Understanding rural women’s intention toward breast cancer screening: a qualitative study using the Theory of Planned Behavior in Bangladesh

Abstract

Breast cancer remains one of the leading causes of cancer-related mortality in Bangladesh. Although low-cost screening methods, such as Clinical Breast Examination (CBE), have been introduced with a focus on rural populations, where approximately 70% of the population resides, screening participation among rural women remains critically low. Given the limited research on rural women’s decision-making regarding cancer screening, this study aimed to examine how the socio-cultural environment and health knowledge shape women’s attitudes, social and familial influences, and perceived confidence in seeking preventive care, and how these factors, in turn, influence their intention to participate in screening. Ten rural women were interviewed to explore their lived experiences, focusing on socio-cultural stigma, health beliefs, decision-making confidence, and the influence of family and community support. The findings indicate that women’s attitudes toward preventive cancer screening, as well as the support they receive from family and society, are strongly shaped by cultural taboos and social norms surrounding breast health. Many participants had a limited understanding of preventive screening, and their perceived risk of breast cancer and perceived benefits of screening significantly influenced their attitudes. Additionally, social influences rooted in stigma, limited health knowledge, lack of formal health communication, and women’s restricted autonomy over health decisions emerged as key barriers. A key finding of this study is that, although structural and logistical barriers exist, participants did not perceive them as the primary obstacles. Instead, perceived risk, perceived benefits, the need for spousal permission, and the availability of female healthcare providers emerged as the most influential factors shaping future screening intentions. This study contributes to the application of the Theory of Planned Behavior (TPB) in a restrictive sociocultural context by showing that, while subjective norms, particularly spousal influence, directly shape behavioral intentions, TPB constructs alone do not fully explain women’s screening behavior. Instead, these constructs are influenced by broader socio-cultural conditions and gaps in health communication. The study also offers participant-informed implications, highlighting the need for culturally sensitive and context-specific health communication strategies to improve screening participation among rural women.