Iterative Situated Engagement Perspective: Meaning-Making Challenges Across Cancer Screening Phases.

Area of Science:

• Public Health
• Health Psychology
• Sociology of Health

Background:

• Breast and cervical cancer screening are crucial for early detection but face suboptimal participation.
• Patient-centered care emphasizes engagement as a dynamic, emotional process.
• Engagement in healthcare decision-making is conceptualized in three phases: recruit, retain, and sustain.

Purpose of the Study:

• To explore women's experiences and negotiation of challenges within the three phases of engagement in cancer screening.
• To differentiate meaning-making challenges across the 'recruit', 'retain', and 'sustain' phases using the Iterative Situated Engagement (ISE) lens.

Main Methods:

• Theory-driven qualitative design utilizing semi-structured interviews.
• 40 women aged 25-69 participating in public breast and cervical cancer screening programs were interviewed.
• Thematic analysis was performed using the Framework Method.

Main Results:

• 'Recruit' phase engagement drivers: Cancer Risk Monitoring, Self-care Motivation, Fear of Death Management, Coincidence.
• 'Retain' phase drivers: Trust in Healthcare Providers, Service Accessibility, Recurrent Invitations, Informal Result Previews.
• 'Sustain' phase drivers: Healthcare Provider Continuity, Best Practices Dissemination, Service Flexibility, Shorter Waiting Times.

Conclusions:

• Women's engagement in cancer screening is a dynamic, multi-phase process influenced by psychological, emotional, and organizational factors.
• Findings support the Iterative Situated Engagement (ISE) conceptual proposal, viewing participation as an iterative, situated, meaning-making trajectory.
• Personalized health communication and improved primary care coordination can enhance sustained screening participation, reduce health disparities, and promote preventive practices.