title: Response costs of mammography adherence: Iranian women's perceptions.
abstract: BACKGROUND
  Mammography as the most common secondary prevention method has known to be helpful in detecting breast cancer at the early stages. Low level of participation among women toward mammography uptake due to cultural beliefs is a great concern. This study aimed at exploring the perceptions of women about response costs of mammography adherence (MA) in Yazd, Iran.
  
  
  METHODS
  A qualitative study using semi-structured interviews was performed. Fourteen women,one oncology nurse, and a breast cancer survivor were purposefully interviewed. Interviews were transcribed verbatim and analyzed by directed content analysis method based on protection motivation theory (PMT).
  
  
  RESULTS
  One main theme was emerged from the analysis namely called "response costs".Two main categories were also emerged from the data; (1) psychological barriers with six subcategories including "embarrassment," "worry about being diagnosed with cancer," "preoccupation with underlying disease," "misconception about mammography," "need for an accompanying person," and "internalizing the experiences of the others," and (2) maladaptive coping modes which encompassed three subcategories: "religious faith," "fatalism," and"avoidance and denial."
  
  
  CONCLUSIONS
  Useful information was provided about the response costs of mammography utilization based on the perceptions of women. Cognitive barriers may be decreased by conducting modifications in women's awareness and attitude toward MA as well as changing the national health system infrastructures. Incorporating religious and cultural belief systems into MA educational programs through motivational messages is recommended.
authors.affiliation: Department of Health Education & Promotion, Shahid Sadoughi University of Medical Sciences (International Campus), Yazd, Iran.
authors.forename: Mahsa
authors.initials: M
authors.lastname: Khodayarian
authors.affiliation: Department of Health Education & Promotion, Shahid Sadoughi University of Medical Sciences (International Campus), Yazd, Iran.
authors.forename: Seyed Saied
authors.initials: SS
authors.lastname: Mazloomi-Mahmoodabad
authors.affiliation: Department of Midwifery and Reproductive Health, Tarbiat Modares University, Tehran, Iran.
authors.forename: Minoor
authors.initials: M
authors.lastname: Lamyian
authors.affiliation: Department of Health Education & Promotion, Shahid Sadoughi University of Medical Sciences (International Campus), Yazd, Iran.
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Morowatisharifabad
authors.affiliation: Department of Nursing & Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Hossein
authors.initials: H
authors.lastname: Tavangar
keywords: Breast cancer prevention; Directed content analysis; Maladaptive coping modes; Mammography adherence; Protection Motivation Theory; Response costs