Factors supporting informed decision-making in breast cancer screening programme
This thesis investigated aspects that influence informed decision-making (IDM) within breast cancer screening programmes across Europe. The aim was to identify and analyse factors that affect IDM at individual, policy, and stakeholder levels. The research adopted a mixed methods approach and followed a sequential approach beginning with a systematic review and meta-analysis, which focused on the Health Belief Model and the Theory of Planned Behaviour to determine their explanatory power regarding breast cancer screening participation. While both models show positive explanatory value, the focus mostly rests on cognitive aspects rather than the overall effectiveness of the models in explaining screening participation. Subsequently, an analysis of how IDM about breast cancer screening has been addressed across Europe was performed, and a typology of approaches developed based on the analysis of data from derived from 28 countries. A cluster analysis of the results identified three distinct groups. This research highlighted not only the relatively widespread adoption of IDM principles but also demonstrated the heterogeneity of their application in practice. Attitudes, values and other factors that may influence IDM for women eligible for breast cancer screening breast cancer screening were investigated via a cross-sectional survey was distributed to women from Belgium, France, Italy, Spain, and the United Kingdom. A total of 1180 participants responded to the survey. In total, 56.9% of participants responded that they would be more likely to participate in screening in the future after being informed about the benefits and harms of breast cancer screening. Additionally, key stakeholders implicated in breast cancer screening were interviewed to explore diverse perspectives on IDM in breast cancer screening. The semi-structured interviews reported a unanimous recognition of IDM's significance, albeit with varied implementation methodologies, which suggest the need for guidance and informational tools tailored to the national and regional context. In conclusion, the thesis underscores that whilst IDM is recognised as an important component of breast cancer screening in Europe, the operationalisation of IDM exhibits considerable variability across, marked by a lack of consensus on terminologies and decision aids. Therefore, specific guidelines to develop, implement, and evaluate context-sensitive materials and programmes, aimed at strengthening IDM in breast cancer screening would be a positive development.
Antwerp : University of Antwerp, Faculty of Medicine and Health Sciences , 2024
199 p.
Supervisor: Van Hal, Guido [Supervisor]
Supervisor: Van den Broucke, Stephan [Supervisor]
Full text (open access)
The publisher created published version Available from 29.01.2025
Research group
Publication type
Publications with a UAntwerp address
External links
Creation 22.01.2024
Last edited 31.01.2024
To cite this reference