{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T19:05:10Z","timestamp":1782846310458,"version":"3.54.5"},"reference-count":53,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Mammography screening uptake in Singapore remains below 40% despite campaigns and subsidies. Natural language processing (NLP) can extract nuanced attitudes from free text that fixed response options miss, revealing latent factors influencing breast cancer (BC) screening behavior.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study characterized women\u2019s attitudes toward mammography using mixed methods data, examined associations between BC awareness and screening willingness, and identified barriers and facilitators through NLP of free-text responses.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We conducted a cross-sectional study within the\n Breast Screening Tailored for Her<\/jats:italic>\n multicenter cohort in Singapore (October 2021-December 2023). In total, 4169 women aged 35\u201059 years (median 48, IQR 43\u201054) were recruited via convenience sampling (3 hospitals and 2 polyclinics). Participants completed online structured questionnaires on demographics and screening history, then a BC education quiz with feedback. Participants answering >80% correctly were classified as \u201cBC-aware.\u201d Posteducation, participants reported screening willingness (motivated or neutral) with optional free-text explanations. Logistic regression models (adjusted for study site, age, ethnicity, marital status, housing, and education) examined the associations with willingness. For 3819 English-language respondents, biterm topic modeling identified themes and sentiment analysis quantified emotional tone. Statistical significance:\n \u03b1<\/jats:italic>\n =.05.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Overall, 79% (3287\/4169) were BC-aware, and 94% (3908\/4169) reported increased motivation posteducation. BC-aware women had higher screening motivation than BC-unaware women (adjusted odds ratio [aOR] 2.88, 95% CI 2.19\u20103.80;\n P<\/jats:italic>\n <.001). Motivation was higher among those with larger public housing (OR 1.81, 95% CI 1.30\u20102.50;\n P<\/jats:italic>\n <.001) and private housing vs 1\u20103 room units (OR 2.69, 95% CI 1.75\u20104.13;\n P<\/jats:italic>\n <.001), married vs not separated, divorced, or widowed (OR 2.38 [inverse of 0.42], 95% CI 1.75\u20103.13;\n P<\/jats:italic>\n <.001), and prior screening attendance (OR 3.49, 95% CI 2.71\u20104.50;\n P<\/jats:italic>\n <.001). Women who disagreed that mammography was expensive had higher motivation (aOR 1.94, 95% CI 1.50\u20102.50;\n P<\/jats:italic>\n <.001). Among 3819 English respondents, 94% (3579\/3819) were motivated and 6% (240\/3819) neutral. Free-text responses came from 34% (1220\/3579) of motivated and 64% (153\/240) of neutral participants. Biterm topic modeling revealed motivated participants emphasized early detection benefits, health awareness, BC risk, and logistics; neutral participants focused on mammography pain experiences and cost barriers. Mean sentiment was 0.207 (range: \u22121.00 to 1.65), with motivated participants displaying more positive sentiments than neutral participants (linear regression,\n P<\/jats:italic>\n <.001). Identical words carried different emotional tones across subgroups: \u201chealth\u201d had positive sentiment among motivated participants (mean difference, Welch\n t<\/jats:italic>\n tests\n P<\/jats:italic>\n <.05) but negative sentiment among neutral participants. Word frequency analysis showed motivated participants used positive-sentiment words (\u201cbetter,\u201d \u201ccure,\u201d and \u201cprevention\u201d). Neutral participants emphasized negative words (\u201cpainful\u201d and \u201cuncomfortable\u201d).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Integrating quantitative surveys with NLP revealed that the same screening concepts are emotionally framed differently by motivated vs neutral women, a finding missed by knowledge- or intent-focused approaches alone. In practice, these findings support the need for emotionally tailored BC education and prevention strategies.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/78439","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T20:26:49Z","timestamp":1773174409000},"page":"e78439-e78439","source":"Crossref","is-referenced-by-count":0,"title":["Breast Cancer Screening Knowledge and Sentiments in Singaporean Women: Mixed Methods Study Using Topic Modeling, Sentiment Analysis, and Structured Questionnaire Data"],"prefix":"10.2196","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3017-4023","authenticated-orcid":false,"given":"Peh Joo","family":"Ho","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7854-8728","authenticated-orcid":false,"given":"Zi 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