Culturally tailored counselling improves mammographic screening uptake among Malay-Muslim women

A culturally responsive pamphlet to guide counselling on breast cancer and mammography in a primary care setting can encourage Malay-Muslim women in Singapore to undergo mammographic screening, as shown in a randomized controlled trial.

The pamphlet, which is available in both English and Malay, includes a picture of a Malay-Muslim woman undergoing mammography. It was designed to address key barriers and concerns that prevent women in this community from getting screened.

In the intervention arm consisting of an 8-min counselling session, doctors showed the pamphlet to participants while emphasizing the benefit of early breast cancer detection. They corrected the common misconception that a woman needs to have symptoms to undergo mammography and reassured participants regarding the gender of the radiographer performing the procedure.

The counselling also helped ease common fears about mammography itself, such as the fear of pain during the procedure and the fear of receiving a cancer diagnosis. Towards the end, the patients were advised to set an appointment for mammography at the screening counter.

This approach of culturally responsive pamphlet–guided counselling led to a 65-percent increase in mammographic screening uptake. Specifically, 31.03 percent of women in the intervention arm completed the procedure vs only 23.64 percent of those in the control arm who received an 8-min counselling on dietary care (incidence rate ratio [IRR], 1.65, 95 percent confidence interval [CI], 1.17–2.31). [Asian Pac J Cancer Prev 2025;26:2811-2818]

Mammographic screening uptake rate remained higher in the intervention vs the control arm despite adjusting for age differences between the two arms (adjusted IRR, 1.64, 95 percent CI, 1.17–2.30).

“The use of culturally responsive content enabled counselling to focus on factors associated with mammogram uptake within the short span of time, hence effectively increasing mammogram uptake in this community,” according to first author Dr Shipra Lather of National University Polyclinics, National University Health Systems, Singapore, and colleagues.

Because the participants already had a “good existing knowledge” about mammography, Lather and colleagues noted the possibility that the personalized counselling “activated” this existing knowledge and motivated the participants to book and complete their mammography appointment.

“An unexpected finding in our study was a marginal statistically significant difference between arms for ‘I must have symptoms before I decide to go for mammogram’, whereby those in the intervention arm were more likely to agree to this statement (p=0.08),” they said.

“Repetition of the misinformation in our study pamphlet may have contributed to fluency, familiarity, and perhaps acceptance of the misinformation when encountered again at follow-up. Furthermore, given that the occurrence of symptoms is at the centre of perception of illness for most, it may seem illogical to seek healthcare in the absence of symptoms, particularly in a community such as this, which prioritizes the needs of their loved ones even when one is ill. As such, the misinformation may be preferred over the corrected information,” they explained.

Overall, the findings suggest that culturally responsive pamphlet–guided counselling can boost mammographic screening uptake among Malay-Muslim women and that further subsidies for the procedure, while available, may not be necessary if counselling is done effectively, according to Lather and colleagues. The authors believe such an approach can be used in Malaysia and Indonesia, since Malay-Muslims in Singapore share cultural roots with people in those neighbouring countries.

A total of 319 Malay-Muslim women aged 50–69 years who had not undergone mammography in the past 2 years participated in the trial. They were randomly allocated to the intervention arm (n=154, mean age 60.08 years) or the control arm (n=165, mean age 61.27 years).

Generally, participants in the two arms had a mostly similar level of knowledge and beliefs. Most participants reported correct knowledge and perception for a high number of variables at baseline and at follow-up.

Radiographers confirmed that 99 (31.03 percent) participants overall completed mammography after receiving counselling. There were 10 participants (6.49 percent) in the intervention arm and five (3.03 percent) in the control arm who postponed or cancelled their appointment.