Determinants of participation in a cardiometabolic health check among underserved groups

Abstract

Cardiometabolic diseases affect underserved groups disparately. Participation in health checks is also lower, widening health inequalities in society. Two-stage screening (non-invasive health risk assessment (HRA) and GP consultations for high-risk individuals) seems cost-effective, provided that drop-out rates are low in both steps. We aimed to explore the process of decision-making regarding HRA participation among underserved groups (45–70 y): native Dutch with a lower socioeconomic status (SES), Turkish, Moroccan, and Surinamese participants. We conducted a cross-sectional questionnaire study. The questionnaire comprised the following determinants: a self-formulated first reaction, a structured set of predefined determinants, and the most important barrier(s) and facilitator(s) for HRA completion. We used univariable and (stepwise) multivariate logistic regression analyses to assess which determinants were associated with HRA completion. Of the 892 participants in the questionnaire, 78% (n = 696) also completed the HRA. Moroccans and patients from GP practices with a predominantly non-Western population less often completed the HRA. A lower SES score, wanting to know one's risk, not remembering receiving the invitation (thus requiring a phone call), fear of the test result and/or adjusting lifestyle, perceived control of staying healthy, wanting to participate, and perceiving no barriers were associated with completing the HRA. We conclude that our ‘hard-to-reach’ population may not be unwilling to participate in the HRA. A more comprehensive approach, involving key figures within a community informing people about and providing help completing the HRA, would possibly be more suitable. Efforts should be particularly targeted at the less acculturated immigrants with an external locus of control.

Uptake of health checks by residents from the Danish social housing sector – a register-based cross-sectional study of patient characteristics in the ‘Your Life – Your Health’ program

“…In light of this, efforts to improve the uptake and eliminate the differences we see between attenders and non-attenders should thus target people with low educational level as well as the unemployed. Studies from The Netherlands and Scotland suggest that a face-to-face community-based approach, engaging peers and community leaders in outreach work can increase the attendance at health checks in socially deprived settlements [ 32 , 33 ].…”

Feasibility and success rates of response enhancing strategies in a stepwise prevention program for cardiometabolic diseases in primary care

“…Previous studies showed heterogeneous results for extended educational material and public information campaigns [ 17 , 27 ]. The extended information letter that we used in our study was not personalised, a potentially stimulating factor that might be addressed more with a face-to-face reminder [ 5 , 9 , 28 ].…”

“…Non-responders are reported to be more often male, smoke more often and being of younger age [ 5 , 7 , 8 , 10 – 14 ]. A lower socio-economic status (SES) and a migrant status is also reported to be related to non-response [ 5 , 7 , 9 , 10 , 15 ]. If these groups could be reached with targeted response enhancing strategies, this could lead to an increased participation.…”

Vroegopsporing en ‘moeilijk bereikbare’ groepen

“…Deze combinatie van verhoogd risico en lagere deelname aan opsporingsiniatieven draagt bij aan het vergroten van de bestaande gezondheidsverschillen. Om meer inzicht te krijgen in de beweegredenen van kwetsbare groepen met betrekking tot deelname aan het PreventieConsult en hen te ondersteunen bij het maken van een geïnformeerde beslissing, voerden wij het CHECK'D-onderzoek uit [2]. Dit onderzoek bestond uit 21 focusgroepen en uit een interventie waarbij we een getrechterde uitnodigingsstrategie (schriftelijk → telefonisch → persoonlijk door de huisarts) testten.…”