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  • 1.
    Norfjord van Zyl, Maria
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Access to and participation in mammographic screening within a region in Sweden2020Doctoral 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.

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  • 2.
    Norfjord van Zyl, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Akhavan, Sharareh
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Natl Board Hlth & Welf, Evaluat & Anal Unit, Stockholm, Sweden..
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Asp, Margareta
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Experiences and perceptions about undergoing mammographic screening: a qualitative study involving women from a county in Sweden2018In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 13, no 1, article id 1521256Article in journal (Refereed)
    Abstract [en]

    Purpose:An organized population-based mammographic screening programme aims for an early detection of potential breast abnormalities so that treatment can commence. Continuous participation and a high attendance rate are vital for an effective programme. It is important to understand the underlying reasons for participation in mammographic screening, should there be factors that are amendable within reason and could be adjusted. Therefore, the invited women are valuable sources of information. This study aimed at describing the experiences and perceptions about mammographic screening of women from three municipalities in a Swedish county.Method:Six semi-structured focus-group discussions, each with four to five participants, were held. Content analysis was then conducted.Results:The screening procedure, such as staff professionalism, was covered. Other people's opinions and the woman's own understanding affected the women's decisions on whether or not to undergo the procedure. Structural conditions, such as travel time and financial issues, were sources of concern. However, the offer to perform mammographic screening was perceived with gratitude.Conclusions:Structural conditions, risk and time perceptions, the screening procedure, attitudes towards undergoing it and appreciation of its benefit may influence the women's continuous willingness to be screened, which in turn may affect public and individual health.

  • 3.
    Norfjord van Zyl, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Akhavan, Sharareh
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Asp, Margareta
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Non-participation in mammographic screening – experiences of women from a region in Sweden2020In: BMC Public Health, E-ISSN 1471-2458, Vol. 20, no 1, article id 219Article in journal (Refereed)
    Abstract [en]

    Understanding women’s life conditions regarding their non-participation in different health-promoting and disease-preventing activities is important as it may draw attention to potential areas for improvement in the healthcare sector. Mammographic screening, a disease-preventing service, facilitates early detection of any potential malignancies and consequently prompts initiation of treatment. The reasons for non-participation in mammographic screening can be understood from different perspectives, such as socioeconomic and lifestyle-related determinants of health. This study aims to gain a deeper understanding of women’s experiences and perceptions about non-participation in mammographic screening in a Swedish region with a single mammographic facility.

    Methods

    Data from individual semi-structured interviews, conducted in 2018 with eleven women between the ages of 48 and 73, were analysed by a qualitative content analysis.

    Results

    The findings reveal three main categories: 1) doubts regarding mammographic screening and its organisation, 2) sense and sensibility in the decision to refrain from mammographic screening, and 3) dependency and options. These three categories indicate aspects, such as the individual’s life situation, accessibility to the offered service, and the flexibility of the healthcare system, that need to be considered to improve the organisation of mammographic screening.

    Conclusion

    Listening to the women’s voices regarding their experiences and perceptions about mammographic screening is important as individual characteristics and social circumstances interact with healthcare and affect the degree of participation.

  • 4.
    Norfjord van Zyl, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Asp, Margareta
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    The politicians’ perspectives on participation in mammographic screening:: an interview-based study from a region in Sweden2021In: Archives of Public Health, ISSN 0778-7367, E-ISSN 2049-3258, Vol. 79, no 1, article id 52Article in journal (Refereed)
    Abstract [en]

    Breast cancer is the most common cancer type among women globally. To facilitate early detection,all 40–74-year-old female residents of Sweden are invited to participate in a population-based mammographic screening programme. Approximately 20% of all invited women decline the offer, and if this is due to systematic differences that can be adjusted, it can indicate inequity in healthcare. Assessment of and being updated about the health and healthcare of the residents are largely the responsibilities of the self-governed regions in Sweden. The understanding of the residents’ health serves as a basis for decision making and priority setting. This study aims todescribe how politicians representing a region in Sweden perceive women’s participation in mammographic screening and the politicians’ own possibility to promote such participation.Methods: Qualitative thematic analysis was conducted on the data obtained from individual semi-structured interviews held in 2019. The interviewees comprised ten politicians (six women and four men, 38–71 years old) representing a sub-committee focusing on public health and healthcare issues.Results: Two main themes have been identified: 1) expected actions and 2) expected conditions for acting,including a total of four sub-themes. According to the politicians, the expected actions, such as obtaining information and being updated about matters regarding mammographic screening, concern both the women invited to the screening and the politicians themselves. Additionally, for both the individual and the healthcare organisation, here represented by the politicians, expected actions entail a shared commitment to maintain health.The expected conditions for acting refer to the politician’s awareness of the factors influencing the women’s decision to undergo or refuse the screening and having the resources to enable taking actions to facilitate participation. Conclusions: Expected actions and expected conditions for acting are tightly connected and entail some form of prioritisation by the politicians. Setting the priorities can be based on information about the purpose of thescreening and an understanding of social determinants’ impacts on women’s decision to refrain frommammographic screening, as well as available resources.

  • 5.
    Norfjord Zidar, Maria
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Peter, Larm
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Cty Council Vastmanland, Ctr Clin Res, Uppsala, Sweden; Uppsala University, Sweden.
    Tillgren, Per
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Akhavan, Sharareh
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Non-attendance of mammographic screening: the roles of age and municipality in a population-based Swedish sample.2015In: International Journal for Equity in Health, E-ISSN 1475-9276, Vol. 14, no 1, article id 157Article in journal (Refereed)
    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.

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