Evaluating Women's Awareness, Understanding & Experiences of BreastCheck
- November 2004
Key Indicators
Awareness of BreastCheck is very high amongst its target audience of women aged 50-64 and is almost universal in areas in which the service is available.
Nationally, 84% of women aged 50-64 have heard of BreastCheck, rising to 98% in Leinster and 100% in Dublin.
97% were aware that BreastCheck screened women for cancer.
The vast majority of women are very positive towards the service and those who have experienced it, rate it highly.
- 97% of those screened agree or strongly agree that the service is very professional
• 95% agree or strongly agree that the staff were very friendly
• 96% agree or strongly agree that they felt looked after
• 98% agree or strongly agree that the service was convenient
• 96% that it was efficient
• 90% of those screened said that they would be very likely to attend again.
Overall, women aged 50-64 believe that the service is vital and its rapid roll out is key.
Health
The respondents in the group discussions can be classified into a number of segments based on their attitude to health:
- complacent acceptors who have had a successful history of health and had to trust the medical profession
- fear avoiders who avoid health issues until they actually occur
- dismissive rejectors who believe that there is no way of knowing when ill-health might occur, so why worry about it now
- fatalists who have a fatalistic obsession with ill-health.
In general, the closer the experience of ill-health is to home, the great the awareness of and concern for personal health.
The research identifies two over-riding, top-of-mind health concerns: cancer and heart health. These are seen as the main causes of mortality in today’s society.
Health checks tend to be ad-hoc rather than routine, and reactive rather than pro-active. There is some confusion about certain tests – such as cholesterol and the smear test – which tends to deter uptake.
There was spontaneous recall of mammograms in seven of the eight groups.
While almost all women had a family doctor, visits were typically infrequent and cost was cited as a deterrence. There is a high level of credibility in a doctor’s advice.
Cancer & Heart Health
Cancer is a top-of-mind health concern. It is regarded as being more prevalent in recent times and a minority of the women exhibited a strong fear of the topic.
Breast cancer was the most commonly cited cancer that specifically affects women.
Many women believe that it is hereditary.
Heart health is not as pressing an issue and appears to be a less emotive topic.
BreastCheck
There was a high level of awareness of BreastCheck in the national survey and spontaneous recall in all but one of the group discussions. In the areas where the service is offered, awareness of BreastCheck is close to universal.
The name is positively regarded, self-explanatory, relevant and credible.
The primary sources of awareness of BreastCheck are the media, GPs, word of mouth and in some cases, women first heard of BreastCheck on receiving their consent letter.
97% of the women in the national survey knew that BreastCheck screened women for cancer. However, large numbers also believed that BreastCheck campaigned for a better cancer service and ran the Pink Ribbon campaign – neither of which it does.
The age band for screening was a contentious issue. It is regarded as being too narrow. The greatest concern is with the upper age limit of 64 95% of those surveyed in the national survey would like BreastCheck to be more available. Only 48% believed that it is reasonable to have a gradual roll-out rather than the immediate introduction across the country.
Attendance
Nationally, 31% of the women claim to have attended BreastCheck for screening. This rises to 67% of those living in Dublin.
The main reasons cited for non-attendance were ineligibility. Of the other reasons for non-attendance having had a recent mammogram elsewhere was the most common reason (15%). Smaller number of women cited fear (5%), inconvenience (2%) and lack of confidence in the service (3%).
The GP is regarded as the most likely encouragement to attend for screening, followed by more information about the procedure and encouragement from family and friends.
Fear of attending involves fear of the end result, fear of the mammogram and fear of coping, fear of dying and fear of mis-diagnosis.
Those who attend view the screening as a precautionary measure and have an optimism that cancer will not be detected. Having had a previous mammogram or having experience of breast cancer among family or friends have a positive influence on the decision to attend.
From the group discussions, attendees tend to be
- younger
- better educated
- have an active social life
- either have had experience of ill-health or are very healthy
Whereas, non-attendees tend to be
- older
- less well educated
- a less active social life
- have less experience of ill-health or a very strong negative experience of breast cancer.
Mammogram
There is a general understanding of what a mammogram involves. The top of mind association is that it is painful. While it would not deter those who had previously been screened it did act as a deterrence for those who had not attended in the past.
It is understood that a mammogram is used to detect cancer cells. It is assumed to detect all cancers and there is a preference to believe that it foolproof and has a 100% detection capability.
Few respondents physically examine their own breasts. Most were afraid of what they might find. There was some conflicting advice from GPs with some known to have told women to leave their breasts alone. There was a consensus amongst the women that they knew how to do a physical examination.
The Process
There is a general level of understanding of the need for BreastCheck to operate by appointment only. It is regarded as a necessary mechanism to cater for the numbers.
There was a high level of satisfaction with time keeping. 96% of those who attended said they were seen as promptly as possible. No-one in the group discussions complained about delays.
Those who attended commended the staff very highly. They also rated the experience as better than their most recent hospital visit.
BreastCheck is seen as delivering a high quality of service and the service is likened to that of a private clinic.
The radiographer is the main or only point of contact and plays a critical role in the delivery of the service and in the public image of BreastCheck. It is preferable that the radiographer is female.
The facilities are very positively regarded. 94% of those who attended rated them as pleasant and comfortable. A repeat x-ray at the same appointment is neither expected nor appealing.
It is assumed that a repeat x-ray would be indicative of a problem in the breast rather than in the technology.
90% of those screened said they received their results within 3 weeks. 68% rate the follow-up process very good, and an additional 21% rate it as fairly good. While the 3 week waiting time for results is almost acceptable, it is expected that one would hear earlier if there was a problem.
There is uncertainty as to who reads the x-ray – a team is preferred to one person – and uncertainty as to who sends out the results – BreastCheck or her GP.
There is a high level of awareness of the two year period between mammograms. There is uncertainty as to why the gap is two years. There is a high expectation for repeat attendance. 97% said they would be very, or fairly likely, to attend again.
Communications
The women in the groups assumed that their name is taken from a database, but the exact source is unquestioned.
96% agreed that the letter of invitation was clear. It is seen as easy to read and understand.
There was limited recall of having received the appointment leaflet with the letter.
There is strong recall of advertising. 66% have seen or heard advertising for BreastCheck, rising to 87% in Dublin. There was spontaneous recall of the advertising in all the group discussions. 43% recalled the outdoor poster and 91% rated it as good or very good.
There is a strong empathy with the three women in the poster/leaflets. They are seen to humanise the service.
48% recalled the radio advertisement and 94% rated it as good or very good. It was primarily associated with local radio and there was strong recall and appeal for Marian Finucane. It is seen to play an informative role
and is encouraging and reassuring.
There was low awareness of the helpline and only 4% claim to have called it.
Only 2% have ever visited the website. However there was limited usage of the Internet by the women in group discussions.
Although only 1 in 4 are aware of the women’s charter, it is rated highly. 34% rated it as excellent, while 79% rated it above average.
The over-riding personality of BreastCheck is that of a caring service. It is associated with strong positive imagery which augers well for future.
Download full report: evaluating_report04.pdf (pdf format, 454kb, 56 pages A4)