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Non-attendance of mammographic screening: the roles of age and municipality in a population-based Swedish sample.
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. (LIVSSTIL)ORCID iD: 0000-0002-4629-7781
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Cty Council Vastmanland, Ctr Clin Res, Uppsala, Sweden; Uppsala University, Sweden. (Equity research)ORCID iD: 0000-0002-3452-7260
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. (LIVSSTIL&SAMPRODUKTION)ORCID iD: 0000-0002-3787-1040
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. (Equity research)ORCID iD: 0000-0001-9059-599X
2015 (English)In: International Journal for Equity in Health, E-ISSN 1475-9276, Vol. 14, no 1, article id 157Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Inequality in health and health care is increasing in Sweden. Contributing to widening gaps are various factors that can be assessed by determinants, such as age, educational level, occupation, living area and country of birth. A health care service that can be used as an indicator of health inequality in Sweden is mammographic screening. The non-attendance rate is between 13 and 31 %, while the average is about 20 %. This study aims to shed light on three associations: between municipality and non-attendance, between age and non-attendance, and the interaction of municipality of residence and age in relation to non-attendance.

METHODS: The study is based on data from the register that identifies attenders and non-attenders of mammographic screening in a Swedish county, namely the Radiological Information System (RIS). Further, in order to provide a socio-demographic profile of the county's municipalities, aggregated data for women in the age range 40-74 in 2012 were retrieved from Statistics Sweden (SCB), the Public Health Agency of Sweden, the National Board of Health and Welfare, and the Swedish Social Insurance Agency. The sample consisted of 52,541 women. Analysis conducted of the individual data were multivariate logistic regressions, and pairwise chi-square tests.

RESULTS: The results show that age and municipality of residence associated with non-attendance of mammographic screening. Municipality of residence has a greater impact on non-attendance among women in the age group 70 to 74. For most of the age categories there were differences between the municipalities in regard to non-attendance to mammographic screening.

CONCLUSIONS: Age and municipality of residence affect attendance of mammographic screening. Since there is one sole and pre-selected mammographic screening facility in the county, distance to the screening facility may serve as one explanation to non-attendance which is a determinant of inequity. From an equity perspective, lack of equal access to health and health care influences facility utilization.

Place, publisher, year, edition, pages
BMC , 2015. Vol. 14, no 1, article id 157
Keywords [en]
Age, Distance, Equitable health care, Mammographic screening, Municipality of residence, Sweden
Keywords [sv]
Avstånd, Jämlik vård, Kommuntillhörighet, Mammografisk screening, Sverige, Ålder
National Category
Health Sciences
Research subject
Care Sciences
Identifiers
URN: urn:nbn:se:mdh:diva-30717DOI: 10.1186/s12939-015-0291-7ISI: 000367510100001PubMedID: 26715453Scopus ID: 2-s2.0-84952316155OAI: oai:DiVA.org:mdh-30717DiVA, id: diva2:894223
Available from: 2016-01-14 Created: 2016-01-14 Last updated: 2024-01-17Bibliographically approved
In thesis
1. Access to and participation in mammographic screening within a region in Sweden
Open this publication in new window or tab >>Access to and participation in mammographic screening within a region in Sweden
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The population-based mammographic screening programme offers every woman in Sweden between 40 and 74 years of age a mammogram with the purpose of early detection of potential breast cancer. The programme is seemingly equal in its setup; however, approximately 20 percent of the women do not participate in the screening. The overall aim of Sweden’s public health policy is to create prerequisites for good and equal health, and health care, a health determinant, falls under the responsibility of the self-governed Regions. Therefore, it is important to analyse regional participation in mammographic screening to develop strategies to reach those who refrain from screening.

The aim of the doctoral dissertation was to describe, explore and understand access to and participation in health care using mammographic screening as an example. Study I was a quantitative cross-sectional study based on individual and aggregated data. The analysis consisted of frequencies of data, multivariate logistic regressions, and pairwise chi-square tests. Study II used group discussions with women participating in mammographic screening for data collection. In Study III, women who had not participated in mammographic screening for at least the last two invitational rounds were interviewed. In Study IV, interviews with regional politicians were conducted. The method of analysis for Studies II and III was qualitative content analysis, and in Study IV a reflexive thematic analysis was performed.

The results show that access to and participation in mammographic screening involve both structural and individual conditions. Municipality of residency as a potential proxy for distance to the mammographic facility is indicated to impact participation, as is age. Getting to and from the facility and taking time off from work are examples of structural conditions. Facilitators for and barriers to participation in mammographic screening are similar for women who participate and women who lately have not. The phases of the screening process are addressed. Psychological preparation before the visit, encounters with the staff, and managing the wait for the results reflect individual determinants. Caring for health is perceived as a shared commitment between politicians and individuals. This responsibility requires information and understanding of the impact social determinants have on the decision to participate in the screening. It also requires resources for the lowering of thresholds for participation.

Encounters with the health care system and the health care systems responsiveness are important for continuous participation in mammographic screening, whereas information and knowledge are pivotal to making well-informed decisions.

Place, publisher, year, edition, pages
Västerås: Mälardalen University, 2020
Series
Mälardalen University Press Dissertations, ISSN 1651-4238 ; 323
Keywords
Access, experiences, mammographic screening, participation, perceptions, public health, qualitative content analysis
National Category
Health Sciences
Research subject
Public Health Sciences
Identifiers
urn:nbn:se:mdh:diva-51561 (URN)978-91-7485-486-2 (ISBN)
Public defence
2020-12-18, Delta +(Online Zoom), Mälardalens högskola, Västerås, 09:00 (English)
Opponent
Supervisors
Available from: 2020-10-19 Created: 2020-10-19 Last updated: 2020-12-17Bibliographically approved

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Norfjord Zidar, MariaPeter, LarmTillgren, Per

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