Practice, Perception and Satisfaction Regarding Mammography among Saudi Females

Bandar Salem Mana Alhindi^1*

¹College of Medical Science, University of Bisha, Saudi Arabia.

*Email: [email protected]

ABSTRACT

The leading cause of death for women in developing nations is breast cancer. Mammography is a reliable screening technique for detecting breast cancer in its early stages. To measure Saudi females' satisfaction, perception, and level of practice regarding their mammography experience. Between January 2021 and March 2021, a descriptive cross-sectional study was conducted. Participants' information was gathered using an electronic pre-structured questionnaire. Through the use of social media, it was posted online. Everyone who could participate in the study and was eligible was asked to complete the attached form. Exact of 270 (66.7%) of the females underwent mammography. Generally, 58.1% of the females were highly satisfied regarding their mammography experience, while only 13.7% had a poor satisfaction level. The current study revealed that women’s levels of mammography practice and satisfaction were moderate (more than half were satisfied and about two thirds had underwent mammography). Also, women’s intent to undergo mammography for breast cancer screening was also less than expected due to stress feelings and long distance.

Key words: Practice, Perception, Satisfaction, Mammography, Saudi females

INTRODUCTION

Breast cancer is nearly 25% of all cancers with an average annual incidence of about 1.7 million new cases [1]. The number of newly diagnosed cases of breast cancer is highest in developed nations, with rates ranging from 92 per 100,000 in North America to 27 per 100,000 in Eastern Asia and the Middle of Africa [1]. The leading cause of death for women in developing nations is breast cancer, which is also the fifth leading cause of death for all cancers [2]. Breast cancer is a common malignancy in Saudi Arabian women. According to estimates, 21.8 percent of Saudi females will develop breast cancer [3]. Breast cancer is the ninth-leading cause of death among Saudi women, according to recent studies assessing cancer-related mortality [4-6]. In a study conducted by Al-Qahtani et al., it was discovered that breast cancer is the second most prevalent malignancy in Saudi women [7]. Muhammad et al. However, Ibrahim et al. predict that as the population ages and grows, breast cancer incidence in Saudi Arabia will increase over the coming decades [8].

Regular screening for early breast cancer detection is a highly significant predictor of higher survival rates [9, 10]. Recent studies have confirmed the importance of mammography as a screening tool for early breast cancer detection in asymptomatic women. With reductions of 20% to 35%, it has been the most effective method for reducing disease-related mortality, especially in women 50 years or older [11-14]. On the other hand, these studies revealed that study women practiced mammography at various rates [11]. The national Saudi Health Interview Survey (NSHIS) in 2015 revealed a very low rate of MS utilization as 92 percent of eligible women reported not having a mammogram in the previous year, despite the fact that mammography screening has been established throughout Saudi Arabia since 2005 [15]. The purpose of the current study was to evaluate Saudi females' practice levels, perceptions of the procedure, and levels of satisfaction.

MATERIALS AND METHODS

Between January 2021 and March 2021, a descriptive cross-sectional study was conducted among Saudi women to evaluate practices, perceptions, and female satisfaction regarding mammography. The study survey was distributed to 500 females in total. A total of 405 respondents completed the survey, with an 81 percent response rate. Data collection began after receiving approval from the institutional ethics committee. Participants' information was gathered using an electronic pre-structured questionnaire. Following a thorough literature review and expert consultation, the researchers created the questionnaire. A panel of three experts examined the questionnaire for validity and applicability. The satisfaction and perception section of the pilot study with 15 participants yielded a reliability coefficient (α-Cronbach's) of 0.71. The following information was included in the survey: Age, marital status, employment, education, and family history of breast cancer are examples of sociodemographic information about women. The second section discussed mammography screening practices for women. Nine questions in the third section used a Likert scale with a range of 1-6 points to gauge how satisfied females were with mammography. The last section discussed how women perceive their mammogram experiences. Between January 1 and March 15, 2021, the researchers and their friends uploaded the questionnaire to the internet using social media platforms. Everyone who could participate in the study and was eligible was asked to complete the attached form.

Data analysis

The data was revised, coded, and fed into the statistical software IBM SPSS version 22 after being extracted (SPSS, Inc., Chicago, IL). Use of two-tailed tests was applied to all statistical analysis. P value less than 0.05 was considered statistically significant. The discrete summation of the various items' discrete scores was computed for the satisfaction items. A female with a score of less than 50% of the total score was considered to have poor satisfaction, a score of 50-<75% of the total score was considered fair satisfaction, and a score of 75% of the total score was considered to have high satisfaction. All variables, including demographic information, mammogram screening practice, frequency and challenges faced by women, and satisfaction with the screening experience, were subjected to a descriptive analysis based on frequency and percent distribution. Crosstabulation was used to determine the distribution of females' satisfaction with their mammogram experiences based on their individual and perceptual information. Because the frequencies were so low, relationships were tested using an exact probability test.

RESULTS AND DISCUSSION

405 females participated in the study and answered the questionnaire. The average age of the females, who ranged in age from 40 to 69, was 42.9 ± 12.7 years. A total of 319 women (78.8%) were married, compared to 40 (9%), who were unmarried. In terms of education, 243 (60%) of the female population had a university degree, but 247 (61%) were housewives, and 139 (34.3%) were employed. A total of 151 (37.3%) females with monthly incomes under 5000 Sr and 295 (72.8%) without health insurance. Among 25.9% of females, breast cancer in the family had been reported (Table 1).

Table 1. Bio-demographic data of study females, Alhasa, Saudi Arabia

Table 2 shows reported practice regarding mammography among surveyed females in Alhasa, Saudi Arabia. Exact of 270 (66.7%) of the females underwent mammography. It was for 2 years or less among 50% of those females, while 17.8% had underwent the test more than 5 years ago. Exactly 33.7% of women underwent mammograms once and 23% annually. Regarding the problems of women undergoing mammogram, long distance was reported by 12.2% of women, transportation problems (8.9%), while 68.5% had no problems. Exact of 155 (57.4%) of the females who underwent mammography were stressed before doing the test.

Table 2. Reported practice regarding mammography among females in Alhasa, Saudi Arabia

Table 3 illustrates satisfaction among study females regarding mammography Experience in Alhasa, Saudi Arabia. The highest satisfaction score was for the fact that privacy was maintained during the examination (4.76 out of 6), followed by satisfaction level regarding the test result report (4.62 out of 6), radiology technician co-operation (4.60 out of 6), and security cooperation (4.59), while the least satisfaction was for the feeling of stress caused by the tool (3.74 out of 6). Totally, the females mean satisfaction score was 39.1 out of 54 (72.4%). Generally, 58.1% of the females were highly satisfied regarding their mammography experience, while only 13.7% had a poor satisfaction level (Figure 1).

Table 3. Satisfaction among study females regarding mammography Experience, Alhasa, Saudi Arabia

Table 4 reveals females’ perception and decision regarding mammography experience. On asking about “What bothered you the most during the examination”, 165 (61.1%) females said “nothing”, while 11.9% talked about pain sensation due to the procedure, 11.5% talked about pressure on their breast, 9.6% reported fear of the process, and 1.5% were shy due to being bared.

Table 4. Females’ perception and decision regarding mammography experience

Table 5 reveals the distribution of females’ satisfaction regarding mammography experience by their personal and perception data. In the married female group, 63.7 percent reported high satisfaction, compared to 46.7 percent of the single group, with statistical significance (P=.003). Additionally, 68.7% of females with private insurance reported high levels of satisfaction compared to 53.5% of those without insurance (P=.019). Exact of 62% of females who intended to undergo the experience again were highly satisfied compared to 46.4% of those who will not (P=.049). All other factors were insignificantly related to the satisfaction level of female.

Table 5. Distribution of females’ satisfaction regarding mammography experience by their personal and perception data

P: Exact probability test

* P < 0.05 (significant)

The current study aimed to evaluate satisfaction with mammography experience among Saudi females in Al-Asha city. Also, to detect the impact of their experience in seeking mammogram examination again. The concept of patient satisfaction is a personal and individualized one. The term "satisfaction" refers to a patient's positive assessment of the medical care they receive, and it implies that this assessment is influenced by how well the service meets the patients' expectations [16]. In breast screening, the issue of patient satisfaction is particularly important because women who appear to be in good health and who are not motivated by illness are invited to the examination [17, 18]. According to Marshall et al., half of females who skip subsequent mammography screening exams cite their first visit experience as the primary deterrent [19, 20]. Pain and discomfort were the main reasons for not going. Although stress and embarrassment were also linked to absences, they paled in significance next to pain. Women's decisions to return to the center are thus influenced by their memories of their prior experiences there. Therefore, satisfaction is a sign of later compliance [21].

More than two-thirds of the study's female participants had previously underwent mammography screening, with half having done so within the previous two years, according to the current research. Also, one third of the females underwent mammography screening irregularly, but one fifth did it annually. The main reported difficulties were related to distance and transportation to the screening setting, and stress was reported by more than half of the females. In contrast to the findings of Qin et al. who found that 14.3 percent of females had ever had a mammogram, this estimated practice for mammography screening was much higher [22]. Women aged 35 to 39 years old had the highest prevalence of mammography use (31 percent). According to a second survey of Arab Americans, about 58 percent said they had a mammogram every one to two years, and 70 percent had one at some point [23]. The percentage of women between the ages of 40 and 75 who had a mammogram in Saudi Arabia was 4.9%, compared to 8.9% in Oman, 13.9% in the UAE, and 14.6% in Kuwait [24]. Marital status, wealth, education, nationality, and place of residence are all related to screening uptake, with the unmarried, poor, and those with lower levels of education having the lowest uptake rates [25].

Considering mammography experience satisfaction among the study females, it was clear that more than half of the females were highly satisfied regarding their experience while only 13% had poor satisfaction. The highest satisfaction areas were for setting privacy, reporting provisions, and manpower cooperation, including security and radiologist attitude. The main factors that bothered females during their examination were pain due to the screening procedure and fear. Regardless of their pain and due to their high satisfaction, more than 80% of the females showed their intention to repeat the experience again. Satisfaction was higher among married females than in the single group, which makes sense given that married females may have undergone the procedures multiple times and are aware of the expected difficulties and procedure sequence. Also, females who had insurance in the private sectors showed higher satisfaction, mostly due to the high quality of provided services, less waiting time, more privacy, and more staff cooperation. As for the intention to repeat the experience, the more satisfied group showed a higher intention to do it again. In order to gauge patient satisfaction with the King Abdulaziz Medical City's breast cancer screening program, Wali et al. conducted a study in Jeddah [26]. Prior to mammography, the majority of patients (80.9%) expressed satisfaction with their appointment wait times; however, they felt anxious while they waited (51 percent). Most patients felt at ease in the examination room's physical surroundings during mammography (weighted mean 4.19), which included undressing there (weighted mean 4.16). Patients were generally happy with their mammography experiences. Numerous studies also showed that a variety of factors, such as pain during or following the procedure, embarrassment, discomfort, fear, and inconvenience, can affect women's readiness to participate in breast cancer screenings [27, 28]. A deeper comprehension of these elements might aid in the creation of tactics to motivate women to take part in breast cancer screenings. Therefore, ongoing assessments of patient satisfaction are required to guarantee the provision of high standards of care and enable adjustments that better meet patient needs [29].

CONCLUSION

The current study concluded that women had a moderate level of mammography practice and satisfaction (more than half were satisfied and about two thirds underwent mammography). Also, women intent to undergo mammography for breast cancer screening was also less than expected due to stress feeling and the long distance. Improved women's knowledge, attitudes, and screening mammography practices are crucial for the successful fight against breast cancer. This includes encouraging behaviour changes in women and health professionals, particularly those who provide care to the underprivileged.

ACKNOWLEDGMENTS : None

CONFLICT OF INTEREST : None

FINANCIAL SUPPORT : None

ETHICS STATEMENT : Permission to conduct the study was obtained from the Research Ethics Committee of the Directorate of Health Affairs, Najran, Saudi Arabia.