Barriers and facilitators of mammography screening among Bahraini women: a cross-sectional study in primary care

Abstract Background Breast cancer is the most prevalent malignancy among women in Bahrain, with the highest age-standardized incidence rate in the Gulf Cooperation Council (GCC) region. Despite mammography being the gold standard for early detection, screening uptake remains suboptimal. This study aimed to evaluate knowledge, attitudes, and practices regarding mammography screening among Bahraini women and identify barriers and facilitators to its utilization in primary care. Methods A cross-sectional analytical study was conducted among 400 Bahraini women aged ≥ 40 years attending five randomly selected primary healthcare centers across Bahrain. Data were collected via face-to-face interviews using a semi-structured questionnaire covering socio-demographics, medical history, knowledge, attitudes, practices, and barriers. Chi-square tests and binary logistic regression were used to identify predictors of screening uptake. Results Participants had a mean age of 54.4 ± 8.8 years. Knowledge was predominantly average (47.3%) to good (34.5%). While 70.3% held a positive attitude toward mammography and 68% had been screened at least once, only 43.8% adhered to recommended periodic intervals. The leading enabler was physician recommendation (66.9%). Key barriers included absence of physical symptoms (41.7%), lack of time (41%), and fear of pain or cancer diagnosis (38.9%). Factors significantly associated with higher uptake included older age ( p < 0.001), higher knowledge ( p = 0.003), positive family history ( p < 0.001), history of benign breast disease ( p = 0.022), and unemployed or retired status ( p = 0.001). Binary logistic regression confirmed independent predictors: age > 60 years (AOR = 5.84, 95% CI: 2.84–12.01, p < 0.001), family history (AOR = 2.39, 95% CI: 1.36–4.20, p = 0.002), benign breast disease (AOR = 2.89, 95% CI: 1.26–6.63, p = 0.012), and good knowledge level (AOR = 3.23, 95% CI: 1.49–6.97, p = 0.003). Conclusions Bahraini women demonstrate fair knowledge and positive attitudes toward mammography, yet a significant gap persists between initial screening and periodic adherence. Primary care interventions must move beyond general awareness to address symptom-driven misconceptions and psychological fears. Strengthening physician-led recommendations and implementing electronic reminder systems for high-risk groups are essential to improving national screening program effectiveness.