186 Chapter 7 electronic medical record data from GPs. This would enable us to gain a more detailed insight of the determinants that influence attendance and non-attendance concerning the CSPs, currently lacking as we showed in Chapter 2. In ideal circumstances we would like to have information on the living environment of the screening-eligible people, and gain information on someone’s profession, house value, family composition and financial situation. Furthermore, we would like to have insight in several medical characteristics, such as medical history, family history, medication, and substance use. In addition, would we be interested in the frequency of general practitioner (GP) visits, and maybe also recent health measurements (such as vital parameter, and for example body mass index as indicators of overall health). The challenge with all these variables is that the data, especially when combined, must not be traceable back to individuals. For the future, non-commercial information systems should become available that allow free data linkage, sharing, and re-using (routine) data in primary care. A recent report by the ministry of Health, Welfare and Sports suggested that they are currently investigating how certain, more privacy sensitive data, can be (re)used for certain specified aims.26 For the study described in Chapter 4 our original plan was to proactively recruit screening-eligible individuals and conduct a face-to-face Q-methodological study in selected lower socioeconomic status (SES) neighbourhoods. However, due to the COVID19 pandemic and the associated safety concerns, people were hesitant about leaving their homes, unable to replace this completely with adequate remote facilities, and the government advised minimizing contact with others and staying at home. Consequently, we had to find alternative approaches to reach and include participants. This ultimately did result in an online panel for recruitment, with pros and cons regarding the selection of panel members. By leveraging an existing research panel, we were able to include a considerable number of individuals. However, it is important to acknowledge that employing an online panel introduced a selection bias. As the study progressed, it became evident that our sample primarily consisted of individuals who held, on average, more positive views towards the CSPs and their participation. Therefore, we cannot deny the possibility that other perspectives would have emerged if we had been able to include screening-eligible individuals with different characteristics. The studies presented in Chapters 5 and 6 can be considered exploratory in nature. To improve the robustness of our study findings, additional study inclusions would have been necessary. For Chapter 5 this would mean more marginalised women should be included and screened. As described, we view this study as a ‘proof of concept’. Municipal health services (GGD; Gemeentelijke Gezondheidsdienst) in The Hague, Rotterdam, and Amsterdam are currently exploring how they can utilize the findings from our study to
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