Codeveloping a Set of Quality of Care Indicators for People Living With Multiple Long-Term Conditions in Primary Care: Protocol for a Modified RAND/UCLA Study.

Cancer accounts for nearly one in six deaths worldwide - a mortality rate that could be greatly reduced with early detection and treatment []. Organised screening enables the detection of cancer at earlier stages, when less aggressive treatment is more effective [–]. However, prevention service policies, provision, and uptake differ substantially between European countries. The International Agency for Research on Cancer (IARC) [] reported in 2017 that population-based screening programmes were not fully established in all member states and that average participation rates across the European Union (EU) for breast (60%), cervical (51%), and colorectal (38%) cancer screening remained below the respective acceptable standards of 70%, 70% and 45%. Lagging participation rates result from diverse and interrelated factors from individual and healthcare system levels []. The Behavioural Model of Health Services Use [] illustrates how enabling resources such as social support could affect individuals’ health behaviours. Studies have identified positive associations between the social support and uptake of breast [–], cervical [], and colorectal [] cancer screening. Yet other predisposing characteristics may influence both individuals’ level of social support and perception of health status, indirectly affecting healthcare utilisation []. These are individual level characteristics such as lower education levels [–], being unemployed [], younger ages and those residing in rural areas [], worse self-rated health [], living with comorbidities [], and worse mental health [] which have been found to be associated with lower cancer screening uptake. Particularly in the case of colorectal screening, males are less likely to attend than females [–]. Furthermore, certain household types, for example being without a partner [] or living alone [], are associated with lower cancer screening uptake. The magnitude and direction of these associations tend to differ across cancer types [], suggesting the potential of comparing analyses of social support across cancers.