Determinants of mammography screening participation among Turkish immigrant women in Germany - a qualitative study reflecting key informants' and women's perspectives

Abstract

Mammography screening programmes aiming to reduce mortality from breast cancer are implemented in most European countries. Immigrant women are less likely to participate than women of the respective autochthonous populations in several European countries but not in Germany. Qualitative, semi-structured interviews were conducted with 16 key informants and 10 Turkish immigrant women aged 50-69 years to analyse the factors influencing their screening participation in Germany. Interviews were analysed using summarising content analysis. The Theory of Planned Behaviour was used for structuring the results. Key informants stated poor German language skills and insufficient knowledge about breast cancer and screening as factors influencing screening participation. Immigrant women demonstrated basic knowledge about screening, but their attitudes towards screening varied. Information from the invitation letter of the screening programme was often filtered by family members. Key informants tended to emphasise barriers and system-related factors while the Turkish women focused more on factors on the individual level. Contrasting both perspectives is helpful for health professionals to critically assess their own views. Measures to improve screening participation need to address not only barriers but also take women's attitudes and norms into account, thus helping women to make an informed decision.

Health literacy among different age groups in Germany: results of a cross-sectional survey

“…However, among adolescents and seniors we did not find an effect. An explanation could be that adolescents with migrant background are mostly second-generation and thus differ little from autochthonous young people concerning their general literacy and German language skills [25, 31]. Persons with migrant background in the other age groups may have lower proficiency in German language and therefore use of health information might be perceived more difficult.…”

“…Persons with migrant background in the other age groups may have lower proficiency in German language and therefore use of health information might be perceived more difficult. In addition, their expectations towards information and communication [31] and their skills regarding this might be different from the autochthonous population. An explanation for not showing a relation of migrant background and limited perceived health literacy among the subsample of seniors might be that respondents with migrant background in the oldest age group in our study may not have been representative according their language skills Especially older persons with migrant background with poor German language skills may have been underrepresented as they are difficult to recruit for research [32, 33].…”

“…The differences in perceived health literacy among the subgroups may also be explained by the use of different information resources and its reliability and clarity. Persons with migrant background, for example, are known to rely on doctors and family members when seeking for health information and making decisions about health and health care [31]. Higher social class, not having a migrant background and high frequency of health care service use are for example associated with using the Internet for health-related matters [34].…”

Participation in cancer screening among female migrants and non-migrants in Germany

“…[47–49] Also, barriers and a limited health literacy resulting from poor proficiency of the language of the host country have been identified to limit access to preventive services for migrants, including cancer screening. [11,50] As the GEDA survey that we used for our study is conducted in German language and only respondents with sufficient language skills are included, [42] poor language proficiency, however, cannot explain our results.…”

Screening, resilience, patient navigation and information needs - key areas in cancer control

“…Berens et al . () examine determinants of breast screening among Turkish women in Germany. Their findings highlight common themes in the screening literature – language skills, insufficient knowledge about breast cancer and a range of attitudinal factors.…”