Women as the Target Population: The First Decade of the Israeli National Program for Early Detection of Breast Cancer

The present paper presents a series of three consecutive action-research projects attempting to increase adherence to mammography (MM) screening among women in Israel: a field experiment inviting a sample of 1500 women to a pre-scheduled appointment and interviewing them afterwards; an evaluation study of primary care medical personnel (n=2356) calling their non-attending patients (n=7229), inquiring into their reasons for non-attendance, and encouraging attendance; qualitative studies unravelling women�s perceptions and motives (personal constructs) regarding MM. The mailed invitation initiative increased the rate of adherence to MM from 16% of self-screeners to 45%, and established a national policy of initiated MM appointments. The evaluation study found that women used mostly non-confrontational ways of declining the appointment. The qualitative inquiry found that adherent women described themselves in positive terms, while non-adherent women viewed themselves as non-responsive only temporarily. MM was construed with fear on one pole yet many options as its opposite: pleasure, revival, calm, life saving, duty, and obligation. The above sequence demonstrates that change can be achieved within the relatively short period of a decade. The advantages of a two-stage approach model are discussed, and adherent women are presented as early innovation adopters.