Factors influencing uptake of screening programmes for women in Poland.

1. Factors influencing uptake of screening programmes for women in Poland.

2. The research I am going to present today is part of my PhD study which has the following aims: To explore the relationship between socio-economic status, area and women’s unequal access and uptake to screening procedures. Within this context, to examine the women’s attitudes toward screening programme invitations and factors influencing them. To examine if type of a health care system or type of screening programme (e.g. cervical screening, mammography) play a significant role in response to an invitation. To assess the extent to which women’s attitudes vary by type of the screening programme. The compared programmes are breast and cervical screening. To assess the extent to which women’s screening beliefs and attitudes vary between Poland and the UK.

3. The main project focuses on data from: Cervical Screening – Knowsley PCT, Merseyside Breast Screening – Wythenshawe Hospital, Manchester Breast and cervical screening data from Polish study conducted in 2006

4. Cervix uteri cancer. Mortality trends for Poland and UK

5. Breast cancer. Mortality trends for Poland and UK

6. Eastern Europe In Eastern Europe in last two decades the social and institutional context of reforms of health care systems has important implications for cervical and breast cancer screening and prevention.

7. Poland provided universal free health prior to it’s transition from communism in 1989 and then in the early 1990s. It has experienced an economic shock and many government resources were restructured. Until 2006 Poland has experienced two large health care reforms that influenced a formally free access to health care.

8. 2006 Polish national survey:Knowledge about cancer and cancer prophylaxis. The study was conducted nationwide in 16 counties called voivodships The aim of this study was diagnosis of the knowledge level and attitude of Polish people towards elements of healthy lifestyle from European Code Against Cancer. The study was done by: Department of Cancer Control and Epidemiology at Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.( kindly given to us by Prof.W Zatonski) In the Polish study participated over 4290 women aged: 18-24 – 14,8%, 25-39 – 27,2%, 40-59 – 33,3%, 60 and over – 24,6% We considered predictors were: age, size of town, marital status, material conditions, previous tumour diagnosis, education of respondent and number of people living in the household

9. Results to date:

10. Cytology

13. Mammography Here we took into consideration all women which answered this question. That means we included even women younger than those who should be screened. We did this to show how the lack of centralised screening system can influence the use of those services. Even though breast screening is available to women 50-64 we can see that there were some much younger women who had undertaken this examination. It most of cases it will be due to lack of centralised screening system. As in Poland for many years screening were organised spontaneously and often by private sponsors and organisations like churches etc. Here we took into consideration all women which answered this question. That means we included even women younger than those who should be screened. We did this to show how the lack of centralised screening system can influence the use of those services. Even though breast screening is available to women 50-64 we can see that there were some much younger women who had undertaken this examination. It most of cases it will be due to lack of centralised screening system. As in Poland for many years screening were organised spontaneously and often by private sponsors and organisations like churches etc.

14. Here we can see that odds of having mammography decrease with age. This can be due to the actual age bands for screening but also due to the screening itself as it was not conducted in systemised way. The bottom slide is showing very interesting dependence of uptake of mammography on patients education. Patients with primary and lower technical education are 3 times less likely to undergo breast screening than the reference group – women with higher education. Similarly women with high school are twice less likely to have mammography. Here we can see that odds of having mammography decrease with age. This can be due to the actual age bands for screening but also due to the screening itself as it was not conducted in systemised way. The bottom slide is showing very interesting dependence of uptake of mammography on patients education. Patients with primary and lower technical education are 3 times less likely to undergo breast screening than the reference group – women with higher education. Similarly women with high school are twice less likely to have mammography.

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19. Inferences to date: In Poland the information about available screening is not sufficient what can be seen by looking at reasons why women do not uptake mammography. There is a contrast between women´s knowledge and implementation of health behaviours. There are visible differences in access to health services and patients beliefs between rural and urban areas in Poland.

20. Study conducted in the United Kingdom The data for the study is collected separately for breast and cervical screening. The questionnaires for both sides of the study are similar to Polish study as the comparison will be used to create some conclusions on the influence of patients beliefs on the uptake of screening. Questionnaire asks about: Patients behaviours in relation to screening Their motives regarding the attending the appointment or why they choose not to undertake the screening Their previous screening experiences and the knowledge or what they would like to know about the screening Their socio-economic status and general health issues. ( financial conditions, ethnicity, marital status etc)

21. THANK YOU