br I did not know that
“I did not know that there is a screening test. mammography for people who developed BC or have signs of BC” P4 (Focus group 1)
A lack of knowledge of MS was identified as a potential barrier towards self-referral for screening by women of an eligible age. Similarly, Kawar (2013) found that the lack of knowledge about MS acted as a deterrent for many women; the very fact that they did not know what occurred during screening, mixed with piecemeal information from women who
had attended, referring to pressure and discomfort, acted as a barrier to not attending.15 In describing the process of mammography, most of the par-ticipants repeated the words ‘stress’ and ‘pressure’ as an explana-tion of the MS procedure:
“My friend told me that it is a painful examination, with a pressure on the breast” P2 (focus group 1)
“What I know is that the machine presses each breast” P7 (focus group 2)
Such concern about the pain and discomfort that may be
experienced during screening mammography is well documented in literature18,20,22,23,25 and is often exaggerated by hearsay and
women's talk of previous negative experiences of mammography. Such sharing of negative experience and the resulting fear of an
expectation of pain and discomfort has the potential to prevent women from attending18,20,22,23,25
During focus group discussion of participant's knowledge of MS, participants also discussed BSE and CBE, which subsequently formed an important sub-theme.
“I do not know how to perform BSE, I just do random touching” P5 (focus group 1)
“I don't know about BSE, I use my hands after the Meropenem to search for lumps” P11 (focus group 1)
Although the knowledge of BSE, in general, was higher among focus group 1 participants, more than half in both focus groups had a poor knowledge of how to perform BSE and at what age to perform it. Such poor knowledge of how to perform self- r> examination correctly has been widely reflected within literature.14,17,41,44
(3) Personal factors
‘Personal factors’ was identified as a major theme preventing individual participants from attending MSS. Fear of discovering BC, fear of having the mammogram itself, fatalism and family history of BC, subsequently formed a series of sub-themes
Fear was identified as both being afraid of having a mammo-gram and/or the fear of discovering BC. One of the participants showed a lack of trust of the diagnoses of doctors, beside the fear of discovering cancer:
“I am afraid of discovering cancer, I don't trust the accuracy of doctors, they might be wrong” P5 (focus group 1)
“I am afraid of the test itself, it is painful my friend said that she felt her soul went to her breast from the pain’’ P11 (focus group 2)
Similarly, Davie (2007) found that the fear of what was going to happen during screening mammography as well as disease dis-covery may both act as potential barriers to attending screening mammography.20 A potential reason for not attending was cited as a lack of trust in the physicians’ ability to interpret the imaging. This lack of trust was guided by false positive and false negative results provided in previous medical examinations.
A small number of participants in both focus groups identified fatalism as a barrier to the uptake of MS, identifying that they must accept their directed fate.
“A breast cancer is an affliction from Allah… anything that Allah decides to happen will happen, no matter what we do.“ P1 (focus group 2)
“If Allah wants the woman to develop breast cancer, she will develop it” P4 (focus group 2)