150 Chapter 6 of available time, or that their time could be better spent on other things (Q29, Q31, Q34). On the other hand, GPs also realized that the involvement of GP-practices would probably lead to a higher screening uptake (Q28, Q33, Q36). A kind of ‘add-on methodology’ where GPs can decide, maybe in agreement with the national screening organisation, to also invite patients themselves, so in addition to the general invitation, was considered as a possible positive proposal by all the interviewees. This idea was first introduced by GP I, Q30: “Everyone is invited by default, but on top, GPs are given a list of high-risk screeningeligible people… You could be more creative than either just the entire invitation via the screening organisation, or via GPs”. And then later named by GP II (Q32): “What could be done is a kind of ‘add-on methodology’. So, in addition to a common basis, something extra can be done on the community-level by GP-practices. Think of a letter, or maybe even a call from the practice”. Such a methodology seems to be in line with Q35, which addressed that screening-eligible people currently do not feel seen individually. Another, less intrusive strategy, would be to send the invitation letter on behalf of the GP, or with an envelope that states that the GP supports the CSPs (Q33, Q36). Topic IV: Tailor-made strategies for subpopulations/lower SES-neighbourhoods By the GPs (I, III, V), working in more disadvantaged neighbourhoods, with a relatively lower socioeconomic status (SES), it was extensively discussed that tailor-made strategies are needed for specific subpopulations. As was stated (Q38): “Given the complexity of participation, it is not surprising that people living in a low SES-neighbourhood and with a non-western migration background are less likely to participate. You have to do it all yourself, read it, understand it etc…”. Several barriers were considered to be especially relevant for people living in the lower SES-neighbourhoods, such as: the lack of (health) literacy, poor education and certain taboos. Furthermore, GPs reported that people living in disadvantaged neighbourhoods often have low trust in everything related to the government (Q44). We found no clear consensus on what these tailor-made strategies should look like (Q39-44). The earlier described ‘add-on methodology’ however, was thought to be effective increasing screening uptake for socioeconomically disadvantaged populations and was designated as positive by all GPs. Accurate information in several languages, and proactively approaching screening-eligible people were furthermore often mentioned as possibilities (Q39, Q40). Topic V: Other optimalization opportunities Numerous other optimalization opportunities for increasing participation were suggested in the open-ended questions of the questionnaire and by the interviewed GPs. Most of the idea’s involved solutions as: making use of education videos on smartphones, pictograms, QR-codes and influencers (Q48, Q50, Q51). Furthermore, the waiting room information screen was suggested as a useful tool for informing patient on the CSPs
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