Predictors of uptake of screening mammography

BACKGROUND Policymakers believe mammography uptake is declining; whether there is a decrease, and in whom is not known. There is a wealth of research focussed on single predictors of uptake in mammography such as socioeconomic status or ethnicity. However, there are limited papers investigating global predictors, particularly with an international focus. AIM The thesis aims to: identify predictors of (1) mammography uptake worldwide and (2) in South-West London; ascertain if patterns of attendance have changed and if so, in whom, and; commence questionnaire development to determine influencers of uptake. METHODS A systematic search was conducted on six databases in 2016. Two reviewers independently examined the articles using pre-defined inclusion criteria. Random-effects meta-analyses and sub-group meta-analyses were conducted. Mixed-effects logistic models analysed dichotomised cohort data. The questionnaire was developed with a patient and public representative prior to testing. Thirteen cognitive interviews were conducted and analysed using thematic and content analysis. RESULTS Data from 91 studies met the systematic review inclusion criteria. Marital status, smoking status, insurance status and number of chronic conditions or primary care visits were found to be statistically associated with uptake. Ethnicity, age, socioeconomic status, income, education, housing tenure and obesity were not significantly associated. The database provided attendance information from 406,015 women. Overall, older women had lower odds of attending mammography than younger women. Odds of attending appeared to increase with affluence, disability or a previous recall and were lower in minority ethnic women compared with White women. Few concerns were identified with the questionnaire items. Minor alterations to questions were made in response to data where appropriate. CONCLUSION Many variable factors influence uptake. The generalisability of the results to a UK population needs establishing. The questionnaire needs further development to establish validity before establishing which women make informed decisions. Future research should evaluate if personalised information, in line with risk status and other known factors associated with uptake, would be beneficial for screening programmes