184 Chapter 7 Given these harms, there are numerous reasons why people refrain from participation. The GP in this case however, also finds out that deciding on CSP attendance is not always a matter of purely rational decision-making.11-14 Similar to John’s situation there are many people who do not understand the invitation or do not have a clue about the CSPs at all. In this regard, our GP develops the opinion that primary/GP-care has a pivotal role in providing guidance and information for potential participants concerning the CSPs. Because the GP believes that John may have a higher risk of developing colorectal cancer, he contacts the family. Methodological considerations In this thesis all three Dutch cancer screening programmes (CSPs) are examined and discussed, taking the differences and similarities of the programmes into account, over a longer period of time. The presented studies in this thesis can all be regarded as building blocks that improve the evidence needed for the Screening the CITY project, in which we aimed to explore and resolve specific problems that come up in highly urbanized areas when the CSPs were implemented and seem to be underused. The individual studies conducted in this thesis employed a diverse range of research methodologies and focused on different study populations. By utilizing varied research methodologies and study populations, we intended to overcome potential limitations of each sub-study, as discussed in each chapter. In two studies (see Chapter 2 and 4), we made use of the Integrated Change Model as a comprehensive theoretical framework to enhance our understanding of screening participation.15, 16 Some of the studies in the Screening the CITY project were conducted different than originally intended. This was mainly due to the outbreak of the COVID-19 pandemic and its associated effects. At the peak of the pandemic the CSPs were temporally suspended, and over the course of the pandemic, screening organisations understandably prioritized other pressing matters over facilitating scientific research.17, 18 This led to several modifications to our studies, and had in particular impact on the studies described in Chapter 3 and 4. Concerning the research presented in Chapter 3 we encountered an issue where we were unable to access the data on cervical CSP. Consequently, we were unable to combine data on all three cancer screening programmes in the city of The Hague. It transpired that the data on this screening programme resided within a separate data
RkJQdWJsaXNoZXIy MTk4NDMw