188 Chapter 7 Included women were asked about their attitude regarding the cervical CSP, and it turned out that they became more positive regarding the screening programme after seeing a culturally sensitive educational video to facilitate informed cervical cancer screening decisions.34 Furthermore, future researchers should look into some relatively small modifications, such as altering the envelope, or the invitation letter by including a text stating, such as: “The message is positively endorsed by your GP”. Subtle adjustments like these might already have large positive impact on the attendance rates, without having to invest to much effort, and should therefore be considered in future studies. Finally, as a last suggestion and thus far unexplored in our studies, integrating all three CSPs together may have unknown benefits. It might be profitable and convenient for women to receive an invitation for all three CSPs simultaneously. Combining the three CSPs might contribute to providing women with comprehensive information and facilitating their participation in screenings to the fullest extent possible. Implications for clinicians: GPs and (other) primary healthcare providers As a positive note to be mentioned, is that our findings highlight the enduring high appreciation and trust that the public places in primary care and in GPs. In these postCOVID-19 pandemic times this is in contrast with another notion, that public trust in (medical) science seems to be declining. Two important points for medical professionals ‘in the field’. First, clinicians are able to influence the attendance rates of the CSPs. Second, GPs are in the position and capable of ensuring that individuals with higher risks do participate in the CSPs; this follows both from our sub-studies, but is also earlier described in several publications.35-37 Clinicians therefore should realize that it matters how they speak, feel and decide upon the CSPs. They can really make a difference concerning cancer screening participation. Thereby, engagement in a CSP is not a purely rational matter. It is shaped by practical, emotional, cultural, and religious factors.38 This further emphasises the significance of fostering and enlarging the role of primary healthcare providers within the CSPs. For multiple studies, especially the one described in Chapter 3, we tried to make use of routine care – and registry data that are already present in the electronic health records (EHRs) of general practices. However, during our studies we encountered a common problem, which is that medial data are somewhat poorly coded and underused in current EHRs. As reuse of EHR-data will probably become more important in the nearby future, to reduce patient selection in research and for population health management purposes, greater emphasis should be placed on the value of correct coding of medical information
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