182 Chapter 7 The overall aim of this thesis was to identify cues that may contribute to optimizing the current attendance rates of the cancer screening programmes (CSPs) in the Netherlands, with a focus on the potential role of primary care. We hypothesised that the CSPs that currently handle a ‘one-size-fits-all’ approach, with a limited role for primary care and general practitioners (GPs), should shift to a more targeted approach for subpopulations at relatively higher risk, with sophisticated involvement of primary healthcare providers and healthcare centres to support such a new approach. In this final chapter, the study findings are outlined and discussed in relation to each other. First the key findings of the studies in this thesis will be presented. Then, we will look back at the case of the Janssen family and discuss the methodological considerations of this thesis. Thereafter, the implications of our findings and recommendations for future research will be discussed. Finally, the overall conclusion based on this thesis will be presented as a reflection on our hypothesis. Main findings Reviewing the literature in Chapter 2, shows that thus far published studies tend to describe the well-known and general characteristics of (non-)attenders, but rarely provide in-depth information on other factors that may influence participation. Non-influenceable determinants as a non-Western migration background, living in a highly urbanised area and with a lower socioeconomic status (SES) background, were most often described as being associated with low(er) cancer screening attendance. Our findings in Chapter 3 also suggest that non-attendance at the cancer screening programmes (CSPs) aiming at breast and colorectal cancer in a highly urbanised area, is linked to living in lower SES-neighbourhoods. Additionally, it is associated with a more unfavourable tumour-stage at diagnosis. In Chapter 4 we present evidence that beliefs and motivations towards the CSPs and CSP attendance are not only different between attenders and non-attenders, but can also differ between subgroups of people holding different perspectives. We identified three different perspectives. Responders holding one specific perspective – those doubting screening attendance and anticipating the potential consequences of the screening results – were in particular open to receive information provided by a general practitioner (GP), or another trusted primary healthcare provider. Chapter 5 can be seen as a ‘proof of concept’ study, in which we showed that a targeted proactive primary care approach for a subpopulation at relatively higher risk on the development of (in this case: cervical) cancer, is needed – sometimes even essential – to enhance screening. In Chapter 6 we concluded that GPs are generally positive about the CSPs and are willing to positively empower the CSPs. The GPs involved suggested several options to improve the current CSPs, especially to increase screening uptake for populations in a socioeconomic or otherwise socially disadvantaged position.
RkJQdWJsaXNoZXIy MTk4NDMw