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A health systems approach to identifying barriers to breast cancer screening programmes. Methodology and application in six European countries

Author

Listed:
  • Turnbull, Eleanor
  • Priaulx, Jennifer
  • van Ravesteyn, Nicolien T.
  • Heinävaara, Sirpa
  • Siljander, Ilona
  • Senore, Carlo
  • Segnan, Nereo
  • Vokó, Zoltán
  • Hagymásy, Judit
  • Jarm, Katja
  • Veerus, Piret
  • de Koning, Harry J.
  • McKee, Martin

Abstract

The benefits of population-based screening for breast cancer are now accepted although, in practice, programmes often fail to achieve their full potential. In this paper, we propose a conceptual model that situates screening programmes within the broader health system to understand the factors that influence their outcomes. We view the overall screening system as having multiple sub-systems to identify the population at risk, generate knowledge of effectiveness, maximise uptake, operate the programme, and optimise follow-up and assurance of subsequent treatment. Based on this model we have developed the Barriers to Effective Screening Tool (BEST) for analysing government-led, population-based screening programmes from a health systems perspective. Conceived as a self-assessment tool, we piloted the tool with key informants in six European countries (Estonia, Finland, Hungary, Italy, The Netherlands and Slovenia) to identify barriers to the optimal operation of population-based breast cancer screening programmes. The pilot provided valuable feedback on the barriers affecting breast cancer screening programmes and stimulated a greater recognition among those operating them of the need to take a health systems perspective. In addition, the pilot led to further development of the tool and provided a foundation for further research into how to overcome the identified barriers.

Suggested Citation

  • Turnbull, Eleanor & Priaulx, Jennifer & van Ravesteyn, Nicolien T. & Heinävaara, Sirpa & Siljander, Ilona & Senore, Carlo & Segnan, Nereo & Vokó, Zoltán & Hagymásy, Judit & Jarm, Katja & Veerus, Piret, 2018. "A health systems approach to identifying barriers to breast cancer screening programmes. Methodology and application in six European countries," Health Policy, Elsevier, vol. 122(11), pages 1198-1205.
    • Handle: RePEc:eee:hepoli:v:122:y:2018:i:11:p:1198-1205
    DOI: 10.1016/j.healthpol.2018.08.003
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    References listed on IDEAS

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    1. Midgley, G., 2006. "Systemic intervention for public health," American Journal of Public Health, American Public Health Association, vol. 96(3), pages 466-472.
    2. Will Maimaris & Jared Paty & Pablo Perel & Helena Legido-Quigley & Dina Balabanova & Robby Nieuwlaat & Martin Mckee, 2013. "The Influence of Health Systems on Hypertension Awareness, Treatment, and Control: A Systematic Literature Review," PLOS Medicine, Public Library of Science, vol. 10(7), pages 1-18, July.
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    1. Jennifer Priaulx & Marcell Csanádi & Harry J. de Koning & Martin McKee, 2019. "A choice experiment to identify the most important elements of a successful cancer screening program according to those who research and manage such programs," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 34-45, January.

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