Exploring Perceived Barriers of Mammography and Developing Instrument for Barriers of Mammography for Iranian Women: A Multiphase Mixed Method Design

Abstract

background and aim: With the knowledge of mammography barriers, we can made interventions to eliminate them and increase mammography adoption. Since interventions should be designed and implemented based on the needs, culture and value system of the community that in which the individual lives, Therefore, the present study was used a multiphase mixed method design to explore the barriers of mammography adoption and designing an instrument for measuring the barriers of performing mammograms based on Iranian women. Materials and methods: This study was carried out using a multiphase mixed method design with the participation of women older than 40 in three cities of the country (Tabriz, Hamedan, and Sanandaj). In the first phase, the predictive effect of cognitive factors including health belief model constructs using Champaign's Health Belief Model scale, self-efficacy for performing mammograms and breast conflict using the Women’s Breast Conflict Scale and the Self‐efficacy Scale for Mammography was investigated. Also, in this phase, Participants for the qualitative part of the study were selected based on the score of the perceived barriers. second phase of the study was conducted using the qualitative content analysis method. Extraction of scale items was carried out using a combination of interviews with 24 people (women with and without mammogram history, women with family history of breast cancer and a mammography technician), and content analysis of thier interview texts and literature review. third phase of the study was conducted to investigate the psychometric properties of the scal, using face validity, content validity ratio and content validity index. In addition, the internal consistency and stability of the scale and the construct validity by means of exploratory and confirmatory factor analysis were investigated. Finally, in the fourth phase, a pilot study was conducted to examine the predictive role of barriers to performing mammography based on designed instrument. Generalized structural equation modeling and hierarchical logistic regression were used for data analyses. Version 21 of the SPSS and STATA14 statistical software were used for data analyeis. The level of significance was set, a priori, at the 0.05. Result: After Adjusting for demographic factors, perceived barriers, perceived benefits and self-efficacy were significantly associated to mammography adoption (P <0.05). Based on the results of qualitative study, the barriers of mammography were addressed in 5 dimensions that were including: consisting of unawareness of mammography, fear control, priority of needs to mammography, inadequate competency of mammography centers, and a sense of losing family support. At the end of the qualitative study, the designed scale was entered into a psychometric step with 36 items. After assessing content and face validity, finally instrument entered construct validity stage with 30 items. Based on the results of factor analysis, the eight factors including lake of information, distrust of mammography, fear, no priority of mammography, difficulty doing mammography, defensive avoidance, breast conflict and belief in fate were determined with change percentage of 74-75. Internal consistency for all items was 0/ 68. Test-retest reliability of instrument was ICC= 0/ 897 (0/ 586-0/ 974).Based on the results of the pilot study, after adjusting for demographic variables, the independent variable of barriers of mammography was significantly, independent predictive of mammography adoption. Conclusion: mammography barriers instrument in Iranian women was reliable and valid and can be used by researchers for measuring barriers of mammography adoption.