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

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

Health Policy, 2018, vol. 122, issue 11, 1198-1205

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.

Keywords: Cancer screening; Health systems; Breast cancer (search for similar items in EconPapers)
Date: 2018
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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Persistent link: https://EconPapers.repec.org/RePEc:eee:hepoli:v:122:y:2018:i:11:p:1198-1205

DOI: 10.1016/j.healthpol.2018.08.003

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