Table 5.

Appraised Articles Based on Mutual Consensus among the Researchers for which the Data were Extracted

No		Authors and publication year		Country		Sample size (n)		Proportion of Muslim women (%)		Age range of participants (years)		Methodology and instruments		Outcome
1		Alatrash, 2020		USA		316		67.4		40 and older		Quantitative/ Questionnaire		Screening rates among Muslim women were lower than Christian women attributable to how benefits and barriers regarding screening practices were perceived and the modesty of Muslim women and their religion that bans exposing the body to a male physician.
2		Shirazi et al., 2013		USA		53		100		40–87		Qualitative/ Interview		The study showed that Muslim women have low rates of BC screening due to husbands’ influence on screening decisions, being more concerned about the well-being of children and family than their own health, prevailing tradition of cultural privacy and modesty, and lack of knowledge.
3		Madkhali et al., 2019		SA		64		100		18 and older		Qualitative/ Interview		Religion, cultural background and healthcare services were found to influence the participation of Muslim women in BC screening. No differences were found between female nurses and females from the general population in terms of their knowledge of BC and awareness of breast health.
4		Vahabi et al., 2017		Canada		238,218		17.9		50–74		Quantitative/ Questionnaire		Screening rates were significantly lower among immigrant women from Muslim-majority countries. The decision to undergo BC screening may be influenced by women’s religious beliefs, a confluence of cultural beliefs and practices, socio-demographic, and immigration trajectories.
5		Pratt et al., 2020		USA		30		100		30–70		Quantitative/ Questionnaire		Some of the Muslim women's religiously attributed barrier beliefs may be combined with other cultural factors that affected the screening decisions.
6		Al-Amoudi et al., 2015		USA		14		100		30–69		Qualitative/ Focus groups interview		Barriers to participating in BC screening were reported to include fear of pain, lack of knowledge about where to seek services, preference for female or Muslim doctors, lack of doctor advice, reluctance to discuss breast health, difficulty with transport and perceiving religion as a coping mechanism for illness.
7		Padela et al., 2015		USA		240		100		40 or older		Quantitative/ Questionnaire		Mammography screening rates were found to be varied based on Islam-related factors in which Muslim women with positive religious coping mechanisms and those who perceived religious discrimination in healthcare were less likely to have had a mammogram in the past two years.
8		Mukem et al., 2015		Thailand		24,194,750		4.7		30–70		Quantitative/ Questionnaire		Reasons for non-uptake of the screening included the perception that screening is not necessary and feeling nothing wrong with the breast. Muslim women were reported to have lower levels of knowledge about mammogram than Buddhist and Christian women.
9		Padela et al., 2018		USA		58		100		ND		Quantitative/ Questionnaire		Barrier beliefs impeding mammography screening among Muslim American women were addressed through reframing, reprioritizing, or reforming such beliefs. Findings showed nearly 40% of women obtained a mammogram within 12 months of the intervention.
10		Salman, 2012		USA		50		100		18 or older		Quantitative/ Questionnaire		Participation in mammography screening was hampered by lack of time, insurance coverage and embarrassment or modest about exposing their breasts in front of strangers.
11		Zorogastua et al., 2017		USA		140		100		18 and older		Mixed-methods/ Questionnaire and focus groups interview		Barriers to screening adherence revealed include negative perceptions that BC is a serious and deadly disease, misconceptions such as BC is contagious, BC is caused by mammogram, and BC screening is only necessary when women take oral contraceptives.
12		Islam et al., 2017		USA		12		75		ND		Qualitative/ Interview		Structural and socio-cultural barriers emerged as barriers to BC screening. Among them were language, insurance, immigration status, the feeling of fatalism, doctor’s gender, embarrassment, perceiving screening as unnecessary, prioritizing their family's health over their own and lack of knowledge about preventive care/ cancer.
13		Soffer et al., 2020		Israel		433		85.9		26–70		Quantitative/ Questionnaire		Laywomen held more cultural beliefs and more fatalistic beliefs than physicians. Laywomen also were reported to have greater social barriers to BC screening such as fear of being pitied, fear of being detachment and resentment from husbands, fear of being disrespected by family, fear of losing the place of work and friends and fear of neglecting family).
14	Padela et al., 2019		USA		58		100		40–74		Quantitative/ Questionnaire		Religiously-tailored messages to modify mammography-related beliefs among Muslim Americans were made possible as the percentage of those who agreed that BC screening is unimportant because God decides who gets the disease significantly decreased. Additionally, knowledge of mammography among participants improved after the intervention.
15	Kissal et al., 2018		Turkey		339		100		40–50		Quantitative/ Questionnaire		The findings revealed poor participation rates for women in BC screening due to high levels of perceived barriers. The women’s fear of BC was determined to be at a high level, while their fatalism was at a moderate level.
16	Shaw et al., 2018		Singapore		27		92.6		40–69		Qualitative/ Focus groups interview		Low BC screening uptake rates were attributable to barriers such as spiritual and religious beliefs, preference for traditional medicine over Western medical recommendations, family and community influence on health-related decisions, and differences in intergenerational beliefs that created different attitudes toward screening and prevention.
17	Padela et al., 2016		USA		69		100		40–75		Qualitative/ Focus groups and individual interview		Muslim women reported religion-related salient beliefs to influence their screening behaviours which included perceived responsibility for body and health care, religious practices as methods of disease prevention, fatalistic views about health, and preference for female healthcare providers due to modesty norms.
18	Alkhasawneh et al., 2016		Oman		1391		100		20 and older		Mixed-methods/ Questionnaire, interviews and focus group discussions		The level of early detection screening practice was reported to be influenced by age, education and marital status. Additionally, the factors also included the perception of BC such as BC as a cursed word, “taboo” and ill-fated disease, and superstitious beliefs especially the belief in the “evil eye” or envy as a risk factor for BC.
19	Kawar, 2013		USA		107		52.3		20–80		Qualitative/ Interview		Findings revealed numerous barriers to BC screening which include embarrassment, fear of getting BC, ignorance, lack of motivation, stigmatization of cancer, family relationships, fatalistic beliefs, consultation of traditional healers, affordability, availability of services, citizenship and language issues.
20	Saadi et al., 2015		USA		57		96.5		18–75		Qualitative/ Interview		Among the barriers to BC screening among refugee women were fear of pain and diagnosis, modesty, work and childcare commitments, outreach efforts, appointment reminders, personal contact from health providers, varying degrees of medical exposure to doctors in home countries and the impact of war on health systems.
21	Raza et al., 2012		Pakistan		300		81		23–63		Quantitative/ Questionnaire		The embarrassment, painful procedures, fear of bringing disgrace to their families and fear of being rejected or divorced by husbands from the diagnosis of BC, lack of transportation and expense of travel were cited as barriers to screening.
22	Elobaid et al., 2016		UAE		19		100		35–68		Qualitative/ Interview		The themes that emerged with regards to barriers in health seeking behavior were symptom recognition and appraisal, fear of societal stigmatization, fear of being abandoned by the husband because of BC, lack of awareness of the nature of BC and routine screening, and healthcare system such as male doctors and errors in diagnosis.

ND, no data