Systematic reviews as a “lens of evidence”: determinants of participation in breast cancer screening

OBJECTIVE: To assess determinants of the participation rate in breast cancer screening (BCS) programs by conducting a systematic review of reviews. METHODS: We conducted a systematic search in Pubmed via Medline, Scopus, Embase, and Cochrane identifying the literature up to April 2019. Out of 2,258 revealed unique abstracts, we included 31 reviews from which 25 were considered as systematic. We applied the Walsh & McPhee Systems Model of Clinical Preventive Care to systematise the determinants of screening participation. RESULTS: The reviews, mainly in high-income settings, reported a wide range for BCS participation rate: 16-90%. The determinants of BCS participation were simple low-cost interventions, such as invitation letters, basic information on screening, multiple reminders, fixed appointments, prompts from healthcare professionals, and healthcare organizational factors (eg. close proximity to screening facility). More complex interventions (such as face-to-face counselling or home visits), mass media or improved access to transport should not be encouraged by policy makers unless other information appears. The repeated participation in mammography screening was consistently high, above 62%. Previous positive experience with screening influenced the repeated participation in screening programs. The reviews were inconsistent in the use of terminology related to BCS participation, which may have contributed to the heterogeneity in the reported outcomes. CONCLUSIONS: This study shows that consistent findings of systematic reviews bring more certainty into the conclusions on effects of simple invitation techniques, fixed appointments and prompts, as well as healthcare organizational factors on promoting participation rate in screening mammography

Youth Assets and Sexual Activity Among Hispanic Youth

Hispanic females, ages 15-19, experienced the highest birth rates and smallest decline in birth rates over the past decade compared to youth of other racial/ethnic groups. This study’s purpose was to investigate relationships among a series of protective factors, or youth assets, and sexual activity in the Hispanic/Latino youth population. Data were collected from Hispanic youth and their parents (N=232 youth/parent pairs) in randomly selected households using in-person, in-home interview methods. Independent variables were nine youth assets; “never had sexual intercourse” was the dependent variable. Data were analyzed using logistic regression analysis. Three assets were found to be significantly associated with whether or not Hispanic/Latino youth ever had sexual intercourse. Odds of never having had sexual intercourse were at least three times higher for youth with the Peer Role Models, Use of Time (religion), or Responsible Choices assets, compared to youth without these assets. Further Hispanic youth asset/risk behavior research is merited

Potential Protective Effect of the Community Involvement Asset on Adolescent Risk Behaviors

The potential of Community Involvement as a protective factor (youth asset) for eight adolescent risk behaviors was examined in this study. Cross-sectional data were collected from a randomly-selected population using in-home, in-person interviews in racially diverse inner-city neighborhoods of two Midwestern cities. Research participants were teenagers (n=1,278) and parents of the teenagers (n=1,278). Data included demographic variables; eight adolescent risk behaviors, including sexual activity, violence and the use of tobacco, alcohol and drugs. This study found youth with the Community Involvement asset were significantly (

Youth Assets and Sexual Activity Among Hispanic Youth

Hispanic females, ages 15-19, experienced the highest birth rates and smallest decline in birth rates over the past decade compared to youth of other racial/ethnic groups. This study’s purpose was to investigate relationships among a series of protective factors, or youth assets, and sexual activity in the Hispanic/Latino youth population. Data were collected from Hispanic youth and their parents (N=232 youth/parent pairs) in randomly selected households using in-person, in-home interview methods. Independent variables were nine youth assets; “never had sexual intercourse” was the dependent variable. Data were analyzed using logistic regression analysis. Three assets were found to be significantly associated with whether or not Hispanic/Latino youth ever had sexual intercourse. Odds of never having had sexual intercourse were at least three times higher for youth with the Peer Role Models, Use of Time (religion), or Responsible Choices assets, compared to youth without these assets. Further Hispanic youth asset/risk behavior research is merited

Potential Protective Effect of the Community Involvement Asset on Adolescent Risk Behaviors

The potential of Community Involvement as a protective factor (youth asset) for eight adolescent risk behaviors was examined in this study. Cross-sectional data were collected from a randomly-selected population using in-home, in-person interviews in racially diverse inner-city neighborhoods of two Midwestern cities. Research participants were teenagers (n=1,278) and parents of the teenagers (n=1,278). Data included demographic variables; eight adolescent risk behaviors, including sexual activity, violence and the use of tobacco, alcohol and drugs. This study found youth with the Community Involvement asset were significantly (

Mammography screening: views from women and primary care physicians in Crete

Background: Breast cancer is the most commonly diagnosed cancer among women and a leading cause of death from cancer in women in Europe. Although breast cancer incidence is on the rise worldwide, breast cancer mortality over the past 25 years has been stable or decreasing in some countries and a fall in breast cancer mortality rates in most European countries in the 1990s was reported by several studies, in contrast, in Greece have not reported these favourable trends. In Greece, the age-standardised incidence and mortality rate for breast cancer per 100.000 in 2006 was 81,8 and 21,7 and although it is lower than most other countries in Europe, the fall in breast cancer mortality that observed has not been as great as in other European countries. There is no national strategy for screening in this country. This study reports on the use of mammography among middleaged women in rural Crete and investigates barriers to mammography screening encountered by women and their primary care physicians. Methods: Design: Semi-structured individual interviews. Setting and participants: Thirty women between 45–65 years of age, with a mean age of 54,6 years, and standard deviation 6,8 from rural areas of Crete and 28 qualified primary care physicians, with a mean age of 44,7 years and standard deviation 7,0 serving this rural population. Main outcome measure: Qualitative thematic analysis. Results: Most women identified several reasons for not using mammography. These included poor knowledge of the benefits and indications for mammography screening, fear of pain during the procedure, fear of a serious diagnosis, embarrassment, stress while anticipating the results, cost and lack of physician recommendation. Physicians identified difficulties in scheduling an appointment as one reason women did not use mammography and both women and physicians identified distance from the screening site, transportation problems and the absence of symptoms as reasons for non-use. Conclusion: Women are inhibited from participating in mammography screening in rural Crete. The provision of more accessible screening services may improve this. However physician recommendation is important in overcoming women's inhibitions. Primary care physicians serving rural areas need to be aware of barriers preventing women from attending mammography screening and provide women with information and advice in a sensitive way so women can make informed decisions regarding breast caner screening

The association between family and community social capital and health risk behaviours in young people: an integrative review

Background: Health risk behaviours known to result in poorer outcomes in adulthood are generally established in late childhood and adolescence. These ‘risky’ behaviours include smoking, alcohol and illicit drug use and sexual risk taking. While the role of social capital in the establishment of health risk behaviours in young people has been explored, to date, no attempt has been made to consolidate the evidence in the form of a review. Thus, this integrative review was undertaken to identify and synthesise research findings on the role and impact of family and community social capital on health risk behaviours in young people and provide a consolidated evidence base to inform multi-sectorial policy and practice.<p></p> Methods: Key electronic databases were searched (i.e. ASSIA, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Embase, Medline, PsycINFO, Sociological Abstracts) for relevant studies and this was complemented by hand searching. Inclusion/exclusion criteria were applied and data was extracted from the included studies. Heterogeneity in study design and the outcomes assessed precluded meta-analysis/meta-synthesis; the results are therefore presented in narrative form.<p></p> Results: Thirty-four papers satisfied the review inclusion criteria; most were cross-sectional surveys. The majority of the studies were conducted in North America (n=25), with three being conducted in the UK. Sample sizes ranged from 61 to 98,340. The synthesised evidence demonstrates that social capital is an important construct for understanding the establishment of health risk behaviours in young people. The different elements of family and community social capital varied in terms of their saliency within each behavioural domain, with positive parent–child relations, parental monitoring, religiosity and school quality being particularly important in reducing risk.<p></p> Conclusions: This review is the first to systematically synthesise research findings about the association between social capital and health risk behaviours in young people. While providing evidence that may inform the development of interventions framed around social capital, the review also highlights key areas where further research is required to provide a fuller account of the nature and role of social capital in influencing the uptake of health risk behaviours.<p></p&gt

How well do the theory of reasoned action and theory of planned behaviour predict intentions and attendance at screening programmes? A meta-analysis

Meta-analysis was used to quantify how well the Theories of Reasoned Action and Planned Behaviour have predicted intentions to attend screening programmes and actual attendance behaviour. Systematic literature searches identified 33 studies that were included in the review. Across the studies as a whole, attitudes had a large-sized relationship with intention, while subjective norms and perceived behavioural control (PBC) possessed medium-sized relationships with intention. Intention had a medium-sized relationship with attendance, whereas the PBC-attendance relationship was small sized. Due to heterogeneity in results between studies, moderator analyses were conducted. The moderator variables were (a) type of screening test, (b) location of recruitment, (c) screening cost and (d) invitation to screen. All moderators affected theory of planned behaviour relationships. Suggestions for future research emerging from these results include targeting attitudes to promote intention to screen, a greater use of implementation intentions in screening information and examining the credibility of different screening providers

What can be done to Encourage Women from Black, Asian and Minority Ethnic Backgrounds to Attend Breast Screening? - A Qualitative Synthesis of Barriers and Facilitators

Objective: to identify the barriers to UK Black, Asian and Minority Ethnic (BAME) women attending breast screening and subsequently, support the growing evidence base providing solutions to the public health problem of ethnic variation within screening attendance. Study design: A systematic review and thematic analysis of UK based, qualitative studies concerning BAME women.Methods: the methodology of this review is based on Cochrane guidelines. A search strategy was applied to Embase, PubMed and Medline. Pre-defined inclusion and exclusion criteria yielded 8 final papers which were appraised and thematically analysed.Results: The main findings of the review revealed three overarching themes: Knowledge-related, Access-related and Cultural-related factors. The emphasis of the importance of knowledge was highlighted by all studies identifying a lack of knowledge as a key barrier to screening attendance