Identification of the implementation influencing factors of the organized breast cancer screening in Ordos city: from caregivers' perspectives.

Abstract

Background: An organized breast cancer screening program has been introduced by the local government in Ordos City since 2010. Women between 35 and 64 years are eligible to be screened freely at local maternal and child healthcare hospitals. The screening coverage rate in Ordos City is relatively higher than the national average level. However, the overall breast cancer detection rate remains low. This study aims to identify contextual influencing factors of this program from local maternal and child healthcare hospitals' perspectives and provide suggestions for screening service improvement in Ordos City.

Methods: We conducted a qualitative study to evaluate the implementation of the organized breast cancer screening program from maternal and child healthcare hospitals' perspectives in Ordos City. Four domains (outer setting, inner setting, individuals, and process) and nine constructs were selected for evaluation under the instruction of the Consolidated Framework for Implementation Research (CFIR). CIFR constructs were rated in both valence and strength factors. The interview scripts were coded and themes were generated by using content analysis. Data obtained were interpreted and described by tables and charts.

Results: A total of 28 individuals participated in our study. We found that the implementation of the organized breast cancer screening in Ordos City went well. Policies & laws, partnerships & connections, performance-measurement pressure, implementation leads, teaming, and engaging constructs holistically facilitated the implementation performance. Available resources varied and this construct chiefly displayed a neutral impact. Access to knowledge & information and doing constructs were considered to negatively influence the implementation performance. Political commitment to cervical cancer elimination, multisectoral collaboration, specialized leadership, and structured screening teams were the main factors promoting the screening progress. Inconsistent referrals, underqualified professional competence of primary health workers, and non-interoperable electronic systems were the main barriers to screening performance.

Conclusions: We recommend that Ordos City further facilitates the prompt referral for imaging and biopsy, promotes the capacity building of primary health workers, and strengthens the construction of electronic systems. Future quantitative studies are necessary to comprehend the knowledge and attitudes of caregivers and target population toward breast cancer screening. Interviews with other stakeholders, such as policymakers and target population, are also needed.