Cultural Beliefs, Provider Gender Preferences and Discomfort as Predictors of Medical Imaging Avoidance or Delay: A Cross-Sectional Survey in Northern Ghana

Abstract

Aim: To assess the extent to which cultural beliefs, preferences, and related experiences are associated with self-reported avoidance or delay of medical imaging procedures among patients at the Tamale Teaching Hospital (TTH), Ghana. Methodology: This hospital-based cross-sectional questionnaire survey involved 304 patients who accessed medical imaging services at TTH between June and July 2024. Participants were recruited through consecutive non-probability sampling. The minimum sample size of 296 was determined using Yamane's formula, based on a weekly patient volume of approximately 1,140, and 304 participants were ultimately enrolled. The primary outcome was self-reported avoidance or delay of a scheduled imaging procedure by more than 48 hours for cultural reasons, coded dichotomously at enrolment. Descriptive statistics were used to summarise respondent characteristics, cultural beliefs and preferences, and decision factors influencing imaging acceptance. Bivariate associations were assessed using Pearson's chi-square test. Multivariable binary logistic regression was then used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for factors independently associated with avoidance or delay. Results: Seventy-six respondents (25.0%) reported having ever avoided or delayed undergoing a medical imaging procedure for cultural reasons. Cultural beliefs or taboos related to imaging were reported by 23.7% of respondents, traditional healing practices were reported as preferred over imaging in the community by 63.5%, 39.1% reported discomfort or embarrassment during imaging for cultural reasons, and 59.5% reported a preference regarding provider gender during imaging. In the adjusted model, cultural beliefs or taboos (aOR 2.35, 95% CI 1.11 to 4.97), somewhat adherence to cultural beliefs (aOR 2.65, 95% CI 1.20 to 5.85), strong adherence to cultural beliefs (aOR 4.73, 95% CI 1.63 to 13.69), discomfort or embarrassment during imaging (aOR 7.09, 95% CI 3.47 to 14.48), and provider gender preference (aOR 2.94, 95% CI 1.30 to 6.67) were independently associated with avoidance or delay. Cost was the most frequently reported decision factor overall (73.0%). Conclusion: Self-reported avoidance or delay of medical imaging in this setting is shaped by both cultural and practical considerations. Imaging departments should strengthen pre-procedure communication, protect patient privacy and modesty, and accommodate provider gender preferences where staffing permits. At the system level, expanding National Health Insurance Scheme coverage of imaging services is a priority to reduce cost-related barriers alongside these cultural interventions.