Participation in a breast cancer screening program: influence of past behavior and determinants on future screening participation.

BACKGROUND: This study analyzed the relationship between past screening behavior, determinants, intention, and future screening participation in the Dutch national breast cancer screening program.
METHODS: Participation at the first and second screening rounds was monitored. Furthermore, between the first and the second screening rounds, women received a questionnaire (response 58%, n = 395). The questionnaire was based on the ASE model, including attitude (consequences, anticipated regret, and moral obligation), social influence (support and modeling), and self-efficacy. Other distal variables assessed were previous screening behavior, evaluation of screening characteristics, and demographics.
RESULTS: Participants at the second screening differed from nonparticipants on all ASE determinants. Stepwise multiple regression analyses showed that for previous participants and nonparticipants different ASE determinants and distal variables explained the variance in intention to participate in the next screening (30 to 45%). Logistic regression analyses showed that past behavior and intention (which mediated the effects of the ASE variables) were significant predictors of participation in the second screening.
CONCLUSIONS: Differences between previous participants and nonparticipants in determinants of intention and future screening behavior can be used to improve participation and adherence to breast cancer screening.