Understanding women's breast screening behaviour: a study carried out in South East London, with women aged 50-64 years

Objective To understand low uptake of breast cancer screening through exploring the personal reasoning underlying women's attendance or non-attendance, and identifying differences between those who attend and those who decline.

Design Cross-sectional survey.

Setting Community and home environments of women eligible for breast screening aged 50—64 years, living in South East London. Method Structured, self-completed or assisted-completion questionnaires.

Results The decision to attend or decline screening is rational and personally justifiable, engaging factors linked to emotions and attitude. Attitudes about breast screening and perceived personal importance of breast screening are the strongest predictors of attendance and non-attendance. There are differences between ethnic groups in perceptions of breast screening. Regular attendance at screening is associated with ethnicity, although consistent avoidance of mammography is not. Inconvenience is an important factor in missing appointments, and tends to be prolonged rather than specific to the time or day of the pre-booked invitation. GP and health worker advice are good persuaders towards attendance. Pain and anxiety during mammography are notable dissuaders against re-attending.

Conclusion Appropriate service provision requires consideration of local factors, as well as the medical needs of the population eligible for breast screening. Lay perceptions of potential personal costs of attending or not attending breast screening are important for guiding health promotion. Information providers should consider the language needs of a culturally and educationally mixed community. Health care professionals are well placed to encourage uptake of breast screening through disseminating information that promotes attendance, both within and outside the breast screening service.

A low intensity, community based lifestyle programme to prevent weight gain in women with young children : cluster randomised controlled trial

Objective To develop and evaluate the effectiveness of a community behavioural intervention to prevent weight gain and improve health related behaviours in women with young children.
Design Cluster randomised controlled trial.
Setting A community setting in urban Australia. 
Participants 250 adult women with a mean age of 40. 39 years (SD 4.77, range 25-51) and a mean body mass index of 27.82 kg/m2 (SD 5.42, range 18-47) were recruited as clusters through 12 primary (elementary) schools. Intervention Schools were randomly assigned to the intervention or the control. Mothers whose schools fell in the intervention group (n=127) attended four interactive group sessions that involved simple health messages, behaviour change strategies, and group discussion, and received monthly support using mobile telephone text messages for 12 months. The control group (n=123)
attended one non-interactive information session based on population dietary and physical activity guidelines. 
Main outcome measures The main outcome measures were weight change and difference in weight change between the intervention group and the control group at 12 months. Secondary outcomes were changes in serum concentrations of fasting lipids and glucose, and changes in dietary behaviours, physical activity, and self management behaviours.
Results All analyses were adjusted for baseline values and the possible clustering effect. Women in the control group gained weight over the 12 month study period (0.83 kg, 95% confidence interval (CI) 0.12 to 1.54), whereas those in the intervention group lost weight (−0.20 kg, −0.90 to 0.49). The difference in weight change between the intervention group and the control group at 12 months was −1.13 kg (−2.03 to −0.24 kg; P<0.05) on the basis of observed values and −1.11 kg (−2.17 to −0.04) after multiple imputation to account for possible bias created by missing values. Secondary analyses after multiple imputation showed a difference in the intervention group compared with the control group for total cholesterol concentration (−0.35 mmol/l, −0.70 to −0.001), self management behaviours (diet score 0.18, 0.13 to 0.33; physical activity score 0.24, 0.05 to 0.43), and confidence to control weight (0.40, 0.11 to 0.69). Regular self weighing was associated with weight loss in the intervention group only (−1.98 kg, −3.75 to −0.23).
Conclusions Weight gain in women with young children could be prevented using a low intensity self management intervention delivered in a community setting. Self management of health behaviours improved with the intervention. The response rate of 12%, although comparable with that in other community studies, might limit the ability to generalise to other populations.    
Trial registration Australian New Zealand Clinical Trials Registry number ACTRN12608000110381.

"My midwife said that having a glass of red wine was actually better for the baby": a focus group study of women and their partner's knowledge and experiences relating to alcohol consumption in pregnancy.

BACKGROUND: While it is well established that alcohol can cross the placenta to the foetus and can affect an infant's development, many women continue to drink during pregnancy. For this reason it is important to determine what information is being provided, what information may be missing, and the preferred sources of information on this issue. In order to improve prevention strategies, we sought to understand the knowledge and experiences of pregnant women and their partners regarding the effects of alcohol consumption during pregnancy. METHODS: The current study utilised a qualitative study design in order to gain insight into the views and experiences of pregnant women, newly delivered mothers and their partners. Focus groups examined the participant's knowledge about the effects of alcohol consumption during pregnancy, the sources of information on this issue, and the psycho-social influences on their drinking behaviour. Five focus groups were conducted involving a total of 21 participants (17 female). A six-stage thematic analysis framework was used to analyse all focus group discussions in a systematic way. RESULTS: Seven major themes were identified from the focus group data: 1) knowledge of Foetal Alcohol Spectrum Disorders; 2) message content and sources; 3) healthcare system; 4) society and culture; 5) partner role; 6) evaluation of risk; and 7) motivation. The findings indicated that although the majority of participants knew not to drink alcohol in pregnancy they had limited information on the specific harmful effects. In addition, routine enquiry and the provision of information by health care professionals were seen as lacking. CONCLUSIONS: The findings of this research provide important insights in to the relationship between pregnant women, their partners, and their healthcare providers. Several recommendations can be made on the basis of these findings. Firstly, public health messages and educational materials need to provide clear and consistent information about the effects of alcohol consumption on the developing baby. Additionally, more thorough and consistent routine enquiry for alcohol consumption in pregnant women needs to occur. Finally, it is important to ensure ongoing education for health professionals on the issue of alcohol consumption during pregnancy.