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Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 1994 Feb;48(1):65–73. doi: 10.1136/jech.48.1.65

Prospective study of predictors of attendance for breast screening in inner London.

S Sutton 1, G Bickler 1, J Sancho-Aldridge 1, G Saidi 1
PMCID: PMC1059897  PMID: 8138773

Abstract

OBJECTIVE--To investigate the predictors of first-round attendance for breast screening in an inner city area. DESIGN--Prospective design in which women were interviewed or completed a postal questionnaire before being sent their invitation for breast screening. Sociodemographic factors, health behaviours, and attitudes, beliefs, and intentions were used as predictors of subsequent attendance. A randomised control group was included to assess the effect of being interviewed on attendance. SETTING--Three neighbouring health districts in inner south east London. PARTICIPANTS--A total of 3291 women aged 50-64 years who were due to be called for breast screening for the first time. The analysis of predictors was based on a subsample of 1301, reflecting a response rate of 75% to interview and 36% to postal questionnaire. MAIN RESULTS--Attendance was 42% overall, and 70% in those who gave an interview or returned a questionnaire. There was little evidence for an interview effect on attendance. The main findings from the analysis of predictors are listed below. (These were necessarily based on those women who responded to interview/questionnaire and so may not be generalisable to the full sample.) (1) Sociodemographic factors: Women in rented accommodation were less likely to go for screening but other indicators of social class and education were not predictive of attendance. Age and other risk factors for breast cancer were unrelated to attendance, as was the distance between home and the screening centre. Married or single women were more likely to attend than divorced, separated, or widowed women, and black women had a higher than average attendance rate; however, neither of these relationships was found in the interview sample. (2) Health behaviours: Attenders were less likely to have had a recent breast screen, more likely to have had a cervical smear, more likely to go to the dentist for check ups, and differed from non-attenders with regard to drinking frequency. Exercise, smoking, diet change, and breast self-examination were unrelated to attendance. (3) Attitudes, beliefs, and intentions: The two best predictors were measures of the perceived importance of regular screening for cervical and breast cancer and intentions to go for breast screening. Also predictive were beliefs about the following: the personal consequences of going for breast screening, the effectiveness of breast screening, the chances of getting breast cancer, and the attitudes of significant others (the woman's husband/partner and children). Women who reported a moderate amount of worry about breast cancer were more likely to attend than those at the two extremes. CONCLUSIONS--Attenders and non-attenders differ in two broad areas: the health related behaviours they engage in and the attitudes, beliefs, and intentions they have towards breast cancer and breast screening. The latter are potentially amenable to change, and though different factors may operate among women who do not respond to questionnaires, the findings offer hope that attendance rates can be improved by targeting the relevant attitudes and beliefs. This could be done by changing the invitation letter and its accompanying literature, through national and local publicity campaigns, and by advice given by GPs, practice nurses, and other health professionals. It is essential that such interventions are properly evaluated, preferably in randomised controlled studies.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anda R. F., Sienko D. G., Remington P. L., Gentry E. M., Marks J. S. Screening mammography for women 50 years of age and older: practices and trends, 1987. Am J Prev Med. 1990 May-Jun;6(3):123–129. [PubMed] [Google Scholar]
  2. Bickler G., Sutton S. Inaccuracy of FHSA registers: help from electoral registers. BMJ. 1993 May 1;306(6886):1167–1167. doi: 10.1136/bmj.306.6886.1167. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Calnan M. The health belief model and participation in programmes for the early detection of breast cancer: a comparative analysis. Soc Sci Med. 1984;19(8):823–830. doi: 10.1016/0277-9536(84)90399-x. [DOI] [PubMed] [Google Scholar]
  4. Fallowfield L. J., Rodway A., Baum M. What are the psychological factors influencing attendance, non-attendance and re-attendance at a breast screening centre? J R Soc Med. 1990 Sep;83(9):547–551. doi: 10.1177/014107689008300905. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Fink R., Shapiro S., Lewison J. The reluctant participant in a breast cancer screening program. Public Health Rep. 1968 Jun;83(6):479–490. [PMC free article] [PubMed] [Google Scholar]
  6. Hobbs P., Smith A., George W. D., Sellwood R. A. Acceptors and rejectors of an invitation to undergo breast screening compared with those who referred themselves. J Epidemiol Community Health. 1980 Mar;34(1):19–22. doi: 10.1136/jech.34.1.19. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hunt S. M., Alexander F., Roberts M. M. Attenders and non-attenders at a breast screening clinic: a comparative study. Public Health. 1988 Jan;102(1):3–10. doi: 10.1016/s0033-3506(88)80004-0. [DOI] [PubMed] [Google Scholar]
  8. Lancaster G., Elton P. Does the offer of cervical screening with breast screening encourage older women to have a cervical smear test? J Epidemiol Community Health. 1992 Oct;46(5):523–527. doi: 10.1136/jech.46.5.523. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. McEwen J., King E., Bickler G. Attendance and non-attendance for breast screening at the south east London breast screening service. BMJ. 1989 Jul 8;299(6691):104–106. doi: 10.1136/bmj.299.6691.104. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Roberts M. M., Alexander F. E., Anderson T. J., Chetty U., Donnan P. T., Forrest P., Hepburn W., Huggins A., Kirkpatrick A. E., Lamb J. Edinburgh trial of screening for breast cancer: mortality at seven years. Lancet. 1990 Feb 3;335(8684):241–246. doi: 10.1016/0140-6736(90)90066-e. [DOI] [PubMed] [Google Scholar]
  11. Sutton S. Social-psychological approaches to understanding addictive behaviours: attitude-behaviour and decision-making models. Br J Addict. 1987 Apr;82(4):355–370. doi: 10.1111/j.1360-0443.1987.tb01492.x. [DOI] [PubMed] [Google Scholar]
  12. Williams E. M., Vessey M. P. Compliance with breast cancer screening achieved by the Aylesbury Vale mobile service (1984-1988). J Public Health Med. 1990 Feb;12(1):51–55. doi: 10.1093/oxfordjournals.pubmed.a042506. [DOI] [PubMed] [Google Scholar]
  13. Woolhandler S., Himmelstein D. U. Reverse targeting of preventive care due to lack of health insurance. JAMA. 1988 May 20;259(19):2872–2874. [PubMed] [Google Scholar]

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