Author/Editor		Turnbull, Eleanor; Priaulx, Jennifer; Ravesteyn, Nicolien T. van; Heinävaara, Sirpa; Siljander, Ilona; Senore, Carlo; Segnan, Nereo; Vokó, Zoltán; Hagymásy, Judit; Jarm, Katja
Title		A health systems approach to identifying barriers to breast cancer screening programmes
Type		članek
Vol. and No.		Letnik 122, št. 11
Publication year		2018
Volume		str. 1198-1205
ISSN		0168-8510 - Health policy (Amsterdam, Netherlands)
Language		eng
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		presejalni programi zdravstveni sistem rak dojke presejanje za raka cancer screening health systems breast cancer