Non-attendance to mammography screening : a qualitative study among nonattendees in Malta

Abstract

Background: There is limited qualitative research exploring reasons for underutilisation of breast screening and the broader contexts that affect health-seeking behaviour among women who do not respond to breast screening invitations. This study aims to advance understanding of factors that influence breast screening non-attendance among lifetime nonattendees in Malta. Methods: Twenty face-to-face qualitative interviews were conducted with women in Malta. These explored women’s illness perceptions regarding breast cancer, knowledge on screening, mammography beliefs, past health-related experiences, medical help seeking behaviour, health and social interactions, and effective interventions that would facilitate mammography attendance. Data were analysed using thematic analysis. Results: Four themes emerged: 1) attitudes, feelings, beliefs and perceptions; 2) knowledge; 3) social network experiences and 4) perceived effective interventions. Fear of breast cancer and screening emerged as barriers to mammography. The majority of participants had not received physician advice. Previous familial cancer diagnosis prompted lifestyle changes in women, but it was not the primary motivator to attendance. Participants talked about fear of death and traumatic histories from experiences of relatives with cancer or personal traumas. Practical and emotional support are important to non-attendees. Conclusions: The impact of physical and psychosocial variables on personal resilience and self-confidence should inform the planning of screening interventions. Professionals must refer to patients’ wider support networks and make the necessary referrals, while policy makers should ensure services providing psychological, social and emotional support are accessible.