Understanding Barriers to Mammography Screening among Women in Bangladesh
DOI:
https://doi.org/10.54536/ajmsi.v5i2.8183Keywords:
Breast Cancer, Barriers, Bangladesh, Equation Modeling, Health Belief Model, Mammography, Screening Intention, StructuralAbstract
This study examined the cognitive, structural, psychosocial, and social determinants of mammography screening intention among women in Bangladesh. A quantitative cross-sectional survey was conducted among 615 women aged 40 years and older. Data were collected using a structured questionnaire grounded in an extended Health Belief Model and analysed through structural equation modelling. The measurement model demonstrated satisfactory reliability, convergent validity, discriminant validity, and overall model fit. The structural model explained 71.9% of the variance in mammography screening intention. Perceived benefits emerged as the strongest positive predictor, followed by self-efficacy, cues to action, screening knowledge and awareness, subjective norms, and perceived susceptibility. Structural barriers and psychosocial barriers exerted significant negative effects, with psychosocial barriers showing the stronger adverse influence. Perceived severity did not significantly predict screening intention. Only 23.9% of respondents had ever undergone mammography. Previous mammography use was significantly associated with age, household income, and provider advice. These findings indicate that improving mammography participation in Bangladesh requires more than awareness-focused interventions. Public health strategies should emphasize the benefits of early detection, strengthen women’s confidence, increase provider recommendations, reduce financial and service-access constraints, and address fear, embarrassment, and procedural anxiety through culturally sensitive, supportive screening programmes for eligible women across Bangladesh.
Downloads
References
Abed, A. S. A., Garcia-Valdes, L., Taha, H., & Amezcua-Prieto, C. (2025). Health belief model-based educational interventions for knowledge, beliefs, and intentions on mammography: A systematic review. BMC Women’s Health, 26(1), 48. https://doi.org/10.1186/s12905-025-04218-9
Agide, F. D., Garmaroudi, G., Sadeghi, R., Shakibazadeh, E., Yaseri, M., & Koricha, Z. B. (2024). A health belief model-based community health education on mammography screening among reproductive-aged women in Ethiopia: A randomized controlled trial. Frontiers in Public Health, 12, 1377173. https://doi.org/10.3389/fpubh.2024.1377173
Akter, Mst. F., & Ullah, M. O. (2022). Awareness levels of breast cancer among female university and medical college students in Sylhet city of Bangladesh. Cancer Reports, 5(11), e1608. https://doi.org/10.1002/cnr2.1608
Alam, N. E., Islam, Md. S., Ullah, H., Molla, Md. T., Shifat, S. K., Akter, S., Aktar, S., Khatun, Mst. M., Ali, Md. R., Sen, T. C., Chowdhury, K., Pervin, R., & Mohiuddin, A. K. M. (2021). Evaluation of knowledge, awareness and attitudes towards breast cancer risk factors and early detection among females in Bangladesh: A hospital based cross-sectional study. PLOS ONE, 16(9), e0257271. https://doi.org/10.1371/journal.pone.0257271
Amin, M. N., Uddin, Md. G., Uddin, Md. N., Rahaman, Md. Z., Siddiqui, S. A., Hossain, Md. S., Islam, Md. R., Hasan, Md. N., & Uddin, S. M. N. (2020). A hospital based survey to evaluate knowledge, awareness and perceived barriers regarding breast cancer screening among females in Bangladesh. Heliyon, 6(4), e03753. https://doi.org/10.1016/j.heliyon.2020.e03753
Chin, J. H., & Mansori, S. (2019). Theory of Planned Behaviour and Health Belief Model: Females’ intention on breast cancer screening. Cogent Psychology, 6(1), 1647927. https://doi.org/10.1080/23311908.2019.1647927
Duffy, S. W., Tabár, L., Yen, A. M., Dean, P. B., Smith, R. A., Jonsson, H., Törnberg, S., Chen, S. L., Chiu, S. Y., Fann, J. C., Ku, M. M., Wu, W. Y., Hsu, C., Chen, Y., Svane, G., Azavedo, E., Grundström, H., Sundén, P., Leifland, K., … Chen, T. H. (2020). Mammography screening reduces rates of advanced and fatal breast cancers: Results in 549,091 women. Cancer, 126(13), 2971–2979. https://doi.org/10.1002/cncr.32859
Ebrahimoghli, R., Aghaei, M. H., Azami-Aghdash, S., & Houssami, N. (2025). Uptake of breast cancer screening practices in low- and middle-income countries: A systematic review and meta-analysis. JNCI: Journal of the National Cancer Institute, 117(1), 29–39. https://doi.org/10.1093/jnci/djae187
Ezema, R. N., Igbokwe, C. C., Iwuagwu, T. E., Agbaje, O. S., Ofuebe, J. I., Abugu, L. I., Eze, D. D., & Wamanyi, Y. (2021). Association of Sociodemographic Factors, Breast Cancer Fear, and Perceived Self-Efficacy With Breast Cancer Screening Behaviors Among Middle-Aged Nigerian Women. Breast Cancer: Basic and Clinical Research, 15, 11782234211043651. https://doi.org/10.1177/11782234211043651
Farr, D. E., Brandt, H. M., Friedman, D. B., Adams, S. A., Armstead, C. A., Fulton, J. K., & Bull, D. M. (2020). False-positive mammography and mammography screening intentions among black women: The influence of emotions and coping strategies. Ethnicity & Health, 25(4), 580–597. https://doi.org/10.1080/13557858.2019.1571563
Ghaffari, M., Esfahani, S. N., Rakhshanderou, S., & Koukamari, P. H. (2019). Evaluation of Health Belief Model-Based Intervention on Breast Cancer Screening Behaviors among Health Volunteers. Journal of Cancer Education, 34(5), 904–912. https://doi.org/10.1007/s13187-018-1394-9
Hoq, M. I., Jahan, S., Mahmud, Md. H., Hasan, Md. M. U., & Jakaria, Md. (2024). Breast cancer screening awareness, practice, and perceived barriers: A community based cross sectional study among women in south eastern Bangladesh. Health Science Reports, 7(1), e1799. https://doi.org/10.1002/hsr2.1799
Mahboobighazaani, F., Karimi, M., Azadbakht, M., & Ghahremani, L. (2024). The effectiveness of educational intervention based on the Health Action Model (HAM) in improving breast cancer screening behaviors. BMC Women’s Health, 24(1), 21. https://doi.org/10.1186/s12905-023-02816-z
Mann, R. M., Athanasiou, A., Baltzer, P. A. T., Camps-Herrero, J., Clauser, P., Fallenberg, E. M., Forrai, G., Fuchsjäger, M. H., Helbich, T. H., Killburn-Toppin, F., Lesaru, M., Panizza, P., Pediconi, F., Pijnappel, R. M., Pinker, K., Sardanelli, F., Sella, T., Thomassin-Naggara, I., Zackrisson, S., … On behalf of the European Society of Breast Imaging (EUSOBI). (2022). Breast cancer screening in women with extremely dense breasts recommendations of the European Society of Breast Imaging (EUSOBI). European Radiology, 32(6), 4036–4045. https://doi.org/10.1007/s00330-022-08617-6
Manson, E. N., & Achel, D. G. (2023). Fighting breast cancer in low-and-middle-income countries – What must we do to get every woman screened on regular basis? Scientific African, 21, e01848. https://doi.org/10.1016/j.sciaf.2023.e01848
Martinez, M. E., Schmeler, K. M., Lajous, M., & Newman, L. A. (2024). Cancer Screening in Low- and Middle-Income Countries. American Society of Clinical Oncology Educational Book, 44(3), e431272. https://doi.org/10.1200/EDBK_431272
Mascara, M., & Constantinou, C. (2021). Global Perceptions of Women on Breast Cancer and Barriers to Screening. Current Oncology Reports, 23(7), 74. https://doi.org/10.1007/s11912-021-01069-z
Naik, S., Varghese, A. P., Asrar Ul Haq Andrabi, S., Tivaskar, S., Luharia, A., & Mishra, G. V. (2024). Addressing Global Gaps in Mammography Screening for Improved Breast Cancer Detection: A Review of the Literature. Cureus. https://doi.org/10.7759/cureus.66198
Nduka, I. J., Ejie, I. L., Okafor, C. E., Eleje, G. U., & Ekwunife, O. I. (2023). Interventions to increase mammography screening uptake among women living in low-income and middle-income countries: A systematic review. BMJ Open, 13(2), e066928. https://doi.org/10.1136/bmjopen-2022-066928
Olasehinde, O., Alatise, O. I., Arowolo, O. A., Mango, V. L., Olajide, O. S., Omisore, A. D., Boutin-Foster, C., & Kingham, T. P. (2019). Barriers to mammography screening in Nigeria: A survey of two communities with different access to screening facilities. European Journal of Cancer Care, 28(2), e12986. https://doi.org/10.1111/ecc.12986
Ritchie, D., Van Den Broucke, S., & Van Hal, G. (2021). The health belief model and theory of planned behavior applied to mammography screening: A systematic review and meta analysis. Public Health Nursing, 38(3), 482–492. https://doi.org/10.1111/phn.12842
Sarker, R., Islam, Md. S., Moonajilin, Mst. S., Rahman, M., Gesesew, H. A., & Ward, P. R. (2022). Effectiveness of educational intervention on breast cancer knowledge and breast self-examination among female university students in Bangladesh: A pre-post quasi-experimental study. BMC Cancer, 22(1), 199. https://doi.org/10.1186/s12885-022-09311-y
Shubayr, N., Khmees, R., Alyami, A., Majrashi, N., Alomairy, N., & Abdelwahab, S. (2022). Knowledge and Factors Associated with Breast Cancer Self-Screening Intention among Saudi Female College Students: Utilization of the Health Belief Model. International Journal of Environmental Research and Public Health, 19(20), 13615. https://doi.org/10.3390/ijerph192013615
Tabár, L., Dean, P. B., Chen, T. H., Yen, A. M., Chen, S. L., Fann, J. C., Chiu, S. Y., Ku, M. M., Wu, W. Y., Hsu, C., Chen, Y., Beckmann, K., Smith, R. A., & Duffy, S. W. (2019). The incidence of fatal breast cancer measures the increased effectiveness of therapy in women participating in mammography screening. Cancer, 125(4), 515–523. https://doi.org/10.1002/cncr.31840
Tu, H., Zhang, L., Xu, M., Zhao, Z., Han, J., & Yan, L. (2024). The mediating effect of self-efficacy on social support and cancer screening behavior among Chinese women: A cross-sectional study. BMC Women’s Health, 24(1), 454. https://doi.org/10.1186/s12905-024-03296-5
Van Den Broek-Altenburg, E. M., Leslie, A. A., Benson, J. S., & DeStigter, K. K. (2024). Disparities in Mammography Screening: Analyzing Barriers to Access Using Individual Patient Perspectives and the Health Belief Model. Cancer Control, 31, 10732748241248367. https://doi.org/10.1177/10732748241248367
Wang, X., Chen, D., Xie, T., & Zhang, W. (2019). Predicting women’s intentions to screen for breast cancer based on the health belief model and the theory of planned behavior. Journal of Obstetrics and Gynaecology Research, 45(12), 2440–2451. https://doi.org/10.1111/jog.14109
Zhang, M., Wei, W., Li, Q., Chen, X., Zhang, M., Zuo, D., & Liu, Q. (2021). Determinants of Intention to Participate in Breast Cancer Screening among Urban Chinese Women: An Application of the Protection Motivation Theory. International Journal of Environmental Research and Public Health, 18(21), 11093. https://doi.org/10.3390/ijerph182111093
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Jannatul Shamia, Bappi Bhushan Das, Most Farhana Akter, Md. Arefin
This work is licensed under a Creative Commons Attribution 4.0 International License.
