Influence of Digital Media on Awareness of Endometrial Cancer among Women in Osun State, Nigeria ()
1. Introduction
Good health and well-being of the world population are global concerns. There is the significant number of diseases that affect the good health and well-being of women particularly their sexual and reproductive health, one of which is endometrial cancer.
Endometrial cancer, also known as uterine cancer or uterine sarcoma, is a prevalent gynecological malignancy affecting women worldwide that originates in the lining of the uterus and primarily affects postmenopausal women [1] . It is the most common gynecological cancer in developed countries and accounts for a significant proportion of cancer-related deaths among women [2] . It also occupies the third position in the hierarchy of common gynecological cancers in many low- and middle-income countries, while it is the third most common gynecological malignancy in Lagos, Nigeria [3] . Early-stage detection greatly improves the chances of successful treatment and long-term survival. However, limited awareness about endometrial cancer symptoms, risk factors, and screening methods often results in delayed diagnosis and poorer outcomes.
Hypertension and diabetes mellitus are regarded as predisposing factors, including any condition that increases exposure to unopposed estrogen which also increases the risk of endometrial cancer, as well as tamoxifen therapy, estrogen replacement therapy without progestin and the presence of estrogen-secreting tumors are all risk factors [4] . Comorbidity and obesity present challenges in delivering optimal therapy for many women with endometrial cancer [2] . Given the above stated elements of this disease, sensitizing women to the nature of this disease is essential to promote good health and well-being (sustainable development goal 3) of women. The importance of communicating ideas about health, and facilitating learning and discussion amongst the public and particular interest groups, is an enduring component of the function of health systems across the world [5] . A popular media for health communication and awareness is the digital media.
In recent years, the rise of digital media, including social networking sites, online health forums, blogs, and smartphone applications among others, has altered the nature of interactions around health issues and revolutionized how people access and share information from a passive one-way transfer of information, often from health professionals to the public, digital media has democratized those interfaces with open dynamic dialogue taking place, often at a very fast pace and at all times of day [5] . Digital media platforms provide an opportunity to reach diverse audiences and disseminate health-related content. Furthermore, they allow for interactive engagement, creating a potential pathway to increase awareness and knowledge about diseases such as endometrial cancer.
The influence of digital media on health-related behavior and awareness has been studied extensively in various contexts. Research has shown that digital media interventions can be effective in increasing health literacy, promoting preventive behaviors, and improving disease outcomes [6] . However, the specific impact of digital media on endometrial cancer awareness among women remains relatively unexplored. Hence, the study examines the influence of digital media on awareness of endometrial cancer among Nigeria women.
2. Statement of the Problem
Endometrial cancer is a common gynaecological cancer in the world with relatively limited attention directed toward its treatment, understanding and public awareness (of the disease). This lack of progress in treatment is, in part, related to our limited understanding of the molecular pathology of Endometrial Cancer. There is a pressing need to improve our understanding of Endometrial Cancer and to develop new treatment strategies to improve outcomes. In addition, compared with ovarian and cervical cancer, EC and uterine carcinosarcoma (CS) have been studied much less extensively [2] .
According to the National Cancer Institute (NCI) Trusted Source, approximately 3 in 100 women will be diagnosed with endometrial cancer at some point in their lives. More than 80 percent of people with endometrial cancer survive for 5 years or longer after receiving the diagnosis [7] . Given the high rate at which women are being diagnosed with this disease, there is a need to access the extent to which women in Nigeria are aware of the existence and nature of this disease in relationship with the digital media through which information about endometrial cancer is easily disseminated to the public in today’s modern world.
This is important because managing and surviving endometrial cancer is dependent on the level and quality of information (about the disease) available to the public (medical practitioners, patients diagnosed with the disease and their family and women generally). Also, little is known about endometrial cancer epidemiology and trend in Nigeria with most research focusing more on breast cancer and related cancer disease like cervical cancer. It is for this reason that this study examines the influence of digital media on awareness of endometrial cancer among Nigerian women.
3. Objectives of the Study
The main objective of this study is to examine the influence of digital media on awareness of endometrial cancer among Nigerian women. Other specific objectives include to:
1) determine the extent to which digital media raise awareness of the Nigerian women about endometrial cancer.
2) identify specific information Nigerian women have access to about endometrial cancer on digital media.
3) assess the authenticity of information Nigerian women have about endometrial cancer.
4. Literature Review
4.1. Endometrial Cancer
Endometrial cancer is a type of uterine cancer that starts in the inner lining of the uterus. This lining is called the endometrium [7] . Endometrial cancer (EC) is one of the commonest gynaecological malignancy and the sixth most common cancer in women worldwide [8] . Rise of endometrial cancer in women have been linked to factors such as changes in hormone, use of tamoxifen, prolonged menstruation and obesity among others. Any condition that increases exposure to unopposed estrogen increases the risk of endometrial cancer, tamoxifen therapy, estrogen replacement therapy without progestin and the presence of estrogen-secreting tumors are all risk factors [9] .
[10] in their study found that prolonged menstruation was related to an increased risk of endometrial cancer while pregnancy, including induced abortion, reduced the risk of endometrial cancer. Younger patients with endometrial cancer are generally more obese, with lower grade, lower stage disease, and with more favorable histological cell types. Despite this, approximately a quarter have stage II?IV disease and 9% have positive lymph nodes [11] . The older patients represent a dramatically different subset of patients. They are more likely to have aggressive papillary serous histology, higher-grade tumors, and advanced-stage disease. Age should be a consideration in appropriate referrals to gynecologic oncologists [11] .
[12] in their study found a clinically observed association of postmenopausal bleeding and endometrial cancer, as well as, highlighting the strong association of abnormal vaginal discharge and endometrial cancer. Patients presenting with such symptoms require prompt evaluation and gynaecological referral, and particularly, the symptom of abnormal vaginal discharge should not be overlooked.
Endometrial cancer is increasingly being diagnosed in women aged 40 years or younger. Surgical management in the form of total hysterectomy and bilateral salpingo-oophorectomy without lymphnode dissection is the standard treatment for any woman with endometrial cancer. Conservative management with hormonal therapy may be considered in carefully selected women with well-differentiated early-stage endometrial cancer. This treatment option deviates from standard management and requires careful pre-treatment evaluation and counseling [13] . Recent study revealed that endometrial cancer research activity is continuously increasing from a global viewpoint. However, the majority of original articles are published by authors based in high-income countries. Together with the finding that the research field of public health only plays a minimal role, our study points to the necessity that global health aspects should be introduced to endometrial cancer research [14] .
4.2. Health Communication and Digital Media
Digital media has indeed transformed the way we share health information in numerous ways and it has allow for free flow of information and communication with instant feedback. Digital media have become a common channel to follow events all over the world just with few clicks as the media spread the message almost immediately even when the programme is still going on which makes it better than the traditional media which will wait to read in the newspaper, listen to on radio or watch on television news bulletin [15] . According to [16] , digital media refers to media that is encoded in machine-readable formats that has been digitally converted and can be transmitted across computer networks or the internet. This can be in the form of text, music, video, or images. In other words, Digital media can be created, displayed, communicated, modified and stored on digital electronic devices such as software, digital images, videos, web pages, websites, social media, digital data, digital audio files and e-books.
Health communication is beyond the communication between a doctor and his patients. It can be communication between any medical personnel and patients, doctor to doctor, doctor to nurse, patients to patients. It can be interpersonal communication, group communication or mass communication. The speed at which digital media work cannot be underscored when it comes to having a very important and urgent health message to pass to the general public, because the faster the message can reach the public, the faster it generates rapid actions from its recipients. Digital media is of important in the collection, processing and storage of health-related data. Through the use of applications on mobile phones, determining diagnoses of diseases of any individual is possible even before going to the hospitals to see health providers. Hence, digital media provide a quicker guidance to individual. Social media make communication with instant feedbacks among medical practitioners possible. For example, online meetings among health workers of the same hospital are held on Whatsapp groups or other social media, health related conferences or seminars are done via Google meet or Whatsapp group video calls [15] .
Social media is a component of digital media that facilitates instantaneous communication and interaction among a diverse audience. In addition to the potential for scaled delivery and broad reach, social media and Health technologies provide clear advantage of reach, and offer the ability to scale and engage entire populations at low cost, develop supportive social networks, connect patients and providers, encourage adherence with cancer care, and collect vast quantities of data for advancing cancer research [17] . However, it’s important to acknowledge that the proliferation of health information on digital media also presents challenges, such as the potential for misinformation, privacy concerns, and information overload. Critical evaluation of sources, verification of information, and collaboration between health professionals and digital media platforms are crucial in ensuring the accuracy, reliability, and ethical dissemination of health information online.
During any break out of diseases, the influence of digital media cannot be underscored. For instance, during the outbreak of COVID-19 in nearly all nations of the world and Ebola outbreak in some parts of African nations, motion pictures educating and instructing viewers about the symptoms, prevention and treatment from many authoritative health bodies such as the World Health Organization and other medical institutions were available on digital media platforms like YouTube, WhatsApp, Facebook and others [18] . However, there were also a lot of videos generated by amateurs or bloggers who only wanted engagements for their social media handles so as to generate income. For instance in 2014 during the Ebola outbreak, some Nigerian social media users came online to instruct their followers to bath with salt water and drink some of the salt water to prevent and cure Ebola disease. Considering speed as one of the attributes of digital media, the message went viral within a short time. It was later reported that two persons died and about 20 people were hospitalised because they yielded to the information gotten on social media [19] . Afterward, the Ministry of Health and some other social media influencers came on board, using all mass media platforms to inform and educate people that the information was not only fake but also deadly [20] .
4.3. Theoretical Framework
Health Belief Model
This theory is anchored on the propositions of the Health Belief Model. The Health Belief Model (HBM) posits that messages will achieve optimal behavioural change if they successfully target perceived barriers, benefits, self-efficacy, and threat [21] . The Health Belief Model contains several primary concepts that predict why people will take action to prevent, to screen for, or to control illness conditions; these include susceptibility, seriousness, benefits and barriers to a behavior, cues to action, and most recently, self-efficacy [22] . In relations to this study encounters with information or content about endometrial cancer on digital media will increase awareness and attention towards the illness because of the following components [22] .
A. Perceived Susceptibility: The Belief about the chances of experiencing a risk or getting endometrial cancer.
B. Perceived Seriousness: Belief about how serious endometrial cancer is among women.
C. Perceived Benefits: Belief in efficacy of the advised action to reduce risk or seriousness of having endometrial cancer.
D. Perceived Barriers: Belief about the tangible and psychological costs of treatment of endometrial cancer.
E. Cues to Action: Strategies to activate actions in reducing endometrial cancer.
F. Self-Efficacy: Having being aware of the disease, the confidence in women’s ability to take action on preventing the disease.
Based on this model, The Health Belief Model was used to develop messages that motivate people to make decision. People make certain health decisions based on the degree of fear or the perceived threat of disease which makes them take health practices serious. For instance, women who understand that they are at risk or understand the potential consequences of endometrial cancer may be more inclined or motivated to engage in preventive measures such as regular check-ups, screening tests, or adopting a healthier lifestyle. However, when women are not aware of a threat endometrial cancer poses, they tend not to take precautions or take health practice serious and this may spell danger for them and make them susceptible to the disease unknowingly. While self-efficacy can be enhanced through health information and education, awareness campaign, online support communities, Telemedicine and Remote Consultations, Mobile Applications and access to resources from certified digital media which empower women to engage in behaviors that reduce their risk of endometrial cancer.
5. Methodology
The study was carried out using a quantitative approach through the use of a descriptive survey design. The Leslie Kish formula was used to determine the sample size of 228 respondents using a prevalence rate of endometrial cancer at 16.0% [3] . The study employed a two-stage sampling technique; a simple random technique was used in selecting Oshogbo and Ede North Local Government Area for the study location, while purposive sampling technique was used to determine women who makes use of digital media and are in their post-menopausal age due to the peculiarity of the disease which is found in women. An online questionnaire was designed to elicit information from respondents. While respondents were reached through community WhatsApp group.
Data Analysis
Demographic Information of the Respondents
Analysis from the study revealed that 65% (148) were within the age of 40 - 44, 15% (34) were within the age of 45 - 49, 7% (16) were within the age of 50 - 54, 13% (30) were within the age of 55 - 59 and 0% (0) were 60 and above. The educational level of the respondents shows that 0% (0) had no formal education, 0% (0) had primary education, 0% (0) had secondary school education, 15% (34) had diploma certification, 46% (105) had bachelor’s degree and 39% (89) had Master’s degree and higher.
Research Question One: To what extent do digital media raise the awareness of Nigerian women about endometrial cancer?
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Table 1. Awareness of endometrial cancer.
Source: Field Survey, 2023.
Table 1 above revealed that out of the 228 respondents, majority of the respondents 87% (198) often use digital media platforms for information and entertainment purpose on a daily basis. While a certain portion of respondents 41% (94) frequently use digital media platforms for health-related information. This indicates that most of the respondents rely on digital media platforms for entertainment and information, most especially health-related information.
Research question one: Have you come across any information related to endometrial cancer on digital media platforms?
The below Figure 1 reveals that majority of respondents 57% (129) claimed to have come across information related to endometrial cancer on digital media platforms, indicating that a good number of the respondents were aware of endometrial cancer.
Research question two: If yes, how did you come across this information? (Select all that apply)?
Source: Field Survey, 2023.
Figure 1. Frequency and percentage result showing if respondents have come across endometrial cancer related information on digital media.
Source: Field Survey, 2023.
Figure 2. Frequency and percentage result showing how respondents come across endometrial cancer information.
Figure 2 reveals that out of 57% (129) respondents who are aware of endometrial cancer, a good number of them (70) claim to have come across the information through the social media (Social media posts (Facebook, Twitter, Instagram, etc). This implies that most of the respondents who were aware of endometrial cancer became aware through the social media.
Research Question Two: What are the specific information women in Osun state have access to about endometrial cancer on digital media?
Figure 3 below reveals that out of 129 respondents who were aware of endometrial cancer, 84 of them claim that the symptoms of endometrial cancer were the specific type of information they had come across about endometrial cancer on digital media. This suggests that a good number of the respondents have been exposed more to information about the symptoms of endometrial cancer than any other specific information on digital media about endometrial cancer.
Source: Field Survey, 2023.
Figure 3. Frequency and percentage result showing results of specific types of information respondents have come across about endometrial cancer?
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Table 2. Frequency and percentage result showing specific information women in Osun State have access to about endometrial cancer.
Source: Field Survey, 2023.
The above Table 2 revealed that majority of the respondents (46%) affirmed that unusual vaginal bleeding (Postmenopausal bleeding), Watery virginal discharge, difficulty in urination, pelvic pain and weight loss are common symptoms of endometrial cancer’s specific information they have come across on digital media. Specifically, the majority of the respondents (54%) agreed that Changes in the balance of female hormones in the body and obesity are common risk factors associated with endometrial cancer’s specific information that they have come across on digital media. On the other hand, a significant number of respondents (62%) claimed that Surgery (total hysterectomy bilateral salpingo-oophorectomy) is a treatment for endometrial cancer’s specific information that they have come across on digital media. While a good portion of the respondents (58%) affirmed that regular annual check-ups with your gynaecologist, keeping your weight under control, using oral contraceptives, low-fat diet are specific information they have come across about endometrial cancer on preventive care. This implies that women in Osun State have access to specific information about endometrial cancer on digital media such as symptoms, risk factors, treatment and preventive measures.
Research Question Three: What is the level of authenticity of information Nigerian women have about endometrial cancer?
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Table 3. Frequency and percentage results showing authenticity of Information Nigerian women have about endometrial cancer.
Source: Field Survey, 2023.
Table 3 reveals that majority of the respondents (54%) claimed that they sometimes consult healthcare professionals to validate the information they have about endometrial cancer, while a portion of the respondents (50%) sometimes rely on digital media platforms for obtaining information about endometrial cancer. Specifically, a portion of the respondents (50%) claimed that the information they have about endometrial cancer is moderately authentic, while a significant number of the respondents (54%) claimed that they are somewhat confident in the accuracy and reliability of the information about endometrial cancer shared on digital media platforms. On the other hand, a large number of the respondents (77%) agreed that they believe the information they get from digital media about endometrial cancer is factual. While a good portion of the respondents (77%) agreed that they are able to engage with information on endometrial cancer on digital media. Furthermore, majority of the respondents (77%) agreed that they perceive the digital media through which they access information about endometrial cancer to be managed by experts, while a good portion of the respondents (73%) claimed they find the information they access on endometrial cancer useful. This suggests that a nuanced landscape where individuals utilize both traditional healthcare sources and digital media platforms for information, recognizing the strengths and limitations of each. Also, the level of trust and engagement with digital media indicates its growing influence in the dissemination of health-related information most especially on endometrial cancer as well as the authenticity of such information.
6. Discussion of the Findings
RQ1: To what extent do digital media raise the awareness of Nigerian women about endometrial cancer?
Findings revealed that a significant number of the respondents are aware of endometrial cancer and most respondents who are aware indicated that the social media is their major source of information about endometrial cancer. This suggests that digital media plays a key role in disseminating information about health issues. It also emphasizes the influence and reach of social media in creating awareness about health issues, including endometrial cancer. While the popularity of social media as a source of information underscores the need for accurate and reliable health information dissemination through these channels. This finding negates [23] that Women lack knowledge about endometrial cancer. However, it should be noted that all the respondents belong to the educated class which also plays an important role in the outcome of these findings. This finding also aligns with [24] that Greater awareness in both the BW/BSA communities of the symptoms associated with endometrial cancer, while the finding align with [25] , that the use of internet to search for health information is greater among women with higher levels of income and education. In addition, this gives credence to [26] that Social media is highly influential in educating Nigerians on issues pertaining to cancer.
RQ2: What are the specific information women in Osun State have access to about endometrial cancer on digital media?
Findings revealed that specific information respondents access about endometrial cancer include; symptoms information such as unusual vaginal bleeding, pelvic pain and weight loss are common symptoms of endometrial cancer, information on risk factors such as changes in the balance of female hormones in the body and obesity are common risk factors associated with endometrial cancer, treatment options such as surgery (total hysterectomy bilateral salpingo-oophorectomy) is a treatment for endometrial cancer respectively, while majority of the respondents were more exposed to the specific information on the symptoms of endometrial cancer. This implies that digital media in Osun State is providing information that helps women recognize and understand the symptoms, medical intervention, preventive care and risk factors associated with endometrial cancer. It also means that women in Osun State seem to have access to diverse and informative content about endometrial cancer on digital media. This finding corroborates [27] , that the use of the Internet is common among patients with cancer and their companions. The findings also align with [28] that many patients with cancer search out information about their cancer on the internet. Similarly, the findings align with [29] that Social media platform endometriosis support groups are found to set expectations, provide education, and highlight ways to manage chronic illness.
RQ3: What is the level of authenticity of information Nigerian women have about endometrial cancer?
Findings revealed that the majority of the respondents have a certain level of believe about the information they get from digital media about endometrial cancer with respondents occasionally consulting healthcare professionals to validate the information. This showcases the recognition of traditional sources while indicating the growing influence of digital media platforms as a source of health-related information. Also respondents believe that the information from digital media is factual, reflecting a high level of trust. The findings also suggest a balanced approach where women in Osun State leverage both traditional healthcare channels and digital media platforms for information on endometrial cancer. This means that digital media is increasingly becoming a trusted and valuable resource for health-related information. This finding corroborates [25] that women increasingly rely on the internet to supplement health information received from traditional sources. The findings also align with [30] that most women found health information on the Internet to be reliable and useful.
7. Conclusion and Recommendation
The study provides a comprehensive insight into the awareness, specific information access and authenticity perception of Osun state women regarding endometrial cancer through digital media. The study concludes that educated women in their menopausal age in Osun State, who have access to digital media platform have a significant rate of awareness on endometrial cancer with all respondents being well educated, and those who are aware primarily acquire their knowledge through social media platforms, while the women are more expose to specific information about the symptoms of endometrial cancer among other information. Regarding authenticity of information, the study discovered that a considering portion of women in Osun state consults healthcare professionals for validation, while a good number of them believe that the information they get about endometrial cancer on digital media is moderately authentic and express confidence in its accuracy which indicate a growing trust in digital media platforms for health-related contents. Improving awareness through exploring various media of communication and developing programmes focused on endometrial cancer may result in a modification of public awareness and behaviour while improved knowledge of symptoms is critical to increasing early detection and reduction of chronicity and mortality rates related to endometrial cancer, thus improving the quality of life for women. It is based on this that the study recommends that
1) More focus and sensitization should be dedicated to endometrial cancer through the use of various medium of communication in order to gain public awareness like breast cancer.
2) Government at all levels in collaboration with Non-Governmental Organisation (NGOs) should prioritise health education on endometrial cancer viz-a-viz the health workers most especially in the rural areas where there is limited access to digital media.
3) Information on endometrial cancer on digital media should be based on the knowledge of relevant experts and medical practitioners in collaboration with relevant health agencies which will help validate the credibility of health information on digital media.
4) Foster collaboration between healthcare professionals and digital media platforms to ensure the dissemination of accurate and reliable health information.