205 Summary formed by respondents providing explanations for their rankings. In our study, we also interviewed selected respondents after they completed their rankings. We identified three different perspectives. The first identified perspective was labelled as ‘positive about participation’. These are the people who typically always participate in the screening programmes. They have a positive attitude towards the screening programmes, and respondents indicated that participation in the screening programmes is part of their (social) norm. Interestingly, the interviewed respondents with this perspective could not always provide correct information about the screening programmes, particularly not about the medical follow-up tests. Therefore, we questioned whether their decision to participate in the screening programmes is the result of a deliberate, well-informed choice. The second perspective was labelled as ‘thoughtful about participation’. People with this perspective were found to be more hesitant about participating in the screening programmes. They more often doubted the effectiveness of the screening programmes and considered the potential consequences of screening (including false-positive and false-negative results) more important. These respondents were generally better informed about the potential consequences of the screening programmes. Unique to this perspective is the role that respondents see for their general practitioner/primary care provider(s) as advisors. The third perspective was labelled by us as ‘fear drives participation’. These people mostly participate in the screening programmes, but this is mainly due to feelings of fear and discomfort. Most respondents with this perspective knew people who had actually suffered from or died from the consequences of cancer. Respondents may have felt more vulnerable to being diagnosed with cancer themselves. People with this perspective were less open to external influence and guidance. The main findings from this Q-study are that beliefs and motivations about the screening programmes not only differ between participants and non-participants, but also can differ between subgroups of people with different underlying perspectives. We believe that it is meaningful to adjust communication about the screening programmes to the perspectives of potential participants. For people belonging to perspective 1 (positive about participation), more attention should be paid to providing information about the screening programmes and the medical follow-up tests. For perspective 2 (thoughtful about participation), more attention should be paid to the potential drawbacks of screening. For perspective 3 (fear drives participation), more attention should be paid to the risks (and numbers) associated with participation in the screening programmes. For two of the perspectives in this study, communication channels outside of primary care seem suitable. However, for respondents belonging to the second perspective, who are doubtful about participating in the screening programmes, it appears that they value information provided by a general practitioner or other trusted primary care provider. 8
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