Abstract
BackgroundThe knowledge of Maltese women not attending the Maltese Breast Screening Programme (MBSP) for mammography screening is scarce. Previous research has identified two distinct groups of non-attendees: those who do not attend because a mammogram was taken elsewhere and those who never attended for mammography anywhere. It is however unknown which determinants are predictive of lifetime attendance ‘anywhere’ and ‘real’ non-attendance. The present study examines the relationship between ever-using (Lifetime attendees) or never using mammography (Lifetime non-attendees) and psychosocial - as well as sociodemographic factors, with the aim to identify predictors that can inform practice.MethodsWomen’s characteristics, knowledge, health beliefs and illness perceptions were compared, based on prior data of 404 women, aged 50–60 years at the time of their first MBSP invitation. The main variable of interest described women’s attendance to mammography (LIFETIME ATTENDEES) and no mammography (LIFETIME NON-ATTENDEES). Data were analyzed using descriptive statistics, chi-square tests, Mann Whitney test, Independent Samples t-test, Shapiro Wilk test and logistic regression.ResultsDuring their lifetime, 86.1% of Maltese women (n = 348) were attendees, while 13.9% (n = 56) were non-attendees. Non-attendees were more likely to be women with a lower family income (χ2 = 13.1, p = 0.011), widowers (χ2 = 9.0, p = 0.030), non-drivers (χ2 = 7.7, p = 0.006), without a breast condition (χ2 = 14.2, p < 0.001), who had no relatives or close friends with cancer (χ2 = 8.3, p = 0.016), and who were less encouraged by a physician (χ2 = 4.9, p = 0.027), unsure of the screening frequency (χ2 = 28.5, p < 0.001), more anxious (p = 0.040) and fearful (p = 0.039). Perceived benefits, barriers, cues to action, self-efficacy and emotional representations were the most significant variables to describe the differences between lifetime attendees and non-attendees. Perceived barriers and cues to action were the strongest predictors for lifetime non-attendance (p < 0.05 respectively).ConclusionsThe health beliefs of women who have never attended for mammography during their lifetime should be targeted, particularly perceived barriers and cues to action. Further research should focus on understanding knowledge gaps, attitudinal barriers and emotional factors among ‘real’ non-attendees who require a more targeted approach.
Highlights
The knowledge of Maltese women not attending the Maltese Breast Screening Programme (MBSP) for mammography screening is scarce
General barriers to screening by mammography in Malta have been identified in our earlier study [19], our findings showed that our screening cohort consisted of attendees and non-attendees to the Maltese Breast Screening programme (MBSP); we recognised that the MBSP non-attendees consisted of a heterogeneous group of women with diverse reasons for non-attendance
Our findings show that women who perceive more barriers to mammography attendance, fewer benefits, lower cues to action and lower self-efficacy, and who have higher emotional representations of Breast cancer (BC) were less likely to attend for mammography during their lifetime
Summary
The knowledge of Maltese women not attending the Maltese Breast Screening Programme (MBSP) for mammography screening is scarce. Previous research has identified two distinct groups of non-attendees: those who do not attend because a mammogram was taken elsewhere and those who never attended for mammography anywhere. It is unknown which determinants are predictive of lifetime attendance ‘anywhere’ and ‘real’ nonattendance. Lower utilization rates may be associated with three main factors: (a) logistical determinants such as the availability and accessibility of a screening center, test affordability, time from work or travelling time [3, 14, 15], (b) psychosocial factors such as values, expectations and beliefs which affect the way women transform knowledge regarding mammography into actual behaviour [16], and (c) socio-demographic determinants which impact on the way structural and psychosocial factors predict mammography use [17, 18]. Most of the literature does not take into account the context of mammography provision, such as countries with dual health systems (organized and private screening)
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