Doctor’s Counselling Using Culturally Responsive Pamphlet Increased Mammogram Uptake among Malay-Muslim Women in Singapore: A Randomized Controlled Trial in a Primary Healthcare Clinic

Abstract

Objective: Malay-Muslim women experienced higher breast cancer mortality rate and lower mammogram uptake rate compared to other ethnic groups in Singapore despite equal access to health facilities. We aimed to increase mammogram uptake rate among Malay-Muslim women attending a primary healthcare clinic by providing doctor’s counselling on mammogram and breast cancer. Methods: We conducted a randomized controlled trial to evaluate effectiveness of doctor’s counselling using a culturally responsive pamphlet in increasing mammogram uptake among Malay-Muslim women attending the clinic. Those in intervention arm received 8-minutes doctor’s counselling on mammogram and breast cancer while those in control arm received 8-minutes doctor’s counselling on usual care – dietary care. We recruited 319 Malay-Muslim women aged 50-69 years old who have not undergone a mammogram in the past 2 years. We used Poisson regression to determine effectiveness of intervention in increasing mammogram uptake and to determine any change in knowledge, perceptions and faith-based beliefs on breast cancer and mammogram after counselling. Results: Those in intervention arm had 1.64 times higher mammogram uptake compared to those in control arm. Non-discernible changes in knowledge, perceptions and faith-based beliefs were observed, whereby only “I must have symptoms before I decide to go for mammogram” was significantly different between arms following counselling. Conclusion: Cue to action from doctor led to increased mammogram uptake among Malay-Muslim women. Future interventions to promote screening should include doctors and religious leaders to further improve mammogram uptake, and change knowledge, perception, and beliefs.