Behind the Screen: an exploratory study of factors influencing breast screening uptake in Lancashire (UK)

Abstract

Background: Breast screening uptake has improved nationally to 62% in the UK, though regionally, engagement challenges remain in northern regions such as Lancashire (54-59%). It is important therefore to understand the barriers that women face, to enable appropriate person and community centred engagement in health screening behaviours.

Objectives: This study aimed to be the first mixed-method questionnaire exploration of women in Lancashire (UK) to explore attitudes, behaviour, awareness, barriers, and facilitators to breast screening.

Design: Cross-sectional cohort study.

Method: The Breast Cancer Fear Scale, modified Mammography Self Efficacy Scale and the General Practice Physical Activity Questionnaire were included in the questionnaire alongside open-ended elements on breast screening behaviour and awareness. Registered female participants (n=50) were provided with digital-assistance or language interpretation where requested.

Results: Ethnicity, faith, and location all affected perceived levels of breast screening awareness, yet only age and faith influenced understanding of the process. Irrespective of protected characteristics, fear of breast cancer did not significantly vary between women. Racially minoritised women were less comfortable in removing clothing during screening. Participants reported barriers related to health awareness, patient experience, screening age and access to healthcare. Facilitators to address barriers were identified using a socio-ecological framework to identify key areas of development needed at an individual, interpersonal, organisational, community and public policy level.

Conclusion: Protected characteristics and geographical location significantly influence breast screening behaviour. Targeted person-centred health awareness, cultural competency and inclusive practice is needed to promote awareness, remove taboos, and open-up dialogue and acceptance of breast cancer screening in communities. Use of the socioecological model highlighted that the responsibility to reduce barriers to breast screening in Lancashire is collective from an individual to public policy level. Further patient-public involvement would ensure adequate demographic representation and effectively investigate differences between ethnic subgroups.

Patient or Public Contribution: This article captures the viewpoints of individuals with and without experience of the breast screening process in the UK. A small group of individuals of white and racially minoritised backgrounds were involved in the design of the study to ensure the suitability and acceptability of the tool.