Knowledge, Attitude, and Practice of Breast Self-Examination Among Female Health Care Professionals at Selected Hospitals in Hargeisa, Somaliland

Abstract

Mustafe Yusuf Said*, Noura Jama Ali Abyan, Hussien Abdi Ali, Zainab Mohamed Ali, Mustafe Mohamed Elmi, Hodan Hussein Adam and Najma Abdirahman Mohamed

Background: Breast cancer is a leading cause of cancer-related morbidity and mortality among women worldwide. Early detection through screening methods such as breast self-examination (BSE) is critical, particularly in low-resource settings where access to mammography is limited. Healthcare professionals play a key role in promoting breast cancer awareness, yet their own knowledge, attitudes, and practices of BSE in Somaliland remain understudied. This study aimed to assess the knowledge, attitudes, and practices regarding breast self-examination and to identify associated factors among female healthcare professionals at selected hospitals in Hargeisa, Somaliland.

Methods: An institution-based cross-sectional study was conducted from March to July 2025 among 171 female healthcare professionals (nurses, midwives, doctors, and pharmacy technicians) working in five hospitals in Hargeisa. Participants were selected using proportionate stratified random sampling. Data were collected using a structured, self-administered questionnaire assessing socio-demographic characteristics, knowledge (17 items), attitudes (10 Likert-scale statements), and BSE practices (10 items). Knowledge was categorized using Bloom's cut-off points, attitude by median split, and practice as good (≥6) or poor (<6). Bivariate and multivariate logistic regression analyses were performed to identify factors associated with BSE practice.

Results: The mean age of participants was 28.4 years (SD = 6.2). Overall, 67 (39.2%) had good knowledge, 39 (22.8%) had average knowledge, and 65 (38.0%) had poor knowledge. A favorable attitude toward BSE was observed among 93 (54.3%) participants. However, only 44 (25.7%) reported ever practicing BSE, and merely 30 (17.5%) demonstrated good practice. Among those who practiced, most used correct techniques. In multivariate analysis, good knowledge (AOR = 1.96, 95% CI: 0.95–4.02, p = 0.041), favorable attitude (AOR = 2.14, 95% CI: 1.01–4.54, p = 0.046), and prior training on BSE (AOR = 3.62, 95% CI: 1.65–7.93, p = 0.001) were significantly associated with BSE practice.

Conclusion: Despite moderate knowledge and favorable attitudes, BSE practice among female healthcare professionals in Hargeisa is low. Training, knowledge, and positive attitudes are key predictors of practice. There is an urgent need for targeted educational interventions and regular BSE training programs within healthcare institutions to improve personal screening behaviors and enhance community health education.

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