Breast cancer is the leading cause of death amongst women worldwide (Ferlay et al., 2013). It is the second most common cancer with about 1.7 million new cases diagnosed worldwide in 2012 (World Health Organisation, 2013). The incidence of breast cancer varies in different geographical locations, with Western Europe reporting the highest incidence and middle Africa reporting the lowest incidence (Ferlay et al., 2013). Higher mortality rates, however, are found within the African continent, with more than half of the women found to have had breast cancer dying of the condition (Ferlay et al., 2013). The high mortality rate in these regions could be associated with factors such as: late presentation of the women for diagnosis and treatment, inadequate diagnostic and treatment facilities, poor knowledge and lack of participation of women in the breast cancer screening programmes where available (Coleman et al., 2008).
accompanying information provided by the inviting orga- nization makes it appear that choosing to attend is a more appropriate decision, thus removing uncertainty from the message. Research shows that an informed choice is not achieved in a large proportion of mammography screen- ing decisions: Mathieu et al. arrived at the figure of 48 % informed choices ; van Agt et al. found 88 % . Indeed, the term “uninformed compliance”  has been coined to describe participation in this screening. Uninformed compliance is a major public health problem in the Ger- man MSP, since many women in the target group of the MSP have unrealistic expectations regarding its potential benefits . Weighing benefits against harms is a value judgment, thus no correct answer can be determined  making this decision preference sensitive.
As shown in multivariate model 2, the effect of social participation was not appreciably affected by the presence of other social network variables or familial factors. A so- cial network may encourage greater screening attendance or other preventive health care, perhaps through perceived sense of responsibility towards one’s social group to take care of oneself or through social pressures to follow pre- vailing social norms around screening. As demonstrated in other studies, mammographyscreening is positively associated with general social support [9,15], having a close friend , social support from significant others (e.g. spouse, friends, health professional) [7,38], being a mem- ber of a volunteer group [8,9], and inversely associated with social isolation . However, in a US study, no asso- ciation was evident between ever having had a mammo- graphic screening test and a social network index variable . In the present study, social participation was the only other social network factor that remained statistically significant after adjusting for cohabitation and number of children.
Thirty women attending the PHCCs during the study period (March-June 2004) were recruited. In order to obtain a broad range of views and experiences, we aimed to recruit a random sample closely representing all the dif- ferent rural areas in Crete. The sample was drawn from the list of regular appointments at every Health Centre. The interviewer (MT) attended each PHCC on a set day and approached the first two women to attend, provided they were residents of the catchment area covered by the cen- tre, aged 45–65 years, and were attending for a regular check-up appointment with a GP or internist. Every woman approached was interested and agreed to partici- pate, and after the interview many women asked for more information about mammography. Twenty-eight primary care physicians (PCPs) were recruited. The interviewer asked the two physicians on the morning shift for an interview. Where more than two were working, two were selected at random. One physician refused, so a physician working the next shift was asked to participate. The study recruited physicians only, as they are the PHCC health professionals who give individual women advice about mammographyscreening. Participants received written information about the study's aim, the voluntary nature of participation and assurance of confidentiality. All were asked to sign a consent form. Interviews took place in the primary care centre and lasted 30–45 minutes.
Introduction: The death rates from breast cancer have declined in the past decades; however, disparities between racial/ethnic groups remain. South Carolina has some of the largest health disparities in the nation, particularly breast cancer morbidity and mortality. The Best Chance Network was established to reduce the burden of breast cancer among disadvantaged women in the state. Although much has been done to identify factors related to breast cancer mortality, little has been done to examine the influence of geographic accessibility to health facilities and breast cancer mortality. The purpose of this study was to investigate whether travel distance to the screening referral provider and mammography facility are associated with breast cancer-specific and all-cause mortality among women participating in South Carolina’s Best Chance Network. We also sought to contrast and compare by race breast cancer-specific and all-cause survival among BCN participants. Methods: Women in South Carolina’s Best Chance Network, who
“Planned future participation in mammography screen- ing” had three alternative answers: “yes”, “no” and “don’t know”. “Self-rated risk for getting breast cancer” was rated as “low”, “medium” and “high”. “Attitude on mam- mography screening” was assessed by the question: “what do you think about mammographyscreening” and had three alternative answers: “it is good—it improves the chance to recover from breast cancer”, “it makes no difference—does not affect my health” and “it does more harm than good—can be dangerous”. “Previous cervical screening” was defined from the question: “have you made a gynaecological health control with pap smear test” with alternative answers “yes” and “no”.
effective in increasing breast cancer screening rates . A few studies have used a combination of theoretical models [22,23] by incorporating elements of theories that have been positively associated with mammography behavior. In this study, we also used an integrative conceptual frame- work that incorporated elements from the Theory of Planned Behavior (TPB) [24,25], Social Cognitive Theory (SCT; self-efficacy, social modeling) , the Health Belief Model (perceived susceptibility) , and concepts that have been shown consistently to be related to mammog- raphy screening such as fatalism [28,29] and cultural norms . The TPB has been used as the primary concep- tual model for the development of the assessment survey used in this study [25,30]. The theory posits that intention is the immediate antecedent of behavior and it is assumed to capture the motivation to behave in a particular way. According to the TPB, intention is determined by three factors: attitude toward the behavior, subjective norms (i.e. social norms), and perceived behavioral control (i.e., per- ceived ease or difficulty of performing a behavior). The the- ory is based on the assumption that individuals are rational actors and underlying individual reasons determine one’s motivation to perform a behavior, regardless of whether those beliefs are logical, or correct by some objective stand- ard. The strength of the TPB is that it offers a framework for deciphering individuals’ actions by identifying, measur- ing and combining beliefs that are relevant to individuals and groups, allowing us to understand their own reasons that motivate the behavior of interest. Several studies [31-35] have successfully applied the TPB in mammog- raphy screening; however, none of the studies was applied among an AI population. A diagram of the integrated con- ceptual framework of the TPB is shown in Figure 1.
Aside from age being a factor associated with women’s participation in screeningmammography, factors related to health care use, namely, having a regular doctor, demonstrated a stronger association with women aged 40 to 74 having had recent mammograms than any sociodemographic or lifestyle-related factors. The jurisdiction-specific information found in this study should be of value to governments and advocacy and patient groups in assessing the effectiveness of their screening programs. Future research should consider corroborating mammography histories with clinical records, examining mammographyparticipation in light of individual risk factors, and capturing information on women’s perceptions of screeningmammography. The CTFPHC’s update of its 2011 guidelines is expected to be released some time this year, and given the 25-year follow-up results of the Canadian National Breast Screening Study, guidelines around screeningmammography could change. The findings of this study provide baseline participation levels against which future participation can be compared.
Findings from these studies show that functional limita- tions and comorbidities when measured using the CCI are associated with decreased SM utilization, while absolute number of comorbidities was weakly associated with increased screening utilization. When discussing SM with older women, providers should ask questions or consult medical records to learn more about these life expectancy factors to better assess the potential benefit older women might receive from undergoing SM. Decision aids have been developed in breast cancer screening to measure key comorbidity and functional measures, though none have been widely implemented. 72,73 While more research is necessary to
reported cost-effectiveness analyses of mammographic screening using DBT based on direct radiology costs resulting from differences in the recall rate observed at one institu- tion over a 12-month period. The results suggested a direct cost savings of $10.19 per woman screened (not including an incremental cost of the DBT examination), which is about one third of our base-case estimate of $28.53. The difference between our analysis and the previous work of Kalra et al is likely due to the respective study designs and data. Specifically, the previous study by Kalra et al used 2011 Medicare reimbursement rates to estimate costs for all patients (including non-Medicare patients), excluded some diagnostic costs outside of radiology (eg, open biopsy), and did not account for cost savings due to earlier cancer detection. A follow-on study by Kalra et al 29 confirmed find-
Abstract: This paper examines women’s participation in politics and their perfor- mance in electoral contests. Nigeria embraced democracy in 1999 after 16 years of consecutive military rule. Among the features of democracy, there is universal suffrage which ensures participation of all eligible citizens in the process of electing a leader. This paper adopts a qualitative method using data collected from In-Depth Interviews and Key Informant Interviews in some selected states in Nigeria. The findings of the study reveal that there is an increase in the number of women who participated in political party rallies, campaigns and registered as a voter but the percentage of wom- en who won elected political offices and political appointments are not commensurate with their level of participation. The study establishes that despite the number of reg- istered female voters in the general elections, they lack identity consciousness to vote for female candidates to reduce the gap between male and female representation in government. The preference of male candidates over female candidates could be at- tributed to religious, cultural, economic and psychological factors. The paper con- cludes that the absence of identity consciousness among women has aggravated the marginalized condition of women in government. Therefore, the reasons for the low participation of women in democratic governance in Nigeria – apart from cultural, financial and religious factors – are emotional factors and a lack of identity conscious- ness.
stress than non-participants , and others that have found greater women’s empowerment among micro- credit clients [23, 51]. These findings may be due to the increased income available to these women, or to the increased opportunities for networking in the context of loan groups . Other studies, however, have found worsened stress and depressive symptoms among female clients. Several qualitative studies have suggested that tense household dynamics and in- creased debt burden may be contributing to worsened mental health among female clients [11, 22], but it may be that relations among members at Prisma are more supportive. The findings highlight the import- ance of conducting evaluations across country settings since community contexts may differ in important ways. Of note, we find that the average score for depres- sive symptoms among participants is above the U.S. cut- off of 16 that indicates a high risk for clinical depression. While this seems high, it is similar to other vulnerable populations in prior studies in Peru [52, 53]. It is possible
Qualitative research is an overall term for a group of approaches that is concerned with the investigation of experiences and behaviour, and the meanings and interpretations that people attach to these 12 . It is therefore an exploration of the natural setting; in this case the breast screening units in this study. An ethnographic approach of observing practice was initially considered but this was rejected as being too intrusive for the clients and potentially a contentious ethical issue. It was however recognised that by seeking the practitioners own perspective the validity of the findings were limited to their interpretation of their compression force practice.
Strengths of our study include our sample of primary care providers and staff from 13 VA community-based clinics. This provides a picture of nonacademic settings and allows for the assessment of the entire interdisciplinary team. Clinic staff, rather than the physician, often assist in completion of preventive health maintenance, and they may be the team members who actually provide the counseling and order the screening test. 22 Hence, without involvement from the entire
Confirmation of understanding has been found to be an essential component of effective patient education, as patients rarely disclose their lack of understanding of the information provided (Hersh et al., 2015). Several studies have validated that teach-back is an effective educational strategy for health professionals to incorporate in healthcare for improving health behaviors and subsequent outcomes (Dinh et al. 2013; Ferreira, 2005; Schillinger et al., 2003). A study that evaluated 74 diabetic patient encounters by 38 physicians by audiovisual means found that patients whose physicians had assessed comprehension and recall had significantly lower levels of hemoglobin A1C levels than patients whose physicians did not (Schillinger et al., 2003). A multiple regression analysis confirmed that the interactive communication was the variable most associated with improved glycemic control (Schillinger et al., 2003). Likewise, a quasi-random control trial of 2,046 veterans due for a colonoscopy screening established that colorectal cancer-screening rates improved when healthcare professionals incorporated health literacy communication strategies (Ferreira, 2005). Furthermore, a recent systematic review of the effectiveness of health education using the teach-back method established that teach-back is an effective strategy for improving management of chronic disease, knowledge of informed consent, and reduction in readmission rates (Dinh et al., 2013). The teach-back method has been used in diverse populations, including health
Applications involving the use of behavioural science to pre-test policy are also under way on a smaller scale elsewhere within the public service. In 2017, SEAI established a behavioural economics unit with the intention of engaging in pre- tests of interventions. Work under way includes laboratory pre-tests designed to increase the effectiveness of the Building Energy Rating (BER) certificate, trials of an online calculator designed to assist consumers’ understanding of electrical vehicles, and pre-tests of alternative webpages that aim to encourage the take-up of grants for energy efficiency upgrades. Some of the behavioural researchers at Revenue, whose work is described above, are members of IGEES. Other IGEES staff in central government departments are involved in various trials designed to improve the efficiency of administrative practice. Most of this work is at an earlier stage of development than the research undertaken in Revenue. It includes trials of behaviourally informed communications in employment centres and of letters to outpatients designed to improve the management of hospital waiting lists. This type of pre-testing is broadly similar to that undertaken by BIT in the UK, in terms of both scientific method and the sort of policy research questions addressed. The work is summarised in an IGEES paper (Purcell, 2016).
Due to a limited agreement for the use of data, women screened in other screening regions than the BOB, and therefore do not have a complete screening history, are left out of the analysis (N=18,730, 16.0% of all women 70 years and older and screened in the BOB region). Reasons to be left out of the analysis can be: women moving to a different region and resume the screening program there, or moving into the northern region after being screened in one of the other regions. Another reason can be that women are treated in a hospital that is in the northern region so the tumour will be registered as diagnosed in the northern region, but she was screened in another region. This means that it is possible that women, even though they were screened at least four times, are left out of the analysis. It is unknown if these 18.730 women were diagnosed with breast cancer or not, and therefore it is difficult to indicate how much this has influenced the results. For example, leaving these women out of the analyses could have led to an underestimation of the effect of regular participation in the screening program.
This study utilized both the Health Belief Model and the Integrated Model of Behavior in its framework. The gaining of new information was considered a “cue to action” as it was the trigger that prompted engagement in health-promoting behaviors . Also, any increased awareness of a health-promoting behavior may serve as motivation for an individual to further increase their knowledge of it. This increased knowledge then leads to greater behavioral intention by increasing an individual’s awareness of the illness/disease . Knowledge can affect other constructs of the Health Belief Model such as perceived susceptibility by letting certain populations know they may be at greater risk for an illness/disease or perceived benefits by making them aware of the positive results that can be achieved through preventative action. Finally, behavioral intention is shown leading to behavior since the Integrated Model of Behavior and its predecessors consider intention to be the direct antecedent to actual behavior change.
Mammography remains the most important breast imaging technique. It is the method of choice for breast cancer population screening in asymptomatic women and is the first imaging technique indicated to evaluate most clinical breast alterations (FLETCHER, 2003). Mammography also allows biopsies of suspected lesions to be performed before they manifest clinically. There is broad agreement that mammographic screening reduces breast cancer mortality by 30 to 40% among regularly screened asymptomatic women (KADAOUI, 2012). Other benefits of early detection include the possibility of more conservative breast-preserving surgeries, increased overall survival and disease-free time (FITZGERALD, 2012). The National Cancer Institute (INCA, in portuguese) recommends that women between 50 and 69 years old have a mammogram every two years. This is also the routine adopted in most countries that implemented breast cancer screening and had an impact on reducing mortality from breast cancer. The benefits of screeningmammography include the possibility of finding cancer at an early stage and having a more conservative and therefore less aggressive treatment, as well as a lower chance of death due to the disease due to timely treatment (INCA, 2016). Breast cancer screening programs have significantly reduced mortality due to early diagnosis in a large number of cases; however, it has been observed that screening mammograms have been followed up with a large number of cases. number of unnecessary biopsies. In Brazil, in the quest for standardization of mammographic reports, the Breast Imaging Reporting and Data System (BI- RADS™) model adopted by the American College of Radiology was adopted as a consensus. It comprises not only a classification of results, but also a set of results. actions that, when applied, allow greater efficiency of early breast cancer detection programs (ROVEDA JUNIOR, 2017). Therefore, this study aims to evaluate the promotion of early diagnosis of breast cancer by performing screeningmammography in women aged 50 to 69 years.
enhance participants’ feeling of discomfort, indicating that staff involved in the mammographic process may need to consider how to communicate the need for repeated repositioning of the breast. Women perceived that they had increased anxiety levels due to the limited communication around the length of screen, as staff failed to inform the women they were having multiple images taken because of their large breasts (and not because something had been detected on imaging). This finding is pertinent given that the mammographic staff who took part in this study reported that their focus was on obtaining the right image rather than ensuring the women had an acceptable experience of having the mammogram. This poor practitioner-patient communication is consistent with previous research among obese women and their cervical screening behaviours , and may be due to weight being seen as a taboo topic. Research examining the communication needs of obese women during their mammogram appears warranted.