Determinants of non attendance to mammography program in a region with high voluntary health insurance coverage.
BACKGROUND
High participation rates are needed to ensure that breast cancer screening programs effectively reduce mortality. We identified the determinants of non-participation in a public breast cancer screening program.


METHODS
In this case-control study, 274 women aged 50 to 64 years included in a population-based mammography screening program were personally interviewed. Socio-demographic characteristics, health beliefs, health service utilization, insurance coverage, prior mammography and other preventive activities were examined.


RESULTS
Of the 192 cases and 194 controls contacted, 101 and 173, respectively, were subsequently interviewed. Factors related to non-participation in the breast cancer screening program included higher education (odds ratio [OR] = 5.28; 95% confidence interval [CI95%] = 1.57-17.68), annual dental checks-ups (OR = 1.81; CI95%1.08-3.03), prior mammography at a private health center (OR = 7.27; CI95% 3.97-13.32), gynecologist recommendation of mammography (OR = 2.2; CI95%1.3-3.8), number of visits to a gynecologist (median visits by cases = 1.2, versus controls = 0.92, P = 0.001), and supplemental private insurance (OR = 5.62; CI95% = 3.28-9.6). Among women who had not received a prior mammogram or who had done so at a public center, perceived barriers were the main factors related to non-participation. Among women who had previously received mammograms at a private center, supplemental private health insurance also influenced non-participation. Benign breast symptoms increased the likelihood of participation.


CONCLUSIONS
Our data indicate that factors related to the type of insurance coverage (such as prior mammography at a private health center and supplemental private insurance) influenced non-participation in the screening program.
Esteva
Magdalena
M
Research Unit, Majorca District Department of Primary Health Care, Balearic Institute of Health, Reina Esclaramunda 9, 07003 Palma de Mallorca, Spain. mesteva@ibsalut.caib.es
Ripoll
Joana
J
Leiva
Alfonso
A
Sánchez-Contador
Carmen
C
Collado
Francisca
F
D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D007407:Interviews as Topic; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012044:Regression Analysis