Abstract
BackgroundA range of barriers influence women’s uptake to a first breast screening invitation. Few studies however, have examined factors associated with second screening uptake. This study follows Maltese women to explore predictors and behaviours to re-attendance, and to determine if uptake of first invitation to the Maltese Breast Screening Programme (MBSP) is a significant predictor of second screening uptake.MethodsA prospective study was conducted to determine factors associated with re-attendance for 100 women invited to the second MBSP round. Records of women’s second attendance to the MBSP were extracted in January 2016 from the MBSP database. Data were analyzed using chi-square tests, Independent Samples t-test, Mann Whitney test, Shapiro Wilk test and logistic regression.ResultsThere were no significant associations for sociodemographic or health status variables with second screening uptake (p > 0.05), except breast condition (Fisher’s exact test, p = 0.046). Non-attendees at second screening were most unsure of screening frequency recommendations (χ2 = 9.580, p = 0.048). Attendees were more likely to perceive their susceptibility to breast cancer (p = 0.041), believed breast cancer to be life changing (p = 0.011) and considered cues to action to aid attendance (p = 0.028). Non-attendees were in stronger agreement on mammography pain (p = 0.008) and were less likely to consider cues to action (15.4% non-attendees vs 1.4% attendees) (p = 0.017 respectively). ‘Perceived barriers’, ‘breast cancer identity’, ‘causes’ and ‘consequences’ were found to be significant predictors of second screening uptake, with ‘perceived barriers’ being the strongest. The inclusion of illness perception items improved the regression model’s accuracy in predicting non-attendance to the second screening round (84.6% vs 30.8%). First screening uptake was found to be a significant predictor of subsequent uptake (OR = 0.102; 95% CI = 0.037, 0.283; p = 0.000).ConclusionsInterventions to increase uptake should target first invitees since attending for the first time is a strong predictor of uptake to the second cycle. Further research is required given the small sample. Particular attention should be paid to women who did not respond to their first invite or are unsure or reluctant participants initially.
Highlights
A range of barriers influence women’s uptake to a first breast screening invitation
The literature suggests that previous mammography use is highly associated with future use [12] because women believe in the effectiveness of screening which in turn increases their intentions to go for screening, resulting in their adherence to subsequent screens [13]
We found that Health Belief Model (HBM) constructs were the strongest predictors of uptake of first invitation to the Maltese Breast Screening Programme (MBSP), though the inclusion of illness representation dimensions improved the predictive accuracy for non-attendance
Summary
A range of barriers influence women’s uptake to a first breast screening invitation. Few studies have examined factors associated with second screening uptake. This study follows Maltese women to explore predictors and behaviours to re-attendance, and to determine if uptake of first invitation to the Maltese Breast Screening Programme (MBSP) is a significant predictor of second screening uptake. Regular breast screening (BS) for breast cancer (BC) could lead to a 25–30% reduction in mortality rates in the population of women invited for screening [2]. This evidence led to the implementation of screening programmes across Europe based on the EU Council recommendations, which recommend biennial screening mammography in average-risk women aged 50–69 years [3]. In a comparative study of 200 re-attenders and 200 non-re-attenders for second triennial National Breast Screening Programme appointments in Nottingham [10], the 200 women who failed to accept their invitation implicated their negative initial screening experience in their decision, with 41% implicating pain, 6% stress and 3% embarrassment
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