Lifetime utilization of mammography among Maltese women: a cross-sectional survey

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.

A national cross-sectional study of adherence to timely mammography use in Malta

“…A plausible explanation for the disappearance of an effect of socio-demographic factors in our subgroup analyses on adherence in this study is that they represent ‘carriers’, as described by Lagerlund [ 65 ], of already established health-related behaviours. This is evidence in all our studies on first invitation to MBSP [ 13 ], re-attendance [ 14 ] and lifetime mammography use [ 63 ], where different socio-demographic and health status variables were non-significant predictors of uptake to mammography screening.…”

“…In all our data analyses, knowledge of the BS frequency was found to be significantly associated with MBSP attendance [ 13 ], re-attendance [ 14 ], lifetime screening [ 63 ] and likewise in this study on timely mammography adherence, showing that women who were unsure were less likely to attend for a mammogram at recommended intervals. Ritvo et al [ 19 ] expands on such data, showing that it becomes more consequential with findings that the belief about recommended screening intervals predicts screening adherence in women with a family history of BC.…”

“…Those who never attended for mammography anywhere ( n = 56) were excluded from this analysis as this group was already analysed in further detail in our previous published paper on lifetime mammography use [ 63 ].…”

Predicting reattendance to the second round of the Maltese national breast screening programme: an analytical descriptive study

“…Similar to the analysis carried out in our previous papers to analyse the associations between attendees and non-attendees in relation to lifetime mammography practices [30] and timely adherence [31], the following analysis focused on the associations between attendees and non-attendees to a second BS invitation.…”

“…Similar to the analyses carried out in our previous paper to predict lifetime mammography attendance in Malta [30], the following analyses focused on predicting attendance and non-attendance to the second BS invitation. The most significant variables for all logistic regression models are presented in Table 5.…”