Social support and country-level factors associated with cancer screening participation in 18 European countries: a multilevel analysis of the European Health Interview Survey.

BACKGROUND: Amid the rising burden of cancer in Europe, participation in colorectal, breast, and cervical cancer screening programmes remains inadequate. The potential role of social support in increasing screening uptake across different types of cancer screening and within multinational contexts remains underexplored. METHODS: Two-level multilevel analyses were conducted using data from the European Health Interview Survey Wave 3 in 18 European countries. We analysed data from subsamples of participants who responded to the questions for colorectal (n = 65,089), breast (n = 35,281), and cervical (n = 36,763) cancer screening. Social support was measured using the Oslo-3 Social Support Scale. Participants were classified as overdue for screening according to cancer-specific guidelines for different target age groups. RESULTS: The overall prevalence of being overdue was 43% for colorectal, 31% for breast, and 19% for cervical tests; however, substantial variation was observed between countries (i.e., from 22% in Denmark to 72% in Greece for colorectal, 4% in Sweden to 57% in Estonia for breast, and 6% in Sweden to 43% in the Netherlands for cervical screenings). Stronger social support was associated with a greater likelihood of being up to date with cancer screening, with stronger associations observed for breast and cervical cancers than for colorectal cancer. Country-level factors, including screening programme availability, social progress, out-of-pocket payments, and general practitioner density, explained nearly half of the variation in breast and colorectal cancer screening uptake, but less so for cervical cancer. CONCLUSIONS: Interventions promoting screening uptake should consider strengthening individual-level social support and addressing contextual-level structural barriers.