br These findings echo previous
These findings echo previous studies which indicate that women from rural communities with lower levels of educational
attainment and poor literacy who are unable to engage with pub-licity material, show lower levels of attendance,18,27,28
Accessing breast cancer screening services
Women from both focus groups showed a poor knowledge of the MS programme in current use in Kuwait. Only two participants from the focus group 1 and one participant from the focus group 2 knew how to access screening clinics. Being able to access mammography screening services and identifying a suitable time to attend within a busy lifestyle have been cited as a potential barrier to attendance.18 Most participants felt that they if they decided to attend for MS that they would simply attend their local hospital facility. None of the participants were aware that women of eligible age could self-refer to MS, or the exact location of MSS clinics in Kuwait.
“If I decide to go for screening, I will go to the gynaecologist and she Acetylcysteine will give me a request and tell me where to do it” P10 (focus group 1)
Social and professional roles
A busy family, social and/or a professional role were also iden-tified as potential barriers to attending BCS:
“Every day I say tomorrow and then I postpone, I will go, I am planning” P11 (focus group 2)
“I think I am too lazy to go and take an appointment and wait for my turn” P4 (focus group 1)
Similarly, Malhotra, et al.47 found that job circumstances and not considering health promotion and disease prevention as primary activities in their daily lives have negatively affected women's at-titudes towards breast cancer screening. This suggests a need to
offer flexible appointments that would encourage attendance at MS48
Member checking was used to ensure that the transcribed dis-cussions faithfully expressed the opinions and attitudes expressed by participants and thus establish credibility and confirmability.49 Dependability or reproducibility of results has been assured by the detailed documentation of the methodology employed.49 Transferability has been assured by providing contextual knowl-edge so allowing comparison to other studies50
The discussion within the two focus groups has provided a valuable insight into understanding participant's knowledge of breast cancer and their beliefs and attitudes toward mammography screening. A poor knowledge of breast cancer was identified in both focus groups and stamens in part was highlighted as a potential barrier to attending breast cancer screening. In addition, personal factors
such as fear of discovering a malignant tumour, fear of mammog-raphy, fatalism, and negative experiences of family and friends act as barriers to the uptake of breast cancer screening. The research also highlights the role of physicians in encouraging eligible women to self-refer for MS and the importance of developing appropriate marketing campaigns, dispelling myths of breast can-cer screening and encouraging self-referral and attendance.
Conflicts of interest
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Appendix A. Supplementary data
Appendix B. Topic Guide
Questions Prompt Rationale
What do you know about breast cancer? Does anyone have a personal connection with someone Setting the scene What is breast cancer? who has or has had breast cancer? Gaining background on knowledge and awareness
of breast cancer as a disease
Potential for knowledge of breast cancer to