Abstract
BACKGROUND: European guidelines recommend a minimum participation rate of 70% for mammography screening programs (MSP), but the rate in Germany has so far been only 50% per round. In this study, we identify factors associated with non-participation in MSP. METHODS: Cross-sectional data on women aged 50 to 69 from the population-based NAKO Health Study (2014-2019) were used to identify factors associated with MSP participation, and dimensions of participatory behavior were derived by principal component analysis (PCA). RESULTS: Of 48 057 women aged 50 to 59, 14.6% had never participated in MSP, 35.3% had participated once, and 50.2% had participated multiple times. Age-adjusted regression analyses of individual factors revealed that the use of other primary and secondary prevention measures was the strongest predictor of MSP participation. Smoking was associated with lower participation rates (odds ratio [OR]: 0.70; 95% confidence interval: [0.67; 0.75]), and overweight with higher ones (OR: 1.26 [1.19; 1.34]). PCA enabled the aggregation of factors into three dimensions: "use of preventive measures," "socioeconomic status," and "lifestyle factors." CONCLUSION: In this study, marked differences were found between MSP non-participants and participants, especially with respect to their use of other preventive measures and their socioeconomic status. One limitation of this study was the self-reporting of MSP participation. Its findings nevertheless provide a basis for interventions directed at specific target groups, for example, education about preventive services (and MSP in particular) in the primary care setting.