Feasibility of a tailored intervention to improve preventive care use in women

What do we know about who does and does not attend general health checks? Findings from a narrative scoping review

BACKGROUND

General and preventive health checks are a key feature of contemporary policies of anticipatory care. Ensuring high and equitable uptake of such general health checks is essential to ensuring health gain and preventing health inequalities. This literature review explores the socio-demographic, clinical and social cognitive characteristics of those who do and do not engage with general health checks or preventive health checks for cardiovascular disease.

METHODS

An exploratory scoping study approach was employed. Databases searched included the British Nursing Index and Archive, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews (CDSR) and Database of Abstracts of Reviews of Effects (DARE), EMBASE, MEDLINE, PsycINFO and the Social Sciences Citation Index (SSCI). Titles and abstracts of 17463 papers were screened; 1171 papers were then independently assessed by two researchers. A review of full text was carried out by two of the authors resulting in 39 being included in the final review.

RESULTS

Those least likely to attend health checks were men on low incomes, low socio-economic status, unemployed or less well educated. In general, attenders were older than non-attenders. An individual's marital status was found to affect attendance rates with non-attenders more likely to be single. In general, white individuals were more likely to engage with services than individuals from other ethnic backgrounds. Non-attenders had a greater proportion of cardiovascular risk factors than attenders, and smokers were less likely to attend than non-smokers. The relationship between health beliefs and health behaviours appeared complex. Non-attenders were shown to value health less strongly, have low self-efficacy, feel less in control of their health and be less likely to believe in the efficacy of health checks.

CONCLUSION

Routine health check-ups appear to be taken up inequitably, with gender, age, socio-demographic status and ethnicity all associated with differential service use. Furthermore, non-attenders appeared to have greater clinical need or risk factors suggesting that differential uptake may lead to sub-optimal health gain and contribute to inequalities via the inverse care law. Appropriate service redesign and interventions to encourage increased uptake among these groups is required.

Factors associated with lack of interest in HIV testing in older at-risk women

OBJECTIVE

To determine the factors and reasons associated with lack of interest in HIV testing among older women from a high prevalence community.

METHODS

We conducted a cross-sectional study of women aged >or=50 seeking medical care. The main outcome measures were (1) interest in HIV testing and (2) reasons for women's interest or lack of interest assessed using open-ended questions. We compared the characteristics of women based on testing interest and fit two multivariable logistic regression models to identify factors associated with lack of testing interest among never tested women and women with moderate or high HIV risk factors. Responses to short answer questions were analyzed according to participants' HIV testing interest. Coding was performed by two independent reviewers using deductive application of themes identified in previously published literature on HIV testing interest.

RESULTS

Of 564 eligible women, 514 (91%) enrolled. Only 22% were interested in HIV testing. Those who lacked interest were more likely to be older (63.3 vs. 58.4, p < 0.001), African American (77% vs. 60%, p < 0.001), have poor HIV knowledge (68% vs. 57%, p = 0.02), and have low perceived HIV risk (82% vs. 69%, p = 0.01). Lack of interest in HIV testing was associated with increasing age and African American race among women with moderate or high-risk factors, whereas age, African American race and low perceived risk were important for never tested women. Common reasons for lacking interest in testing were perceived lack of need, perceived lack of risk, and a prior history of HIV testing.

CONCLUSIONS

Few of these older, high-risk women were interested in HIV testing despite the fact that more than half had risk factors for having been exposed to HIV during their life-time. Efforts to increase HIV testing interest should educate older women about HIV risk and transmission factors and promote accurate risk self-assessment.