Perceived Behavioral Control in Mammography: A Qualitative Study of Iranian Women’s Experiences

Abstract

Background: Mammography is one of the best methods to screen breast cancer. Because mammography screening is not entirely under the control of the person, the study of perceived behavioral control (PBC) is valuable in this regard. Objectives:The aim of this study was to investigate PBC in mammography in women in Khorramabad, Lorestan province, Iran (550 kilometers north of Persian Gulf). Methods: In this qualitative study conducted using semi-structured and in-depth interviews, 22 women, a gynecologist, and a general surgeon were interviewed purposively. The interviews were recorded, transcribed, and analyzed, using the directed qualitative content analysis. The MAXQDA10 software was used to analyze the data. Results: Two categories, namely facilitators and barriers to mammography screening and 5 subcategories, namely individual facilitators, social facilitators, psychosocial barriers, barriers related to mammography technique, and structural barriers were drawn from the data. Individual facilitators included having faith and heart belief in God (Faith in God was a comfort for the participants and the acceptance of God's favor), family support, and follow-up; the only social facilitator drawn was respecting the rights of the referring people; psychosocial barriers were embarrassment, fear of breast cancer diagnosis, and belief in fate; the barriers related to mammography technique were radiation and painful mammography and lack of insurance; and high costs and long wait in public mammography centers were drawn as structural barriers. Conclusions:The results of this study provided useful information about the experiences regarding mammography. Psychological barriers may be reduced by changing women's knowledge and attitudes toward mammography, as well as by changing the national health system infrastructure. It is also recommended to strengthen cultural and religious beliefs along with holding training programs regarding mammography performing.

A national survey to assess breast cancer awareness among the female university students of Pakistan

“…That's why they are diagnosed at the last stage when there is the only option of surgery [35][36][37][38]. Similarly in Iran embarrassment, fear of breast cancer diagnosis, and belief in fate were the major reported barriers by females to breast cancer screening [39]. In addition, the study conducted in Canada reported the uncomfortable feeling of women while discussing breast cancer screening as a barrier to the screening of breast cancer.…”

Qualitative factors influencing breast and cervical cancer screening in women: A scoping review

“…These were based on a woman’s role in the household (Theme 1.1.1); women were expected to prioritise looking after their family’s needs and managing domestic responsibilities due to their position as wives and mothers ( Macdonald et al, 2015 , Urrutia et al, 2017 , Yang et al, 2019 , Trigoni et al, 2008 , Nyblade et al, 2017 , Thomas et al, 2011 , Safizadeh et al, 2018 , Shirzadi et al, 2020 , Rasul et al, 2015 , Baron-Epel et al, 2004 , Azaiza and Cohen, 2008 , Ngugi et al, 2012 , Wong et al, 2008 , Markovic et al, 2005 , Khan and Woolhead, 2015 , Daley et al, 2012 , Filippi et al, 2013 , Tessaro et al, 1994 , Nekhlyudov et al, 2003 , Nolan et al, 2014 , Nonzee et al, 2015 ). Women in the included studies also expressed that there were sociocultural expectations on female behaviour (Theme 1.1.2); they were expected to care for others’ health above their own ( Trigoni et al, 2008 , Wong et al, 2008 , Filippi et al, 2013 , Tessaro et al, 1994 , Thomas et al, 2011 , Safizadeh et al, 2018 , Shirzadi et al, 2020 , Rasul et al, 2015 , Nolan et al, 2014 , Nonzee et al, 2015 , McMichael et al, 2000 , Manderson and Hoban, 2006 , Dey et al, 2016 , Savabi-Esfahani et al, 2018 , Khazaee-pool et al, 2014 , Khazir et al, 2019 ), and were expected to have a sense of modesty that was incompatible with the bodily exposure required during breast or cervical screening ( Macdonald et al, 2015 , Azaiza and Cohen, 2008 , Isa Modibbo et al, 2016 , Püschel et al, 2010 , Ndejjo et al, 2017 ). However, women in several studies also mentioned that there was a motivation to engage in cancer screening in order to stay healthy for the sake of their family.…”

“…It is this normative perception of privilege or exclusiveness that causes men and women to feel uncomfortable with the perceived inappropriateness about interactions involving a woman’s sexual organs that are not specifically with her husband. In addition to the fear of being seen as promiscuous due to the nature of cervical cancer, women reported that these two cancers – and female health issues in general – were generally taboo topics that should not be discussed except in private ( Thomas et al, 2011 , Azaiza and Cohen, 2008 , Khan and Woolhead, 2015 , Khazir et al, 2019 , Bayrami et al, 2015 , Malhotra et al, 2016 , Lunsford et al, 2017 , Shaw et al, 2018 , Onyenwenyi and Mchunu, 2018 ).…”

“…fewer opportunities to learn and/or acquire information) context ( Macdonald et al, 2015 , Yang et al, 2019 , Ngugi et al, 2012 , Markovic et al, 2005 , Daley et al, 2012 , Filippi et al, 2013 , Nolan et al, 2014 , Ndejjo et al, 2017 , Kahn et al, 2006 , Binka et al, 2019 , Onyenwenyi and Mchunu, 2018 , Brandt et al, 2019 , Teng et al, 2014 , Oscarsson et al, 2008 ). Women were also more likely to need financial support (Theme 3.2) and be financially dependent on spouses or their families ( Shirzadi et al, 2020 , Ngugi et al, 2012 , Filippi et al, 2013 , Tessaro et al, 1994 , Ndejjo et al, 2017 , Binka et al, 2019 , Shaw et al, 2018 , Mutyaba et al, 2007 , Pelcastre-Villafuerte et al, 2007 , Darj et al, 2019 , Urrutia et al, 2017 , Yang et al, 2019 , Trigoni et al, 2008 , Dey et al, 2016 , Savabi-Esfahani et al, 2018 , Khazaee-pool et al, 2014 , Khazir et al, 2019 , Granado et al, 2014 , Bahmani et al, 2016 , Malhotra et al, 2016 , Gu et al, 2017 , Andrasik et al, 2008 , Ersin and Bahar, 2011 , Lovell et al, 2007 , Holroyd et al, 2004 ). Lastly, women in several studies highlighted practical barriers (Theme 3.3) that prevented them from attending breast and cervical screening programmes, even if there was the intention to do so.…”

Effect of Educational Intervention Based on the Theory of Planned Behavior on Mammography Performance in Iranian Women: a Randomized Controlled Trial Study

“…Khazir quotes from the WHO, 2015, in poor communities, most women are diagnosed with late-stage disease and their 5-year survival rate is 10 to 40%. In more developed communities, where the disease is diagnosed and treated in the early stages, the 5-year survival rate reaches 80% [5] . Annually, more than 1.1 million new cases of breast cancer are diagnosed globally, and over 41,000 deaths occur as a result of the disease [6] .…”