This dissertation focuses on women’s participation in mammography screening, which is a vital component of early detection and effective management of breast cancer. All Swedish women in the age group of 40-74 receive an invitation by mail at regular intervals of 18-24 months. However, about 20% of Swedish women fail to attend the mammography screening they were offered. The impact on mortality within a population is contingent on theparticipation rate, underscoring the importance of making efforts to attain a high level of participation. This thesis is an attemt to improve understanding and awareness of the women’s choices and actions that can influence life or death, especially considering that being a woman is the most significant risk factor for breast cancer. The overall aim of this thesis was to explore the phenomenon of women’s participation in mammography screening by exploring the reasons why women refrain from mammography screening from the perspective of non-attending women (Paper I) and factors that affect women’s participation in mammography screening in the Nordic countries.

The research was conducted through qualitative and mixed studies review method studies. The data collection methods comprised ten personal interviews (Paper I), and 16 articles (Paper II).

Qualitative content analysis was used to analyse the interviews in an indictive approach (Paper I). A deductive approach with segregated mixed research synthesis was used to analyse and summarise findings from articles in systematic review (Paper II). Health Promotion Model by N. Pender was used as a theoretical framework.

Participation in mammography screening is a complex phenomenon that has many dimensions. The thesis results underscore the significance of comprehending the unique and subjective encounters of women in the context of mammography screening. These experiences hold substantial sway over their perspectives and actions regarding this procedure. Additionally, the research suggests that effective communication and prior experiences, whether positive or negative, play pivotal roles in shaping women's knowledge and attitudes towards mammography. These findings align with the biopsychosocial perspective, which underscores the intricate interplay of biological, psychological, and social factors in individuals' lives. Mammography screening, as demonstrated in Paper I, operates as a standardized system aimed at addressing the diverse and individual needs of women. Various factors, such as individual characteristics, past experiences, cognitive factors related to behavior, emotional aspects, competing priorities, and the organizational aspects of screening, collectively influence women's participation in both positive and negative ways (Paper II). Promotional efforts are essential to motivate women to actively engage in their healthcare.