203 Summary Key findings of this thesis Although various studies have been conducted on the different factors influencing participation in the Dutch population-based cancer screening programmes (CSPs), there was no systematic literature review systematically describing, ranking, and analysing all these factors. In Chapter 2, we therefore begin with a systematic review in which we describe all literature published up to February 2018 regarding the characteristics of both participation and non-participation in the screening programmes. For this purpose, we searched all known and relevant electronic databases, including PubMed, Cochrane Library, and PsycINFO. Additionally, we utilized the so-called grey literature (e.g., reports from the National Institute for Public Health and the Environment (RIVM) and the national screening organisation (Bevolkingsonderzoek Nederland)). To organize all identified characteristics, we used the Integrated Change model (I-Change model) by De Vries et al. This is a model from health psychology that incorporates elements from various widely used and valued theories of health behaviour, such as the Health Belief Model, the Protection Motivation Theory, the Theory of Planned Behaviour, and the Precaution Adoption Process Model. Through this literature study, we were able to identify knowledge gaps. This study thereby formed the basis for this thesis. The main findings arising from this study are that the previously published studies primarily tend to describe the general characteristics of (non-)attendance and (non-) attenders, but that they rarely provided in depth information on other factors of (non-) participation. We found that classic – often non-influential factors – such as socioeconomic status (SES), country of birth, and place of residence are most frequently reported and investigated in their relationship to participation in the screening programmes. Low SES, non-Western migration background, and living in an urban environment were strongly correlated with lower participation in the screening programmes. Additionally, we found that younger women and men (of course only applicable for the colorectal cancer screening programme) are less inclined to participate. Finally, we found some indications that general practitioners may be able to influence the attendance rates of the screening programmes. The I-Change model proved to be a useful tool in mapping the current knowledge about participation in the screening programmes. In Chapter 3, we describe a retrospective data study to further understand which potential participants are less likely to participate in the CSPs in the city of The Hague and what risks (in terms of tumour outcomes) this entails. Due to limitations in data availability, we had to focus on the screening programmes targeting at breast cancer (BC-SP) and colorectal cancer (CR-CSP). Although it is unfortunate that we could not examine all three CSPs collectively, this did give us a unique opportunity to compare a 8
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