Enter your email address
Submit
Write your message
Volume 19, Issue 2 (Iranian Journal of Breast Diseases 2026)
ijbd 2026, 19(2): 113-133 |
Back to browse issues page
Ethics code: IR.HUMS.REC.1402.101
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
yari A, hassani L, dadipour S, ghanbarnejad A. Determinants of Mammography Screening among Women in Southern Iran: A Qualitative Study. ijbd 2026; 19 (2) :113-133
URL: http://ijbd.ir/article-1-1224-en.html
URL: http://ijbd.ir/article-1-1224-en.html
1- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
2- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
3- Tobacco and Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran ,mdadipoor@yahoo.com
4- Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
2- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
3- Tobacco and Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran ,
4- Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
Abstract: (390 Views)
Introduction: Breast cancer is a leading cause of cancer-related mortality among women, and mammography remains the most effective method for its early detection. However, mammography screening uptake among Iranian women remains low, with reported participation rates generally below 25%. Understanding the factors influencing screening behavior is therefore essential for designing effective interventions. This qualitative study aimed to explore and describe the multi-level determinants of mammography screening uptake using the Intervention Mapping framework.
Methods: Data were collected through semi-structured in-depth interviews and focus group discussions with 34 participants, including women aged 40–70 years who were eligible for breast cancer screening and healthcare providers involved in screening services. Participants were selected through purposive sampling with maximum variation. Data were analyzed using conventional content analysis to identify barriers and facilitators across five ecological levels.
Results: Mammography uptake was influenced by a complex interaction of factors at multiple levels. At the intrapersonal level, limited awareness, misconceptions about breast cancer and screening, fear of diagnosis, and low self-efficacy emerged as major barriers. At the interpersonal level, inadequate support from spouses and family members, as well as negative experiences with healthcare personnel, discouraged participation. Organizational and environmental barriers included high screening costs, limited physical access to services, time constraints, and insufficient privacy in screening facilities. At the community level, breast cancer screening was often perceived as a low priority. At the policy-related and structural levels, inadequate insurance coverage and broader economic difficulties were identified as important obstacles to screening participation.
Conclusion: The findings highlight that mammography screening behavior is shaped by determinants operating at multiple ecological levels. Efforts to improve screening participation should address individual knowledge and beliefs, strengthen family and healthcare-provider support, and reduce structural barriers related to affordability and access. These findings may inform the development of context-specific interventions and policies aimed at improving mammography screening uptake among women in southern Iran.
Methods: Data were collected through semi-structured in-depth interviews and focus group discussions with 34 participants, including women aged 40–70 years who were eligible for breast cancer screening and healthcare providers involved in screening services. Participants were selected through purposive sampling with maximum variation. Data were analyzed using conventional content analysis to identify barriers and facilitators across five ecological levels.
Results: Mammography uptake was influenced by a complex interaction of factors at multiple levels. At the intrapersonal level, limited awareness, misconceptions about breast cancer and screening, fear of diagnosis, and low self-efficacy emerged as major barriers. At the interpersonal level, inadequate support from spouses and family members, as well as negative experiences with healthcare personnel, discouraged participation. Organizational and environmental barriers included high screening costs, limited physical access to services, time constraints, and insufficient privacy in screening facilities. At the community level, breast cancer screening was often perceived as a low priority. At the policy-related and structural levels, inadequate insurance coverage and broader economic difficulties were identified as important obstacles to screening participation.
Conclusion: The findings highlight that mammography screening behavior is shaped by determinants operating at multiple ecological levels. Efforts to improve screening participation should address individual knowledge and beliefs, strengthen family and healthcare-provider support, and reduce structural barriers related to affordability and access. These findings may inform the development of context-specific interventions and policies aimed at improving mammography screening uptake among women in southern Iran.
Keywords: Breast Cancer, Mammography, Qualitative Study, Intervention Mapping, Conventional Content Analysis, Behavioral Determinants
Type of Study: Research |
Subject:
prevention
Received: 2025/11/14 | Accepted: 2026/06/2 | Published: 2026/07/26
Received: 2025/11/14 | Accepted: 2026/06/2 | Published: 2026/07/26
References
1. Sanaat Z, Dolatkhah R. Epidemiologic profile of breast cancer in Iran: a systematic review and meta-analysis. Clinical Epidemiology and Global Health. 2024;26:101537. doi:1016/j.cegh.2024.101537 [DOI:10.1016/j.cegh.2024.101537]
2. Hajian K, Gholizadehpasha A, Bozorgzadeh S. Association of Obesity and Central Obesity with Breast Cancer Risk in Pre- and Postmenopausal Women. J Babol Univ Med Sci. 2013;15(3):7-15. (Persian)
3. Akbari ME, Akbari A, Akbari M, Khayamzadeh M. Survival Rate of Breast Cancer and Related Factors in Iran: A 27-Year Follow-Up. Iran J Public Health. 2025;54(4):870-880. doi: 10.18502/ijph.v54i4.18426 [DOI:10.18502/ijph.v54i4.18426] [PMID] [PMCID]
4. Shamshirian A, Heydari K, Shams Z, Aref AR, Shamshirian D, Tamtaji OR, et al. Breast cancer risk factors in Iran: a systematic review & meta-analysis. Hormone Molecular Biology and Clinical Investigation. 2020;41(4):20200021. doi:10.1515/hmbci-2020-0021 [DOI:10.1515/hmbci-2020-0021] [PMID]
5. Ghiasvand R, Bahmanyar S, Zendehdel K. et al. Postmenopausal breast cancer in Iran: risk factors and their population attributable fractions. BMC Cancer, 2012;12(14).1-9. doi:10.1186/1471-2407-12-414. (Persian) [DOI:10.1186/1471-2407-12-414] [PMID] [PMCID]
6. Shadmani F.K, Mansori K, Khazaei S, Hanis S.M, Khazaei S, Sani M, et al. Geographic distribution of breast cancer incidence in Iran. Biomedical Research and Therapy. 2017;4(05):1295-304. doi:10.15419/bmrat.v4i05.168 [DOI:10.15419/bmrat.v4i05.168]
7. Yusof A, Chia YC, Hasni YM. Awareness and prevalence of mammography screening and its predictors-a cross sectional study in a primary care clinic in Malaysia. Asian Pacific Journal of Cancer Prevention. 2014;15(19):8095-9. doi:10.7314/APJCP.2014.15.19.8095 [DOI:10.7314/APJCP.2014.15.19.8095] [PMID]
8. Jokhadze N, Das A, Dizon DS. Global cancer statistics: A healthy population relies on population health. CA: a cancer journal for clinicians. 2024;74(3):224-6. doi:10.3322/caac.21838. [DOI:10.3322/caac.21838] [PMID]
9. Balenger A, Seth G, Bhattarai S, Collin LJ, McCullough L, Gogineni K, et al. Barriers to breast cancer screening in Atlanta, GA: results from the Pink Panel survey at faith-based institutions. Cancer Causes Control. 2022;33(12):1465-72. doi:10.1007/s10552-022-01631-5. [DOI:10.1007/s10552-022-01631-5] [PMID] [PMCID]
10. Leeman J, Moore A, Teal R, Barrett N, Leighton A, Steckler A. Promoting community practitioners' use of evidence-based approaches to increase breast cancer screening. Public Health Nurs. 2013;30(4):323-31. doi: 10.1111/phn.12021. [DOI:10.1111/phn.12021] [PMID]
11. Hatefnia E, Niknami Sh. Survey of Factors affecting to predict mammography in employed women aged 35 years and older based on the Theory of planned behavior. J Health Syst Res. 2013;9(10):1062-70. (Persian)
12. Farhadifar F, Taymoori P, Bahrami M, Zarea S. The relationship of social support concept and repeat mammography among Iranian women. BMC Women's Health. 2015;15:92. doi:10.1186/s12905-015-0253-7. [DOI:10.1186/s12905-015-0253-7] [PMID] [PMCID]
13. Roberto A, Colombo C, Candiani G, Giordano L, Mantellini P, Paci E, et al. Personalized informed choice on evidence and controversy on mammography screening: study protocol for a randomized controlled trial. BMC Cancer. 2017;17(1):429. doi:10.1186/s12885-017-3428-9. [DOI:10.1186/s12885-017-3428-9] [PMID] [PMCID]
14. Calderón-Garcidueñas AL, Flores-Peña Y, De León-Leal S, Vázquez-Martínez CA, Farías-Calderón AG, Melo-Santiesteban G, et al. An educational strategy for improving knowledge about breast and cervical cancer prevention among Mexican middle school students. Prev Med Rep. 2015;2:250-4. doi: 10.1016/j.pmedr.2015.02.006. [DOI:10.1016/j.pmedr.2015.02.006] [PMID] [PMCID]
15. Mazarei M, Abedini S, Montaseri M. Knowledge and Behavior Among Women Referring to Health Care Institutions Screening for Breast Cancer in the South of Iran. 2020;9(1):1-6. doi:10.34172/iejm.2020.01 [DOI:10.34172/iejm.2020.01]
16. Davis TC, Rademaker A, Bennett CL, Wolf MS, Carias E, Reynolds C, et al. Improving mammography screening among the medically underserved. J Gen Intern Med. 2014;29(4):628-35. doi:10.1007/s11606-013-2743-3. [DOI:10.1007/s11606-013-2743-3] [PMID] [PMCID]
17. Mirzaei-Alavijeh M, Hidarnia A, Kok G, Niknami Sh, Motlagh MI. The 'My Family-Study' onset substance use prevention program in early childhood: an introduction. Arvand J Health Med Sci 2016;1(3):188-190. (Persian) [DOI:10.22631/ajhms.2016.43197]
18. Momayyezi M, Fallahzadeh H. Construction and Validation of Breast Cancer Awareness Scale in Iranian Women. J Caring Sci. 2020;9(3):140-7. doi: 10.34172/jcs. 2020.021. [DOI:10.34172/jcs.2020.021] [PMID] [PMCID]
19. Roald T, Køppe S, Bechmann Jensen T, Moeskjær Hansen J, Levin K. Why do we always generalize in qualitative research? Qualitative Psychology. 2021;8(1):69-81. doi:10.1037/qup0000138 [DOI:10.1037/qup0000138]
20. Tomaszewski LE, Zarestky J, Gonzalez E. Planning qualitative research: Design and decision making for new researchers. International journal of qualitative methods. 2020;19:1609406920967174. doi.org/10.1177/1609406920967174 [DOI:10.1177/1609406920967174]
21. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse education today. 2004;24(2):105-12. doi.org/10.1016/j.nedt.2003.10.001 [DOI:10.1016/j.nedt.2003.10.001] [PMID]
22. Rastad Z, Kaboudi M, Shiri N. Breast cancer awareness's and attitude among regular health-care users versus irregular in a sample of Kurdish women in the West of Iran. J Educ Health Promot. 2021;10:316. doi: 10.4103/jehp.jehp_1023_20. [DOI:10.4103/jehp.jehp_1023_20]
23. Fayanju OM, Kraenzle S, Drake BF, Oka M, Goodman MS. Perceived barriers to mammography among underserved women in a Breast Health Center Outreach Program. The American Journal of Surgery. 2014;208(3):425-34. doi:10.1016/j.amjsurg.2014.03.005 [DOI:10.1016/j.amjsurg.2014.03.005] [PMID] [PMCID]
24. Hayati F, Jahani S, Mousavi P, Haghighizade MH. Association between personal characteristics and health beliefs with pre-mammography anxiety in women referred to mammography centers. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2017;20(2):31-40. doi:10.22038/ijogi. 2017.8712
25. Tavafian SS, Hasani L, Aghamolaei T, Zare S, Gregory D. Prediction of breast self-examination in a sample of Iranian women: an application of the Health Belief Model. BMC Women's Health. 2009;9:37. doi: 10.1186/1472-6874-9-37 [DOI:10.1186/1472-6874-9-37] [PMID] [PMCID]
26. Ossai EN, Azuogu BN, Ogaranya IO, Ogenyi AI, Enemor DO, Nwafor MA. Predictors of Practice of Breast Self-examination: A Study among Female Undergraduates of Ebonyi State University, Abakaliki, Nigeria. Nigerian Journal of Clinical Practice. 2019;22(3):361-9. doi: 10.4103/njcp.njcp_482_18 [DOI:10.4103/njcp.njcp_482_18] [PMID]
27. Shadabi N, Saeieh SE, Qorbani M, Babaheidari TB, Mahmoodi Z. The relationship of supportive roles with mental health and satisfaction with life in female household heads in Karaj, Iran: a structural equations model. BMC Public Health. 2021;21(1):1643. doi:10.1186/s12889-021-11656-1. [DOI:10.1186/s12889-021-11656-1] [PMID] [PMCID]
28. D'Souza MS, Karkada SN, Somayaji G. Factors associated with health-related quality of life among Indian women in mining and agriculture. Health Qual Life Outcomes. 2013;11:9. doi:10.1186/1477-7525-11-9. [DOI:10.1186/1477-7525-11-9] [PMID] [PMCID]
29. Khazaee-Pool M, Montazeri A, Majlessi F, et al. Breast cancer-preventive behaviors: exploring Iranian women's experiences. BMC Women's Health. 2014;14(41):1-9. doi.org/10.1186/1472-6874-14-41 [DOI:10.1186/1472-6874-14-41] [PMID] [PMCID]
30. Moghaddam Tabrizi F, Vahdati S, Khanahmadi S, Barjasteh S. Determinants of Breast Cancer Screening by Mammography in Women Referred to Health Centers of Urmia, Iran. Asian Pac J Cancer Prev. 2018;19(4):997-1003. doi: 10.22034/APJCP.2018.19.4.997.
31. Taymoori P, Berry T, Farhadifar F. Predicting mammography stage of adoption among Iranian women. Journal of education and health promotion. 2012;1(1):13. doi:10.4103/2277-9531.98571 [DOI:10.4103/2277-9531.98571] [PMID] [PMCID]
32. Noroozi A, Jomand T, Tahmasebi R. Determinants of Breast Self-Examination Performance Among Iranian Women: An Application of the Health Belief Model. J Canc Educ. 2011;26: 365-74. doi:10.1007/s13187-010-0158-y [DOI:10.1007/s13187-010-0158-y] [PMID]
33. Saravani K, Saravani S, Dadras F. Investigating attitudinal barriers to breast cancer mammography screening among women in Zabol city. Cellular, Molecular and Biomedical Reports. 2021;1(4):158-67. doi:10.55705/cmbr.2021.411556.1167 [DOI:10.55705/cmbr.2021.411556.1167]
34. Montazeri A, Vahdaninia M, Harirchi I, Harirchi AM, Sajadian A, Khaleghi F, et al. Breast cancer in Iran: need for greater women awareness of warning signs and effective screening methods. Asia Pac Fam Med. 2008;7(1):6. doi: 10.1186/1447-056X-7-6. [DOI:10.1186/1447-056X-7-6] [PMID] [PMCID]
35. Noori S, Schouten BC. Perceptions of Iranian women regarding breast cancer screening behaviour. East Mediterr Health J. 2019;24(12):1165-71. doi: 10.26719/emhj.18.018. [DOI:10.26719/emhj.18.018] [PMID]
36. Hayati F, Rouhandeh R. Evaluation of the demographic factors and health beliefs associated with screening mammography in the female employees aged 35 years and more in the schools of medical sciences in Abadan, Iran. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2018;21(1):52-9. doi:10.22038/ijogi. 2018.10582
37. Meshkini A, Ebrahimi M. Investigating Access Status to Healthcare Centers with the Spatial Justice Approach (A Case Study: District 7 of Tehran). Journal of Management Strategies in Health System. 2018;3(1):5-16. (Persian)
38. Reshadat S, Zangeneh A, Saeidi S. Teimouri R, Yigitcanlar T. Measures of spatial accessibility to health centers: investigating urban and rural disparities in Kermanshah, Iran. Journal of Public Health: From Theory to Practice. 2019;27:519-29. doi.org/10.1007/s10389-018-0966-9 [DOI:10.1007/s10389-018-0966-9]
39. Abouie A, Majdzadeh R, Khabiri R, Hamedi-Shahraki S, Emami Razavi SH, Yekaninejad MS. Socioeconomic inequities in health services' utilization following the Health Transformation Plan initiative in Iran. Health Policy Plan. 2018;33(10):1065-72. doi: 10.1093/heapol/czy096. [DOI:10.1093/heapol/czy096] [PMID]
40. Yao J, Murray AT, Agadjanian V, Hayford SR. Geographic influences on sexual and reproductive health service utilization in rural Mozambique. Applied Geography. 2012;32(2):601-7. doi:10.1016/j.apgeog.2011.07.009 [DOI:10.1016/j.apgeog.2011.07.009] [PMID] [PMCID]
41. Jabbari A, Najafpour Z, Ourang S, Loveimi S, Bohrani R, Baymani M. Implementation and performance barriers in Iran's breast cancer screening program: a qualitative case study. Front Public Health. 2025;13:1490191. doi: 10.3389/fpubh.2025.1490191. [DOI:10.3389/fpubh.2025.1490191] [PMID] [PMCID]
42. Smith M, Hammond I, Saville M. Lessons from the renewal of the National Cervical Screening Program in Australia. Public Health Res Pract. 2019;29(2):2921914. doi: 10.17061/phrp2921914. [DOI:10.17061/phrp2921914] [PMID]
43. Özkan İ, Taylan S. Barriers to women's breast cancer screening behaviors in several countries: A meta-synthesis study. Health Care Women Int. 2021;42(7-9):1013-43. doi:10.1080/07399332.2020.1814777. [DOI:10.1080/07399332.2020.1814777] [PMID]
44. Lamyian M, Heidarnia A, Ahmadi F, Faghihzadeh S, AguilarVafaie M. Women's prospect of breast cancer early detection behavior: a qualitative research. Journal of Birjand University of Medical Sciences 2008;15(3):88-102. (Persian)
45. Doshmangir L, Bazyar M, Rashidian A, Gordeev VS. Iran health insurance system in transition: equity concerns and steps to achieve universal health coverage. Int J Equity Health. 2021;20(1):37. doi: 10.1186/s12939-020-01372-4. [DOI:10.1186/s12939-020-01372-4] [PMID] [PMCID]
46. Jaafaripooyan E, Emamgholipour S, Raei B. Efficiency measurement of health care organizations: What models are used? Med J Islam Repub Iran. 2017;31:86. doi: 10.14196/mjiri.31.86. [DOI:10.14196/mjiri.31.86] [PMID] [PMCID]
47. Moghadam MN, Sadeghi V, Parva S. Weaknesses and challenges of primary healthcare system in Iran: a review. The International journal of health planning and management. 2012;27(2):e121-31. doi:10.1002/hpm. 1105 [DOI:10.1002/hpm.1105] [PMID]
48. Hemmat M, Ayatollahi H, Maleki M, Saghafi F. Health information technologies in Iran: Opportunities for development. Med J Islam Repub Iran. 2019;33:103. doi: 10.34171/mjiri.33.103. [DOI:10.47176/mjiri.33.103] [PMID] [PMCID]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
