Document Type



Doctor of Philosophy (PhD)


Public Health

First Advisor's Name

Elena Bastida

First Advisor's Committee Title

Committee chair

Second Advisor's Name

Zoran Bursac

Second Advisor's Committee Title

Committee member

Third Advisor's Name

Patria Rojas

Third Advisor's Committee Title

Committee member

Fourth Advisor's Name

Richard Beaulaurier

Fourth Advisor's Committee Title

Committee member


Knowledge, Culture, Mammograms, Breast Cancer, Saudi, Women

Date of Defense



Breast cancer is the most frequent malignant tumor that threatens the lives of women globally. In Saudi Arabia, breast cancer incidence was observed among younger and premenopausal women due to diagnosis at advanced stages. The late diagnosis results in poor prognosis and poor outcomes. The survival rates in Saudi women with breast cancer are low. This can be attributed to several reasons such as lack of knowledge and barriers embedded in cultural values. However, low rates of breast cancer screening account for the increasing number of breast cancer detected at much higher stages in Saudi Arabia and resulting deaths, making it challenging to offer successful treatment.

This study was conducted to assess knowledge and cultural values related to breast cancer and mammography screening among Saudi women in Saudi Arabia. Additionally, it explored how knowledge and cultural values of Saudi women may act as barriers to mammogram screening.

The study used an explanatory mixed-method design: quantitative through the administration of a survey instrument; and qualitative through the application of focus groups. The sampling pool consisted of the universe of the twelve largest general hospitals in the Eastern Province in Saudi Arabia. They included four government-owned, four privately owned, and four under military jurisdiction. A matrix was constructed, inclusive of the twelve hospitals above; using this matrix, six hospitals were drawn randomly from the matrix.

The mean ±SD of knowledge about breast cancer was 5.53±2.38, with significant differences found regarding educational level and occupational status. There were 71.7% heard about mammogram screening, and 83.3% reported that mammogram screening was important. The mean± SD of religious health fatalism was 21.6 ±4.19, and that of breast cancer, barriers, and recommendations to encourage participation in mammogram screening was 10.3±1.98, 40.8±9.73, and 10.76±3.77, respectively.

There was inadequate knowledge among women regarding breast cancer, with a high score of barriers. Religious beliefs affected the knowledge of women and acted as a barrier to screening. Both the level of knowledge and barriers also affected the practice of women for mammogram screening.



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