Given the diverse beliefs uncovered in other countries and the limited studies in Ghana, our current study aims to evaluate perceptions, beliefs and attitudes towards mammography screening among mothers in Ghana.

The study employed exploratory descriptive qualitative research design21 to gain deeper insights into complex phenomena like mammography screening with limited prior knowledge. Qualitative research, as described by Bhandari,22 uncovers thought trends and opinions while delving into the issue. The exploratory descriptive design offers broad insights into specific phenomena.23 This design was chosen to explore the beliefs and attitudes towards mammography screening in Ghana. Participants were purposively sampled, and individual indepth interviews were conducted using a semistructured interview guide to understand the beliefs and attitudes towards mammography screening in Ghana.

The study focused on mothers from Teshie, a diverse community in Accra with approximately 171 875 residents. Until 2010, Teshie lacked a local clinic, and medical services were provided by private doctors’ surgeries.24 In response, the citizens of Teshie organised fundraising efforts and coordinated workers to build a local clinic, which was completed in October 2008 and officially inaugurated in December 2010.24 25 The clinic operates under the management of the Ghana Health Service. Historically, Teshie was the largest fishing town along the Ga coast, boasting three beautiful fishing beaches and hundreds of canoes, employing many men and women in the fish trade. The town is home to approximately 29 large inland villages.26

Participants included women aged 18 and older who are mothers and who communicated in English, as the researchers did not speak Ga. Those unable or unwilling to participate were excluded. The sample consisted of 30 mothers selected via convenience sampling from the community clinic, homes and streets. 20 were recruited from the clinic, six from their homes and four from the streets. The final sample size was determined by data saturation, evidenced by repeated themes in beliefs and attitudes. Initially, 45 women were approached; 10 declined to participate, and an additional five opted out after learning the study details and that interviews would be recorded.26

The study employed a semistructured interview guide in English, comprising three sections. The first section gathered sociodemographic data, the second section posed open-ended questions about beliefs and perceptions related to mammography screening, and the third section explored attitudes towards mammography screening. A semistructured interview guide usually consists of main questions with probes.27 Key questions included: ‘What do you think about mammography screening?’, ‘How do you feel about going for mammography screening?’ and ‘What factors influence your decision to undergo screening?’ A pilot study was carried out in a neighbouring community involving four mothers, using the interview guide.

An introductory letter and ethical clearance (approved under the number DHRCIRB/049/03/22, to validate the interview protocol) were presented to the leaders of the Teshie community to gain permission for data collection. Once permission was granted, visits were made to the clinic, community and homes to communicate the study’s objectives, outline the informed consent process, explain the data collection methods and ensure confidentiality and voluntary participation. Participants were informed of their right to withdraw at any time without repercussions, and the study’s inclusion and exclusion criteria were detailed. Each interview lasted between 45 min and 60 min. Data collection spanned 2 months and 2 weeks, from April to June 2022. There were no repeated interviews collected following the data collection.

Data analysis for this study employed a content analysis approach. Initially, the first three authors conducted the analysis, with subsequent review and resolution of any discrepancies by the next three authors. Data analysis involves identifying essential patterns in gathered data, prioritising relevance to the research objectives, especially when dealing with substantial amounts of data.28 Content analysis, on the other hand, entails systematically coding and categorising textual information to explore trends and patterns, including word frequency, relationships and communication structures. In this study, content analysis involved preparing and transcribing collected data verbatim, considering observations and grouping it into themes aligned with the study objectives.29 30 Coding was applied to identify similarities among topics or ideas, which were then organised into subthemes. Data consistency was ensured through careful review and, if necessary, recoding. The study’s findings were presented based on the generated themes, supported by data and quotations corresponding to the developed codes.

Methodological rigour, essential for data trustworthiness and study quality, involves four key qualitative study criteria: credibility, transferability, dependability and confirmability.31 To enhance credibility, the researchers ensured prolonged engagement in the field by collecting data over a span of 10 weeks. The study was also peer-reviewed by experts in the field during preparation for publication. Triangulation was achieved through inter-rater reliability, where the first three authors performed the coding, which was then reviewed by the next three authors and approved by all authors. Additionally, the researchers practised self-reflection throughout the study process. As nurses, we engaged in reflective discussions during meetings to ensure that our biases and personal experiences did not affect the study in any way. Transferability was ensured by providing a detailed description of the study setting, the population, including the sociodemographic characteristics of participants and data collection procedures. Confirmability was maintained by using direct verbatim quotes to support the findings and conducting verbatim transcriptions of the data collected from participants.32 The researchers held peer debriefing sessions to discuss areas of disagreement. Dependability was ensured by accurately reporting participants’ narratives with verbatim quotes, and all authors peer-reviewed the paper and reached consensus prior to submission for publication.

The sociodemographic characteristics of the respondents reveal that the majority were aged 30–39 years (46%) and had secondary-level education (50%). Most were Christians (83.3%) and self-employed (60%), with a significant proportion being married (60%). In terms of family, most respondents had three children (33.3%). Regarding mammography screening, a large majority had not undergone screening (93%), with only 7% reporting having had the procedure. See table 1 for further details.

From the data collected, there are two major themes and 10 subthemes. The major and subthemes are presented in the table 2.

Beliefs and perceptions play a significant role in shaping an individual’s response to various situations. The participants in this study expressed a range of beliefs and perceptions regarding mammography screening. From their interviews, six subthemes emerged, highlighting the diversity of their views on the screening process.

Pain is a significant factor influencing healthcare decisions, as individuals often go to great lengths to avoid discomfort. More than half of the participants in this study expressed concerns about the potential pain associated with mammography screening, even though they had no prior experience with the procedure. Some of their responses included the following:

I am afraid that going for mammography screening will be painful. I heard a machine will be used and looking at how sensitive my breast is with the slightest touch; I think this procedure will cause pain in the breast. P5.

As for me I cannot tolerate any kind of pain. So, I don’t see any reason why I have to put myself through unnecessary pain when there is no urgent need for it. This mammography screening you are talking about I don’t know how it’s done but when I think I have to go through pain before doing it, then I ask myself…is it necessary because I am not ill or anything of that sort. P9.

Some of the study participants believed the procedure will be painful and this will interfere with their husbands handling the breast during intimacy. Below is a participant’s view:

I think getting a mammography screening is painful, and I'm concerned it might affect intimacy with my husband. Therefore, I prefer not to undergo the procedure and avoid unnecessary discomfort. P2.

Fear is a common issue, often arising from uncertainty or situations perceived as inescapable. In mammography screening, the exposure of the breast was a primary cause of fear among two-thirds of participants in this study, leading to concerns about potential embarrassment.

I am shy about showing my breasts to a stranger because I was told that before the screening is done, I have to make sure my breasts are not covered. What if it is someone I know? P17.

I’m a shy person naturally…even at home it is difficult for me to wear any clothing that is revealing too much of my body in any way. When I think about going for a mammography screening and having to expose my breast, I feel uncomfortable and shy doing that. P3.

What makes me hesitant about mammography is the possibility of being attended to by a man. You know, the female breast is something very personal and precious. P10.

Some of the participants also had opposite views on having to expose the breasts during mammography screening. One of these expressions is as follows:

Oh, I don’t see any challenge with having to expose my breasts before the screening is done. It is for the screening and nothing else, I have done it oce and showing my uncovered breasts is not any kind of shame to me. I’m very ok with that…. As mother of 3 kids, I have exposed my breasts several times so there is no embarrassment in this. P22.

An individual’s religious beliefs can impact their adherence to treatment. Therefore, it is crucial not to overlook religious considerations in care provision. This study found that religious beliefs had both positive and negative effects on participants’ willingness to undergo mammography screening, as expressed in the following opinion:

I am worried about this screening because per what I understand, I will go naked up to my waist level before the screening can be done. I am a Muslim and it is an abomination for any other person to see my nakedness in any way except my husband so I will not be able to do it if the one to do the screening for me is a man. P29.

On the other hand, other participants also cited that their religious beliefs will in no way hinder them from conducting a mammography test. These were expressed as below:

My religion teaches me that I must do the needful without breaking my faith when attending to my health, so my Bible will not be against my decision to go for a mammography screening despite the fact that I will have to expose my breasts. P18.

Oh, if revealing my naked breasts to undergo a test for breast cancer will be against my religious beliefs then no woman must allow a male healthcare provider to attend to them when in labour or even in any situation that they have to be indecent. Can you just think about it? It is absurd that any religion will say no to mammography screening. P25.

Some of the study participants explained that their faith made provisions for exceptions. Captured were some expressions:

Though it is against my faith that a man other than my husband sees any private part of my body, the faith also makes provisions for situations like this which is for the purpose of seeking critical care and if not can lead to serious complications or even death and breast cancer is a typical example. P13.

Women worldwide have diverse healthcare-seeking experiences. Although nearly all participants had not personally undergone mammography, they shared stories from friends and relatives who had the procedure. The participants indicated that these accounts heavily influenced their decision-making. Some of their narrations include:

Hmmm, this mammography you are talking about I don’t know what it is and I have I never had one done before in my life. This is actually my first time of hearing about it…I only knew about self-breast examination but my aunty said she did some 2 years ago and it was not painful. P6.

Well, if I say I really know anything about mammography I will be lying because I am not aware that there is a kind of machine-like x-ray that can also take the picture of the breasts too. I wish I will have more education on it because a colleague once shared her experience of how she was at the outcome of the screening. P27.

my friend told me when she went to do the mammography screening, that it was not time consuming. All she had to do was expose her breast while an x-ray is been taken. P21.

Only a few of the participants had some personal stories from their own experience about mammography to tell. Below was one of such a narration:

I have a family history of breast cancer, as my older sister passed away from it. Because of this, I was advised to begin screening when I turned 40. The process was surprisingly quick and painless. P19.

Culture plays a crucial role in shaping the health behaviours of a community, with both positive and negative impacts. In Ghana, cultural beliefs, particularly those surrounding women’s health, have a significant influence on attitudes towards breast cancer screening. Participants in this study shared insights into how these cultural beliefs affect the perception and practice of mammography screening. Some of these views are highlighted below:

Oh, I am not really aware of any cultural beliefs of mine that may cause challenges with screening my breast by mammography. Besides, as time changes, we must also change to suit the tide. As you are all aware breast cancer was not something that was seen in our ethnicity…it was the disease of the western world but now it is no more like that. If mammography is one of the ways, then I think culture should not be an obstacle. P26.

I know culture is not static, it is adjustable in every society hence, if the mammography is good, I think I do not even need the permission from my husband to do it. I will just inform him and whether he agrees or not I will go for it because it is my body!! P30.

Few of the participants also expressed their views on how their cultural beliefs affect their thoughts about mammography. Below is one of these views:

Modesty is very essential in my culture and because of this I will find it uncomfortable to willingly show my naked breast to someone I don’t know. You know, what worries me is that I am very much aware that I’m not sick or something. P18.

Due to limited awareness of how mammography is performed and lack of personal experience with the procedure, participants in this study expressed fear of undergoing mammography. Their primary concern was the potential exposure to radiation during the procedure, as reflected in the following narratives:

I fear about what the radiations from the X-ray will do to me. I have heard that radiations itself can also cause cancer hence it puts me off from thinking about testing with a mammography since it also uses radiation. P23

So, this mammography I have read somewhere that frequent use of it can lead to you getting breast cancer because of this, I doubt if I will ever have trust in believing that it is safe for use. I am scared if I go and do it, it will rather give me breast cancer which I don’t have in the first place. Please just let me be. P14

In the context of mammography screening, study participants expressed diverse attitudes. Four subthemes emerged, including spousal support and approval, negative attitudes, positive attitudes and motivation towards mammography screening.

In marriages, spouses are typically aware of each other’s activities and decisions. Many participants in this study expressed a strong belief in the importance of gaining their partners’ support for mammography screening. As a result, they were willing to inform their husbands about the procedure in order to seek their approval and support.

Oh my husband will be very supportive if I tell him that I am going to have a mammography screening because I want to prevent cancer. When it comes to my health, my husband is very much supportive. P15.

I don't see any problem with going for a mammography screening and informing my husband about it. I just need to explain the reason behind it—to prevent breast cancer—and he will understand. This is not a problem at all. P10.

A few of the study participants indicated that their husbands may not be supportive due to the nature of the procedure. One of these opinions is reported as follows:

My husband won't like it because I have to expose my breast to someone other than him. He is a very jealous man, so he wouldn't be comfortable with it. Unless I go without him knowing, but even then, if he finds out, there will be trouble. P3.

A few of the study participants also revealed they were willing to go for the mammography screening without the spouse’s consent. Captured, were some of the narrations:

I really will not wait for my husband to decide for me when it is about my health. For me, I would go for the screening whether he is in favour of it or not. I heard you have to go for it when you are above 40 years so I’m just waiting. P9.

Negative attitudes significantly influence health-seeking behaviour, potentially contributing to a higher incidence of breast cancer cases. Many participants in this study expressed reluctance to undergo mammography screening or stated they had no intention of doing so, due to various perceptions and misconceptions about breast cancer and the screening process. These concerns were reflected in their statements, as shown below:

I am not comfortable about going to have a mammography done because I believe I don’t have any breast cancer, and there is no need to start looking for one. P14.

You know, sometimes it is just better not to know. I understand that having the mammography doesn't guarantee that I won't have cancer. It’s probably best not to find out at all, especially since there’s no cure. P28

A few of the participants also believed they were not of the required age for mammography screening. This was captured as follows:

I would like to do it but not now, I think I am too young because I learnt from somewhere that it is best you do the screening when you are 40 years and above if you don’t have any relative who has had it before. I am 32 years now so I have a few years to come before I do it. N30.

Just as negative attitudes can hinder health outcomes, positive attitudes serve as a strong motivator for healthy behaviour. A positive attitude towards mammography screening can help reduce breast cancer cases in the long term. Some participants in this study expressed their willingness to undergo mammography screening as a protective measure against breast cancer. The study participants shared the following views:

I will want to get a mammography screening because it is a preventive measure against breast cancer. From now, I wish to at least have a yearly breast self exam so that If there are any signs of cancer, I can quickly go for that before it is too late. P13.

Some study participants were willing to make use of any free mammography screening available and to also inform friends and relatives about it. This was expressed as follows:

After today, whenever I hear that there is a free mammography screening going on, I will make sure that I grab that opportunity to have my breast checked. I would also make sure that my sisters and friends also make use of the chance. P5.

Motivation is a key factor in shaping and maintaining individuals' health-related decisions. In this study, participants shared various motivations that influenced their willingness to undergo mammography screening, as demonstrated in their statements:

I will go for the screening because, What I saw my elder sister go through has put so much fear in me now, especially since I now understand because she had breast cancer there is a likelihood, I would also get it. I don’t want to go through all that pain she went through then die like she did. P30.

Some of them cited fear of dying as a motivation. One of these views is expressed below;

I don’t want to die and leave my children…they are young. What will happen to them if I don’t take care of myself and I die. I would make good use of any opportunity that will prolong my life with them and if mammography will also serve this purpose, then I would make use of it. P1.

Some of the participants also mentioned the fear of losing their breasts was a motivation to them. One of these narrations is captured as below:

I want my breast to always be with me because as a woman, my breast defines me physically…I can’t imagine how I would look without my breast. So I had no choice than to do this screening when I turned 48 years. P12.

The aim of this study was to investigate the beliefs and attitudes of community women towards mammography screening. A large proportion of study participants (93%) had not undergone mammography screening, with only a minority (7%) having prior experience. This outcome was expected, given that most participants were in their thirties, an age group not commonly advised for routine mammography screening. However, raising awareness among these women can help prepare them and enhance their willingness to undergo screening when recommended for early detection of abnormalities.

With regards to the beliefs on mammography, participants in the study conveyed concerns about potential pain associated with mammography screening, which contributed to their reluctance to undergo the procedure. This indicates a lack of awareness regarding the non-invasive nature of the screening method. Therefore, it is imperative for healthcare providers, media outlets, religious leaders and policymakers to devise strategies to enhance awareness about mammography screening, dispel misconceptions and promote adherence to recommended practices. A prior study revealed that a considerable proportion of participants (67%) anticipated experiencing pain during the procedure, with nearly half (47.8%) reporting discomfort during the actual screening process.33

The study also highlighted a prevalent fear of embarrassment among participants regarding mammography screening. Many expressed discomfort with the idea of exposing their bare breasts to unfamiliar individuals, particularly when the examiner was of the opposite sex, despite acknowledging the procedure’s health benefits. This reluctance stems from a natural inclination to feel embarrassed about such exposure, as many women find it uncomfortable. However, through increased health promotion efforts addressing this issue, participants’ willingness to adhere to recommended screening practices when necessary is expected to improve. Additionally, some participants cited discomfort with the manner in which the procedure was conducted, especially when a male examiner was involved.34

The study found that participants did not consider potential religious barriers as major obstacles to undergoing mammography screening, despite the necessity of breast exposure during the procedure. They recognised that while their religion discouraged immodesty, it also supported health-related actions, which were consistent with the screening process. Consequently, these participants were more inclined to follow screening recommendations. It highlights the importance of addressing religious and cultural influences in health promotion efforts to cultivate appropriate attitudes and behaviours. Additionally, a separate study revealed that participants regarded caring for their bodies as a religious duty, emphasising their dedication to self-care and their religion’s encouragement of health-promoting behaviours.35

Many participants stated that their cultural beliefs do not affect their screening decisions, as they perceive their culture as supportive of health-beneficial procedures. Cultural beliefs that align with evidence-based medicine and prioritise societal well-being should be promoted. In contrast, cultural beliefs were considered a barrier to mammography screening in a study, where a belief that men are the ultimate decision-makers negatively impacted the participants’ screening habits, preventing them from making independent health-related decisions in the Arabic society.36

With regards to the attitude towards mammography screening, the study revealed strong spousal support for mammography screening, with husbands valuing their wives’ health and endorsing preventive measures, including mammography. Participants prioritised well-being, and husbands’ acceptance of breast exposure during the procedure reflected genuine concern for their wives’ health. This supportive attitude is likely to enhance mammography participation, as participants are reassured by their husbands’ shared concern. A previous study noted partners discussing and sometimes accompanying women to their screenings.37

Although participants in this study had mixed attitudes towards mammography screening, many were motivated to undergo the screening due to fears of breast cancer. For over half of the participants, concerns included the premature death of people they knew, the potential for complications such as breast loss and the emotional impact of dying from cancer and leaving their children behind. This fear serves as a potent driver, encouraging participants to take preventive actions like having a mammogram to avert avoidable deaths. Emphasising this positive motivator is crucial. Additionally, mothers, as identified in a study, viewed their caregiving roles as a contributing factor motivating them to undergo screening, driven by the desire to maintain good health for their families.38

The study’s relatively small sample size of 30 mothers may not fully represent the diverse beliefs and attitudes toward mammography within the entire population of mothers in Ghana, limiting the generalisability of the findings. Since the study focused exclusively on mothers at Teshie Community Clinic in Ghana, the findings may not be directly applicable to other regions or cultural contexts, potentially limiting the broader relevance of the results.

Consent obtained directly from patient(s).

This study involves human participants and was ethical clearance was secured from the Dodowa Health Research Centre Institutional Review Board (DHRCIRB) under protocol number DHRCIRB/049/03/22 prior to data collection. Additionally, permission was obtained from the Medical Director of Kole-Bu Teaching Hospital, referencing the clearance letter and that of the school. Participants gave informed consent to participate in the study before taking part.