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Clarke G, Hyland P, Comiskey C. Women over 50 who use alcohol and their engagement with primary and preventative health services: a narrative review using a systematic approach. J Addict Dis 2024; 42:238-252. [PMID: 37161667 DOI: 10.1080/10550887.2023.2190869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Women who are over 50 years are drinking alcohol in higher quantities and more frequently than in previous decades. Good engagement with primary care is crucial for women's physical and psychological health, particularly if they use alcohol. However, there is little known about the alcohol use of women over 50 and their use of primary care. METHODS A systematic search was conducted on six databases; CINAHL, Medline, PsycINFO, Academic Search Complete, EMBASE and Web of Science to identify literature on primary health care engagement of women 50 years and older (50+) who use alcohol. Titles and abstracts were reviewed and full texts were independently reviewed by two researchers. A narrative review, critical appraisal and synthesis of the eligible studies produced common themes and key findings. RESULTS After excluding 3822 articles, 13 articles were deemed eligible for the review. For this age group (50+), findings were: 1) women who drink heavily were less likely than men to attend General Practitioners (GPs), moderate drinkers were more likely than abstainers to attend mammogram screening, 2) GPs were less likely to ask questions or discuss alcohol with women than with men, 3) GPs offered less advice on alcohol to women than to men, and 4) less women than men received alcohol screening from their GP. DISCUSSION While women 50+ are drinking more, their alcohol use is underreported and insufficiently provided for in primary health. As women's life expectancy increases, improved GP engagement will benefit women's health and reduce future healthcare costs.
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Affiliation(s)
- Grainne Clarke
- School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland
| | | | - Catherine Comiskey
- School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland
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2
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Huybrechts I, Kliemann N, Perol O, Cattey-Javouhey A, Benech N, Maire A, Lignini T, Carretier J, Saurin JC, Fervers B, Gunter MJ. Feasibility Study to Assess the Impact of a Lifestyle Intervention during Colorectal Cancer Screening in France. Nutrients 2021; 13:3685. [PMID: 34835941 PMCID: PMC8621980 DOI: 10.3390/nu13113685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 11/21/2022] Open
Abstract
Current evidence suggests that 30-50% of cancers are attributable to established lifestyle risk factors. Cancer-screening has been identified as an opportunity for delivering advice on lifestyle behaviour change for cancer prevention. This study aimed to evaluate the feasibility and acceptance of promoting advice on the latest evidence-based lifestyle recommendations for cancer prevention at the time of colorectal cancer screening at two hospitals in Lyon, France. This feasibility study included 49 patients (20 men and 29 women) who were invited for colonoscopy. Patients received a leaflet with lifestyle recommendations for cancer prevention, accompanied with a logbook to plan and monitor their behavioural changes. Feedback from patients, hospital staff, and researchers was received via evaluation questionnaires (n = 26) completed after testing the educational material for at least two weeks and via two focus group discussions (n = 7 and n = 9 respectively) organized at the end of the study. All interviewed patients were interested in lowering their cancer risk, and the majority felt ready to change their lifestyle (88%), although most did not know how to decrease their risk of cancer (61%). All patients found the educational material easy to understand and sufficiently attractive and 50% of the patients reported having achieved at least one of the healthy behaviours recommended within the two weeks following the intervention. All hospital staff and almost all patients (92%) involved found that the screening program and the visits planned for colonoscopy was an appropriate moment to provide them with the educational material. This feasibility study has shown that the content, paper-based format, and time of delivery of the intervention were adequate. Health professionals seem to be willing to provide lifestyle recommendations, and patients appear interested in receiving advice for lowering their cancer risk during screening visits.
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Affiliation(s)
- Inge Huybrechts
- International Agency for Research on Cancer, CEDEX 08, 69372 Lyon, France; (N.K.); (T.L.); (M.J.G.)
| | - Nathalie Kliemann
- International Agency for Research on Cancer, CEDEX 08, 69372 Lyon, France; (N.K.); (T.L.); (M.J.G.)
| | - Olivia Perol
- Centre Léon Bérard, 69008 Lyon, France; (O.P.); (A.C.-J.); (A.M.); (J.C.); (B.F.)
| | - Anne Cattey-Javouhey
- Centre Léon Bérard, 69008 Lyon, France; (O.P.); (A.C.-J.); (A.M.); (J.C.); (B.F.)
| | - Nicolas Benech
- Service d’Hépato-Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69003 Lyon, France; (N.B.); (J.-C.S.)
| | - Aurelia Maire
- Centre Léon Bérard, 69008 Lyon, France; (O.P.); (A.C.-J.); (A.M.); (J.C.); (B.F.)
| | - Tracy Lignini
- International Agency for Research on Cancer, CEDEX 08, 69372 Lyon, France; (N.K.); (T.L.); (M.J.G.)
| | - Julien Carretier
- Centre Léon Bérard, 69008 Lyon, France; (O.P.); (A.C.-J.); (A.M.); (J.C.); (B.F.)
| | - Jean-Christophe Saurin
- Service d’Hépato-Gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69003 Lyon, France; (N.B.); (J.-C.S.)
| | - Beatrice Fervers
- Centre Léon Bérard, 69008 Lyon, France; (O.P.); (A.C.-J.); (A.M.); (J.C.); (B.F.)
| | - Marc J. Gunter
- International Agency for Research on Cancer, CEDEX 08, 69372 Lyon, France; (N.K.); (T.L.); (M.J.G.)
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3
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Optimisation of the ActWELL lifestyle intervention programme for women attending routine NHS breast screening clinics. Trials 2020; 21:484. [PMID: 32503606 PMCID: PMC7275549 DOI: 10.1186/s13063-020-04405-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/11/2020] [Indexed: 11/11/2022] Open
Abstract
Background Around 30% of post-menopausal breast cancer is related to excess body fat, alcohol intake and low levels of physical activity. Current estimates suggest that there is a 12% increased risk in post-menopausal breast cancer for every 5 kg/m2 increase in body mass index (BMI). Despite this evidence there are few lifestyle programmes directed towards breast cancer risk reduction. This paper describes the process of optimising of the ActWELL programme which aims to support weight management in women invited to attend routine National Health Service (NHS) breast screening clinics. Methods A feasibility study of a prototype programme aiming to change lifestyle behaviours was successfully undertaken. The programme used educational approaches and behaviour change techniques delivered by lifestyle coaches using individual face to face meetings and telephone sessions. To optimise the intervention for a definitive randomised controlled trial of weight management, data from the feasibility trial, focus group discussions conducted with the target population, feedback from the trial public advisory group and comments from peer reviewers were obtained. Concepts from implementation research provided further guidance to assist in the refinement of the intervention, which was then discussed and agreed by all investigators and the Trial Steering Group. Results The results from the feasibility trial were considered appropriate for moving on to a full trial with 70% of participants finding the programme acceptable. The primary outcomes (weight loss and physical activity) provided an important focus for design input from the target group. The contributions highlighted the need to review programme duration, coach contact time, content and use of behaviour change techniques and communications generally (e.g. science and evidence, non-judgemental approaches and avoiding guilt). In addition, the need for emphasis on support rather than education became apparent. The recommendations from peer reviewers focussed on the magnitude of effort required to achieve the intended weight loss and weight loss maintenance. Implementation science supported the use of the capability/opportunity/motivation (COM-B)model in overall design. Conclusions The optimisation process has facilitated the development and evaluation of a programme that enables the delivery of a promising intervention to achieve weight management in post-menopausal women. Trial registration ISRCTN: ISRCTN11057518. Registered on 21 July 2017. Retrospectively registered.
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Sinclair JMA, Dutey-Magni PF, Anderson AS, Baird J, Barker ME, Cutress RI, Kaner EFS, McCann M, Priest CK, Copson ER. A Context-Specific Digital Alcohol Brief Intervention in Symptomatic Breast Clinics (Abreast of Health): Development and Usability Study. JMIR Res Protoc 2020; 9:e14580. [PMID: 32012091 PMCID: PMC7007589 DOI: 10.2196/14580] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/25/2019] [Accepted: 09/07/2019] [Indexed: 12/28/2022] Open
Abstract
Background Potentially modifiable risk factors account for approximately 23% of breast cancer cases. In the United Kingdom, alcohol consumption alone is held responsible for 8% to 10% of cases diagnosed every year. Symptomatic breast clinics focus on early detection and treatment, but they also offer scope for delivery of low-cost lifestyle interventions to encourage a cancer prevention culture within the cancer care system. Careful development work is required to effectively translate such interventions to novel settings. Objective The aim of this study was to develop a theory of change and delivery mechanism for a context-specific alcohol and lifestyle brief intervention aimed at women attending screening and symptomatic breast clinics. Methods A formative study combined evidence reviews, analysis of mixed method data, and user experience research to develop an intervention model, following the 6 Steps in Quality Intervention Development (6SQuID) framework. Results A Web app focused on improving awareness, encouraging self-monitoring, and reframing alcohol reduction as a positive choice to improve health was found to be acceptable to women. Accessing this in the clinic waiting area on a tablet computer was shown to be feasible. An important facilitator for change may be the heightened readiness to learn associated with a salient health visit (a teachable moment). Women may have increased motivation to change if they can develop a belief in their capability to monitor and, if necessary, reduce their alcohol consumption. Conclusions Using the 6SQuID framework supported the prototyping and maximized acceptability and feasibility of an alcohol brief intervention for women attending symptomatic breast clinics, regardless of their level of alcohol consumption.
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Affiliation(s)
- Julia M A Sinclair
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Peter F Dutey-Magni
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Institute of Health Informatics, University College London, London, United Kingdom
| | - Annie S Anderson
- Centre for Research into Cancer Prevention and Screening, Division of Population Health & Genomics, University of Dundee Medical School, Dundee, United Kingdom
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom.,National Institute of Health Research Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Mary E Barker
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom.,National Institute of Health Research Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Ramsey I Cutress
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Eileen F S Kaner
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | - Mark McCann
- Medical Research Council/Scottish Government Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Caspian K Priest
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Ellen R Copson
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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5
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Chambers SE, Copson ER, Dutey-Magni PF, Priest C, Anderson AS, Sinclair JMA. Alcohol use and breast cancer risk: A qualitative study of women's perspectives to inform the development of a preventative intervention in breast clinics. Eur J Cancer Care (Engl) 2019; 28:e13075. [PMID: 31038252 PMCID: PMC6767031 DOI: 10.1111/ecc.13075] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/18/2019] [Accepted: 03/25/2019] [Indexed: 12/29/2022]
Abstract
Objective This study aimed to explore women's views about breast cancer risk and alcohol use, to inform the design of a prototype for an intervention in breast clinics about alcohol as a modifiable risk factor for breast cancer. Methods Women recruited in NHS breast screening and symptomatic clinics in Southampton, UK, were invited to take part in semi‐structured telephone interviews or a focus group to discuss their perspectives of breast cancer risk, alcohol consumption and their information needs about these topics. Data were analysed thematically. Twenty‐eight women took part in telephone interviews, and 16 attended one of three focus groups. Results While most women reported a personal responsibility for their health and were interested in advice about modifiable risk factors, few without (or prior to) experience of breast symptoms independently sought information. Many considered alcohol advice irrelevant as the association with breast cancer was largely unknown, and participants did not consider their drinking to be problematic. Women reported trusting information from health organisations like the NHS, but advice needs to be sensitive and non‐blaming. Conclusion NHS breast screening and symptomatic clinics offer a “teachable moment” to engage women with context‐specific advice about alcohol and cancer risk that, if targeted correctly, may assist them in making informed lifestyle choices.
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Affiliation(s)
- Sophia E Chambers
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ellen R Copson
- Cancer Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton, Southampton, UK
| | - Peter F Dutey-Magni
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Institute of Health Informatics, University College London, London, UK
| | - Caspian Priest
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Annie S Anderson
- Centre for Research into Cancer Prevention and Screening, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK
| | - Julia M A Sinclair
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Stevens C, Vrinten C, Smith SG, Waller J, Beeken RJ. Acceptability of receiving lifestyle advice at cervical, breast and bowel cancer screening. Prev Med 2019; 120:19-25. [PMID: 30578909 PMCID: PMC6380892 DOI: 10.1016/j.ypmed.2018.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 11/29/2018] [Accepted: 12/16/2018] [Indexed: 12/24/2022]
Abstract
Cancer screening could be an opportunity to deliver cancer prevention advice, but it is not known how such information would be received. We explored willingness to receive lifestyle advice in the context of the English National Health Service cervical, breast, and bowel (FS; flexible sigmoidoscopy) screening programmes. A population-based survey was conducted in 2016 to collect nationally representative data on willingness to receive lifestyle advice across cervical (n = 768), breast (n = 420) and FS (n = 308) screening programmes. Additional items assessed the impact of lifestyle advice on screening attendance, preference for receiving advice in the event of an abnormal screening result, and timing of advice. Most respondents were willing to receive lifestyle advice around the time of cancer screening (cervical 78.9%, breast 79.4%, FS 81.8%), and if their results were abnormal (cervical 86.3%, breast 83.0%, FS 85.1%). A small proportion indicated it may discourage future attendance (cervical 4.9%, breast 7.0%, FS 8.8%). Most preferred information to be delivered at the screening appointment (cervical 69.8%, breast 72.6%, FS 70.7%). There were no associations between sociodemographic characteristics and willingness to receive lifestyle advice at breast screening. For those intending to attend cervical screening, non-White ethnicity and higher education were associated with increased willingness to receive lifestyle advice. Women were more likely to be willing to receive advice at FS screening than men. Providing lifestyle advice at cancer screening is likely to be acceptable to the general population. The optimal approach for delivery needs careful consideration to minimise potential negative effects on screening attendance.
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Affiliation(s)
- Claire Stevens
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Charlotte Vrinten
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Samuel G Smith
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9NL, UK; Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Jo Waller
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9NL, UK; Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK.
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Anderson AS, Craigie AM, Gallant S, McAdam C, Macaskill EJ, Mutrie N, Neilson AR, O'Carroll RE, Rauchhaus P, Sattar N, Stead M, Treweek S. Randomised controlled trial to assess the impact of a lifestyle intervention (ActWELL) in women invited to NHS breast screening. BMJ Open 2018; 8:e024136. [PMID: 30413516 PMCID: PMC6231585 DOI: 10.1136/bmjopen-2018-024136] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION In Scotland, the incidence of breast cancer is predicted to rise significantly in the next few decades and while there are measures to support reductions in morbidity and mortality, the breast cancer community is currently exploring preventative opportunities including supporting weight management programmes in postmenopausal women. This study aims to assess the effectiveness and cost-effectiveness of a theory-based, community delivered, minimal contact, weight management (diet, physical activity and behaviour change techniques) programme (ActWELL) in women with a body mass index (BMI) >25 kg/m2 attending routine breast cancer screening appointments. METHODS AND ANALYSIS The study will be a four-centre, 1:1 parallel group randomised controlled trial of a 12-month weight management intervention initiated in breast cancer screening centres, delivered by trained Breast Cancer Now lifestyle coaches in community settings. The intervention programme involves two intervention meetings with coaches plus (up to) nine telephone contacts over 12 months. The programme will focus on personalised diet (including alcoholic and sugary drinks) and physical activity habits. Behaviour change techniques include self-monitoring, goal setting, implementation intentions, action and coping plans. The study has a sample size of 414 women with a BMI >25 kg/m2 attending routine National Health Service breast cancer screening appointments. Measures will be taken at baseline, 12 weeks and at 12-month follow-up, complemented by qualitative interviews exploring perceived acceptability and impact on habitual behaviours. The two co-primary outcomes are mean change in measured body weight and change in physical activity between groups to 12 months. Secondary outcomes are changes in eating habits, alcohol intake, sedentary time, quality of life, waist circumference, lipid, haemoglobin A1c and insulin profiles, blood pressure and cost-effectiveness of the intervention. ETHICS AND DISSEMINATION The protocol has been approved by East of Scotland Research Ethics Committee (17/ES/0073). All participants provide written informed consent. Dissemination will be through peer-reviewed publication and conference presentations. TRIAL REGISTRATION NUMBER ISRCTN11057518; Pre-results.
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Affiliation(s)
- Annie S Anderson
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Division of Population Health and Genomics, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Angela Mary Craigie
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Division of Population Health and Genomics, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Stephanie Gallant
- Division of Cancer Research, Centre for Research into Cancer Prevention and Screening, Division of Population Health and Genomics, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Chloe McAdam
- Physical Activity for Health Research Centre, Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | - E Jane Macaskill
- Department of Breast Surgery, NHS Tayside, Ninewells Hospital & Medical School, Dundee, UK
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Ronan E O'Carroll
- Division of Psychology, School of Natural Sciences, University of Stirling, Stirling, UK
| | - Petra Rauchhaus
- Tayside Clinical Trials Unit, Tayside Medical Sciences Centre, Ninewells Hospital and Medical School, Dundee, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Martine Stead
- Institute for Social Marketing, University of Stirling, Stirling, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Macleod M, Anderson AS. Cancer prevention-the feasibility and acceptability of promoting breast cancer risk reduction in the screening setting through a lifestyle magazine. Eur J Cancer Care (Engl) 2018; 27:e12823. [PMID: 29380462 DOI: 10.1111/ecc.12823] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2017] [Indexed: 12/20/2022]
Abstract
Cancer prevention and early detection strategies are fundamental to reducing breast cancer burden. Offering prevention guidance on modifiable risk factors within early detection settings is rare. We aimed to evaluate the acceptability of a magazine focused on lifestyle and cancer prevention for use in breast screening clinics. A lifestyle magazine was developed and distributed within two breast screening settings in the West of Scotland over a 2-month period. Women were either offered the magazine on arrival or in a self-service format. Uptake was recorded by NHS staff. Women's views were sought via an evaluation questionnaire. Staff were interviewed on their experiences of intervention delivery. Uptake was greatest when offered to attendees (95% vs. 20% self-service). The evaluation questionnaire response rate was 17.3%. Almost 60% of respondents reported an increased knowledge about breast cancer and lifestyle and felt motivated to find out more about cancer prevention and 40% expressed intentions to make lifestyle changes. Over 90% of respondents thought lifestyle factors were important in breast cancer prevention. Staff feedback was positive, indicating no detrimental effects on workloads. In conclusion, a cancer prevention lifestyle magazine can be successfully delivered in the breast screening setting and deserves further exploration for roll out.
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Affiliation(s)
- Maureen Macleod
- Centre for Research into Cancer Prevention and Screening, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK
| | - Annie S Anderson
- Centre for Research into Cancer Prevention and Screening, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK
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