Community and Policy Factors Influencing the Decision to Undergo Screening Mammography amongst Indian Women in the United Arab Emirates.

OBJECTIVE: This study explored the expectations, requirements, and recommendations and identifies the socio-ecological determinants for the informed uptake of screening mammography amongst expatriate women residing in the UAE. METHODOLOGY: A qualitative research approach was adopted using five focus group discussions. The study comprised two populations- those who had undergone screening mammography and those who had not. Thematic analysis- the six-phase model was adopted and modified for data analysis. RESULTS: The factors that influence the rate of uptake of screening mammography by the participants were multifactorial and reciprocal. The community determinants identified are cultural beliefs, medical professionals, breast cancer survivors, community organizations, and media. The health policies in an expatriate's home country and adopted country were found to have a considerable influence on the health behaviors of the participants. A comprehensive approach to change in health behavior is required to increase the informed uptake of screening mammography by expatriate women residing in the UAE. CONCLUSION: The study identified the need of developing migrant health units with community navigators, international health collaboration, migrant health directory, risk assessment team, automatic invitation system for screening, referral system, migrant cancer registry, and psychological support team in UAE. However, further studies are expected to give a wider perspective.

Health Behavioural Theories and Their Application to Women's Participation in Mammography Screening.

The most effective method of detecting breast cancer among asymptomatic women is by mammography screening. Most countries have this preventive measure in place for women within their society; however, most of these programs struggle with attendance. This article discusses four health behavioural theories and models in relation to mammography screening that may explain the factors affecting women's participation, including the health belief model, theory of planned behaviour, trans-theoretical model, and the theory of care seeking behaviour. In summary, analysis of these theories indicates that the theory of care seeking behaviour has value for exploring these factors because of its sensitivity to socioeconomic differences that exist among women in society and because it has a broader construct (such as habit and external factors) compared to the other health behavioural theories.

Addressing the Patient Experience in a Magnetic Resonance Imaging Department: Final Results from an Action Research Study.

INTRODUCTION: Patients undergoing magnetic resonance imaging (MRI) can experience anxiety and claustrophobia. A multimethod action research study was conducted to determine how patient care was currently being delivered in an MRI department and to determine whether this could be improved. METHODS: This action research study used both quantitative and qualitative methods. Changes were introduced into the department after baseline data collection to address areas for improvement. A survey was conducted of patients to establish their level of satisfaction and/or anxiety and to determine whether this improved during the course of the project. Staff practice was qualitatively observed over the course of the project and observations recorded in a field diary. Finally, focus groups were held with staff. RESULTS: The project resulted in improved satisfaction and lower anxiety for patients, and increased the amount of patients receiving information compared with the results of a baseline survey. However, these findings were not statistically significant. Among staff, qualitative observations portrayed a renewed focus on the patient in MRI including changes in their actions such as increased use of touch, improved communication, and focused efforts to maintain privacy. CONCLUSIONS: This study was able to achieve a change in practice through an action research cycle in a MRI department. Over the course of the project, improvements were made to the department, and radiographers changed the way they acted and interacted with patients.

Patient Anxiety and Satisfaction in a Magnetic Resonance Imaging Department: Initial Results from an Action Research Study.

PURPOSE: The way patients experience health care is largely dependent on the attitudes and actions of the health care professionals they encounter. In medical imaging, the radiographer is often the biggest provider of patient care. Patients undergoing magnetic resonance imaging (MRI) can experience anxiety and claustrophobia. The aim of this study was to determine current levels of anxiety and satisfaction within an MRI unit. METHODS: An action research study was conducted in an MRI unit in a large metropolitan hospital. The focus of this study was on improving patient care within the department. The initial phase of this study focused on determining current levels of anxiety and satisfaction within the department. To achieve this, a survey was conducted of patients attending the department for imaging. RESULTS: Surveys were returned from 120 patients. Overall, the mean anxiety was 2.617 on a 10-point scale (0 = no anxiety, 10 = maximum anxiety; 95% confidence interval, 2.075-3.159; standard deviation, 3). Overall, the mean satisfaction was 8.86 (95% confidence interval, 8.459-9.254; standard deviation, 2.15). There was a statistically significant difference between anxiety for patients who received information and those who did not (information = 2.29, no information = 4.0, P = .045). CONCLUSIONS: Although the vast majority of patients are satisfied with the care they receive during MRI, anxiety is still an issue. The provision of information has been linked to lower levels of anxiety with these patients. The findings from this survey provide insight as to how patients perceive the MRI department and can be used as a benchmark for future surveys to determine if any changes can be made to further improve satisfaction and anxiety during MRI.

Rate of detection of unsuspected pregnancies after implementation of mandatory point-of-care urine pregnancy testing prior to hysterosalpingography.

PURPOSE: The aim of this study was to determine the rate of detection of unsuspected pregnancies after the implementation of mandatory point-of-care urine pregnancy testing before hysterosalpingography (HSG). METHODS: At the authors' institution, HSGs are scheduled to occur during days 8 to 12 of the menstrual cycle. Upon arrival in the radiology department, all women undergo point-of-care urine pregnancy testing before HSG (at a cost of $1.25 per test). Urine pregnancy test results were retrospectively reviewed. RESULTS: Four hundred ten women (mean age, 25.9 years; range, 22-50 years) underwent point-of-care urine pregnancy testing before HSG between October 2010 and July 2012. Study indications were infertility evaluation (90.7% [372 of 410]) and tubal patency assessment after placement of tubal occlusive devices (9.3% [38 of 410]). Two positive urine pregnancy test results (0.5%) were recorded. One positive result was deemed a false-positive because the patient had received an intramuscular injection of ß-human chorionic gonadotropin before the scheduled HSG, and follow-up laboratory testing showed declining ß-human chorionic gonadotropin levels. The second positive result was a true-positive, and the patient was determined to be 4.5 weeks pregnant on the date of the scheduled HSG. CONCLUSIONS: One of 410 women presenting for HSG was found to have an unsuspected early pregnancy, which was detected with a point-of-care urine pregnancy test. Consideration should be given to routine pregnancy testing of women before HSG because scheduling on the basis of menstrual cycle dates can be unreliable.

'I thought it was just an x-ray': a qualitative investigation of patient experiences in cardiac SPECT-CT imaging.

BACKGROUND: Patients attending for complex imaging examinations may experience anxiety and discomfort with associated poor satisfaction and reduced compliance. This may lead to poor quality imaging, repeat scans and nonattendance. Analysing and understanding patient experience to improve the quality of care is of paramount importance within the National Health Service; yet, little published evidence of patient experience research exists within nuclear medicine. This qualitative study aimed to explore the experience of patients referred for cardiac single-photon emission computed tomography-computed tomography (SPECT-CT) in two different clinical environments. METHODS AND RESULTS: Twenty-two patients (13 women, nine men; mean age 63.9 years) were interviewed before and after the procedure to determine their prior knowledge, concerns, expectations and experiences. Thematic analysis demonstrated seven recurring themes: justification, validity of patient information, fear (of their condition, of harm and of the procedure), compliance, role of significant others, mitigation of anxiety, and coping strategies. In most cases an expectation-reality divide was apparent, with the actual experiences of the procedure being in some cases a pleasant surprise, or in other cases a shock. CONCLUSION: Cardiac SPECT-CT patients are often poorly informed and present with a range of anxieties that may ultimately affect examination quality. The imaging team requires an awareness of potential expectation-reality divides, even when there are no overt signs of worry and distress. Written patient information is undoubtedly helpful, but there is no substitute for ongoing and repeated explanations and reassurance by staff. These findings are likely to have implications for other complex nuclear medicine procedures, including noncardiac SPECT-CT examinations and emerging PET-CT applications.