Migrant and Refugee Women’s Relationships with Breast Cancer Screening Technology in Türkiye: A Qualitative Study of Opportunities and Challenges

Migrant and Refugee Women’s Relationships with Breast Cancer Screening Technology in Türkiye: A Qualitative Study of Opportunities and Challenges | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Migrant and Refugee Women’s Relationships with Breast Cancer Screening Technology in Türkiye: A Qualitative Study of Opportunities and Challenges Selma Hedlund, Helen Lindsay, Maha Ahmed, Sevil Hakimi, Dana Albeik, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7723045/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Cancer screening disparities are well documented among refugee and migrant populations in many parts of the world. Despite widely available health services including cancer screening programs, factors such as language, culture, gender, and health literacy continue to affect access to services for many migrant and refugee women in Türkiye. The purpose of this study was to examine how perceptions of technology and related factors were associated with breast cancer screening participation among migrant and refugee women in Türkiye. Methods This was a qualitative study based on 34 semi-structured interviews with women that had migrated to or sought refuge in Türkiye. Transcripts were systematically coded and analyzed with special attention to relationships and perceptions of breast cancer screening technology. Results The findings indicated that technology in breast cancer screenings played a significant role in generating both confidence and mistrust among migrant and refugee women. Perceptions regarding technology were complex, often ambivalent and not necessarily predicted by nationality, education or legal status on an interpersonal level. Conclusions By foregrounding technology, which has often played a latent role in existing literature on cancer screening disparities, we deepen our understanding of screening thresholds and recommend informed, tailored health education and communication drawing on community engagement. Technology breast cancer screening mammography migration displacement Türkiye Background The number of migrants and forcibly displaced persons is on the rise globally. While there is substantial research, and continued interest, on maternal and child health, gender and reproductive health, nutrition, communicable diseases, and immunization among migrant and refugee communities, non-communicable diseases (NCDs) remain relatively understudied [ 1 ]. Evidence suggests that awareness, prevalence and treatment options for NCDs, including cancer, differ between migrants and the host populations. Researchers and policy makers are emphasizing the necessity for more research on cancer prevention and migrant-centered care [ 2 – 4 ]. This qualitative study is focused on Türkiye, hosting one of the largest forcibly displaced populations in the world [ 5 ]. Our study aimed to generate new knowledge about cancer prevention among migrant and forcibly displaced women, by not only assessing awareness on and barriers to cancer screening services, but also by examining understudied areas of trust and comfort with technology. Our approach centers on understanding the interconnected issues of awareness, trust and engagement with screening technologies among migrant women of various legal statuses and backgrounds in the three largest cities in Türkiye – Istanbul, Ankara and Izmir. Women’s health, including breast cancer prevention, is built on high levels of trust and communication, with respect to gender and culture. Based on prior studies [ 1 ], we hypothesize that trust is key to breast cancer screening awareness and participation, and that health technology can affect the level of trust (or mistrust) that women feel towards screening. By centering trust in breast cancer screening and the role of related technologies such as mammography and ultrasonography, we aim to parse out common denominators and shared challenges to equitable breast cancer prevention, in addition to the case-specific dynamics related to parameters such as legal status and reason for migration that require individual attention and intervention. Engagement with technology in the intimate setting of breast cancer screening is affected by many factors including health literacy, culture, religion, and gender norms. With a specific focus on the Turkish setting, our goal in this study was to understand how technology was viewed in the context of screening, and how that engagement, besides social determinants of health, shapes awareness and practice among migrant and refugee women regarding breast cancer. Our novel contribution bridges literature on cancer prevention among migrants with different legal status, and the emerging field of technology and migration, which has predominately been concerned with surveillance and border securitization. Cancer Screening Services for Migrants and Refugees in Türkiye In Türkiye, all registered refugees as well as migrants with public health insurance have free access to primary, secondary, and tertiary public healthcare [ 6 ]. According to the National Cancer Prevention Program of The Ministry of Health, cancer screening services for citizens also apply to the registered migrants. Screening services are available at the Cancer Early Diagnosis and Education Centers (KETEMs), as well as through mobile vehicles that outreach migrants in remote areas. Target population groups for breast cancer, cervix cancer, and colon cancer are women between the ages of 40–69 years, women between the ages of 30–65 years, and men and women between the ages of 50–70, respectively [ 7 ]. Current Research on Migrant Women and Breast Cancer Prevention Globally, breast cancer screening rates are consistently lower among migrant and refugee women compared to native populations. A global meta-analysis reported mammography uptake of 46.2% among immigrants versus 55% among non-immigrants [ 8 ]. Barriers are multifaceted, including language difficulties, low health literacy, fear of diagnosis, and cultural values such as modesty and fatalism [ 9 , 10 ]. Structural challenges such as lack of insurance, transportation, or understanding of healthcare systems, further inhibit access, particularly for refugee populations [ 10 , 11 ]. Additionally, physician recommendation (which tends to facilitate participation) is often less frequently offered to migrant women [ 12 ]. While research into barriers is manifold, few (if any) explicitly touch upon how screening technology affects fear or trust among migrant and refugee women. Despite legal rights to healthcare for registered refugees, Türkiye mirrors many of these obstacles. Studies with refugees in the country indicate obstacles to screening, including language, limited awareness, administrative challenges, and cultural beliefs [ 13 , 14 ]. Regional studies confirm that many refugee women are unaware of screening services or do not seek care unless symptomatic [ 15 ]. Research shows that just like native-born women, breast cancer is the most common cancer form among Afghan and Syrian migrant women in Türkiye [ 16 – 18 ], but that late presentation, delayed diagnosis, and treatment abandonment present major obstacles to better health outcomes [ 19 ]. Experts assert that measures for early detection are an evolving necessity, particularly in high-risk displaced populations [ 20 ]. Educational interventions have shown potential to address these disparities. Studies in Türkiye have shown that providing health education in native languages can significantly improve awareness of breast and cervical cancer [ 21 ]. In Hatay, Arabic-language sessions significantly improved screening knowledge among Syrian women [ 14 ]. Similarly, intervention based health behavior models have successfully increased screening behaviors by addressing perceived barriers and enhancing motivation among migrant women in Türkiye [ 22 ]. At the system level, Türkiye’s population-based breast cancer screening program achieved over 70% coverage in some districts [ 23 ], demonstrating the effectiveness of organized, invitation-based models. ​​However, there is limited research on leveraging commonly used digital social networks and messaging tools to support cancer education and increase uptake of preventive services. Migrants and Health Technologies There has been limited research on migrants’ interactions with health technology. Recently, digital health has occupied more of the conversation surrounding health services for migrants and refugees. Literature reviews reveal digital technologies have the potential to improve healthcare delivery in settings of forced displacement, but barriers to access and concerns regarding technology use persist [ 24 , 25 ]. While the research on these tools is limited in Türkiye, several studies provide some insight. In a study of a mobile health maternal and child health intervention, researchers found that “data security, offline capability, clear-user directions, and data retrievability” were important qualities of mobile health (mHealth) [ 26 ]. A second study showed the adaptability of these tools in crisis, demonstrating the use of mHealth to provide COVID-19 guidance to refugees in Türkiye [ 27 ]. Another study showed that youth-adult partnerships, using community-based participatory research, peer-to-peer methodologies, co-design approaches, and social media tools contribute to the success of mHealth interventions for refugee youth [ 28 ]. Research regarding technology access among forcibly displaced persons in NCD care, particularly cancer screening, is limited, and predominantly conducted in high income countries (mainly in Europe and North America). These studies reveal lower uptake of screening among migrant women, and suggest that socio-cultural factors may influence these decisions, but they do not examine the perceptions of technology or trust in these tools [ 8 , 29 ]. A recent study focused on migrant women’s access in Türkiye revealed limited awareness of and lack of access to mammography [ 30 ]. To our knowledge, ours is the first qualitative study to examine the perspectives of women in Türkiye with diverse national and migration backgrounds, regarding the use of technology for breast cancer screening. Methods Research Design and Sampling Strategy This study, conducted by an interdisciplinary and international research team based in the US and Türkiye, was based on 34 semi-structured interviews with migrant and refugee women. Interviews were conducted in person during the spring of 2025 by three health professional team members based in Türkiye, taking place in the three biggest cities: Istanbul, Ankara, and Izmir. Participants were recruited through local non-governmental organizations working with migrants and refugees, followed by snowball sampling. We limited our inclusion criteria to women of an appropriate age for mammography (40–69 years). The sampling distribution largely reflected the composition of migrant groups in Türkiye, both with regards to their various nationalities and legal statuses. The women in this study were either under temporary protection, undocumented, or residence permit holders. We prioritized rigor by employing a strategy of maximum variability, ensuring a diverse sample based on age, education level, nationality, and socioeconomic status, which enhances the credibility of our findings. While qualitative research makes little claim to representability or replicability, our sample can be considered a “snapshot” of the current migrant landscape of Türkiye, which constitutes a novel sample strategy in studies on migrants and cancer prevention and a complement to quantitative research on cancer screening experiences. An original semi-structured interview protocol was specifically developed and translated for the purpose of this study. Interviews were conducted in Turkish, Arabic, Farsi, or English, depending on participant nationality and preference. All participants were within the age range in which they should be participating in regular mammography screening, according to the National Cancer Screening Program. These demographics, as well at migration type and legal status are described in Table 1 . Although we acknowledge that actual causes for migration are complex and cannot be reduced to a binary of forced displacement versus voluntary migration, we introduce this category for the purpose of differentiating between refugees and other migrant women in the Turkish context. Table 1 Demographics of Interview Participants (n = 34) (April-May, 2025) Number of Participants Percent of Participants Age (yrs) 40–44 9 26% 45–49 7 21% 50–54 7 21% 55–59 9 26% 60+ 2 6% Country of Birth Syria 11 32% Afghanistan 10 29% Iran 7 21% Uganda 3 9% Egypt 1 3% Russia 1 3% Turkmenistan 1 3% Migration Type Forcibly displaced 19 56% Voluntary 15 44% Legal Status Temporary protection* 19 56% Residence permit 11 32% Undocumented 4 12% Educational Attainment Primary School or less 8 24% Middle School 5 15% High School 3 9% University 18 53% Local Language Skills Turkish Speaker 18 53% None 10 29% Some Turkish Proficiency 6 18% Number of Years in Türkiye 0–5 8 24% 6–10 15 44% > 10 11 32% *Legal status, which is similar to refugee Ethical Considerations We obtained approval from the Non-Interventional Studies Ethics Committee of Bahçeşehir University (BAU), on March 6, 2025 (Ref No: 2025-04/05). Prior to each interview, researchers provided participants with clear written and verbal explanations of the study purpose, informed them that participation was voluntary and that they maintained the right to withdraw at any moment without penalty. Consent was obtained continuously, and participants were reminded that they did not have to answer questions that they were uncomfortable with. Towards the end of each interview, participants were informed about cancer prevention and screening services available in their province. Analysis Interviews were transcribed verbatim in their original language and then translated to English. A shared codebook was collectively developed by the team through inductive open coding. Once we confirmed enough evidence in the data to test our hypothesis on technology, we proceeded with in-depth selective coding related to this particular topic. All transcripts were organized and analyzed systematically using NVivo, a qualitative data software, and all participants assigned pseudonyms. Results Participants described several barriers to breast cancer screening, many of which have been described in previous studies of cancer prevention among migrants. The most salient include knowledge limitations, access issues, language barriers, waiting times, stigma, and anxiety or fear. Undocumented and displaced women experienced more barriers and had higher perceived stigma than voluntary migrants. While these thresholds are considerable, the focus of this study was the relationship with technology in breast cancer screening, which often intersects with some of the barriers mentioned above. Attitudes toward screening technology varied widely – from positive beliefs about their efficacy, to a fear of or ambivalence toward technological tools. Positive Relationship with Screening Technology Anya, a Russian woman in her 50’s who came to Türkiye through marriage, perceived women’s cancer screening as essential for safeguarding families and communities: Women's health is very important. If there are children in the family, the mother is needed first, children want their mother. A mother's health is the foundation of the family and if she gets sick, it's bad not just for her but for the entire family. That's why she must do it. It should be mandatory. Some people don't understand because they don't know. For some women, technological devices associated with cancer screening contributed to a stronger sense of trust and confidence in their medical care. Emani, a forcibly displaced university educated woman from Syria in her mid 50’s, saw health technology as a symbol of advancement. She said: I think it's very nice. They’ve made great devices. It’s not like before. There’s early diagnosis. They really care about women. It’s a very good thing. There’s a lot of progress. I thought about the advancement in medicine. I went in feeling very relaxed. When the results came out, I felt even safer. In this non-representative sample, education level did not necessarily predict relationships with health technology. Nadia, an undocumented Tajik woman from Afghanistan of a similar age as Emani, had no high school diploma. Despite the fact that she had not been able to access mammography herself due to financial reasons, she was a strong proponent. She echoed Emani when she said: Now with technological development, I trust these [technologies] very much because everything is advanced. I highly recommend them, everyone should do them. Suri, a university educated Iranian voluntary migrant in her 50’s, went for screenings in her home country before moving to Türkiye. She perceived technology as a necessary complement to interpersonal physical examinations. She said: I had a mammogram last year. I have done them and have some information. I believe it is completely reliable because these tumors cannot be detected from the outside. I am very comfortable with this technology. Having cancer in the family made some women more eager to participate in screenings. Parisa, a displaced Afghan woman with a middle school education in her early 40s, found herself uninformed about how to access healthcare services through insurance, and dreaded not knowing her status after her sister was diagnosed with breast cancer. She said: I want to participate in these screenings because they can create a more comfortable life and health for us. I would trust my health more. We don't know if our body is good or not. That's why such screenings provide us with a lot of benefits and give us information about our body. [...] I didn't have much information [before this interview], but now that I do and I want to go. After my sister's diagnosis, I'm afraid it might be genetic. Sahar, an Iranian voluntary migrant in her 60s, found a painful lump in her breast that turned out to be benign, but was recommended by her doctor to have a mammogram and ultrasound every year. Eight years later, her sister was diagnosed with breast cancer, prompting Sahar to follow her doctor’s advice. She said: These technologies are very good, and I have 100% trust and confidence in them. Every time I receive a negative result, I feel at peace. Because it was the same for my sister; she went for mammograms infrequently and noticed a lump in the upper part of her breast. She was troubled by it. When she went to the doctor, it was discovered to be malignant, and she had surgery. Now, three years have passed since then. This technology provides peace of mind. Sima, a fellow Iranian voluntary migrant in her late 60s, was also prompted to undergo breast cancer screening after her aunt was diagnosed. She said: My aunt had breast cancer and she had her breast removed. Unfortunately, she passed away. After that, I learned about mammography, and I went for a mammogram with my colleagues and also learned about breast examination. I think about how much science has advanced. I felt comfortable, especially when the doctor explained it to me. Negative Relationship with Screening Technology While technology inspired trust with some women, it raised fear and mistrust in others. Zahra, a displaced woman from Syria in her early 40s, had yet to undergo mammography since she has either been pregnant or breastfeeding. Zahra described how fear of technology was so strong that it could deter refugee women from health centers altogether, and that efforts to dispatch mobile units can be futile if this fear is left unaddressed: I heard before that some people even ran away from the mobile unit. Why did they run? They said, “We don’t want to get checked.” They were told, “You can’t go into the health center unless you do the test.” So people started saying, “We don’t even want the clinic anymore.” Why are they scared? There needs to be more awareness because many are afraid. There’s this widespread belief that technology causes health problems — so they’re scared. Maryam, a displaced Syrian woman in her 50s with a primary school education, witnessed her mother’s death due to breast cancer after a late diagnosis in Syria. Her treatment was painful and the late-stage disease was incurable, and this experience did not inspire confidence in health technologies. “Every dose she took made her feel worse, every dose made it worse. At first, she looked fine, and nothing showed, but once she started the medication, she got worse,” Maryam said. On the topic of mammography, she added, “It hurts too, it hurts. Also, you know, X-rays — I don’t like X-rays, I’m afraid of X-rays. I feel like they cause diseases.” Rather than embracing the possibility of early detection, she took a fatalist approach and said she would prefer to not know in case she was sick. “I don’t like it. Psychologically, I can’t do it. It’s not comfortable for me,” she stated. “I’m not afraid of the disease. I feel stronger than the disease. I don’t put it in my mind at all. I don’t feel it. And if I get sick, I’m not afraid.” As in Zahra’s and Maryam’s accounts, a common association with screening is radiation or infection, and that exposure could be harmful. Even women who have a favorable or neutral attitude towards mammography sometimes describe them as potentially detrimental; Anya said, “They say mammograms may be a little harmful but the risk of cancer is higher” and Natalya, another university educated Russian woman in her 50s who moved to Türkiye for marriage, claimed that she felt safe with the technology, “But you shouldn't overuse them… Not excessively.” Reem was a displaced university educated Syrian woman in her mid 40s. She shared some fear and apprehension around the safety of screening technologies. She said: I personally have a fear of these screenings, and I don’t like them. I believe there are better methods. I think that after people undergo screenings, they end up getting cancer. Sometimes something appears after these methods are applied. It might even cause an infection. I don’t trust it. I’m afraid. They took a biopsy from my stomach, and that lessened my fear a bit. But I don’t trust technology. I approach medical devices with caution. For instance, I wonder if they have been properly disinfected. Mentally, Reem also felt that she could not afford any potential bad news after the stressors brought on by long-term displacement in multiple countries. She said: The first thing that comes to mind is my psychological state. I feel like this chaotic situation has been ongoing for 13 years. It feels as if I’m trapped in this feeling. No matter what problems arise, it seems like I can’t escape from this reality. Everything seems to happen to me. Ambivalent Relationship with Screening Technologies Some participants expressed ambivalent feelings about screening technology. Jamila, a voluntary Egyptian migrant in her 40’s explained sensing stigma and xenophobia from medical care providers. Her ambivalence was driven by a mistrust in the healthcare professionals carrying out the screening more so than the device itself. However, as a foreigner, she felt less able to communicate discomfort or advocate for herself in comparison to native women, which affected her experience with technology during mammography. I'm not comfortable at all. I don’t know why, maybe because it was my first time. Because the health care provider was a young man. I didn't know but I was not comfortable, I have no history to compare it to. He was pressing so hard. Still, Jamila was planning on continuing her screenings, and advocated for her and other migrant women’s rights to equal healthcare. All women should be informed, foreigners and native. It is important. They are just afraid. They have seen a lot of neglect. They are ignored. That's why they don’t care. They are mistreated by some doctors. They are afraid of mistreatment. Not being important like other citizens. In other cases, ambivalence took on the form of cognitive dissonance. Samira, a forcibly displaced Syrian woman under temporary protection in her early 50s, described having had a positive experience with mammography, appreciating the advanced technology and trusting the all-female staff. However, it had been six years since her last screening and she now found herself reluctant to go back, citing a combination of financial thresholds and fear of diagnosis. She said: I know that I should continue these early tests, but the costs affect it, and I rely on God... I feel if I knew I had this disease, my mental state would suffer, and that’s why I didn’t participate again. Resembling Reem’s account, Samira’s effort to stay mentally afloat limits her bandwidth for scanning for possible physical ailments. Naseem, a university educated voluntary migrant from Iran in her mid 50s, described how the stressors of migration could clash with healthcare: There are so many stresses that come with migration, a person might not look for a doctor. There are so many important things that a person doesn’t even think about doctors and screenings. But it’s necessary for everyone. We need to be healthy so that migration can continue, and we can stay. Naseem described cancer screening technologies as “very effective,” describing how she had to undergo a hysterectomy in order to remove a large polyp as a direct result of neglecting her pap smear check-ups. Still, she mistrusted mammograms for reasons that she struggled to pinpoint: I didn't trust them and I still don’t. I haven’t done it more than a few times, and that was when I was ill. I always thought the diagnosis was clear, and doing or not doing these tests didn’t matter. Perhaps because I wasn’t feeling well, I didn’t trust them. I felt like they were testing things they weren’t sure about. Maybe my knowledge was limited, but I still don’t. Homeira was a Syrian forcibly displaced woman in her mid 60s with a high school diploma. On an intellectual level, she saw the benefits of screening but on an emotional level, she felt reluctant and claimed she did not need them – even after receiving information about her eligibility. Of course mammograms are helpful. If they weren’t, people wouldn’t use them. Prevention is better than a pound of cure. But I feel no need. And also embarrassment. Someone told me that they take a picture of your chest — I refused. I mean, thank God, I feel reassured about myself, so I said this test and biopsy aren’t necessary for my age. But young women should do it. Honestly, I don’t know — I didn’t feel comfortable with it. I don’t think it would harm me – on the contrary. I just felt it wasn’t necessary for me. But others should do it — better than complications later. I didn’t like it personally. I mean, I have nothing wrong with me, and with my age, I rely on God. But families who have cases [of cancer] must absolutely get checked. Discussion While our research confirms several well-established universal barriers to breast cancer screening among migrant and refugee women (both logistical/practical and cultural/psychosocial) [ 31 , 32 ], it deepens our understanding of screening disparities by examining how the central component of technology affects participation among women on the move in Türkiye. While technology has played a more indirect or implied role in the existing literature, we find that it is a key concept at the forefront of women’s perceptions of cancer screening, to which they ascribe a variety of emotions – good, bad and ambivalent. Consistent with previous studies [ 32 – 35 ], we find that fear of breast cancer is a “double edged sword,” able to both fuel and deter participation. On a novel note, our research shows that relationships with health technology can do the same. Participant accounts reveal how migrant and refugee women’s perceptions of breast cancer screening technology involve a complex interplay of trust, fear, and ambivalence. For many, technology symbolizes medical progress, reliability, and safety; negative results provide peace of mind and reassurance, especially for women with a family history of cancer. For others, screening technologies give rise to aversion, pain, and mistrust. Concerns about the possibility that screenings themselves may cause harm, either through radiation or infection, can deter participation. Mistrust may be rooted in prior experiences of surveillance, stigma, limited health literacy, misinformation, or cultural sensitivities surrounding bodily privacy. Our qualitative research approach uncovered ambivalence, a phenomenon that previous quantitative or statistical studies would be less equipped to convey. Related to what researchers have described as screening indifference [ 33 , 36 ], we found that women may rationally accept the benefits of screening while being avoidant for reasons they sometimes struggle to rationalize or pinpoint. These may include denial, embarrassment, and/or overwhelm by migration-related stressors. As with Sheppard et al. [ 37 ], our findings indicated that trust in the technology itself can be mediated by the quality of healthcare encounters, with negative interactions with providers discouraging participation. Experiences of disease or displacement amplify distrust, while others adopt a fatalistic orientation, defeating the purpose of early detection. The concept of ambivalence or cognitive dissonance related to breast cancer screening and mammography may present a particularly difficult challenge, since it might not be easy to address by either health education or improved access. This can also be the case with fatalism – we find it to be more multifaceted and complex than described in previous studies [ 38 , 39 ]. For some women, it entails an act of radical acceptance and faith in God while for others, it is a result of exhaustion and resignation. As Guo et al. [ 40 ] associate fatalism with immigration status, we are able to link the spectrum of fatalistic sentiments to migration or displacement – the cumulative stressors of long-term displacement can leave women feeling overburdened, where the preservation of mental health takes precedence over seeking preventative care. In such contexts, the fear of receiving bad news from screening may further deter participation. Although in a smaller sample than quantitative studies, we find that nationality or educational attainment does not necessarily predict attitudes toward technology; instead, perceptions are shaped by personal and family health histories, cultural and gender norms, migration stress, and trust in healthcare systems. Screening technologies can function as sources of empowerment and reassurance but may also evoke fear, resistance, or indifference depending on the broader context of women’s lives. The qualitative nature of this study is both its strength and its limitation, illuminating the complexity of breast cancer screening resistance and embracement but without making positivist claims of generalizability. Conclusion This study highlights the central role of screening technology in shaping migrant women’s engagement with cancer prevention. Technologies such as mammography and ultrasonography serve as powerful tools for early detection, reassurance, and peace of mind, with many women perceiving them as symbols of medical progress and essential safeguards for themselves, their families and their communities. At the same time, fear, mistrust, and ambivalence demonstrate that technology’s potential impact is mediated by cultural norms, past experiences, and broader migration/displacement-related stressors. The significance of this research lies in showing that screening technology has the capacity to both instill confidence and deter participation among women on the move – a finding with great significance for future outreach and policy design. By uncovering the social and emotional dimensions of how migrant women perceive these technologies, the study underscores the need for healthcare systems to pair technological advancement with outreach and health communication tailored to the needs of diverse populations, including cultural mediators and trust-building strategies so that the life-saving potential of screening can be fully realized. Future Research There is a need for a more in-depth exploration of how trust, aversion and ambivalence for screening technologies emerge and evolve over time, and how these trajectories vary within and across groups including comparison of migrant and local women with similar rights to healthcare. Future studies should also delve deeper into the relationship between technology and fatalism, and how it relates to fear versus faith. Research could explore whether fatalism is more common among refugee women – the hypothesis that forced displacement can foster radical acceptance, needs further testing. Participant Informed Policy Recommendations We identify a series of policy recommendations that would help foster trust and cancer screening education based on participant suggestions: using digital social media networks, training through trusted non-governmental organizations (NGOs) or community centers, and peer-to-peer support. Chat groups among family, women and other community groups could be utilized to a larger extent for information dissemination on breast cancer prevention and screening. By connecting with women directly, healthcare providers could gain access to these social networks and with the help of well-situated individuals, information and open screening calls could be circulated and misinformation addressed. Here, it is important to tap into various localized networks or chat groups depending on nationality, ethnicity and region to ensure a fuller coverage. We see potential in how positive perception of technology among some women can be utilized to mitigate negative or ambivalent perceptions among others. We agree with participants that assert that women are each other’s key advocates and resources – well-informed individuals with positive experiences could serve as ambassadors and should be given different platforms from which to share their perspectives with others to improve uptake of screening services and cancer related health indicators. Abbreviations NDC: Non-communicative disease NGO: Non-governmental organization KETEM: Cancer Early Diagnosis and Education Center Declarations The manuscript is suitable for BMC Women’s Health since the community we are focusing on women’s health, specifically cancer in women, which is one of the journal’s main areas. Our submission contributes to the journal’s demonstrated interest in research that focuses on healthcare access for chronic/non-communicable diseases in low- to middle income countries. All authors have approved the manuscript for submission. There are no competing interests or issues with journal policies. This manuscript has not been submitted or published elsewhere. Ethics approval and consent to participate We obtained approval from the Non-Interventional Studies Ethics Committee of Bahçeşehir University on March 6, 2025 (Ref No: 2025-04/05). The research is conducted in accordance with the Turkish Good Clinical Practice Guideline , which is based on the Helsinki Declaration. All participants reviewed the consent form and consented to participate. Consent for publication We ensured voluntary and informed consent of research participants through an informed consent form. Researchers shared the purpose of the research with interviewees, emphasizing that participation is their free choice and that they were free to withdraw from the study at any point. Availability of data and materials For the sake of individual privacy and confidentiality, interview transcripts are not publicly available. Anonymized data are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding The research team acknowledges the generous support of Shipley Fund for their generous support to the Boston University Center on Forced Displacement. Authors' contributions SH(a) drafted interview protocols, coded and analyzed all transcripts in NVivo and wrote the first draft of the manuscript. HL contributed to the interview protocol, code development, data interpretation and wrote sections of the literature review. MA contributed to theme identification, literature review and discussion. SH(b), ZA and DA conducted interviews and provided critical feedback on the draft and data interpretation. MZ oversaw the project and its conceptual development, contributed with literature, and provided analytical feedback for the discussion of the paper. OK contributed to research design and conceptualization, handled the ethical review process, organized and oversaw data collection and transcription translations, wrote background sections and provided critical feedback and edits throughout the paper. All authors have read and approved the final manuscript. Acknowledgements We express our deepest gratitude to the women who shared their experiences with us. References Zaman MH. We Wait for a Miracle: Health Care and the Forcibly Displaced. Baltimore: JHU Press; 2023. Agyemang C, van den Born BJ. Non-communicable diseases in migrants: an expert review. J Travel Med. 2019;26(2):1-9. https://doi.org/10.1093/jtm/tay107. Ilbawi A, Slama, S. Cancer care for refugees: time to invest in people and systems. Lancet Oncol. 2020;21(5):604-5. https://doi.org/10.1016/S1470-2045(20)30163-7. Saab R, Slama S, Mansour A, Sater ZA, El Sayed ROLA, Mukherji D. 2022. Chapter 6: Cancer care in humanitarian crises. In: Fadhil I, ed. Cancer Control Eastern Mediterranean Region Special Report .Global Health Dynamics Limited; 2022:68-71. UNHCR. Republic of Türkiye . UNHCR. Accessed August 29, 2025. https://www.unhcr.org/where-we-work/countries/republic-tuerkiye. Migrant Health. Republic of Turkey Ministry of Health: Istanbul Provincial Health Directorate. Accessed Sep. 2, 2025. https://istanbulism.saglik.gov.tr/TR-157187/goc-sagligi.html Sıhhat Project. Ministry of Health Türkiye. Accessed Sep. 2, 2025. https://www.sihhatproject.org/sihhat2_faaliyetler.html. Bhargava S, Moen K, Qureshi SA, Hofvind S. Mammographic screening attendance among immigrant and minority women: a systematic review and meta-analysis. Acta Radiologica. 2018;59(11):1285-1291. https://doi.org/10.1177/0284185118758132. Racine EF, Isik Andsoy I. Breast Cancer Screening in Arab Muslim Immigrant Women: A Narrative Review. J Transcult Nurs. 2022;33(4):542-9. https://doi.org/10.1177/10436596221085301. Nassur J, Dajee D, Leader A, et al. Barriers to Cancer Screening in Refugee Populations: A Rapid Review. J Immigr Minor Health. 2025;27:609-22. https://doi.org/10.1007/s10903-025-01690-1. Kıran Ş, Akbolat M. Perceived barriers and facilitators in access to breast and cervical cancer screening: a qualitative exploration among women in Trabzon, Turkey. J Health Organ Manag. 2025:1-17 https://doi.org/10.1108/JHOM-12-2024-0503. Lofters A, Vahabi M, Glazier R, Creatore L, Moineddin D. Mammography Use among Immigrant and Non-Immigrant Women in Ontario: A Population-Based Study. BMC Public Health . 2015;15:679. https://doi.org/10.1186/s12889-015-2050-5. Koçak HS, Gümüş EC. Knowledge About Early Diagnosis of Breast Cancer, and Breast Cancer Risks Among Syrian Immigrants and Turkish Citizens: A Comparative, Cross-Sectional Study. Eur J Breast Health. 2023;19(3):222-8. https://pmc.ncbi.nlm.nih.gov/articles/PMC10320631/pdf/ejbh-19-222.pdf. Erenoğlu R, Yaman Sözbir Ş.The Effect of Health Education Given to Syrian Refugee Women in Their Own Language on Awareness of Breast and Cervical Cancer, in Turkey: a Randomized Controlled Trial. J Cancer Educ.2019;35:241-7.https://doi.org/10.1007/s13187-019-01604-4. Kutluk T, Şahin B, Kirazlı M, Ahmed F, Aydın S, Çınkır HY, Sezgin G, Bayram I, Ebinç S, Işıkdoğan A, Şaşmaz İ. Clinical characteristics and outcomes of cancer cases among Syrian refugees from southern Turkey. JAMA Netw Open. 2023;6(5):e2312903. https://doi.org/10.1001/jamanetworkopen.2023.12903. Khan SM, Gillani J, Nasreen S, Zai S. Cancer in North West Pakistan and Afghan Refugees. J Pak Med Assoc . 1997;47(4):122-4.https://pubmed.ncbi.nlm.nih.gov/9145643/. ‌Göktaş B, Yılmaz S, Gönenç İM, Akbulut Y, Sözüer A. Cancer Incidence Among Syrian Refugees in Turkey, 2012–2015. Journal of International Migration and Integration. 2018;19:253-8.https://doi.org/10.1007/s12134-018-0549-1. Yusuf MA, Hussain SF, Sultan F, Badar F, Sullivan R. Cancer Care in Times of Conflict: Cross Border Care in Pakistan of Patients from Afghanistan. Ecancermedicalscience. 2020;5(14):1018. https://doi.org/10.3332/ecancer.2020.1018. Kutluk T, Şahin B, Kirazlı M, Ahmed F, Aydın S, Çınkır HY, Sezgin G, et al. Clinical Characteristics and Outcomes of Cancer Cases Among Syrian Refugees From Southern Türkiye. JAMA Netw Open. 2023;6(5):e2312903. https://doi.org/10.1001/jamanetworkopen.2023.12903. Zendehdel K, Basu P, Shaheen R, Slama S, Mukherji D, Al Homoud SAMAR, Al Zahrani ALI, Fahil I, Ginsburg O. Chapter 4: Early detection of cancer: An evolving necessity in the Eastern Mediterranean Region. In: Fadhil I, ed. Cancer Control Eastern Mediterranean Region Special Report .Global Health Dynamics Limited; 2022:45-53. Erenoğlu R, Sözbir ŞY. The effect of health education given to Syrian refugee women in their own language on awareness of breast and cervical cancer in Turkey: A randomized controlled trial. J Cancer Educ. 2020;35:241-247. https://doi.org/10.1007/s13187-019-01604-4. Tuzcu A, Bahar Z, Gözüm S. Effects of interventions based on health behavior models on breast cancer screening behaviors of migrant women in Turkey. Cancer nursing. 2016;39(2):E40-50. https://doi.org/10.1097/NCC.0000000000000268. Ozmen V, Akin M, Cabioglu C, Ozcinar A. Ten-Year Outcomes of Population-Based Breast Cancer Screening in Bahçeşehir, Turkey. BMC Womens Health. 2024;25(1):5. https://doi.org/10.1186/s12905-024-03521-1. Mabil-Atem JM, Gumuskaya O, Wilson RL. Digital mental health interventions for the mental health care of refugees and asylum seekers: Integrative literature review. Int J Ment Health Nurs. 2024;33(4):760-780. https://doi.org/10.1111/inm.13283. Mesmar S, Talhouk R, Akik C, et al. The impact of digital technology on health of populations affected by humanitarian crises: Recent innovations and current gaps. J Public Health Pol. 2016;37 Suppl 2:167-200. https://doi.org/10.1057/s41271-016-0040-1. ‌Meyer CL, Surmeli A, Hoeflin Hana C, Narla NP. Perceptions on a mobile health intervention to improve maternal child health for Syrian refugees in Turkey: Opportunities and challenges for end-user acceptability. Front Public Health. 2022;10:1025675. https://doi.org/10.3389/fpubh.2022.1025675. Narla NP., Surmeli A, Kivlehan SM. Agile Application of Digital Health Interventions during the COVID-19 Refugee Response. Ann Glob Health. 2020;86(1):135. https://doi.org/10.5334/aogh.2995 . Karadag O, Karabey S, Yazbik-Dumit N, Almakhamreh S, Al-Mousa A, Orhon EN, Ceyhan DN, Sumbuloglu I, Dasgupta A, Ben Amor Y. Youth health promotion in countries affected by forced migration: The role of mHealth technologies. Eur J Public Health. 2022;32 Suppl 3:iii232-iii233. https://doi.org/10.1093/eurpub/ckac129.573 . Walker PF, Settgast AM, DeSilva MB. Cancer Screening in Refugees and Immigrants: A Global Perspective. American Journal of Tropical Medicine and Hygiene. 2022;106(6):1593-1600. https://doi.org/10.4269/ajtmh.21-0692. Güney S, Doğan ÖÇ, Bağçivan G. Cancer Care for Refugees in Türkiye: Challenges and Achievements. Semin Oncol Nurs. 2025;41(3):151879. https://doi.org/10.1016/j.soncn.2025.151879. Andreeva VA, Pokhrel P. Breast cancer screening utilization among Eastern European immigrant women worldwide: a systematic literature review and a focus on psychosocial barriers. Psychooncology. 2013;22(12):2664-2675. https://doi.org/10.1002/pon.3344. Dumky H, Fridell K, Leifland K, Metsälä E. Breast cancer screening and immigrant women—A scoping review of attendance, knowledge, barriers and facilitators. Nursing Open. 2023;10(9):5843-56. https://doi.org/10.1002/nop2.1865. Tuzcu A, Bahar A. Barriers and facilitators to breast cancer screening among migrant women within Turkey. J Transcult Nurs. 2014;26(1):47-56. https://doi.org/10.1177/1043659614526245. Clark MJ, Natipagon-Shah B. Thai American women’s perception regarding mammography participation. Public Health Nurs. 2008;25(3):212-22. https://doi.org/10.1111/j.1525-1446.2008.00698.x. Ogedegbe G, Cassells AN, Robinson CM, DuHamel K, Tobin JN, Sox CH, Dietrich AJ. Perceptions of barriers and facilitators of cancer early detection among low-income minority women in community health centers. J Natl Med Assoc. 2005;97(2):162-70. https://pubmed.ncbi.nlm.nih.gov/15712779/. Kissal A, Beşer A. Knowledge, facilitators and perceived barriers for early detection of breast cancer among elderly Turkish women. Asian Pac J Cancer Prev. 2011;12(4):975-984. https://pubmed.ncbi.nlm.nih.gov/21790237/. Sheppard VB, Wang J, Yi B, Harrison TM, Feng S, Huerta EE, Mandelblatt JS. Latin American Cancer Research Coalition. Are health-care relationships important for mammography adherence in Latinas?. J Gen Intern Med. 2008;23:2024-30. https://doi.org/10.1007/s11606-008-0815-6. Abraído-Lanza AF, Martins MC, Shelton RC, Flórez KR. Breast cancer screening among Dominican Latinas: A closer look at fatalism and other social and cultural factors. Health Educ Behav. 2015;42(5):633-41. https://doi.org/10.1177/1090198115580975. De Jesus M, Miller EB. Examining breast cancer screening barriers among Central American and Mexican immigrant women: fatalistic beliefs or structural factors?. Health Care Women Int. 2015;36(5):593-607. https://doi.org/10.1080/07399332.2014.973496. Guo XM, Tom L, Leung I, O’Brian C, Zumpf K, Simon M. Associations between fatalistic cancer beliefs and cancer-screening behaviors in Chinese American immigrant women. J Immigr Minor Health. 2021;23:699-706. https://doi.org/10.1007/s10903-021-01144-4. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 04 Nov, 2025 Editor assigned by journal 29 Oct, 2025 Editor invited by journal 06 Oct, 2025 Submission checks completed at journal 01 Oct, 2025 First submitted to journal 01 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Challenges","fulltext":[{"header":"Background","content":"\u003cp\u003eThe number of migrants and forcibly displaced persons is on the rise globally. While there is substantial research, and continued interest, on maternal and child health, gender and reproductive health, nutrition, communicable diseases, and immunization among migrant and refugee communities, non-communicable diseases (NCDs) remain relatively understudied [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Evidence suggests that awareness, prevalence and treatment options for NCDs, including cancer, differ between migrants and the host populations. Researchers and policy makers are emphasizing the necessity for more research on cancer prevention and migrant-centered care [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This qualitative study is focused on T\u0026uuml;rkiye, hosting one of the largest forcibly displaced populations in the world [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur study aimed to generate new knowledge about cancer prevention among migrant and forcibly displaced women, by not only assessing awareness on and barriers to cancer screening services, but also by examining understudied areas of trust and comfort with technology. Our approach centers on understanding the interconnected issues of awareness, trust and engagement with screening technologies among migrant women of various legal statuses and backgrounds in the three largest cities in T\u0026uuml;rkiye \u0026ndash; Istanbul, Ankara and Izmir.\u003c/p\u003e\u003cp\u003eWomen\u0026rsquo;s health, including breast cancer prevention, is built on high levels of trust and communication, with respect to gender and culture. Based on prior studies [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], we hypothesize that trust is key to breast cancer screening awareness and participation, and that health technology can affect the level of trust (or mistrust) that women feel towards screening. By centering trust in breast cancer screening and the role of related technologies such as mammography and ultrasonography, we aim to parse out common denominators and shared challenges to equitable breast cancer prevention, in addition to the case-specific dynamics related to parameters such as legal status and reason for migration that require individual attention and intervention. Engagement with technology in the intimate setting of breast cancer screening is affected by many factors including health literacy, culture, religion, and gender norms. With a specific focus on the Turkish setting, our goal in this study was to understand how technology was viewed in the context of screening, and how that engagement, besides social determinants of health, shapes awareness and practice among migrant and refugee women regarding breast cancer.\u003c/p\u003e\u003cp\u003e Our novel contribution bridges literature on cancer prevention among migrants with different legal status, and the emerging field of technology and migration, which has predominately been concerned with surveillance and border securitization.\u003c/p\u003e\n\u003ch3\u003eCancer Screening Services for Migrants and Refugees in Türkiye\u003c/h3\u003e\n\u003cp\u003eIn T\u0026uuml;rkiye, all registered refugees as well as migrants with public health insurance have free access to primary, secondary, and tertiary public healthcare [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. According to the National Cancer Prevention Program of The Ministry of Health, cancer screening services for citizens also apply to the registered migrants. Screening services are available at the Cancer Early Diagnosis and Education Centers (KETEMs), as well as through mobile vehicles that outreach migrants in remote areas. Target population groups for breast cancer, cervix cancer, and colon cancer are women between the ages of 40\u0026ndash;69 years, women between the ages of 30\u0026ndash;65 years, and men and women between the ages of 50\u0026ndash;70, respectively [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eCurrent Research on Migrant Women and Breast Cancer Prevention\u003c/h2\u003e\u003cp\u003eGlobally, breast cancer screening rates are consistently lower among migrant and refugee women compared to native populations. A global meta-analysis reported mammography uptake of 46.2% among immigrants versus 55% among non-immigrants [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Barriers are multifaceted, including language difficulties, low health literacy, fear of diagnosis, and cultural values such as modesty and fatalism [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Structural challenges such as lack of insurance, transportation, or understanding of healthcare systems, further inhibit access, particularly for refugee populations [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Additionally, physician recommendation (which tends to facilitate participation) is often less frequently offered to migrant women [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. While research into barriers is manifold, few (if any) explicitly touch upon how screening technology affects fear or trust among migrant and refugee women.\u003c/p\u003e\u003cp\u003eDespite legal rights to healthcare for registered refugees, T\u0026uuml;rkiye mirrors many of these obstacles. Studies with refugees in the country indicate obstacles to screening, including language, limited awareness, administrative challenges, and cultural beliefs [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Regional studies confirm that many refugee women are unaware of screening services or do not seek care unless symptomatic [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Research shows that just like native-born women, breast cancer is the most common cancer form among Afghan and Syrian migrant women in T\u0026uuml;rkiye [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], but that late presentation, delayed diagnosis, and treatment abandonment present major obstacles to better health outcomes [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Experts assert that measures for early detection are an evolving necessity, particularly in high-risk displaced populations [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEducational interventions have shown potential to address these disparities. Studies in T\u0026uuml;rkiye have shown that providing health education in native languages can significantly improve awareness of breast and cervical cancer [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In Hatay, Arabic-language sessions significantly improved screening knowledge among Syrian women [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Similarly, intervention based health behavior models have successfully increased screening behaviors by addressing perceived barriers and enhancing motivation among migrant women in T\u0026uuml;rkiye [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. At the system level, T\u0026uuml;rkiye\u0026rsquo;s population-based breast cancer screening program achieved over 70% coverage in some districts [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], demonstrating the effectiveness of organized, invitation-based models. ​​However, there is limited research on leveraging commonly used digital social networks and messaging tools to support cancer education and increase uptake of preventive services.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMigrants and Health Technologies\u003c/h3\u003e\n\u003cp\u003eThere has been limited research on migrants\u0026rsquo; interactions with health technology. Recently, digital health has occupied more of the conversation surrounding health services for migrants and refugees. Literature reviews reveal digital technologies have the potential to improve healthcare delivery in settings of forced displacement, but barriers to access and concerns regarding technology use persist [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhile the research on these tools is limited in T\u0026uuml;rkiye, several studies provide some insight. In a study of a mobile health maternal and child health intervention, researchers found that \u0026ldquo;data security, offline capability, clear-user directions, and data retrievability\u0026rdquo; were important qualities of mobile health (mHealth) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. A second study showed the adaptability of these tools in crisis, demonstrating the use of mHealth to provide COVID-19 guidance to refugees in T\u0026uuml;rkiye [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Another study showed that youth-adult partnerships, using community-based participatory research, peer-to-peer methodologies, co-design approaches, and social media tools contribute to the success of mHealth interventions for refugee youth [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eResearch regarding technology access among forcibly displaced persons in NCD care, particularly cancer screening, is limited, and predominantly conducted in high income countries (mainly in Europe and North America). These studies reveal lower uptake of screening among migrant women, and suggest that socio-cultural factors may influence these decisions, but they do not examine the perceptions of technology or trust in these tools [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. A recent study focused on migrant women\u0026rsquo;s access in T\u0026uuml;rkiye revealed limited awareness of and lack of access to mammography [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. To our knowledge, ours is the first qualitative study to examine the perspectives of women in T\u0026uuml;rkiye with diverse national and migration backgrounds, regarding the use of technology for breast cancer screening.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eResearch Design and Sampling Strategy\u003c/h2\u003e\u003cp\u003eThis study, conducted by an interdisciplinary and international research team based in the US and T\u0026uuml;rkiye, was based on 34 semi-structured interviews with migrant and refugee women. Interviews were conducted in person during the spring of 2025 by three health professional team members based in T\u0026uuml;rkiye, taking place in the three biggest cities: Istanbul, Ankara, and Izmir. Participants were recruited through local non-governmental organizations working with migrants and refugees, followed by snowball sampling. We limited our inclusion criteria to women of an appropriate age for mammography (40\u0026ndash;69 years). The sampling distribution largely reflected the composition of migrant groups in T\u0026uuml;rkiye, both with regards to their various nationalities and legal statuses. The women in this study were either under temporary protection, undocumented, or residence permit holders. We prioritized rigor by employing a strategy of maximum variability, ensuring a diverse sample based on age, education level, nationality, and socioeconomic status, which enhances the credibility of our findings. While qualitative research makes little claim to representability or replicability, our sample can be considered a \u0026ldquo;snapshot\u0026rdquo; of the current migrant landscape of T\u0026uuml;rkiye, which constitutes a novel sample strategy in studies on migrants and cancer prevention and a complement to quantitative research on cancer screening experiences.\u003c/p\u003e\u003cp\u003eAn original semi-structured interview protocol was specifically developed and translated for the purpose of this study. Interviews were conducted in Turkish, Arabic, Farsi, or English, depending on participant nationality and preference. All participants were within the age range in which they should be participating in regular mammography screening, according to the National Cancer Screening Program. These demographics, as well at migration type and legal status are described in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Although we acknowledge that actual causes for migration are complex and cannot be reduced to a binary of forced displacement versus voluntary migration, we introduce this category for the purpose of differentiating between refugees and other migrant women in the Turkish context.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographics of Interview Participants (n\u0026thinsp;=\u0026thinsp;34) (April-May, 2025)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of Participants\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercent of Participants\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAge (yrs)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e40\u0026ndash;44\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45\u0026ndash;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e50\u0026ndash;54\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e55\u0026ndash;59\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e60+\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eCountry of Birth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eSyria\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eAfghanistan\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eIran\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eUganda\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eEgypt\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eRussia\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eTurkmenistan\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eMigration Type\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eForcibly displaced\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eVoluntary\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eLegal Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eTemporary protection*\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eResidence permit\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eUndocumented\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eEducational Attainment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003ePrimary School or less\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eMiddle School\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eHigh School\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eUniversity\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e53%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eLocal Language Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eTurkish Speaker\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e53%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eNone\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eSome Turkish Proficiency\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNumber of Years in T\u0026uuml;rkiye\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e0\u0026ndash;5\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e6\u0026ndash;10\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003e\u0026gt;\u0026thinsp;10\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e11\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e32%\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003e*Legal status, which is similar to refugee\u003c/h3\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eEthical Considerations\u003c/h2\u003e\u003cp\u003e We obtained approval from the Non-Interventional Studies Ethics Committee of Bah\u0026ccedil;eşehir University (BAU), on March 6, 2025 (Ref No: 2025-04/05). Prior to each interview, researchers provided participants with clear written and verbal explanations of the study purpose, informed them that participation was voluntary and that they maintained the right to withdraw at any moment without penalty. Consent was obtained continuously, and participants were reminded that they did not have to answer questions that they were uncomfortable with. Towards the end of each interview, participants were informed about cancer prevention and screening services available in their province.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eAnalysis\u003c/h3\u003e\n\u003cp\u003eInterviews were transcribed verbatim in their original language and then translated to English. A shared codebook was collectively developed by the team through inductive open coding. Once we confirmed enough evidence in the data to test our hypothesis on technology, we proceeded with in-depth selective coding related to this particular topic. All transcripts were organized and analyzed systematically using NVivo, a qualitative data software, and all participants assigned pseudonyms.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e Participants described several barriers to breast cancer screening, many of which have been described in previous studies of cancer prevention among migrants. The most salient include knowledge limitations, access issues, language barriers, waiting times, stigma, and anxiety or fear. Undocumented and displaced women experienced more barriers and had higher perceived stigma than voluntary migrants. While these thresholds are considerable, the focus of this study was the relationship with technology in breast cancer screening, which often intersects with some of the barriers mentioned above. Attitudes toward screening technology varied widely \u0026ndash; from positive beliefs about their efficacy, to a fear of or ambivalence toward technological tools.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003ePositive Relationship with Screening Technology\u003c/h2\u003e\u003cp\u003eAnya, a Russian woman in her 50\u0026rsquo;s who came to T\u0026uuml;rkiye through marriage, perceived women\u0026rsquo;s cancer screening as essential for safeguarding families and communities:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eWomen's health is very important. If there are children in the family, the mother is needed first, children want their mother. A mother's health is the foundation of the family and if she gets sick, it's bad not just for her but for the entire family. That's why she must do it. It should be mandatory. Some people don't understand because they don't know.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFor some women, technological devices associated with cancer screening contributed to a stronger sense of trust and confidence in their medical care. Emani, a forcibly displaced university educated woman from Syria in her mid 50\u0026rsquo;s, saw health technology as a symbol of advancement. She said:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI think it's very nice. They\u0026rsquo;ve made great devices. It\u0026rsquo;s not like before. There\u0026rsquo;s early diagnosis. They really care about women. It\u0026rsquo;s a very good thing. There\u0026rsquo;s a lot of progress. I thought about the advancement in medicine. I went in feeling very relaxed. When the results came out, I felt even safer.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn this non-representative sample, education level did not necessarily predict relationships with health technology. Nadia, an undocumented Tajik woman from Afghanistan of a similar age as Emani, had no high school diploma. Despite the fact that she had not been able to access mammography herself due to financial reasons, she was a strong proponent. She echoed Emani when she said:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eNow with technological development, I trust these [technologies] very much because everything is advanced. I highly recommend them, everyone should do them.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSuri, a university educated Iranian voluntary migrant in her 50\u0026rsquo;s, went for screenings in her home country before moving to T\u0026uuml;rkiye. She perceived technology as a necessary complement to interpersonal physical examinations. She said:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI had a mammogram last year. I have done them and have some information. I believe it is completely reliable because these tumors cannot be detected from the outside. I am very comfortable with this technology.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eHaving cancer in the family made some women more eager to participate in screenings. Parisa, a displaced Afghan woman with a middle school education in her early 40s, found herself uninformed about how to access healthcare services through insurance, and dreaded not knowing her status after her sister was diagnosed with breast cancer. She said:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI want to participate in these screenings because they can create a more comfortable life and health for us. I would trust my health more. We don't know if our body is good or not. That's why such screenings provide us with a lot of benefits and give us information about our body. [...] I didn't have much information [before this interview], but now that I do and I want to go. After my sister's diagnosis, I'm afraid it might be genetic.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSahar, an Iranian voluntary migrant in her 60s, found a painful lump in her breast that turned out to be benign, but was recommended by her doctor to have a mammogram and ultrasound every year. Eight years later, her sister was diagnosed with breast cancer, prompting Sahar to follow her doctor\u0026rsquo;s advice. She said:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eThese technologies are very good, and I have 100% trust and confidence in them. Every time I receive a negative result, I feel at peace. Because it was the same for my sister; she went for mammograms infrequently and noticed a lump in the upper part of her breast. She was troubled by it. When she went to the doctor, it was discovered to be malignant, and she had surgery. Now, three years have passed since then. This technology provides peace of mind.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSima, a fellow Iranian voluntary migrant in her late 60s, was also prompted to undergo breast cancer screening after her aunt was diagnosed. She said:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eMy aunt had breast cancer and she had her breast removed. Unfortunately, she passed away. After that, I learned about mammography, and I went for a mammogram with my colleagues and also learned about breast examination. I think about how much science has advanced. I felt comfortable, especially when the doctor explained it to me.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eNegative Relationship with Screening Technology\u003c/h2\u003e\u003cp\u003eWhile technology inspired trust with some women, it raised fear and mistrust in others. Zahra, a displaced woman from Syria in her early 40s, had yet to undergo mammography since she has either been pregnant or breastfeeding. Zahra described how fear of technology was so strong that it could deter refugee women from health centers altogether, and that efforts to dispatch mobile units can be futile if this fear is left unaddressed:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI heard before that some people even ran away from the mobile unit. Why did they run? They said, \u0026ldquo;We don\u0026rsquo;t want to get checked.\u0026rdquo; They were told, \u0026ldquo;You can\u0026rsquo;t go into the health center unless you do the test.\u0026rdquo; So people started saying, \u0026ldquo;We don\u0026rsquo;t even want the clinic anymore.\u0026rdquo; Why are they scared? There needs to be more awareness because many are afraid. There\u0026rsquo;s this widespread belief that technology causes health problems \u0026mdash; so they\u0026rsquo;re scared.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eMaryam, a displaced Syrian woman in her 50s with a primary school education, witnessed her mother\u0026rsquo;s death due to breast cancer after a late diagnosis in Syria. Her treatment was painful and the late-stage disease was incurable, and this experience did not inspire confidence in health technologies. \u0026ldquo;Every dose she took made her feel worse, every dose made it worse. At first, she looked fine, and nothing showed, but once she started the medication, she got worse,\u0026rdquo; Maryam said. On the topic of mammography, she added, \u0026ldquo;It hurts too, it hurts. Also, you know, X-rays \u0026mdash; I don\u0026rsquo;t like X-rays, I\u0026rsquo;m afraid of X-rays. I feel like they cause diseases.\u0026rdquo;\u003c/p\u003e\u003cp\u003eRather than embracing the possibility of early detection, she took a fatalist approach and said she would prefer to not know in case she was sick. \u0026ldquo;I don\u0026rsquo;t like it. Psychologically, I can\u0026rsquo;t do it. It\u0026rsquo;s not comfortable for me,\u0026rdquo; she stated. \u0026ldquo;I\u0026rsquo;m not afraid of the disease. I feel stronger than the disease. I don\u0026rsquo;t put it in my mind at all. I don\u0026rsquo;t feel it. And if I get sick, I\u0026rsquo;m not afraid.\u0026rdquo;\u003c/p\u003e\u003cp\u003eAs in Zahra\u0026rsquo;s and Maryam\u0026rsquo;s accounts, a common association with screening is radiation or infection, and that exposure could be harmful. Even women who have a favorable or neutral attitude towards mammography sometimes describe them as potentially detrimental; Anya said, \u0026ldquo;They say mammograms may be a little harmful but the risk of cancer is higher\u0026rdquo; and Natalya, another university educated Russian woman in her 50s who moved to T\u0026uuml;rkiye for marriage, claimed that she felt safe with the technology, \u0026ldquo;But you shouldn't overuse them\u0026hellip; Not excessively.\u0026rdquo;\u003c/p\u003e\u003cp\u003eReem was a displaced university educated Syrian woman in her mid 40s. She shared some fear and apprehension around the safety of screening technologies. She said:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI personally have a fear of these screenings, and I don\u0026rsquo;t like them. I believe there are better methods. I think that after people undergo screenings, they end up getting cancer. Sometimes something appears after these methods are applied. It might even cause an infection. I don\u0026rsquo;t trust it. I\u0026rsquo;m afraid. They took a biopsy from my stomach, and that lessened my fear a bit. But I don\u0026rsquo;t trust technology. I approach medical devices with caution. For instance, I wonder if they have been properly disinfected.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eMentally, Reem also felt that she could not afford any potential bad news after the stressors brought on by long-term displacement in multiple countries. She said:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eThe first thing that comes to mind is my psychological state. I feel like this chaotic situation has been ongoing for 13 years. It feels as if I\u0026rsquo;m trapped in this feeling. No matter what problems arise, it seems like I can\u0026rsquo;t escape from this reality. Everything seems to happen to me.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eAmbivalent Relationship with Screening Technologies\u003c/h2\u003e\u003cp\u003eSome participants expressed ambivalent feelings about screening technology. Jamila, a voluntary Egyptian migrant in her 40\u0026rsquo;s explained sensing stigma and xenophobia from medical care providers. Her ambivalence was driven by a mistrust in the healthcare professionals carrying out the screening more so than the device itself. However, as a foreigner, she felt less able to communicate discomfort or advocate for herself in comparison to native women, which affected her experience with technology during mammography.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI'm not comfortable at all. I don\u0026rsquo;t know why, maybe because it was my first time. Because the health care provider was a young man. I didn't know but I was not comfortable, I have no history to compare it to. He was pressing so hard.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eStill, Jamila was planning on continuing her screenings, and advocated for her and other migrant women\u0026rsquo;s rights to equal healthcare.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eAll women should be informed, foreigners and native. It is important. They are just afraid. They have seen a lot of neglect. They are ignored. That's why they don\u0026rsquo;t care. They are mistreated by some doctors. They are afraid of mistreatment. Not being important like other citizens.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn other cases, ambivalence took on the form of cognitive dissonance. Samira, a forcibly displaced Syrian woman under temporary protection in her early 50s, described having had a positive experience with mammography, appreciating the advanced technology and trusting the all-female staff. However, it had been six years since her last screening and she now found herself reluctant to go back, citing a combination of financial thresholds and fear of diagnosis. She said:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI know that I should continue these early tests, but the costs affect it, and I rely on God... I feel if I knew I had this disease, my mental state would suffer, and that\u0026rsquo;s why I didn\u0026rsquo;t participate again.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eResembling Reem\u0026rsquo;s account, Samira\u0026rsquo;s effort to stay mentally afloat limits her bandwidth for scanning for possible physical ailments. Naseem, a university educated voluntary migrant from Iran in her mid 50s, described how the stressors of migration could clash with healthcare:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eThere are so many stresses that come with migration, a person might not look for a doctor. There are so many important things that a person doesn\u0026rsquo;t even think about doctors and screenings. But it\u0026rsquo;s necessary for everyone. We need to be healthy so that migration can continue, and we can stay.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eNaseem described cancer screening technologies as \u0026ldquo;very effective,\u0026rdquo; describing how she had to undergo a hysterectomy in order to remove a large polyp as a direct result of neglecting her pap smear check-ups. Still, she mistrusted mammograms for reasons that she struggled to pinpoint:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI didn't trust them and I still don\u0026rsquo;t. I haven\u0026rsquo;t done it more than a few times, and that was when I was ill. I always thought the diagnosis was clear, and doing or not doing these tests didn\u0026rsquo;t matter. Perhaps because I wasn\u0026rsquo;t feeling well, I didn\u0026rsquo;t trust them. I felt like they were testing things they weren\u0026rsquo;t sure about. Maybe my knowledge was limited, but I still don\u0026rsquo;t.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eHomeira was a Syrian forcibly displaced woman in her mid 60s with a high school diploma. On an intellectual level, she saw the benefits of screening but on an emotional level, she felt reluctant and claimed she did not need them \u0026ndash; even after receiving information about her eligibility.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eOf course mammograms are helpful. If they weren\u0026rsquo;t, people wouldn\u0026rsquo;t use them. Prevention is better than a pound of cure. But I feel no need. And also embarrassment. Someone told me that they take a picture of your chest \u0026mdash; I refused. I mean, thank God, I feel reassured about myself, so I said this test and biopsy aren\u0026rsquo;t necessary for my age. But young women should do it. Honestly, I don\u0026rsquo;t know \u0026mdash; I didn\u0026rsquo;t feel comfortable with it. I don\u0026rsquo;t think it would harm me \u0026ndash; on the contrary. I just felt it wasn\u0026rsquo;t necessary for me. But others should do it \u0026mdash; better than complications later. I didn\u0026rsquo;t like it personally. I mean, I have nothing wrong with me, and with my age, I rely on God. But families who have cases [of cancer] must absolutely get checked.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eWhile our research confirms several well-established universal barriers to breast cancer screening among migrant and refugee women (both logistical/practical and cultural/psychosocial) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], it deepens our understanding of screening disparities by examining how the central component of technology affects participation among women on the move in T\u0026uuml;rkiye. While technology has played a more indirect or implied role in the existing literature, we find that it is a key concept at the forefront of women\u0026rsquo;s perceptions of cancer screening, to which they ascribe a variety of emotions \u0026ndash; good, bad and ambivalent. Consistent with previous studies [\u003cspan additionalcitationids=\"CR33 CR34\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], we find that fear of breast cancer is a \u0026ldquo;double edged sword,\u0026rdquo; able to both fuel and deter participation. On a novel note, our research shows that relationships with health technology can do the same.\u003c/p\u003e\u003cp\u003e Participant accounts reveal how migrant and refugee women\u0026rsquo;s perceptions of breast cancer screening technology involve a complex interplay of trust, fear, and ambivalence. For many, technology symbolizes medical progress, reliability, and safety; negative results provide peace of mind and reassurance, especially for women with a family history of cancer. For others, screening technologies give rise to aversion, pain, and mistrust. Concerns about the possibility that screenings themselves may cause harm, either through radiation or infection, can deter participation. Mistrust may be rooted in prior experiences of surveillance, stigma, limited health literacy, misinformation, or cultural sensitivities surrounding bodily privacy.\u003c/p\u003e\u003cp\u003eOur qualitative research approach uncovered ambivalence, a phenomenon that previous quantitative or statistical studies would be less equipped to convey. Related to what researchers have described as screening indifference [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], we found that women may rationally accept the benefits of screening while being avoidant for reasons they sometimes struggle to rationalize or pinpoint. These may include denial, embarrassment, and/or overwhelm by migration-related stressors. As with Sheppard et al. [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], our findings indicated that trust in the technology itself can be mediated by the quality of healthcare encounters, with negative interactions with providers discouraging participation. Experiences of disease or displacement amplify distrust, while others adopt a fatalistic orientation, defeating the purpose of early detection.\u003c/p\u003e\u003cp\u003eThe concept of ambivalence or cognitive dissonance related to breast cancer screening and mammography may present a particularly difficult challenge, since it might not be easy to address by either health education or improved access. This can also be the case with fatalism \u0026ndash; we find it to be more multifaceted and complex than described in previous studies [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. For some women, it entails an act of radical acceptance and faith in God while for others, it is a result of exhaustion and resignation. As Guo et al. [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] associate fatalism with immigration status, we are able to link the spectrum of fatalistic sentiments to migration or displacement \u0026ndash; the cumulative stressors of long-term displacement can leave women feeling overburdened, where the preservation of mental health takes precedence over seeking preventative care. In such contexts, the fear of receiving bad news from screening may further deter participation.\u003c/p\u003e\u003cp\u003eAlthough in a smaller sample than quantitative studies, we find that nationality or educational attainment does not necessarily predict attitudes toward technology; instead, perceptions are shaped by personal and family health histories, cultural and gender norms, migration stress, and trust in healthcare systems. Screening technologies can function as sources of empowerment and reassurance but may also evoke fear, resistance, or indifference depending on the broader context of women\u0026rsquo;s lives.\u003c/p\u003e\u003cp\u003eThe qualitative nature of this study is both its strength and its limitation, illuminating the complexity of breast cancer screening resistance and embracement but without making positivist claims of generalizability.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights the central role of screening technology in shaping migrant women\u0026rsquo;s engagement with cancer prevention. Technologies such as mammography and ultrasonography serve as powerful tools for early detection, reassurance, and peace of mind, with many women perceiving them as symbols of medical progress and essential safeguards for themselves, their families and their communities. At the same time, fear, mistrust, and ambivalence demonstrate that technology\u0026rsquo;s potential impact is mediated by cultural norms, past experiences, and broader migration/displacement-related stressors. The significance of this research lies in showing that screening technology has the capacity to both instill confidence and deter participation among women on the move \u0026ndash; a finding with great significance for future outreach and policy design. By uncovering the social and emotional dimensions of how migrant women perceive these technologies, the study underscores the need for healthcare systems to pair technological advancement with outreach and health communication tailored to the needs of diverse populations, including cultural mediators and trust-building strategies so that the life-saving potential of screening can be fully realized.\u003c/p\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eFuture Research\u003c/h2\u003e\u003cp\u003eThere is a need for a more in-depth exploration of how trust, aversion and ambivalence for screening technologies emerge and evolve over time, and how these trajectories vary within and across groups including comparison of migrant and local women with similar rights to healthcare. Future studies should also delve deeper into the relationship between technology and fatalism, and how it relates to fear versus faith. Research could explore whether fatalism is more common among refugee women \u0026ndash; the hypothesis that forced displacement can foster radical acceptance, needs further testing.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eParticipant Informed Policy Recommendations\u003c/h2\u003e\u003cp\u003eWe identify a series of policy recommendations that would help foster trust and cancer screening education based on participant suggestions: using digital social media networks, training through trusted non-governmental organizations (NGOs) or community centers, and peer-to-peer support.\u003c/p\u003e\u003cp\u003eChat groups among family, women and other community groups could be utilized to a larger extent for information dissemination on breast cancer prevention and screening. By connecting with women directly, healthcare providers could gain access to these social networks and with the help of well-situated individuals, information and open screening calls could be circulated and misinformation addressed. Here, it is important to tap into various localized networks or chat groups depending on nationality, ethnicity and region to ensure a fuller coverage.\u003c/p\u003e\u003cp\u003eWe see potential in how positive perception of technology among some women can be utilized to mitigate negative or ambivalent perceptions among others. We agree with participants that assert that women are each other\u0026rsquo;s key advocates and resources \u0026ndash; well-informed individuals with positive experiences could serve as ambassadors and should be given different platforms from which to share their perspectives with others to improve uptake of screening services and cancer related health indicators.\u003c/p\u003e\u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eNDC: Non-communicative disease\u003c/p\u003e\n\u003cp\u003eNGO: Non-governmental organization\u003c/p\u003e\n\u003cp\u003eKETEM: Cancer Early Diagnosis and Education Center\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe manuscript is suitable for \u003cem\u003eBMC Women’s Health\u003c/em\u003e since the community we are focusing on women’s health, specifically cancer in women, which is one of the journal’s main areas. Our submission contributes to the journal’s demonstrated interest in research that focuses on healthcare access for chronic/non-communicable diseases in low- to middle income countries. All authors have approved the manuscript for submission. There are no competing interests or issues with journal policies. This manuscript has not been submitted or published elsewhere.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe obtained approval from the Non-Interventional Studies Ethics Committee of Bahçeşehir University on March 6, 2025 (Ref No: 2025-04/05). The research is conducted in accordance with the Turkish \u003cem\u003eGood Clinical Practice Guideline\u003c/em\u003e, which is based on the Helsinki Declaration. All participants reviewed the consent form and consented to participate.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe ensured voluntary and informed consent of research participants through an informed consent form. Researchers shared the purpose of the research with interviewees, emphasizing that participation is their free choice and that they were free to withdraw from the study at any point.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFor the sake of individual privacy and confidentiality, interview transcripts are not publicly available. Anonymized data are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe research team acknowledges the generous support of Shipley Fund for their generous support to the Boston University Center on Forced Displacement.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors' contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSH(a) drafted interview protocols, coded and analyzed all transcripts in NVivo and wrote the first draft of the manuscript. HL contributed to the interview protocol, code development, data interpretation and wrote sections of the literature review. MA contributed to theme identification, literature review and discussion. SH(b), ZA and DA conducted interviews and provided critical feedback on the draft and data interpretation. MZ oversaw the project and its conceptual development, contributed with literature, and provided analytical feedback for the discussion of the paper. OK contributed to research design and conceptualization, handled the ethical review process, organized and oversaw data collection and transcription translations, wrote background sections and provided critical feedback and edits throughout the paper. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe express our deepest gratitude to the women who shared their experiences with us.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eZaman MH. We Wait for a Miracle: Health Care and the Forcibly Displaced. Baltimore: JHU Press; 2023.\u003c/li\u003e\n \u003cli\u003eAgyemang C, van den Born BJ. 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Health Care Women Int. 2015;36(5):593-607. https://doi.org/10.1080/07399332.2014.973496.\u003c/li\u003e\n \u003cli\u003eGuo XM, Tom L, Leung I, O\u0026rsquo;Brian C, Zumpf K, Simon M. Associations between fatalistic cancer beliefs and cancer-screening behaviors in Chinese American immigrant women. J Immigr Minor Health. 2021;23:699-706. https://doi.org/10.1007/s10903-021-01144-4.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Technology, breast cancer screening, mammography, migration, displacement, Türkiye","lastPublishedDoi":"10.21203/rs.3.rs-7723045/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7723045/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eCancer screening disparities are well documented among refugee and migrant populations in many parts of the world. Despite widely available health services including cancer screening programs, factors such as language, culture, gender, and health literacy continue to affect access to services for many migrant and refugee women in T\u0026uuml;rkiye. The purpose of this study was to examine how perceptions of technology and related factors were associated with breast cancer screening participation among migrant and refugee women in T\u0026uuml;rkiye.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis was a qualitative study based on 34 semi-structured interviews with women that had migrated to or sought refuge in T\u0026uuml;rkiye. Transcripts were systematically coded and analyzed with special attention to relationships and perceptions of breast cancer screening technology.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe findings indicated that technology in breast cancer screenings played a significant role in generating both confidence and mistrust among migrant and refugee women. Perceptions regarding technology were complex, often ambivalent and not necessarily predicted by nationality, education or legal status on an interpersonal level.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eBy foregrounding technology, which has often played a latent role in existing literature on cancer screening disparities, we deepen our understanding of screening thresholds and recommend informed, tailored health education and communication drawing on community engagement.\u003c/p\u003e","manuscriptTitle":"Migrant and Refugee Women’s Relationships with Breast Cancer Screening Technology in Türkiye: A Qualitative Study of Opportunities and Challenges","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-14 07:06:22","doi":"10.21203/rs.3.rs-7723045/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-11-04T12:08:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-29T20:22:09+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-06T08:52:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-01T10:52:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2025-10-01T10:33:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d2404ff4-9b3d-42f3-81c4-866c3327fcbf","owner":[],"postedDate":"November 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-14T07:06:22+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-14 07:06:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7723045","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7723045","identity":"rs-7723045","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}