Table 6.

Results of the Thematic Analysis of the 22 Selected Articles

Main Themes	Sub-themes	Sub sub-themes	Statement
Socio-ethical misconception	Barriers for BC screening	Conception of health	Health is regarded as the absence of disease/ conception of health (Shirazi et al., 2013; Salman, 2012; Saadi et al., 2015; Padela et al., 2016), perceived to be healthy as they don’t have to see a doctor (Islam et al., 2017).
		Healthcare practices	No need to seek medical advice if no symptom(s)/ symptom recognition (Saadi et al., 2015; Elobaid et al., 2016; Kissal et al., 2018; Madkhali et al., 2019), sought care only when necessary (Zorogastua et al., 2017).
	Misconception of BC	Cause of BC	BC is contagious (Al-Amoudi, 2015; Elobaid et al., 2016; Zorogastua et al., 2017), injury to breast cause BC (Al-Amoudi, 2015), etiology of BC (Raza et al., 2012; Al-Amoudi, 2015; Elobaid et al., 2016; Alkhasawneh et al., 2016; Madkhali et al., 2019; Soffer et al., 2020), evil eye (Kawar, 2013; Elobaid et al., 2016; Alkhasawneh et al., 2016; Shaw et al., 2018).
Cultural/ religious belief	Cultural belief	Alternative treatment	Alternative treatment - holy water, superstitious belief, black magic (Kawar, 2013; Shaw et al., 2018; Madkhali et al., 2019).
	Religious belief	Fatalism	Construed cultural and religious beliefs discourage screening (Padela et al., 2019; Pratt et al., 2020), developing cancer is viewed as inevitable, women would not get screened and believed it’s fated (Islam et al., 2017), view illness as divinely ordained (Shirazi et al., 2013; Padela et al., 2015; Saadi et al., 2015; Padela et al., 2016; Alkhasawneh et al., 2016; Shaw et al., 2018; Kissal et al., 2018; Pratt et al., 2020; Soffer et al., 2020).
		Role of religion	Dying from BC as a test of faith in Allah (God) (Madkhali et al., 2019; Pratt et al., 2020), worship practices and faith protect/diminish disease risk (Padela et al., 2016), God’s retribution or curse (Vahabi et al., 2017), punishment from God (Elobaid et al., 2016; Vahabi et al., 2017; Islam et al., 2017; Padela et al., 2019; Soffer et al., 2020), God gave the disease and God can take away the disease (Al-Amoudi, 2015), chances of getting cancer is in the hands of Allah (Zorogastua et al., 2017; Padela et al., 2019).
Cultural/ religious barrier	Cultural barrier	Reluctance to discuss breast health/ screening	Feeling shy with healthcare personnel (Salman et al., 2012; Shirazi et al., 2013; Kawar, 2013), uncomfortable/ reluctance of discussing health matters with healthcare provider (Al-Amoudi, 2015; Elobaid et al., 2016; Padela et al., 2018), embarrassed talking or engaging in screening (Islam et al., 2017), talking about the breast or the body is shameful (Islam et al., 2017).
		Family relationship	Influence of family (Raza et al., 2012; Kawar, 2013; Shaw et al., 2018), negative perceptions of BC screening (Zorogastua et al., 2017), Muslim men against breast screening by male providers (Zorogastua et al., 2017), prioritizing the well-being of family members over own (Shirazi et al., 2013; Islam et al., 2017), work and/or childcare commitments (Saadi et al., 2015; Zorogastua et al., 2017).
	Religious barrier	Modesty	Modesty/ privacy - exposing breast/ body (Salman, 2012; Kawar, 2013; Mukem et al., 2015; Saadi et al., 2015; Padela et al., 2016; Vahabi et al., 2017; Padela et al., 2018; Shaw et al., 2018; Alatrash, 2020), embarrassment of exposing body to the male healthcare providers (Salman, 2012; Kawar, 2013; Shirazi et al., 2013; Mukem et al., 2015; Elobaid et al., 2016; Padela et al., 2016; Padela et al, 2018; Alatrash, 2020), mistrust with male healthcare providers (Zorogastua et al., 2017), modesty of how women should interact with males (Islam et al., 2017), refuse treatment by male healthcare provider (Salman, 2012; Elobaid et al., 2016), adherence practice of religious faith - aurah, close physical contact (Salman, 2012).
Stigma		BC	Stigma with diagnosis of BC (Raza et al., 2012; Kawar, 2013; Elobaid et al., 2016; Soffer et al., 2020; Alatrash, 2020), concerns of healthcare providers living in the same village (Mukem et al., 2015), shame seen by neighbours when attending screening (Mukem et al., 2015; Alatrash, 2020).
		Self-image	Altered image of losing breast(s) - less attractive, feminine (Madkhali et al., 2019), shame to admit if suffer from cancer (Zorogastua et al., 2017).
Fear	BC	Diagnosis	BC diagnosis, abnormalities (Kawar, 2013; Saadi et al., 2015; Kissal et al., 2018; Padela et al., 2018; Alatrash, 2020).
		Screening procedure	Discomfort from the screening procedure (Alatrash, 2020), fear of BC screening (Zorogastua et al., 2017).
		Pain	Fear of pain (Saadi et al., 2015; Al-Amoudi, 2015; Mukem et al., 2015; Padela et al., 2018).
	Rejection		Rejection from family, friends and husband (Raza et al., 2012; Kawar, 2013; Elobaid et al., 2016; Islam et al., 2017; Soffer et al., 2020).