Abstract
Background: Analysis of mammography utilization has traditionally been performed from an individual-level perspective. The purpose of this study was to explore the combined influence of individual- and regional-level determinants of mammography utilization.
Methods: Logistic hierarchical multilevel modelling was used to investigate the influences of region of residence and individual characteristics on mammography utilization. Socio-economic status information about health planning regions was derived from the 1996 Canadian Census. Individual-level information was extracted from the 1996 National Population Health Survey.
Results: After controlling for individual-level education, regions with fewer high school graduates had lower levels of mammography utilization. A cross-level interaction between regional-level education and individual-level social involvement was found. Other individual-level variables associated with screening confirmed previous literature findings.
Conclusion: Our findings suggest that higher levels of participation in social activities modify the detrimental influence on mammography utilization of living in a less educated region. This challenges the current focus of mammography screening research on individual-level determinants of uptake. Multilevel, synergistic strategies to possibly achieve higher levels of screening should be considered by health promotion program planners.
Résumé
Contexte: Par le passé, on a analysé le recours à la mammographie d’un point de vue individuel. Nous avons voulu analyser l’influence combinée des déterminants individuels et régionaux du recours à la mammographie.
Méthode: Par modélisation logistique hiérarchique multiniveau, nous avons étudié l’influence exercée par la région de résidence et par les caractéristiques individuelles sur le recours à la mammographie. Nos données sur le statut socio-économique dans les régions de planification sanitaire sont dérivées du recensement canadien de 1996. L’information individuelle est tirée de l’Enquête nationale sur la santé de la population (1996).
Résultats: Compte tenu du niveau de scolarité individuel, les niveaux de recours à la mammographie étaient moins élevés dans les régions où les titulaires d’un diplôme d’études secondaires étaient moins nombreux. Nous avons constaté une interaction transversale entre le niveau de scolarité au palier régional et la participation individuelle à la vie sociale. Les autres variables individuelles associées au dépistage ont confirmé les constatations d’études antérieures.
Conclusion: Nos constatations donnent à penser que des niveaux de participation supérieurs aux activités sociales modifient l’influence nuisible exercée sur le recours à la mammographie par le fait de vivre dans une région où les niveaux de scolarité sont faibles. Ceci remet en question l’accent qui est mis actuellement, dans les études sur le dépistage mammographique, sur les déterminants individuels de la participation au dépistage. Les planificateurs des programmes de promotion de la santé devraient donc envisager des stratégies multiniveaux synergiques, qui permettraient peut-être d’obtenir des niveaux de dépistage plus élevés.
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