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  • br Methods A pragmatic qualitative methodology was used whic


    Methods: A pragmatic qualitative methodology was used which included the use of two focus groups conducted at two women only social organisations in Kuwait with a total of 23 women. One focus group was conducted at a social and cultural organisation; the second focus group took place at a social organisation whose primary role is the improvement of literacy though the use of religious scripture. Thematic analysis was applied to the recorded verbal transcripts from each focus group.
    Results: Thematic analysis revealed four major themes, accompanied by a series of subthemes (1) knowledge and awareness of BC health, (2) knowledge of MS (3) personal factors, (4) medical provision and social environment.
    Conclusion: Findings suggest that participant's knowledge of BC and the decision to attend MS is influenced by a series of factors both personal and external. An increase in the awareness of BC, MS and the process of accessing MSS will enhance the uptake of MS among Kuwaiti women. Furthermore, doctors and health care providers will need to play a significant role in encouraging women to self-refer.
    © 2018 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.
    Breast cancer (BC) is the most common cancer affecting women, with some 508,000 women dying of breast cancer per year, worldwide.1 In Kuwait, the incidence of BC is 38.3% of newly-discovered cancer cases, with a mortality rate of 27.3%.2e4 Mammography screening of an eligible Quizartinib (AC220) forms part of an early detection system for BC in asymptomatic women.5,6 MS programmes have been established in many countries, with the United Kingdom (UK) being the first country to offer mammog-raphy screening for asymptomatic women of eligible age.7 A similar MSS based on mammography of an eligible population was estab-lished in Kuwait in 2014, providing part of an early detection op-portunity for women aged forty years plus.8 However, the uptake of
    * Corresponding author.
    E-mail address: [email protected] (A. Marzouq Muhanna). 
    Literature review
    A literature search was conducted using CINAHL, Medline/ PubMed, and Google Scholar to include material published in En-glish between 2000 and 2017. The search terms used included screening/breast/cancer/carcinoma/barriers/and mammography (and derivatives of mammography). A total of thirty articles were identified which detailed factors influencing the uptake of screening mammography.
    Previous research has attempted to explore barriers which may exist to prevent women from taking up breast screening opportu-nities and suggests that ethnic background, cultural influences, religion, individual psychology, physician recommendations, sup-port mechanisms and knowledge of breast cancer and the breast cancer screening process may act as potential barriers.12e18 The previous experience of family members and friend appears to have a significant effect on the decision to attend screening mammography.18 Storytelling and hearsay evidence of the pain and
    discomfort of screening mammography is identified as a significant negative barrier.18e25 Associated with religious beliefs and differing cultural norms, the
    act of another person handling an intimate body area also poses a potential significant barrier to uptake.18,19,26 Further, the act of undressing and exposure to a stranger, breaching codes of modesty
    may also act as a potential deterrent for particular communities.13e15,21,26,27 The cultural structure of preventative
    mammography screening may require cultural adaptation to meet the needs of cultural health systems based on symptomatic treatment.26 Many countries, including those with recently developed
    screening mammography rely on women to self-refer for mammography screening.27,28 Such self-referral is often chal-