Factors associated with ever use of mammography in a limited resource setting. A mixed methods study

Objective: To evaluate facilitators and barriers influencing mammography screening participation among women. Design: Mixed methods study. Setting: Three hospital catchment areas in Hidalgo, Mexico. Participants: Four hundred and fifty-five women aged 40-69 years. Intervention: Three hundred and eighty women completed a survey about knowledge, beliefs and perceptions about breast cancer screening, and 75 women participated in semi-structured, in-person interviews. Survey data were analyzed using logistic regression; semi-structured interviews were transcribed and analyzed using elements of the grounded theory method. Main Outcome Measure: Women were categorized as never having had mammography or having had at least one mammogram in the past. Results: From survey data, having had a Pap in the past year was associated with ever having had breast screening (odds ratio = 2.15; 95% confidence interval 1.30-3.54). Compared with neverscreened women, ever-screened women had better knowledge of Mexican recommendations for the frequency of mammography screening (49.5% vs 31.7% P < 0.001). A higher percentage of never-screened women perceived that a mammography was a painful procedure (44.5% vs 33.8%; P < 0.001) and feared receiving bad news (38.4% vs 22.2%; P < 0.001) compared with ever-screened women. Women who participated in semi-structured, in-person interviews expressed a lack of knowledge about Mexican standard mammographic screening recommendations for age for starting mammography and its recommended frequency. Women insured under the 'Opportunities' health insurance program said that they are referred to receive Pap tests and mammography. Conclusions: Local strategies to reduce mammogram-related pain and fear of bad news should work in tandem with national programs to increase access to screening.