204 Chapter 8 long-standing CSP with a relatively new one. We utilized databases from the national screening organisation (Bevolkingsonderzoek Nederland) (supplemented with specific regional data via Bevolkingsonderzoek Zuid-West) and linked them to databases from the Netherlands Comprehensive Cancer Organisation (IKNL). In this study, over the period from 2005 to 2019, we were able to elucidate (at an aggregated level) who did/did not participate in the BC-SP and CRC-SP, and who ultimately was/was not was diagnosed with of one of the screening-specific tumours. For our analyses, we compared two subgroups: potential participants who did (participation >50% after invitation) and did not (participation ≤50% after invitation) participate in the screening programmes over the period. The main findings from this study are that non-participation in the screening programmes can be directly linked to residing in a low socioeconomic status (SES) neighbourhood. Moreover, non-participation is also associated with a less favourable tumour outcome – relatively advanced tumour outcome – at the time of diagnosis. Therefore, nonparticipation in the screening programmes is potentially concerning and problematic, especially for certain subpopulations. When we combined the data from both screening programmes, it became clear that the majority of women do participate and generally do so consistently over time. Also, from the combined datasets, it emerged that women who did not participate in either screening programmes over time were more likely to reside in lower SES-neighbourhoods. Based on these findings, we believe that there is a need for the development of future strategies that engage specific subgroups more effectively in the screening programmes. The city of The Hague, with all its multicultural facets, proved to be an excellent setting for conducting this type of research. This is primarily due to the significant differences that exist between the various neighbourhoods in the city, which are adequately represented by the SES-scores. In Chapter 4, we present a Q-methodology study (Q-study) on the beliefs and motivations of potential participants residing in the city of The Hague regarding participation in the CSPs. The idea behind this study was to clarify what is important to potential participants when they think/decide about participating in the screening programmes. A Q-study is a ‘mixed-methods’ methodology, particularly used to gain insight into prevailing perspectives on specific subjects within certain populations. Due to the COVID-19 pandemic outbreak, we conducted our Q-study online using an existing research panel. In a Q-study, respondents are presented with a set of statements that they must rank based on their beliefs within a predetermined framework. These rankings (one ranking per participant) thus form the quantitative data. Subsequently, factor analysis is conducted to identify significant clusters of correlations. The assumption is that respondents with similar perspectives will rank the statements in similar ways. The qualitative data is
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