The Association Between Immigrant Muslim Arab Women’s Health Beliefs, Knowledge, Fatalism, Modesty, Perceived Spousal Support and Their Mammogram Utilizations: A Mixed- Methods Approach

Background.Breast cancer (BC) is the most commonly diagnosed cancer among females in the United States. Substantial evidence has shown that regular mammogram screenings are effective for early BC detection and mortality reduction. Immigrant Muslim Arab women (IMAW), however, are less likely to be engaged in breast cancer screening (BCS), particularly mammogram screening. Few studies have explored factors associated with low mammogram utilization among IMAW. Additionally, all have overlooked an important factor—a husband’s influence in adherence to mammography screenings. In Arab and Muslim cultures, a husbands’ influence and responsibilities extends to their wives’ healthcare-seeking behaviors, thus becoming an important factor in a woman’s health status.Developing and implementing a qualitative and quantitative mixed-method study sought: 1) to investigate associations between levels of IMAW’s health beliefs, BC knowledge, BC fatalism, modesty, perceived spousal support, and receiving physician recommendations and mammogram utilization; and 2) to better understand IMAW’s experiences and perceptions of spousal influence on mammogram utilization within their sociocultural context. Method.The quantitative portion of the study was guided by the health beliefs model utilizing online surveys in Arabic and English. Due to the COVID 19 pandemic, a convenience sample was recruited using social media methods. Independent variables measured five scales: 1) perceived spousal support, 2) modified Powe fatalism inventory, 3) modesty measure for Muslim women, 4) BC knowledge, and 5) Champion breast health beliefs. Questions regarding receiving a health care providers’ (HCPs) recommendation for mammography was measured by self-report. Logistic regression explored relationships between independent variables and two outcomes: 1) ever had a mammogram, and 2) had a mammogram in the past two years.Guided by symbolic interactionism, the qualitative portion of the study was conducted on a purposive sample of IMAW. A semi-structured ...