31 Determinants of (non)attendance at the Dutch CSPs urbanized regions – the four main cities of the Netherlands: Amsterdam, Rotterdam, Utrecht and The Hague – and women belonging to a low-SES group showed lower attendance.12,13,35 This is particularly detrimental as most abnormalities of the breast and cervix were found in women born outside the Netherlands and in women in lower SES-groups. Additionally, most unfavourable tumour-node-metastases were also found in the low-SES groups.33,34,36-38 Younger age was found to be a determinant of lower attendance in the cervical and the CRC CSPs,6,7,11,31 whereas being single or divorced or having had only one sexual partner increases the likelihood of screening uptake in the cervical CSP.28,31 With respect to screening adherence and the implementation of the self-sampling test among non-responders, native Dutch non-attendees returned more of the self-sampling kits then non-native Dutch non-attenders. Furthermore, women who were screened in the previous rounds seemed to return more self-sampling kits than under-screened or never-screened women.37 Information factors Thirteen studies described information factors to some extent.29-32,35,38-45 At all three the CSPs several studies addressed the lack of tailored communication tools and strategies to inform subpopulations. The need to develop new tools and strategies has been recognized and would particularly benefit ethnic (minority) groups.29,32,35,40,41,42,43 Four studies related to the cervical CSP reported higher attendance rates when the invitation procedure (invitation and reminder) was general practitioner (GP)-based (the channel).30,31,38,39 This approach was found to be particularly effective among women who were not born in the Netherlands.30 The in 2017 introduced self-sampling test within the cervical CSP has been described as a promising, feasible and effective procedure for increasing coverage in a screening programme.38,40,41 Self-sampling responders who did not participate in previous rounds were more often hrHPV positive and had a higher relative risk of ≥cervical intraepithelial neoplasia (CIN) II and ≥CIN III compared with selfsampling women who were screened in the previous rounds.38,40 Knops-Dullens et al. stated that in order to motivate Dutch women to participate in the screening programme they need to be convinced that the advantages outweigh the disadvantages.44 2
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