Barriers to and facilitators for breast cancer screening among Lebanese women

Background: In Lebanon, breast cancer (BC) is the most common cancer among females. Previous studies around the world have shown that early detection through screening can reduce BC mortality and increases the treatment choices. Aim: This thesis explores barriers and facilitators to Lebanese women’s participation in BC screening services. Methods: This aim was achieved by using a mix of qualitative and quantitative methods. A knowledge, attitudes and practices survey was administered with 231 Lebanese women and 17 focus groups discussions were facilitated with 163 women living in eight governorates across Lebanon. 12 interviews were also conducted with key informants, in addition to six women survivors of BC. The health belief model was utilized to structure, guide and explain the thesis findings and analysis. Results: From the different methods used, I obtained some reliable findings regarding Lebanese women’s perceptions, knowledge and beliefs of the barriers and facilitators in accessing BC screening services. Barriers to BC screening include family, knowledge and awareness, perceived susceptibility, healthcare system and experience, self-efficacy, psychological, social, cultural, economic, geographical, as well as religious and fear related factors. Facilitators to screening were related to family, self-motivation and practices, awareness campaigns and knowledge about BC, physicians and healthcare professionals, as well as economic, religious and social factors. Residing in urban areas and being employed, educated or insured influences also women’s participation in BC. Conclusion: There are multiple intertwined factors and identified barriers that simultaneously influence Lebanese women’s decision making process to seek screening. A woman would weigh the different factors, fears and expected outcomes, rather than each element separately. Even when the levels of “ever conducting a mammography test” were relatively high in certain occasions this behavior is not maintained but rather conducted intermittently or on one single occasion in a lifetime. Religion, age, geographical locations and health coverage also play a significant role in influencing women’s decision towards screening. Recommendations: In order to increase women’s participation in BC screening, tackle the identified barriers and capitalize on the facilitators, policies, campaigns and programs can work towards tailoring awareness raising campaigns and adopting more personalized communication and messaging with women, increasing engagement of family members and community-based organizations, placing more attention on women in rural areas, providing psycho-social support for patients and women seeking screening, working on prevention in addition to early detection, encouraging breast self-examination and improving the comfort of mammography experience.