111 Perspectives on cancer screening participation Perspective 3 Respondents with this perspective think it is good that CSPs are in place (18,+4), that having regular medical check-ups is important, even when feeling well (17,+2), and that they can do something positive for their health by participating in CSPs (23,+2). However, contrary to the other perspectives, these respondents are afraid of developing cancer (16,+3) and dying as a consequence. They disagree with the statements about not wanting to know whether you have cancer as long as you do not have complaints (12,-2) and that there are also disadvantages to participating in CSPs (13,-1). Most of all respondents they consider follow-up testing in their decision (25,+1), and reducing the risk of death an important motivation to participate (15,+2). As one respondent explains (ID IJFC): “My core motivation for participating in the CSPs is to reduce my chance of dying as a consequence of cancer. I am quite fearful that sooner or later I will get a cancer diagnose. Just the idea of having cancer terrifies me”. The reason underlying their motivation, also gives them an unpleasant feeling about participation (31,0) (ID IJFC): “I always find it quite tensive to participate in a CSP. Every time again, I am afraid that they will find something. (…) On the other hand, the fear of a cancer diagnosis out of the blue is even more frightening to me. Therefore, I do participate in the screening programmes”. These respondents trust the testing procedures (28,+3), and consider the invitation clear (1,+2) and a reason to participate (24,+1). They think the information flyer about screening is not particularly helpful (2,+1; 3,0; 4;0), however, they would probably not attend a meeting to obtain more information about CSPs (11,-2) (ID 50LC): “I would never go to an information meeting, or something similar (…) Besides, I do not want to talk with strangers on such delicate topics”. They feel sufficiently informed to decide about participation (5,+1) and at any stage do not see a role for their GP (7,-1; 6,0; 8,0) (ID 50LC): “I do not need any contact with my GP about the CSPs. When I have questions, I will look them up myself. And whenever I need more information, or when something bad has been identified, I do want to discuss this with a specialist in the hospital (…) The GP’s opinion has no added value in this case”. We label this perspective “fear drives participation”. A total of 16 respondents were statistically associated with this factor, of whom 12 reported to participate in CSPs, three reported not participating, and one did not report participation status. Consensus statements Several statements were identified as consensus statements (see Table 2), but most of them with scores between +1 and -1, indicating they were not characteristic for the perspectives (or lack of consensus about them within perspectives). Statements 20 and 21 about religion/faith were generally not seen as barriers to screening participation, nor was statement 26 about partaking in CSPs to be time consuming. Moreover, all perspectives disagreed with statement 29 that most peers do not participate in CSPs. 4
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