br Results and discussion br The results

Results and discussion
The results and discussion have been combined in line with the structure of many qualitative studies39
The four major themes included: (1) knowledge and awareness of BC, (2) knowledge of MS, (3) personal factors, (4) medical service provider and social environment.
(1) Knowledge and awareness of breast cancer
Two focus groups were conducted to explore Kuwaiti women's knowledge of BC, attitudes toward MS and reasons for not attending. To represent knowledge and attitudes from a range of perspectives, the focus groups were conducted in two all women social organisations reflecting differing socio-economic, cultural and religious perspectives. One focus group (12 participants) was conducted at a social organisation whose membership take interest in issues relating to health, media, culture and sport (Focus Group 1). The second focus group (11 participants) took place at a social organisation whose role includes the improvement of literacy (Focus Group 2). All participants were of eligible MS age, yet none had previously presented for mammography screening. The age range of participants in group 1 spanned 41e60 years of age and 55e67 years of age in group 2. 
Not all participants had equal knowledge of what BC was, and especially of any potential causes of BC. Those participants from focus group two demonstrated an overall lower knowledge of BC, its manifestations and potential causes. Participants in this AWD 131-138 later group included women of lower socio-economic status who accessed the social organisation to improve their literacy. Such findings are consistent with the reported literature which indicates that knowl-edge of BC and MSS is often limited among women of lower socio-economic status, poor literacy and rural habitation.27,40 Similarly, Lawal et al. (2015) reported that women with a tertiary education had a greater knowledge of breast cancer, were more likely to engage in breast self-examination and to attend for mammography screening, parallelling the responses from focus group one.28
Theme 1: Knowledge Theme 2: Knowledge
and awareness of Theme 3: Personal
of mammography
women-related
factors
screening
breast cancer
Sub-theme1: Fear
Breas eeding
and CBE
Gene c
determina on
Fatalism
Psychological
health
Family and social
support
Extraneous
variables
Sub-theme 5: personality trait
Figure 1. Themes and Sub-themes identified by Thematic Analysis.  67
Theme 4: Medical provision and social environment
Sub-theme 1: Physicians’ recommenda ons
Sub-theme 2: Knowledge of awareness campaigns
Sub-theme 3: Accessing MS services
Sub-theme 4: Social and professional roles
Within interphase general theme of BC knowledge and awareness several sub-themes were identified including:
Breastfeeding
Participants in both focus groups identified the action of breast feeding as a potential preventative action for BC, and would negate any need to attend for MS.
“… breastfeeding is one important way to protect women from developing breast cancer” Participant (P) 8 (Focus group 1)
Not breast feeding and releasing breast milk was identified as a causative agent.
“Breast cancer occurs when the woman does not breastfeed her baby, the milk will be accumulated and … becomes a tumour”. P7 (Focus group 2)
These findings corroborate previous research identifying a fail-
Genetic determination
Participants in both focus groups used familial links to reinforce a potential genetic cause of BC.