Attitudes, beliefs, and knowledge as predictors of nonattendance in a Swedish population-based mammography screening program

Background. The effectiveness of mammography screening could be improved if factors that influence nonattendance were better understood. Methods. We examined attitudes, beliefs, and knowledge in relation to nonat tendance in a population-based mammography screening program, using a case- control design. Data were collected from November 1997 to March 1998 throug h telephone interviews with 434 nonattenders and 515 attenders identified i n a population-based mammography register in central Sweden. The questions asked drew primarily upon the components constituting the Health Belief Mod el. Results. Multivariate analysis showed that nonattendance was most common am ong women within the highest quartile of perceived emotional barriers, comp ared to women within the lowest quartile (OR = 4.81; 95% CI 2.96-7.82). Wom en who worried most about breast cancer were more likely to attend than tho se who worried least (OR = 0.09; 95% CI 0.02-0.31). Women with the highest scores of perceived benefits were more likely to attend than women with the lowest ones (OR = 0.35; 95% CI 0.08-0.75). Other factors associated with n onattendance were less knowledge about mammography and breast cancer, lack of advice from a health professional to participate, and very poor trust in health care. Conclusions, Our findings suggest that increased participation in outreach mammography screening programs can be achieved through enhancement of breas t cancer awareness and possibly by reducing some of the modifiable barriers . (C) 2000 American Health Foundation and Academic Press.