice, 64(10), pp. 1425 1435 Gerrish, K. and Lacey, A. (2010). The Research Process in Nursing. (6th ed). Chichester: Blackwell Publishing Ltd Juliao, A.A., Plata, M., Kazzazi, A., Bostanci, Y. And Djavan, B., 2012. American Urological Association and European Association of Urology guidelines in the management of benign prostatic hypertrophy: revisited. Current opinion in urology, 22(1), pp. 34-39. Kramer, G., Mitteregger, D. & Marberger, M., 2007. Is benign prostatic hyperplasia (BPH) an immune inflammatory disease? European urology, 51, pp.1202–1216 Kirby, R.S., Kirby, M. And Fitzpatrick, J.M., 2010. Benign prostatic hyperplasia: counting the cost of its management. BJU international, 105(7), pp. 901-902 Lane, J., Hamdy, F., Martin, R., Turner, E., Neal, D. And Donovan, J., 2010. Latest results from the UK trials evaluating prostate cancer screening and treatment: the CAP and ProtecT studies. European journal of cancer, 46(17), pp. 3095-3101. Lyratzopoulos, G., Barbiere, J.M., Greenberg, D.C., Wright, K.A. And Neal, D.E., 2010. Population based time trends and socioeconomic variation in use of radiotherapy and radical surgery for prostate cancer in a UK region: continuous survey. BMJ (Clinical research ed.), 340, pp. c1928 McVary, K.T., 2010. BPH: epidemiology and comorbidities. The American journal of managed care, 12, pp.S122–S128 Mirone, V., Sessa, A., Giuliano, F., Berges, R., Kirby, M. And Moncada, I., 2011. Current benign prostatic hyperplasia treatment: impact on sexual function and management of related sexual adverse events. International journal of clinical practice, 65(9), pp. 1005- 1013 Marberger, M., 2010. Managing benign prostatic hyperplasia and prostate cancer–the challenges today. Journal of Mens Health, 7(2), pp. 113-124. Meryn, S., 2010. Prostate health: a new gateway to Mens Health. Journal of Mens Health, 7(2), pp. 106-107. Moule, P. and Goodman, M. (2009). Nursing Research: An Introduction. Los Angeles: Sage Rosen, R.C. et al., 2009. Association of Sexual Dysfunction With Lower Urinary Tract Symptoms of BPH and BPH Medical Therapies: Results From the BPH Registry. Urology, 73, pp.562–566. Sarma, A. V. & Wei, J.T., 2012. Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms. New England Journal of Medicine, 367, pp.248–257 Speakman, M.J., 2008. Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia (LUTS/BPH): More Than Treating Symptoms? European Urology, Supplements, 7, pp.680–689 Spickett, I. And Robertson, J., 2010. Prostate cancer: the ongoing challenge: To mark Prostate Cancer Awareness Month, Ingrid Spickett and John Robertson outline the implications of the disease and the role primary care nurses can play in managing the disease and its side effects. Primary Health Care, 20(2), pp. 16-21. Welman, C., Kruger, F. and Mitchell, B. (2005). Research Methodology. (3rd ed). Cape Town: Oxford Appendix 1. Budget for the study Budget for research Data analysis by independent researcher £100 Digital tape recorder £120 Laptop and software £800 Assess to Library £100 Internet and telephone £100 Photocopying , printing, Stationary and Postage £200 Transportation £400 Refreshment £500 Incentives for participants £100 miscellaneous £200 TOTAL £2620 2. Time frame for conducting research Month 1 2 3 4 5 6 7 Research proposal writing → Sampling → Interview and data analysis → → → Respondent validation → Writing of Report and publishing → → → 3. Letter of approval To the Ethics Committee, TO WHOM IT MAY CONCERN I am a student pursuing BSc (Hons) in Nursing. I hereby seek your permission for a proposed research study that I have to carry out as part of my course. It will be a cross-sectional descriptive study which aims at exploring and assessing the Knowledge, Perception and Awareness of Benign Prostrate Hyperplasia (BPH) Among Men of Age 20-50 Years. Patients’ participation will be voluntary and informed consent will be gained from volunteers. Confidentiality will be maintained throughout the proposed study and participants can choose to disengage at any time during the study. The study will raise awareness among healthcare professionals on the need to raise the standards of care rendered to the clients. A copy of my research proposal has been enclosed. Kindly contact me for any queries. Read More