The name is absent

DRAFT

embodies resources like knowledge, money, power and prestige which enhance
opportunities to adopt healthy lifestyles and behaviours.

As one of the program’s aims is to ensure equity amongst women in the target age group,
the systematic variations found amongst income groups in this study calls for additional
policy responses. However, the appropriate response will depend on the underlying
reason for the systematic variation. If the cause is opportunity costs, the policy response
may require additional efforts to reduce travel and waiting times or provide services with
flexible opening hours (e.g. evenings or weekends). However, if the cause is related to
women’s preferences, the appropriate response will include information targeted at
specific population groups who are known to under utilise services⁵ about the benefits of
the program, as well as targeted and specific recruitment and follow-up activities. More
research is needed to help identify the cause(s) of systematic variation amongst
socioeconomic groups as well as the cost-effectiveness of additional interventions to
boost participation within the context of an existing national screening program.

The results demonstrate that women residing in outer metropolitan Area Health Services
are less likely to screen although the degree of the remoteness (as measured by ARIA of a
woman’s place of residence) was not significant. However, when ARIA was excluded
from the model, the relative risk ratios of four additional rural AHS became significant
for the never screened group. Women living in these rural AHS were more than twice as
likely to have never screened compared to women living in Northern Sydney. This
indicates that remoteness may be a factor in explaining participation for women living
those three rural areas. It should be noted that whilst ARIA is a commonly used indicator
of service access, it is not specific to screening services. Thus ARIA scores may deviate
from screening service access.

The AHS effects might be explained by variation in the availability and accessibility of
Breast Screen facilities. Further research which links supply-side data (e.g. information

⁵ To increase overall participation rates (rather than remove systematic variation), the policy response
would be to reduce opportunity costs and to increase awareness and recruitment activities for all women.

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