barriers of breast cancer screening programs among PHHC female physicians

While breast cancer is a serious health problem to countries as well, breast cancer screening remains underutilized because of many barriers such as costs, pain due to mammogram procedures, lack of knowledge about the benefits of early screening, and many other barriers such as cultural or social factors. But fighting breast cancer means educating women on the importance of early breast screening and detection for prevention as well as for management. In order to educate the general population on the benefits of breast cancer, the present study was done to identify and describe barriers to early detection of breast cancer. This is a survey of 75 female PHC physicians who responded out of the total 79 available female physicians in 43 Primary Health Centers in Al Khobar, Al Dammam, and Al Qatif, Saudi Arabia in 2004 regarding the barriers in implementing of breast cancer screening programs using a specially designed questionnaire which divided into two parts [demographic data, and items regarding barriers in implementing breast cancer screening programs]. Most of the female physicians were Saudi [65%] with mean age of 35.93 +/- 7.23 in years from PHHCs in Al Khobar, Al Dammam, and Al Qatif. The average mean duration of work as physician is 8.82 years and the average duration of work a PHC physician is 8.2 years. 95% of physicians in the study did not undergo post graduate training as compared to literature. The 2 physicians [5%] in the study did not have graduate degrees in family and community medicine but had master's degree in pediatrics [3], obstetrics [1], and gynecology [1]. The physicians reported the different barriers which have prevented them from practicing screening programs in PHHCs with the main barrier given as: there was no national screening program [56 physicians], time pressure [55 physicians], physician's lack of training [48 physicians], lack of good communication between physician and patients [46 physicians], there were not enough facilities in the PHHCs [42 physicians], lack of women cooperation and trust [33 physicians], walk-in clinic [4 physicians], and social and cultural reasons [4 physicians]. Costs and unavailability of mammography are the main barriers in other countries including the United States of America. Such is not the case in Saudi Arabia since mammography is usually given free to Saudi citizens or is part of the patient's insurance coverage. It was found out that physicians who thought that BC screening is important tended to advice patients to undergo BC screening. Physicians with low scores in BC epidemiology in Saudi Arabia claimed Saudi women are not at risk of BC [p = 0.04]. The main barrier of the BC screening program which may be instituted by PHCs female physicians was unavailability of a national screening program. Other barriers include time pressure, lack of training on the part of the physician, lack of good communication, there were not enough facilities in the PHHCs, lack of women cooperation and trust, walk-in clinic, and social and cultural reasons. Development and institutionalization of breast cancer screening program, massive educational program on breast cancer using multi-media tools and strategies, training and intervention program for PHC physicians on breast cancer including screening and early detection, and inclusion of breast cancer education on the medical curriculum are some of the recommendations arising from the study's results

effects of breast cancer early detection training program on the knowledge, attitudes, and practice of female PHHC physicians [Eastern Province; 2004]

It has been shown by many studies that early detection and management of breast cancer had decreased mortality and morbidity from the disease. Several studies showed that physicians' ordering of screening depended on: levels of confidence and comfort, and knowledge of breast screening guidelines, 11 their colleague's mammography practices, the adequacy of insurance coverage, and how often they had spent an unreasonable time explaining mammography results, 12 and beliefs of physicians.1 The present study studied the effects of breast cancer early detection training program on the knowledge, attitudes, and practice of female PHHC physicians. This is a non-r and omized experimental design with 45 PHCCs' female physicians in Al Khobar, and Al Qatif cities [experimental group] during the period: Oct 2003- Feb 2004 participating. A workshop on knowledge of BC concepts and skills was developed and implemented on the participants. A 3-part structured questionnaire [demographic data, general knowledge, and early detection] based on fundamental knowledge of breast cancer and early detection was used as pre-post test instrument. The knowledge measurement is composed of 65 close-ended items with two choices [agree/disagree]. A 30-item likert type of 5 choices questions were used to assess the attitudes of physicians. The Mamma Care program models were used to assess the ability of the physicians in detecting lumps and evaluating the nature of breast tissues. Another part of the assessment tool was the practice part totaling to 16 points, which assessed the lumps using two breast models with 5 lumps. The cut-off points of Knowledge and Practice are: Poor < 60%, Good 6 1-80%, Excellent > 80%. The cut-off points of attitudes were determined after taking the mean of all the respondents. 65% of the respondents were Saudis, 95% hold bachelor's degree and 5% held master's degree. The mean age was 35.91 years. The mean duration of PHHC practice was 6.065 years, and mean duration of practice is 8.35 years. The findings of the study show that the program improved the PHC physicians' KAP significantly. Before intervention was given, the physicians had good knowledge about breast cancer and early detection [67%], but scored low regarding practice of BC [36%], and just 37% had a positive attitude. The pre and post-test mean scores of female physicians on the study group show a marked significant increase on the indicators of KAP after intervention; for knowledge from 67% to 96% [p < 0.001], attitude from 68% to 78% [p < 0.001], and for examination skills from 33% to 77% [p < 0.001]. Before intervention was given, the physicians had good knowledge about breast cancer and early detection but scored low regarding practice of BC early detection and had a negative attitude of it too, and after the educational program, there were significant positive changes in physicians KAP