Factors Influencing Missed Appointments for Mammography Screening at Primary Health Care Clinics

Factors Influencing Missed Appointments for Mammography Screening at Primary Health Care Clinics | 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 Factors Influencing Missed Appointments for Mammography Screening at Primary Health Care Clinics Khawla Eissa Alhajaj, Ola Abdulsamea Aldafrawy, Elham Saeed Alneaimi, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6668279/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Breast cancer is the most common cancer among females and is a major health concern in the United Arab Emirates (UAE). It is characterized by an early onset and significant contributions to female cancer cases and deaths. Despite its significance, low rates of mammogram participation pose challenges for early detection and effective treatment. This study explored the barriers influencing mammogram attendance among women in the UAE. Methods This cross-sectional study surveyed 461 women referred for mammograms but did not attend appointments across twelve primary healthcare centers in Dubai, UAE. The objective was to identify factors affecting mammography attendance, considering system-related factors, procedure-related factors and factors related to women's emotional and practical behavior. Results Emotional factors such as procedure-related pain, fear, or shyness showed no significant association with mammogram attendance across all age groups (p < 0.001). Conversely, practical constraints, including being too busy, hesitancy to request time off work, and weekday morning unavailability, significantly influenced attendance, particularly among women aged 40–50 years (p < 0.001). Age did not significantly impact appointment-related issues like forgetfulness, challenges in rescheduling, or the absence of reminders (p = 0.5). In addition, location preference for mammogram screenings was not influenced by age (p = 0.017). Conclusion Based on the findings, emotional factors were not key determinants for missing mammogram appointments in the included sample. Instead, practical issues, notably work commitments, significantly affect attendance, particularly among women aged 40–50. Accordingly, recommendations include offering extended hours, introducing a dedicated mammogram off day, emphasizing practical issues in awareness campaigns to working women, implementing virtual pre-screening consultations before appointments, providing information in multiple languages to cover the diversity of the population in Dubai, and leveraging AI tracking to minimize no-shows, especially for women aged 40–50 years. These measures would enhance mammogram attendance, facilitating breast cancer detection earlier and improving treatment outcomes in affected population. Breast cancer screening Mammography No-show Public health awareness Dubai UAE Dubai Health 1 Introduction Breast cancer is the most frequently diagnosed cancer globally, with 2.26 million new cases and 685,000 deaths reported in 2020 [ 1 ]. This substantial global burden is mirrored in the United Arab Emirates (UAE), where breast cancer is the primary cause of cancer-related mortality, accounting for 9.64% of cancer deaths in 2021 [ 2 ]. In the same year, 1,139 breast cancer cases were reported, representing 20.3% of all malignant cases [ 3 ]. Data from the UAE National Cancer Registry indicate that breast cancer affects men as well, with nine cases reported among males in 2017 out of a total of 834 cases, constituting 20.23% of all cancers that year. Of these cases, 26% were UAE nationals, while 74% were non-UAE residents from diverse ethnic backgrounds, including Indian, Pakistani, Filipino, and European populations [ 4 ]. Among women, breast cancer was the most prevalent cancer type, accounting for 36.7% of female cancer cases, with a crude incidence rate of 28.6 per 100,000 and an age-standardized rate of 42.1 per 100,000. It was also the leading cause of cancer-related deaths overall (11.5% of cancer deaths) and among women specifically (24.4%) [ 1 , 2 ]. The UAE government has made significant efforts to promote early detection of breast cancer through initiatives led by various health authorities. The Health Authority of Abu Dhabi, the UAE’s largest health district, initiated breast cancer screening programs in 2008 [ 5 ]. Similarly, the Dubai Health Authority, the second-largest health district and the location of this study, launched its breast cancer screening programs in 2014 [ 6 ]. In September 2015, the Ministry of Health, overseeing the other health districts, introduced a nationwide cancer screening campaign to raise awareness about cancer and emphasize the importance of early detection through regular medical check-ups [ 7 , 8 ]. Biennial mammography screening has shown the highest mortality reduction benefit for women aged 50–69 years and is recommended by the European Union and many countries. [ 9 ] Early detection through mammography screening plays a vital role in improving survival rates and treatment outcomes [ 3 ]. Despite its importance, adherence to screening programs continues to pose significant challenges. Globally, no-show rates for mammography appointments vary between 15% and 40%, hindering timely diagnosis and management. Research has identified factors such as younger age, minority racial or ethnic status, and specific types of insurance as being linked to higher rates of nonattendance [ 10 ]. These insights highlight the need to address practical barriers and socio-cultural influences to enhance adherence and outcomes in the UAE. 1.1 Breast Cancer Screening Awareness and Implementation A study conducted in the UAE among 492 women aged 25–45 years found that participants had lower-than-expected knowledge levels regarding breast cancer. The study assessed awareness of risk factors, warning signs, symptoms, and screening behaviours. Compared to similar research conducted in Malaysia among female university students, the UAE study revealed a mean total knowledge score of 60.7%, with many respondents scoring below this average [ 3 ]. Another study used a web-based survey to evaluate breast cancer awareness among 616 women in the UAE. The results indicated a breast cancer prevalence of 3.1%, with 65.8% of respondents demonstrating moderate knowledge, 19% showing poor knowledge, and only 7.6% displaying good knowledge. Awareness of screening methods was the highest (76%), followed by knowledge of symptoms, while risk factors were the least understood [ 11 ]. Among women over the age of 40, 37.1% reported never having undergone a mammogram. Higher knowledge levels were associated with information received through healthcare providers or awareness events. However, gaps in understanding risk factors and the low rates of mammography screening underscore the need for more targeted and effective awareness campaigns [ 11 ]. A separate study demonstrated predominantly positive attitudes among participants toward breast health. The majority acknowledged the importance of regular doctor visits for breast examinations (78.3%) and recognized the life-saving potential of early screening and detection (84.4%). However, concerns about mammography were evident, with many participants believing it could provoke unnecessary fear and panic (56%), be a misuse of resources (48.6%), or cause discomfort (49.3%). Despite these reservations, a substantial proportion (80.7%) stated they would adhere to a doctor’s recommendation to undergo a mammogram. Participants also expressed concerns regarding other screening methods. Many felt that clinical breast examinations by a doctor could create undue fear and anxiety (67.4%), doubted the ability of women to effectively detect breast cancer through self-examinations (67%), and perceived breast self-exams as either painful (61.7%) or anxiety-inducing (68.3%). These findings highlight a mix of positive attitudes and apprehensions about breast cancer screening practices [ 12 ]. The results emphasize the need to enhance breast cancer awareness among women in the UAE to improve participation in screening programs [ 13 ]. Additionally, optimizing the national screening program is critical for enhancing accessibility and ensuring more effective use of available resources [ 14 ]. The UAE’s National Guidelines for Breast Cancer Screening and Diagnosis recommend biennial mammography beginning at the age of 40, aligning with data showing that most breast cancer cases in the country occur in women in their 40s [ 15 ]. However, routine screening is not recommended for women under 40 who are at average risk. This recommendation is based on the low incidence of breast cancer in younger age groups, the lack of large-scale screening trials focusing on these populations, and the reduced accuracy of mammography for younger women. For instance, a study involving 73,335 initial mammograms in women aged 35–39 years found a positive predictive value of just 1.3% [ 16 ]. Despite these limitations, there is growing evidence supporting personalized screening approaches for high-risk women aged 30–40 years. Notably, 21.5% of breast cancer cases in the UAE occur within this age group [ 2 ]. As such, tailoring screening strategies to begin at age 30 for high-risk individuals, using personalized risk assessments to guide the choice of screening methods and intervals, could significantly improve early detection outcomes [ 10 , 11 ]. 1.2 Attitude toward breast cancer screening Studies examining attitudes toward breast cancer (BC) screening in the UAE reveal a complex mix of knowledge gaps, positive attitudes toward medical advice, and concerns about the screening process. A cross-sectional study of 492 women aged 25–45 years in the UAE highlighted that respondents’ knowledge of BC risk factors, warning signs, symptoms, and screening behavior. Almost half (44.8%) of the women who had never undergone a Clinical Breast Exam (CBE) and 44.1% of women who had never undergone mammography reported that they were unaware of these screening methods was below expected levels.[ 2 ] No-show rates for mammogram appointments represent a significant challenge in achieving optimal breast cancer screening rates in the UAE. A no-show occurs when a patient fails to attend a scheduled mammogram appointment, leading to missed opportunities for early cancer detection. A study analyzing data from Kuwait, Oman, Saudi Arabia, and the UAE found that only 13.9% of women aged 40 to 75 in the UAE had undergone a mammogram within the recommended interval. This low uptake suggests potential challenges with appointment adherence, though specific no-show rates for mammography appointments in the UAE are not well-documented. [ 19 ] High no-show rates can lead to poor patient outcomes, decreased staff productivity, and significant loss in revenue for a healthcare system. A no-show rate is the percentage of patients who fail to attend scheduled appointments.[ 20 ] Unfortunately, this issue is particularly evident in microsystems that provide care to underserved populations, possibly contributing to poorer health outcomes often observed among these groups.[ 21 ] Researchers from the University of Washington have reported in the Journal of the American College of Radiology (JACR) that the percentage of radiology patients who miss pre-scheduled imaging appointments is approximately 3%. However, the no-show rates are more than twice as high for mammography and ultrasound appointments.[ 22 ] A study conducted at a community health center in Boston, USA, found that approximately 12% of patients did not attend their scheduled screening mammography appointments. The research highlighted that socioeconomically disadvantaged and racial or ethnic minority patients were disproportionately affected by missed appointments, leading to potential delays in care. [ 23 ] Not showing up for scheduled appointments can have adverse effects on patients' health, such as hindering their diagnosis [ 24 ]. Moreover, high no-show rates lead to reduced available appointments and increased at times [ 25 ], leading to patient dissatisfaction and negatively affecting the quality of care. In addition, no-shows can be a significant financial burden. For instance, in 2004, no-shows in the United Kingdom cost approximately £790 million, which accounted for 1% of the country’s total health expenditures that year [ 26 ]. High no-show rates for mammography appointment within Dubai Health, ranging from 30–40%, have persisted for years, undermining early detection efforts. In 2022, we conducted a cross-sectional study within Dubai Health Authority's primary healthcare system, where the no-show rate during the study period was 40%. This study aims to identify the factors contributing to these high rates and provide actionable insights to improve screening adherence. 2 Methodology 2.1 Study Design, Population, and Sampling This cross-sectional study was conducted in Dubai, United Arab Emirates, targeting women referred for mammography appointments through family physician consultations at Dubai Health’s primary healthcare centers. In this system, family physicians initiate the mammography referral during a consultation by discussing the importance of screening and obtaining the patient’s agreement. Once agreed upon, the physician places the referral order in the electronic medical record, and patients receive appointments scheduled based on their preferred date and time. All twelve primary healthcare centers under Dubai Health were included in the study to ensure inclusivity and a representative sample size. These centers provided mammography referral services, with screenings conducted at four central health centers equipped with mammography facilities. Out of 5,249 mammography referrals made during the study period, only 3,094 women attended their appointments, resulting in a no-show rate of 40.9%. To ensure a robust and representative sample, a target sample size of 365 participants was calculated using an online sample calculator, with a 5% margin of error and a 95% confidence interval. However, a total of 461 participants completed the interviews, providing a larger sample for analysis. This sample was selected from the population of women who missed their scheduled mammography appointments. This study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval for the study was obtained from the Dubai Scientific Research Ethics Committee (DSREC) under reference number DSREC-09/2022-25. All participants provided written informed consent prior to participation in the study. 2.2 Measure A telephone interview was conducted with a researcher to gather information from the sample population regarding the questionnaire. This questionnaire was developed based on prior studies, including an unpublished internal study at DHA and [ 17 ] The questionnaire covered several areas: (a) Socio-demographic data: Age, gender, marital status, presence of children, and nationality. (b) Awareness and knowledge about breast cancer: Participants' understanding of breast cancer, along with emotional factors like shyness, anxiety, and procedure-related pain.(c)Concerns about radiation and interest in screening: Participants' worries about radiation and their interest in undergoing screening.(d)Appointment-related information: Factors like forgetting appointments, being busy, preferred procedure time, and appointment rescheduling.(e)Factors affecting attendance: Consideration of factors like taking time off work, procedure location, transportation, and parking.(f)Issues from experiences and preferences: Exploring negative experiences with family/friends, preference for private hospitals, and sudden constraints affecting participation. All questions had closed-ended 'yes' or 'no' responses, and participants were ensured to answer all questions. 2.3 Statistical Analysis The objective of the survey is to assess the factors contributing to missed mammography appointments. In addition, descriptive statistics such as counts, percentages, and p-values were employed to characterize socio-demographic traits, risk factors, familiarity with the procedure, and determinants factors influencing appointment no-show. The analysis incorporated the chi-squared test to ascertain the significance of relationships between categorical variables encompassing risk factors and demographic information, all within a 95% confidence interval (CI), with the results presented as Chi-square values. All data underwent analysis using IBM SPSS Statistics 28, 2020 edition. 3 Results 3.1 Study Sample Characteristics A total of 461 participants completed the interview. The age distribution was as follows: 40–45 years (n = 147, 31.9%), 46–50 years (n = 127, 27.5%), 51–55 years (n = 92, 20%), 56–60 years (n = 125, 22%), and 61 years and above (n = 56, 12%). The marital status of participants was distributed as follows: Single (n = 37, 8.1%), Married (n = 396, 87.4%), Divorced (n = 8, 1.8%), and Widowed (n = 12, 2.6%). Regarding nationality, the majority were UAE nationals (n = 333, 72.2%), while non-UAE nationals accounted for (n = 128, 27.8%). Table 1 presents a detailed summary of the participants' demographic characteristics. Table 1 The Socio-Demographic Characteristics of the study sample. Number N = 461(%) Age 40–45 147(31.9) 46–50 127(27.5) 51–55 92(20) 56–60 39(8.5) more than 60 56(12) Nationality UAE Nationals 333(72.2) Non-UAE Nationals 128(27.8) Marital Status Single 37(8.1) Married 396(87.4) Divorced 8(1.8) Widow 12(2.6) 3.2 Factors Influencing Mammography Appointment Attendance Among the total no-show participants (n = 461), a low number reported not receiving adequate information about breast cancer (n = 27, 5.9%). The majority, however, had received information about breast cancer screening (n = 424, 94%). Out of 461 women surveyed, only three (n = 3, 0.7%) expressed concerns about radiation exposure during the mammogram procedure, indicating that such concerns are relatively rare in this sample. The statistical analysis showed that age does not significantly affect feelings of procedure-related pain, shyness, or fear. Interestingly, in the 50–60 age group, only 12.8% of women responded with "yes," which was the highest percentage among all age groups. To assess the connection between these variables, we used a Chi-Square test, yielding a result of 0.002. The p-value was less than 0.001, indicating a strong and statistically significant lack of association between age, procedure-related emotional factors, and non-attendance at mammogram screenings. In other words, regardless of age, these emotional factors do not significantly influence whether individuals attend mammogram screenings at Dubai Health. Among those aged 40–45, approximately 25.9% responded 'yes,' indicating that these factors hindered their clinic attendance. In the 46–50 years age group, this percentage increased to around 31.5%. The Chi-Square test produced a result of less than 0.001, and the corresponding p-value was also less than 0.001. This shows a strong and statistically significant difference, suggesting that these factors and age significantly influence whether individuals attend mammogram screenings at Dubai Health clinics. The data particularly emphasizes the greater impact of these factors in the 40–50 years age group. The statistical results illustrate no significant age-related variation in responses to appointment-related issues such as forgetfulness, challenges in rescheduling, and absence of hospital reminders. Among the age group of individuals over 60, approximately 29% answered 'yes', indicating these factors can be associated with their attendance at the clinic. However, the Chi-Square test yielded a value of 0.49, and the corresponding p-value was 0.5. This result has no statistical significance, suggesting that these factors and age do not influence clinic attendance for mammogram screenings at DHA. The statistical analysis using a Chi-Square test revealed no significant association between age and facility preference for mammogram screenings. The Chi-Square value was 0.019, with a p-value of 0.017, which is below the standard significance level of 0.05. Despite the low p-value, the results indicate that individuals across different age groups do not exhibit a statistically significant preference for private clinics, government health centers, or other screening locations over DHA mammogram screenings. Table 2 presents a detailed summary of these findings. Table 2. The Crosstabulation Analysis of Factors and Age in the 2022 Mammogram No-Show Study Among Women in Dubai 4 Discussion In our analysis of non-participation in mammogram screening among women who missed their appointments, we examined the underlying reasons. Our investigation revealed that organizational issues emerged as the most prevalent cause, exhibiting a notable connection with both behavioral and participant attitudes and the prioritization of screening within their busy schedules. In this section, we compared our study's findings with those of previous research and studies. 4.1 Age Age appeared to play a divergent role in breast screening attendance in our study. We observed that individuals aged 40–59 constituted a significant portion of the no-show group (59.6%), highlighting a concerning trend of lower attendance in this age range. In contrast, findings from a meta-analysis of 66 studies involving 22,150,922 participants showed no significant differences in screening attendance across age groups. Specifically, among women aged 60–69 compared to 50–59, observational studies (n = 16, 5,065,779) reported an odds ratio (OR) of 0.97 (95% CI: 0.88 to 1.08), suggesting minimal variation. These contrasting findings suggest that while global data from the meta-analysis show no significant impact of age on attendance, our study indicates that middle-aged individuals (40–59) may have unique barriers or factors influencing their participation in breast screening programs. This discrepancy highlights the need for targeted local interventions to address age-specific barriers and improve attendance rates in this demographic group [ 27 ] 4.2 Interest in mammogram screening Our study revealed that among women who did not attend mammogram screening appointments, the proportion of those who expressed disinterest in undergoing the screening and doesn't have interest was 8.6%. In contrast, another study reported a higher percentage of 18.8%. This discrepancy may arise because the latter study's figure represented the disinterest of all women, not just those who missed their appointments. Therefore, it is plausible that the actual portion of women genuinely uninterested in the screening may be even higher. This insight emphasizes the need for a more comprehensive understanding of women's attitudes toward mammogram screening, beyond those who missed their appointments.[ 28 ] 4.3 Fear of pain from mammograms and detecting cancer In our study, which included 461 participants, fear of pain was reported as a barrier to mammogram screening by only 6.1% of participants. In contrast, a study conducted in Calabar, Nigeria, with a sample size of 365 participants, found that 37.8% of women cited fear as a psychosocial barrier to undergoing mammography screening [ 28 ]. Additionally, another study conducted in the United Arab Emirates, specifically in Ras Al Khaimah (RAK), reported fear as a significant concern for 44.8% of participants, albeit with a smaller sample size of 54 participants. [ 29 ] It is important to consider that the difference in reported fear percentages between this study and ours may be attributed to sample size variations. Our study boasted a larger sample size, which can contribute to more robust and reliable findings. These findings suggest that, within our sample, fear of pain is not a prominent concern and does not serve as a substantial barrier to undergoing the screening. This underscores the importance of considering individual variations in the perceived barriers to mammogram screening and tailoring interventions accordingly. In addition to that, we identified that the fear of being diagnosed with breast cancer accounted for approximately 4.1% of missed appointments, indicating it as a relatively less prevalent reason for non-participation. In contrast, compared to another study, the fear of diagnosis emerged as a significantly more substantial concern. Specifically, in this other study, 35.6% of women who did not attend mammogram screening reported the fear of being diagnosed as a critical reason for their non-participation. [ 30 ] These findings highlight the considerable variation in the perception of fear related to breast cancer diagnosis and mammogram screening among different populations. The lower prevalence in our study suggests that fear of diagnosis and the procedure might have a lesser impact on non-attendance in our particular sample. 4.4 Lack of time : Our study found that organizational issues, such as a lack of time, the inability to seek permission from work, and busy schedules, accounted for 21.5% of no-shows for mammogram screening. This finding aligns with a study conducted in Germany, where out of 1494 surveyed clients, 397 (26.57%) cited time-related problems as a reason for not participating in the screening. Remarkably, the German study categorized lack of time due to health-related issues or long working hours separately, indicating the multifaceted nature of time-related barriers to screening participation. These consistent findings underscore the global relevance of addressing organizational challenges as a significant factor in non-participation in mammogram screening programs. In addition, factors such as the location of screening centers, lack of transportation, appointment-related issues, and the procedure cost did not emerge as significant barriers in our study sample concerning non-attendance for mammogram screening. 5 Conclusion Most women who did not attend mammogram appointments at Dubai Health Clinics had specific reasons for their absence, with time management challenges being particularly significant among women aged 40–50, a group that also showed higher no-show rates. To address these barriers and improve participation, a patient-centered approach is needed. Introducing dedicated “Mammogram Off-Days” during weekdays or weekends can provide convenient screening opportunities for women trying to manage their professional and personal responsibilities. Flexible scheduling, including extended hours, weekend availability, walk-in services, and same-day appointments, can further accommodate diverse needs. Additionally, implementing a user-friendly SMS-based system for reminders, cancellations, and rescheduling can help reduce missed appointments. For younger women in the 40–50 age group, tailored awareness campaigns should highlight the importance of early detection while addressing misconceptions and practical concerns. These campaigns can be delivered through social media, WhatsApp, and workplace outreach to reach women where they are most engaged. Collectively, these strategies foster a more accessible, supportive healthcare environment that aligns with the realities of modern women's lives, ultimately promoting higher attendance rates and improved breast health outcomes. A key limitation of this study is the absence of data on the racial and ethnic backgrounds of non-UAE nationals’ participants. As racial and ethnic factors can influence breast cancer awareness, access, and screening behaviors, the lack of this data may limit the generalizability of our findings and warrants attention in future research. Declarations Acknowledgment: We thank the Dubai Health and the Mohammed Bin Rashid School of Government for their support and assistance. Funding sources: The authors disclose no receipt of any financial support for the authorship, research, and/or publication of this article. Conflict of Interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Data Statement is not applicable. Ethical Statement: The study was approved by Dubai Scientific Research Ethics Committee (DSREC-09/2022_25). Author Contributions: Dr Khawla Eissa Alhajaj, principal researcher, was responsible for writing the proposal, the methodology, analysis, and recommendations. Dr. Ola, was responsible for writing the questionnaires, creating the electronic questionnaires and data analysis. Dr.Fatima Ahmed Alhammadi & Dr. Elham Saeed Alneaimi were responsible to write introdaction, Dr.Amani Salem Alzubaidi ,Dr.Amina Mohamed, Dr.Farzaneh Abedini & Dr.Hanan Ali Almuhaureq were responsible for data collection and coding, Dr.Marwan Zidan conducted data analysis and wrote the results Dr. Immanuel Azaad Moonesar R.D. was assigned to review the full report, data analysis, conclusion. D.Alia Mohammad Aldallal wrote the recommendation & conclusion. All authors give final approval for the version to be published and agree to be accountable for all aspects of the work. Data Availability Statement: All data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author. 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Alhajaj","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABIElEQVRIie3OP0vDQBjH8ScErsvFricB+xYuBILgv7eSIxCXIoGCCAabo9AsoV0v5E2YxdXIQVyEroJLSwYXB0HoWEyqLsI1q2C+832e3wF0df3BaAGaBECgxRHVAYgLoEf6LmJFAF8kKX6Ixie7iA1bAs3jhkA7cXpyKYNwb6Cn1Z0ZhIcX/d5DXAVweqAix9inUpTI4pl/aYqSjPYTxicCPFtJwKUSI6TxbOiYGBF2W9QEg84i1cf6r+8Sb9AZT59qsiHsfrFqyHisIjYZUmlMEeMCO6YxrVfIdkW6qo9Z4i2Qxgx5PPFHR+mMMPG84hmmj5ZqhS7O8wqvy5M8lvlLsL5h87lXfOCr64Fq5bsSfh2lLQAghLajXV1dXf+4T226W+uHut7iAAAAAElFTkSuQmCC","orcid":"","institution":"Dubai Health","correspondingAuthor":true,"prefix":"","firstName":"Khawla","middleName":"Eissa","lastName":"Alhajaj","suffix":""},{"id":497385043,"identity":"ea96c11b-4ebb-448a-9cc0-4fa020d36a4f","order_by":1,"name":"Ola Abdulsamea Aldafrawy","email":"","orcid":"","institution":"Dubai Health","correspondingAuthor":false,"prefix":"","firstName":"Ola","middleName":"Abdulsamea","lastName":"Aldafrawy","suffix":""},{"id":497385044,"identity":"2ae17cfc-53bc-475a-8bee-db77f2c19511","order_by":2,"name":"Elham Saeed Alneaimi","email":"","orcid":"","institution":"Dubai Health","correspondingAuthor":false,"prefix":"","firstName":"Elham","middleName":"Saeed","lastName":"Alneaimi","suffix":""},{"id":497385045,"identity":"b6ceacf1-ad21-430f-bc83-9e15998c326a","order_by":3,"name":"Fatima Ahmed ALHammadia","email":"","orcid":"","institution":"Dubai Health","correspondingAuthor":false,"prefix":"","firstName":"Fatima","middleName":"Ahmed","lastName":"ALHammadia","suffix":""},{"id":497385046,"identity":"6e0826b2-b492-4465-8a34-863e5f0a1cab","order_by":4,"name":"Amani Salem Alzubaidi","email":"","orcid":"","institution":"Dubai Health","correspondingAuthor":false,"prefix":"","firstName":"Amani","middleName":"Salem","lastName":"Alzubaidi","suffix":""},{"id":497385047,"identity":"0edf6124-7e17-47e2-8f92-65cd3f0e0ae7","order_by":5,"name":"Amina Zaher Mohamed","email":"","orcid":"","institution":"Dubai Health","correspondingAuthor":false,"prefix":"","firstName":"Amina","middleName":"Zaher","lastName":"Mohamed","suffix":""},{"id":497385048,"identity":"2476745a-9004-4319-9a24-379dace8c659","order_by":6,"name":"Farzaneh Mohammad Abedini","email":"","orcid":"","institution":"Dubai Health","correspondingAuthor":false,"prefix":"","firstName":"Farzaneh","middleName":"Mohammad","lastName":"Abedini","suffix":""},{"id":497385049,"identity":"949693d3-31df-4eea-bba5-79e62e5651ca","order_by":7,"name":"Hanan Ali Almuhaureq","email":"","orcid":"","institution":"Dubai Health","correspondingAuthor":false,"prefix":"","firstName":"Hanan","middleName":"Ali","lastName":"Almuhaureq","suffix":""},{"id":497385050,"identity":"2c33c52c-3416-4c10-a52b-83231b44beca","order_by":8,"name":"Marwan Zidan","email":"","orcid":"","institution":"Dubai Health","correspondingAuthor":false,"prefix":"","firstName":"Marwan","middleName":"","lastName":"Zidan","suffix":""},{"id":497385051,"identity":"28d36eca-f8e6-4652-abf6-0977c6811118","order_by":9,"name":"Immanuel Azaad Moonesar","email":"","orcid":"","institution":"Mohammed Bin Rashid School of Government","correspondingAuthor":false,"prefix":"","firstName":"Immanuel","middleName":"Azaad","lastName":"Moonesar","suffix":""},{"id":497385052,"identity":"884352da-d58b-4d99-99c8-11aef36a830c","order_by":10,"name":"Alia Mohammad Aldallal","email":"","orcid":"","institution":"Dubai Health","correspondingAuthor":false,"prefix":"","firstName":"Alia","middleName":"Mohammad","lastName":"Aldallal","suffix":""},{"id":497385053,"identity":"28ea5f06-525a-4276-bedf-6c7c85649a20","order_by":11,"name":"Khawla Eissa","email":"","orcid":"","institution":"Dubai Health Authority","correspondingAuthor":false,"prefix":"","firstName":"Khawla","middleName":"","lastName":"Eissa","suffix":""},{"id":497385054,"identity":"0587f3f4-d596-4d20-9fbf-0e9b0f625167","order_by":12,"name":"Alhajaj Consultant","email":"","orcid":"","institution":"Dubai Health","correspondingAuthor":false,"prefix":"","firstName":"Alhajaj","middleName":"","lastName":"Consultant","suffix":""}],"badges":[],"createdAt":"2025-05-15 03:08:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6668279/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6668279/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101880481,"identity":"b25c4f00-b195-4299-8d2a-a5476a41dd9c","added_by":"auto","created_at":"2026-02-04 15:02:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":752124,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6668279/v1/16c7165b-6ea1-441b-9e8e-13c2c0068e7d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors Influencing Missed Appointments for Mammography Screening at Primary Health Care Clinics","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eBreast cancer is the most frequently diagnosed cancer globally, with 2.26\u0026nbsp;million new cases and 685,000 deaths reported in 2020 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This substantial global burden is mirrored in the United Arab Emirates (UAE), where breast cancer is the primary cause of cancer-related mortality, accounting for 9.64% of cancer deaths in 2021 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In the same year, 1,139 breast cancer cases were reported, representing 20.3% of all malignant cases [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eData from the UAE National Cancer Registry indicate that breast cancer affects men as well, with nine cases reported among males in 2017 out of a total of 834 cases, constituting 20.23% of all cancers that year. Of these cases, 26% were UAE nationals, while 74% were non-UAE residents from diverse ethnic backgrounds, including Indian, Pakistani, Filipino, and European populations [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Among women, breast cancer was the most prevalent cancer type, accounting for 36.7% of female cancer cases, with a crude incidence rate of 28.6 per 100,000 and an age-standardized rate of 42.1 per 100,000. It was also the leading cause of cancer-related deaths overall (11.5% of cancer deaths) and among women specifically (24.4%) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe UAE government has made significant efforts to promote early detection of breast cancer through initiatives led by various health authorities. The Health Authority of Abu Dhabi, the UAE\u0026rsquo;s largest health district, initiated breast cancer screening programs in 2008 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Similarly, the Dubai Health Authority, the second-largest health district and the location of this study, launched its breast cancer screening programs in 2014 [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In September 2015, the Ministry of Health, overseeing the other health districts, introduced a nationwide cancer screening campaign to raise awareness about cancer and emphasize the importance of early detection through regular medical check-ups [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Biennial mammography screening has shown the highest mortality reduction benefit for women aged 50\u0026ndash;69 years and is recommended by the European Union and many countries. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eEarly detection through mammography screening plays a vital role in improving survival rates and treatment outcomes [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Despite its importance, adherence to screening programs continues to pose significant challenges. Globally, no-show rates for mammography appointments vary between 15% and 40%, hindering timely diagnosis and management. Research has identified factors such as younger age, minority racial or ethnic status, and specific types of insurance as being linked to higher rates of nonattendance [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. These insights highlight the need to address practical barriers and socio-cultural influences to enhance adherence and outcomes in the UAE.\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003e1.1 \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eBreast Cancer Screening Awareness and Implementation\u003c/span\u003e\u003c/h2\u003e\u003cp\u003e A study conducted in the UAE among 492 women aged 25\u0026ndash;45 years found that participants had lower-than-expected knowledge levels regarding breast cancer. The study assessed awareness of risk factors, warning signs, symptoms, and screening behaviours. Compared to similar research conducted in Malaysia among female university students, the UAE study revealed a mean total knowledge score of 60.7%, with many respondents scoring below this average [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAnother study used a web-based survey to evaluate breast cancer awareness among 616 women in the UAE. The results indicated a breast cancer prevalence of 3.1%, with 65.8% of respondents demonstrating moderate knowledge, 19% showing poor knowledge, and only 7.6% displaying good knowledge. Awareness of screening methods was the highest (76%), followed by knowledge of symptoms, while risk factors were the least understood [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAmong women over the age of 40, 37.1% reported never having undergone a mammogram. Higher knowledge levels were associated with information received through healthcare providers or awareness events. However, gaps in understanding risk factors and the low rates of mammography screening underscore the need for more targeted and effective awareness campaigns [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA separate study demonstrated predominantly positive attitudes among participants toward breast health. The majority acknowledged the importance of regular doctor visits for breast examinations (78.3%) and recognized the life-saving potential of early screening and detection (84.4%). However, concerns about mammography were evident, with many participants believing it could provoke unnecessary fear and panic (56%), be a misuse of resources (48.6%), or cause discomfort (49.3%). Despite these reservations, a substantial proportion (80.7%) stated they would adhere to a doctor\u0026rsquo;s recommendation to undergo a mammogram.\u003c/p\u003e\u003cp\u003eParticipants also expressed concerns regarding other screening methods. Many felt that clinical breast examinations by a doctor could create undue fear and anxiety (67.4%), doubted the ability of women to effectively detect breast cancer through self-examinations (67%), and perceived breast self-exams as either painful (61.7%) or anxiety-inducing (68.3%). These findings highlight a mix of positive attitudes and apprehensions about breast cancer screening practices [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe results emphasize the need to enhance breast cancer awareness among women in the UAE to improve participation in screening programs [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Additionally, optimizing the national screening program is critical for enhancing accessibility and ensuring more effective use of available resources [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe UAE\u0026rsquo;s National Guidelines for Breast Cancer Screening and Diagnosis recommend biennial mammography beginning at the age of 40, aligning with data showing that most breast cancer cases in the country occur in women in their 40s [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, routine screening is not recommended for women under 40 who are at average risk. This recommendation is based on the low incidence of breast cancer in younger age groups, the lack of large-scale screening trials focusing on these populations, and the reduced accuracy of mammography for younger women. For instance, a study involving 73,335 initial mammograms in women aged 35\u0026ndash;39 years found a positive predictive value of just 1.3% [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite these limitations, there is growing evidence supporting personalized screening approaches for high-risk women aged 30\u0026ndash;40 years. Notably, 21.5% of breast cancer cases in the UAE occur within this age group [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. As such, tailoring screening strategies to begin at age 30 for high-risk individuals, using personalized risk assessments to guide the choice of screening methods and intervals, could significantly improve early detection outcomes [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e1.2 \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAttitude toward breast cancer screening\u003c/span\u003e\u003c/h2\u003e\u003cp\u003eStudies examining attitudes toward breast cancer (BC) screening in the UAE reveal a complex mix of knowledge gaps, positive attitudes toward medical advice, and concerns about the screening process. A cross-sectional study of 492 women aged 25\u0026ndash;45 years in the UAE highlighted that respondents\u0026rsquo; knowledge of BC risk factors, warning signs, symptoms, and screening behavior. Almost half (44.8%) of the women who had never undergone a Clinical Breast Exam (CBE) and 44.1% of women who had never undergone mammography reported that they were unaware of these screening methods was below expected levels.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eNo-show rates for mammogram appointments represent a significant challenge in achieving optimal breast cancer screening rates in the UAE. A no-show occurs when a patient fails to attend a scheduled mammogram appointment, leading to missed opportunities for early cancer detection. A study analyzing data from Kuwait, Oman, Saudi Arabia, and the UAE found that only 13.9% of women aged 40 to 75 in the UAE had undergone a mammogram within the recommended interval. This low uptake suggests potential challenges with appointment adherence, though specific no-show rates for mammography appointments in the UAE are not well-documented. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] High no-show rates can lead to poor patient outcomes, decreased staff productivity, and significant loss in revenue for a healthcare system. A no-show rate is the percentage of patients who fail to attend scheduled appointments.[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] Unfortunately, this issue is particularly evident in microsystems that provide care to underserved populations, possibly contributing to poorer health outcomes often observed among these groups.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eResearchers from the University of Washington have reported in the Journal of the American College of Radiology (JACR) that the percentage of radiology patients who miss pre-scheduled imaging appointments is approximately 3%. However, the no-show rates are more than twice as high for mammography and ultrasound appointments.[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] A study conducted at a community health center in Boston, USA, found that approximately 12% of patients did not attend their scheduled screening mammography appointments. The research highlighted that socioeconomically disadvantaged and racial or ethnic minority patients were disproportionately affected by missed appointments, leading to potential delays in care. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eNot showing up for scheduled appointments can have adverse effects on patients' health, such as hindering their diagnosis [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Moreover, high no-show rates lead to reduced available appointments and increased at times [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], leading to patient dissatisfaction and negatively affecting the quality of care. In addition, no-shows can be a significant financial burden. For instance, in 2004, no-shows in the United Kingdom cost approximately \u0026pound;790\u0026nbsp;million, which accounted for 1% of the country\u0026rsquo;s total health expenditures that year [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. High no-show rates for mammography appointment within Dubai Health, ranging from 30\u0026ndash;40%, have persisted for years, undermining early detection efforts. In 2022, we conducted a cross-sectional study within Dubai Health Authority's primary healthcare system, where the no-show rate during the study period was 40%. This study aims to identify the factors contributing to these high rates and provide actionable insights to improve screening adherence.\u003c/p\u003e\u003c/div\u003e"},{"header":"2 Methodology","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.1 \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eStudy Design, Population, and Sampling\u003c/span\u003e\u003c/h2\u003e\u003cp\u003eThis cross-sectional study was conducted in Dubai, United Arab Emirates, targeting women referred for mammography appointments through family physician consultations at Dubai Health\u0026rsquo;s primary healthcare centers. In this system, family physicians initiate the mammography referral during a consultation by discussing the importance of screening and obtaining the patient\u0026rsquo;s agreement. Once agreed upon, the physician places the referral order in the electronic medical record, and patients receive appointments scheduled based on their preferred date and time.\u003c/p\u003e\u003cp\u003eAll twelve primary healthcare centers under Dubai Health were included in the study to ensure inclusivity and a representative sample size. These centers provided mammography referral services, with screenings conducted at four central health centers equipped with mammography facilities. Out of 5,249 mammography referrals made during the study period, only 3,094 women attended their appointments, resulting in a no-show rate of 40.9%.\u003c/p\u003e\u003cp\u003eTo ensure a robust and representative sample, a target sample size of 365 participants was calculated using an online sample calculator, with a 5% margin of error and a 95% confidence interval. However, a total of 461 participants completed the interviews, providing a larger sample for analysis. This sample was selected from the population of women who missed their scheduled mammography appointments. This study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval for the study was obtained from the Dubai Scientific Research Ethics Committee (DSREC) under reference number DSREC-09/2022-25. All participants provided written informed consent prior to participation in the study.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.2 \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMeasure\u003c/span\u003e\u003c/h2\u003e\u003cp\u003eA telephone interview was conducted with a researcher to gather information from the sample population regarding the questionnaire. This questionnaire was developed based on prior studies, including an unpublished internal study at DHA and [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eThe questionnaire covered several areas: (a) Socio-demographic data: Age, gender, marital status, presence of children, and nationality. (b) Awareness and knowledge about breast cancer: Participants' understanding of breast cancer, along with emotional factors like shyness, anxiety, and procedure-related pain.(c)Concerns about radiation and interest in screening: Participants' worries about radiation and their interest in undergoing screening.(d)Appointment-related information: Factors like forgetting appointments, being busy, preferred procedure time, and appointment rescheduling.(e)Factors affecting attendance: Consideration of factors like taking time off work, procedure location, transportation, and parking.(f)Issues from experiences and preferences: Exploring negative experiences with family/friends, preference for private hospitals, and sudden constraints affecting participation.\u003c/p\u003e\u003cp\u003eAll questions had closed-ended 'yes' or 'no' responses, and participants were ensured to answer all questions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.3 \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eStatistical Analysis\u003c/span\u003e\u003c/h2\u003e\u003cp\u003eThe objective of the survey is to assess the factors contributing to missed mammography appointments. In addition, descriptive statistics such as counts, percentages, and p-values were employed to characterize socio-demographic traits, risk factors, familiarity with the procedure, and determinants factors influencing appointment no-show.\u003c/p\u003e\u003cp\u003eThe analysis incorporated the chi-squared test to ascertain the significance of relationships between categorical variables encompassing risk factors and demographic information, all within a 95% confidence interval (CI), with the results presented as Chi-square values. All data underwent analysis using IBM SPSS Statistics 28, 2020 edition.\u003c/p\u003e\u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.1 \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eStudy Sample Characteristics\u003c/span\u003e\u003c/h2\u003e\u003cp\u003eA total of 461 participants completed the interview. The age distribution was as follows: 40\u0026ndash;45 years (n\u0026thinsp;=\u0026thinsp;147, 31.9%), 46\u0026ndash;50 years (n\u0026thinsp;=\u0026thinsp;127, 27.5%), 51\u0026ndash;55 years (n\u0026thinsp;=\u0026thinsp;92, 20%), 56\u0026ndash;60 years (n\u0026thinsp;=\u0026thinsp;125, 22%), and 61 years and above (n\u0026thinsp;=\u0026thinsp;56, 12%).\u003c/p\u003e\u003cp\u003eThe marital status of participants was distributed as follows: Single (n\u0026thinsp;=\u0026thinsp;37, 8.1%), Married (n\u0026thinsp;=\u0026thinsp;396, 87.4%), Divorced (n\u0026thinsp;=\u0026thinsp;8, 1.8%), and Widowed (n\u0026thinsp;=\u0026thinsp;12, 2.6%). Regarding nationality, the majority were UAE nationals (n\u0026thinsp;=\u0026thinsp;333, 72.2%), while non-UAE nationals accounted for (n\u0026thinsp;=\u0026thinsp;128, 27.8%).\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents a detailed summary of the participants' demographic characteristics.\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\u003eThe Socio-Demographic Characteristics of the study sample.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\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=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\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 N\u0026thinsp;=\u0026thinsp;461(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e147(31.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46\u0026ndash;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e127(27.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51\u0026ndash;55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e92(20)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56\u0026ndash;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39(8.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003emore than 60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56(12)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eNationality\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUAE Nationals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e333(72.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon-UAE Nationals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e128(27.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37(8.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e396(87.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(1.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWidow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(2.6)\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\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.2 \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eFactors Influencing Mammography Appointment Attendance\u003c/span\u003e\u003c/h2\u003e\u003cp\u003eAmong the total no-show participants (n\u0026thinsp;=\u0026thinsp;461), a low number reported not receiving adequate information about breast cancer (n\u0026thinsp;=\u0026thinsp;27, 5.9%). The majority, however, had received information about breast cancer screening (n\u0026thinsp;=\u0026thinsp;424, 94%).\u003c/p\u003e\u003cp\u003eOut of 461 women surveyed, only three (n\u0026thinsp;=\u0026thinsp;3, 0.7%) expressed concerns about radiation exposure during the mammogram procedure, indicating that such concerns are relatively rare in this sample.\u003c/p\u003e\u003cp\u003eThe statistical analysis showed that age does not significantly affect feelings of procedure-related pain, shyness, or fear. Interestingly, in the 50\u0026ndash;60 age group, only 12.8% of women responded with \"yes,\" which was the highest percentage among all age groups.\u003c/p\u003e\u003cp\u003eTo assess the connection between these variables, we used a Chi-Square test, yielding a result of 0.002. The p-value was less than 0.001, indicating a strong and statistically significant lack of association between age, procedure-related emotional factors, and non-attendance at mammogram screenings. In other words, regardless of age, these emotional factors do not significantly influence whether individuals attend mammogram screenings at Dubai Health.\u003c/p\u003e\u003cp\u003eAmong those aged 40\u0026ndash;45, approximately 25.9% responded 'yes,' indicating that these factors hindered their clinic attendance. In the 46\u0026ndash;50 years age group, this percentage increased to around 31.5%.\u003c/p\u003e\u003cp\u003eThe Chi-Square test produced a result of less than 0.001, and the corresponding p-value was also less than 0.001. This shows a strong and statistically significant difference, suggesting that these factors and age significantly influence whether individuals attend mammogram screenings at Dubai Health clinics. The data particularly emphasizes the greater impact of these factors in the 40\u0026ndash;50 years age group.\u003c/p\u003e\u003cp\u003eThe statistical results illustrate no significant age-related variation in responses to appointment-related issues such as forgetfulness, challenges in rescheduling, and absence of hospital reminders. Among the age group of individuals over 60, approximately 29% answered 'yes', indicating these factors can be associated with their attendance at the clinic.\u003c/p\u003e\u003cp\u003eHowever, the Chi-Square test yielded a value of 0.49, and the corresponding p-value was 0.5. This result has no statistical significance, suggesting that these factors and age do not influence clinic attendance for mammogram screenings at DHA.\u003c/p\u003e\u003cp\u003eThe statistical analysis using a Chi-Square test revealed no significant association between age and facility preference for mammogram screenings. The Chi-Square value was 0.019, with a p-value of 0.017, which is below the standard significance level of 0.05. Despite the low p-value, the results indicate that individuals across different age groups do not exhibit a statistically significant preference for private clinics, government health centers, or other screening locations over DHA mammogram screenings.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents a detailed summary of these findings.\u003c/p\u003e\n\u003cp\u003eTable 2. The Crosstabulation Analysis of Factors and Age in the 2022 Mammogram No-Show Study Among Women in Dubai\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\" width=\"584\" height=\"274\"\u003e\u003c/p\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eIn our analysis of non-participation in mammogram screening among women who missed their appointments, we examined the underlying reasons. Our investigation revealed that organizational issues emerged as the most prevalent cause, exhibiting a notable connection with both behavioral and participant attitudes and the prioritization of screening within their busy schedules. In this section, we compared our study's findings with those of previous research and studies.\u003c/p\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e4.1 \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAge\u003c/span\u003e\u003c/h2\u003e\u003cp\u003eAge appeared to play a divergent role in breast screening attendance in our study. We observed that individuals aged 40\u0026ndash;59 constituted a significant portion of the no-show group (59.6%), highlighting a concerning trend of lower attendance in this age range. In contrast, findings from a meta-analysis of 66 studies involving 22,150,922 participants showed no significant differences in screening attendance across age groups. Specifically, among women aged 60\u0026ndash;69 compared to 50\u0026ndash;59, observational studies (n\u0026thinsp;=\u0026thinsp;16, 5,065,779) reported an odds ratio (OR) of 0.97 (95% CI: 0.88 to 1.08), suggesting minimal variation.\u003c/p\u003e\u003cp\u003eThese contrasting findings suggest that while global data from the meta-analysis show no significant impact of age on attendance, our study indicates that middle-aged individuals (40\u0026ndash;59) may have unique barriers or factors influencing their participation in breast screening programs. This discrepancy highlights the need for targeted local interventions to address age-specific barriers and improve attendance rates in this demographic group [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e4.2 \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eInterest in mammogram screening\u003c/span\u003e\u003c/h2\u003e\u003cp\u003eOur study revealed that among women who did not attend mammogram screening appointments, the proportion of those who expressed disinterest in undergoing the screening and doesn't have interest was 8.6%. In contrast, another study reported a higher percentage of 18.8%. This discrepancy may arise because the latter study's figure represented the disinterest of all women, not just those who missed their appointments. Therefore, it is plausible that the actual portion of women genuinely uninterested in the screening may be even higher. This insight emphasizes the need for a more comprehensive understanding of women's attitudes toward mammogram screening, beyond those who missed their appointments.[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e4.3 \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eFear of pain from mammograms and detecting cancer\u003c/span\u003e\u003c/h2\u003e\u003cp\u003eIn our study, which included 461 participants, fear of pain was reported as a barrier to mammogram screening by only 6.1% of participants. In contrast, a study conducted in Calabar, Nigeria, with a sample size of 365 participants, found that 37.8% of women cited fear as a psychosocial barrier to undergoing mammography screening [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Additionally, another study conducted in the United Arab Emirates, specifically in Ras Al Khaimah (RAK), reported fear as a significant concern for 44.8% of participants, albeit with a smaller sample size of 54 participants. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] It is important to consider that the difference in reported fear percentages between this study and ours may be attributed to sample size variations. Our study boasted a larger sample size, which can contribute to more robust and reliable findings. These findings suggest that, within our sample, fear of pain is not a prominent concern and does not serve as a substantial barrier to undergoing the screening. This underscores the importance of considering individual variations in the perceived barriers to mammogram screening and tailoring interventions accordingly.\u003c/p\u003e\u003cp\u003eIn addition to that, we identified that the fear of being diagnosed with breast cancer accounted for approximately 4.1% of missed appointments, indicating it as a relatively less prevalent reason for non-participation. In contrast, compared to another study, the fear of diagnosis emerged as a significantly more substantial concern. Specifically, in this other study, 35.6% of women who did not attend mammogram screening reported the fear of being diagnosed as a critical reason for their non-participation. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eThese findings highlight the considerable variation in the perception of fear related to breast cancer diagnosis and mammogram screening among different populations. The lower prevalence in our study suggests that fear of diagnosis and the procedure might have a lesser impact on non-attendance in our particular sample.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e4.4 \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eLack of time\u003c/span\u003e:\u003c/h2\u003e\u003cp\u003eOur study found that organizational issues, such as a lack of time, the inability to seek permission from work, and busy schedules, accounted for 21.5% of no-shows for mammogram screening. This finding aligns with a study conducted in Germany, where out of 1494 surveyed clients, 397 (26.57%) cited time-related problems as a reason for not participating in the screening. Remarkably, the German study categorized lack of time due to health-related issues or long working hours separately, indicating the multifaceted nature of time-related barriers to screening participation. These consistent findings underscore the global relevance of addressing organizational challenges as a significant factor in non-participation in mammogram screening programs.\u003c/p\u003e\u003cp\u003eIn addition, factors such as the location of screening centers, lack of transportation, appointment-related issues, and the procedure cost did not emerge as significant barriers in our study sample concerning non-attendance for mammogram screening.\u003c/p\u003e\u003c/div\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eMost women who did not attend mammogram appointments at Dubai Health Clinics had specific reasons for their absence, with time management challenges being particularly significant among women aged 40\u0026ndash;50, a group that also showed higher no-show rates. To address these barriers and improve participation, a patient-centered approach is needed. Introducing dedicated \u0026ldquo;Mammogram Off-Days\u0026rdquo; during weekdays or weekends can provide convenient screening opportunities for women trying to manage their professional and personal responsibilities. Flexible scheduling, including extended hours, weekend availability, walk-in services, and same-day appointments, can further accommodate diverse needs. Additionally, implementing a user-friendly SMS-based system for reminders, cancellations, and rescheduling can help reduce missed appointments. For younger women in the 40\u0026ndash;50 age group, tailored awareness campaigns should highlight the importance of early detection while addressing misconceptions and practical concerns. These campaigns can be delivered through social media, WhatsApp, and workplace outreach to reach women where they are most engaged. Collectively, these strategies foster a more accessible, supportive healthcare environment that aligns with the realities of modern women's lives, ultimately promoting higher attendance rates and improved breast health outcomes.\u003c/p\u003e\u003cp\u003eA key limitation of this study is the absence of data on the racial and ethnic backgrounds of non-UAE nationals\u0026rsquo; participants. As racial and ethnic factors can influence breast cancer awareness, access, and screening behaviors, the lack of this data may limit the generalizability of our findings and warrants attention in future research.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment:\u0026nbsp;\u003c/strong\u003eWe thank the Dubai Health and the Mohammed Bin Rashid School of Government for their support and assistance.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding sources:\u0026nbsp;\u003c/strong\u003eThe authors disclose no receipt of any financial support for the authorship, research, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u0026nbsp;\u003c/strong\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Data Statement is not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Statement:\u0026nbsp;\u003c/strong\u003eThe study was\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eapproved by Dubai Scientific Research Ethics Committee (DSREC-09/2022_25).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003eDr Khawla Eissa Alhajaj, principal researcher, was responsible for writing the proposal, the methodology, analysis, and recommendations. Dr. Ola, was responsible for writing the questionnaires, creating the electronic questionnaires and data analysis. Dr.Fatima Ahmed Alhammadi \u0026amp; Dr. Elham Saeed Alneaimi were responsible to write introdaction, Dr.Amani Salem Alzubaidi\u003csup\u003e\u0026nbsp;\u003c/sup\u003e,Dr.Amina Mohamed, Dr.Farzaneh Abedini \u0026amp; Dr.Hanan Ali Almuhaureq were responsible for data collection and coding, Dr.Marwan Zidan conducted data analysis and wrote the results\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDr. Immanuel Azaad Moonesar R.D. was assigned to review the full report, data analysis, conclusion. D.Alia Mohammad Aldallal\u0026nbsp;wrote the recommendation \u0026amp; conclusion. All authors give final approval for the version to be published and agree to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u0026nbsp;\u003c/strong\u003eAll data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003eThis study was conducted in accordance with the principles of the Declaration of Helsinki\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization (2021). World Health Organization. \u0026quot;Breast Cancer. accessed on Feb.2023: https://www.who.int/news-room/fact-sheets/detail/breast-cancer). \u003c/li\u003e\n\u003cli\u003eAl-Shamsi HO, Abdelwahed N, Al-Awadhi A, Albashir M, Abyad AM, Rafii S, Afrit M, Al Lababidi B, Abu-Gheida I, Sonawane YP, Nijhawan NA, Haq UU, Dreier N, Joshua TLA, Iqbal F, Yacoub T, Nawaz FA, Abdul Jabbar D, Tirmazy SH, El-Shourbagy DM, Hamza D, Omara. \u0026quot;Breast Cancer in the United Arab Emirates.\u0026quot; \u003cem\u003eJCO Glob Oncol\u003c/em\u003e (2023).\u003c/li\u003e\n\u003cli\u003eMinistry of Health \u0026amp; Prevention. \u003cem\u003eCancer Incidence in United Arab Emirates Annual Report of the UAE\u0026mdash;National Cancer Registry\u003c/em\u003e. Dubai : Ministry of Health \u0026amp; Prevention, 2017.\u003c/li\u003e\n\u003cli\u003eUAE National Cancer Registry (2017). \u003cem\u003eAnnual Cancer Report.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eHAAD Cancer Programs. 2018\u003c/li\u003e\n\u003cli\u003eBreast cancer screening available at DHA centres. 2018.\u003c/li\u003e\n\u003cli\u003eMinistry of Health launches. The National Periodic Health Screening and Cancer Screening initiatives. 2018.\u003c/li\u003e\n\u003cli\u003eChen TH, Yen AM, Fann JC, et al. Clarifying the debate on population-based screening for breast cancer with mammography: A systematic review of randomized controlled trials on mammography with Bayesian meta-analysis and causal model. Medicine (Baltimore). 2017;96(3):e5684.\u003c/li\u003e\n\u003cli\u003eAssociation of European Cancer Leagues. European Union Council Recommendation on Cancer Screening.\u003c/li\u003e\n\u003cli\u003eKaplan-Lewis, E., \u0026amp; Percac-Lima, S. (2013). \u003cem\u003eBarriers to Mammography Screening in Low-Income Minority Women: A Review of Literature.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eAbbas MO, Baig M. Knowledge and Practice Concerning Breast Cancer Risk Factors and Screening among Females in UAE. Asian Pac J Cancer Prev. 2023 Feb 1;24(2):479-487. doi: 10.31557/APJCP.2023.24.2.479. PMID: 36853296; PMCID: PMC10162630.\u003c/li\u003e\n\u003cli\u003eElbarazi I, Alam Z, Abdullahi AS, Al Alawi S, AlKhanbashi M, Rabaa A, Al Aryani A, Ahmed L, Al-Maskari F. Knowledge, Attitudes and Practices of Women in the UAE Towards Breast and Cervical Cancer Prevention: A Cross-Sectional Study. Cancer Control. 2023 Jan-Dec;30:10732748231211459. doi: 10.1177/10732748231211459. PMID: 37950611; PMCID: PMC10640807.\u003c/li\u003e\n\u003cli\u003eAbu Awwad D, Hossain SZ, Mackey M, et al. \u0026quot; Women\u0026apos;s breast cancer knowledge and health communication in the United Arab Emirates.\u0026quot; \u003cem\u003eHealthcare (Basel) \u003c/em\u003e(2020): 495.\u003c/li\u003e\n\u003cli\u003eElobaid Y, Aw TC, Lim JNW, et al. \u0026quot; Breast cancer presentation delays among Arab and national women in the UAE: A qualitative study.\u0026quot; \u003cem\u003eSSM Popul Health \u003c/em\u003e(2016): 155-163.\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eThe National Guidelines for Breast Cancer Screening and Diagnosis\u003c/em\u003e. Dubai: Ministry of Health \u0026amp; Prevention, 2014.\u003c/li\u003e\n\u003cli\u003eSmith, A., Brown, L., and Jones, T. (2020). Positive Predictive Value of Mammography in Younger Women. \u003cem\u003eRadiology Journal\u003c/em\u003e, 27(8), pp.112-118.\u003c/li\u003e\n\u003cli\u003eAl-Shamsi HO, Alrawi S. \u0026quot; Breast cancer screening in the United Arab Emirates: Is it time to call for a screening at an earlier age?\u0026quot; \u003cem\u003eJ Cancer Prev Curr Res\u003c/em\u003e (2018): 123-126.\u003c/li\u003e\n\u003cli\u003eHO, Al-Shamsi. \u0026quot; Mammography screening for breast cancer-the UK Age trial.\u0026quot; \u003cem\u003eLancet Oncol \u003c/em\u003e(2020): 505.\u003c/li\u003e\n\u003cli\u003eAl-Mandhari, A. S., Al-Rawas, O. A., Al-Adawi, S., Al-Kaabi, M. S., \u0026amp; Al-Riyami, M. M. (2020). Uptake of breast and cervical cancer screening in four Gulf Cooperation Council countries. \u003cem\u003eEastern Mediterranean Health Journal\u003c/em\u003e, 26(6), 657-665\u003c/li\u003e\n\u003cli\u003eKheirkhah, P., Qianmei Feng, Travis, L. M., Tavakoli-Tabasi, S., \u0026amp; Sharafkhaneh, A. \u0026quot;Prevalence, predictors and economic consequences of no-shows.\u0026quot; \u003cem\u003eBMC Health Services \u003c/em\u003e(2016).\u003c/li\u003e\n\u003cli\u003eKaplan-Lewis, E., \u0026amp; Percac-Lima, S. \u0026quot;No-show to primary care appointments: Why patients do not come.\u0026quot; Journal of Primary Care \u0026amp; Community Health (2013): 251-255.\u003c/li\u003e\n\u003cli\u003eSlachta, Anicka. \u0026quot;No-shows in radiology most common for mammogram, ultrasound appointments.\u0026quot; 2018.\u003c/li\u003e\n\u003cli\u003eWang, G. X., Mercaldo, S. F., Cahill, J. E., Flanagan, J. M., Lehman, C. D., and Park, E. R. (2024). Missed Screening Mammography Appointments: Patient Sociodemographic Characteristics and Mammography Completion After 1 Year. \u003cem\u003eJournal of the American College of Radiology\u003c/em\u003e, 21(10), pp. 1645\u0026ndash;1656.\u003c/li\u003e\n\u003cli\u003eCohen-Yatziv L, Cohen MJ, Halevy J, Kaliner E. \u0026quot; No-shows in ambulatory clinics and non-utilized appointments for elective operations in selected surgical departments at a tertiary hospital in Israel.\u0026quot; \u003cem\u003eIsr J Health Policy Res.\u003c/em\u003e (2019).\u003c/li\u003e\n\u003cli\u003ePaterson BL, Charlton P, Richard S. \u0026quot; Non-attendance in chronic disease clinics a matter of non-compliance?\u0026quot; \u003cem\u003eJ Nurs Healthc Chronic Illn.\u003c/em\u003e (2010): 63-74.\u003c/li\u003e\n\u003cli\u003eAtun RA, Sittampalam SR, Mohan A. \u003cem\u003eUses and benefits of SMS in healthcare delivery\u003c/em\u003e. Tanaka business school, 2005.\u003c/li\u003e\n\u003cli\u003eUthman OA, Johnson S, Tsertsvadze A, Stinton C, Taylor-Phillips S, Clarke A. Factors associated with attendance at screening for breast cancer: a systematic review and meta-analysis. BMJ Open. 2021 Nov 30;11(11):e046660. doi: 10.1136/bmjopen-2020-046660. PMID: 34848507; PMCID: PMC8634222.\u003c/li\u003e\n\u003cli\u003eNja GME, Okaliwe G, Ibor GO, Ogunkola IO, Okoroiwu HU, Ejemot-Nwadiaro RI, Lucero-Prisno Iii DE. Socio-demographic determinants of mammography uptake among women of 40 years and above in Calabar, South-South, Nigeria: a cross-sectional study. Pan Afr Med J. 2022 Oct 12;43:76. doi: 10.11604/pamj.2022.43.76.32683. PMID: 36590996; PMCID: PMC9789778.\u003c/li\u003e\n\u003cli\u003eAbu Awwad D, Hossain SZ, Mackey M, et al. \u0026quot; Women\u0026apos;s breast cancer knowledge and health communication in the United Arab Emirates.\u0026quot; \u003cem\u003eHealthcare (Basel) \u003c/em\u003e(2020): 495.\u003c/li\u003e\n\u003cli\u003eBancej CM, Maxwell CJ, Onysko J, Eliasziw M. Mammography utilization in Canadian women aged 50 to 69: identification of factors that predict initiation and adherence. Can J Public Health. 2005 Sep-Oct;96(5):364-8. doi: 10.1007/BF03404034. PMID: 16238156; PMCID: PMC6975686.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Breast cancer screening, Mammography, No-show, Public health awareness, Dubai, UAE, Dubai Health","lastPublishedDoi":"10.21203/rs.3.rs-6668279/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6668279/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eBreast cancer is the most common cancer among females and is a major health concern in the United Arab Emirates (UAE). It is characterized by an early onset and significant contributions to female cancer cases and deaths. Despite its significance, low rates of mammogram participation pose challenges for early detection and effective treatment. This study explored the barriers influencing mammogram attendance among women in the UAE.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis cross-sectional study surveyed 461 women referred for mammograms but did not attend appointments across twelve primary healthcare centers in Dubai, UAE. The objective was to identify factors affecting mammography attendance, considering system-related factors, procedure-related factors and factors related to women's emotional and practical behavior.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eEmotional factors such as procedure-related pain, fear, or shyness showed no significant association with mammogram attendance across all age groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Conversely, practical constraints, including being too busy, hesitancy to request time off work, and weekday morning unavailability, significantly influenced attendance, particularly among women aged 40\u0026ndash;50 years (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Age did not significantly impact appointment-related issues like forgetfulness, challenges in rescheduling, or the absence of reminders (p\u0026thinsp;=\u0026thinsp;0.5). In addition, location preference for mammogram screenings was not influenced by age (p\u0026thinsp;=\u0026thinsp;0.017).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eBased on the findings, emotional factors were not key determinants for missing mammogram appointments in the included sample. Instead, practical issues, notably work commitments, significantly affect attendance, particularly among women aged 40\u0026ndash;50. Accordingly, recommendations include offering extended hours, introducing a dedicated mammogram off day, emphasizing practical issues in awareness campaigns to working women, implementing virtual pre-screening consultations before appointments, providing information in multiple languages to cover the diversity of the population in Dubai, and leveraging AI tracking to minimize no-shows, especially for women aged 40\u0026ndash;50 years. These measures would enhance mammogram attendance, facilitating breast cancer detection earlier and improving treatment outcomes in affected population.\u003c/p\u003e","manuscriptTitle":"Factors Influencing Missed Appointments for Mammography Screening at Primary Health Care Clinics","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-08 09:31:18","doi":"10.21203/rs.3.rs-6668279/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c146d9c8-fba8-4307-a532-cd21576238da","owner":[],"postedDate":"August 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-27T10:58:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-08 09:31:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6668279","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6668279","identity":"rs-6668279","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}