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Rombouts M, Raaijmakers LGM, Kuunders TJM, Van Steijn-Martens R, de Vuijst T, van Donkersgoed H, van de Goor LAM. The Acceptance and Use of the e-Health Instrument 'The Personal Health Check' in Four Dutch Municipalities: Lessons Learned. J Prim Prev 2021; 43:25-48. [PMID: 34714455 PMCID: PMC8887919 DOI: 10.1007/s10935-021-00651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/22/2022]
Abstract
This pilot study assessed the acceptance and use of the e-Health instrument “the Personal Health Check” (PHC) among clients and professionals in primary care settings. By filling in the online PHC instrument, participants were provided insights into their health and lifestyle. When results revealed an increased health risk, participants were advised to undertake additional lab tests measuring blood pressure and haemaglobin levels. Based on the online questionnaire and optional lab tests, participants then received a report that included individually-tailored feedback from the e-Health application about personal health risks and suggestions for health interventions. The PHC was implemented in 2016 in four Dutch municipalities that determined which neighbourhood(s) the PHC targeted and how participants were invited. The Unified Theory of Acceptance and Use of Technology was used as a theoretical framework to address our research questions. Methods used to assess acceptance were: PHC instrument data, data from additional questionnaires completed by PHC participants, focus groups with PHC participants and professionals in primary care, and telephone interviews with non-responders to the invitation to participate in the online PHC. Of the 21,735 invited, 12% participated. Our results showed that participants and professionals in this pilot were predominantly positive about the PHC. Participants reported that they made an effort to apply the PHC lifestyle advice they received. Almost all had the knowledge and resources needed to use the PHC online instrument. Invitations from general practitioners almost doubled participation relative to invitations from the sponsoring municipalities. The overall low response rate, however, suggests that the PHC is unsuitable as a foundation on which to develop local public health policy.
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Affiliation(s)
- M Rombouts
- Municipal Health Service West-Brabant, Breda, The Netherlands
| | | | - T J M Kuunders
- Municipal Health Service Hart Voor Brabant, 'S-Hertogenbosch, The Netherlands.,Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | | | - T de Vuijst
- Municipal Health Service Hart Voor Brabant, 'S-Hertogenbosch, The Netherlands
| | - H van Donkersgoed
- Netherlands Institute for Prevention and E-Health Development (NIPED), Amsterdam, The Netherlands
| | - L A M van de Goor
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Badenbroek IF, Nielen MMJ, Hollander M, Stol DM, Kraaijenhagen RA, de Wit NJ, Schellevis FG. Feasibility and success rates of response enhancing strategies in a stepwise prevention program for cardiometabolic diseases in primary care. BMC FAMILY PRACTICE 2020; 21:228. [PMID: 33158419 PMCID: PMC7648376 DOI: 10.1186/s12875-020-01293-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/22/2020] [Indexed: 11/26/2022]
Abstract
Background Prevention programs for cardiometabolic diseases (CMD), including cardiovascular disease, diabetes mellitus and chronic kidney disease are feasible, but evidence for the cost-effectiveness of selective CMD prevention programs is lacking. Response rates have an important role in effectiveness, but methods to increase response rates have received insufficient attention. The aim of the current study is to determine the feasibility and the success rate of a variety of response enhancing strategies to increase the participation in a selective prevention program for CMD. Methods The INTEGRATE study is a Dutch randomised controlled trial to assess the effectiveness and cost-effectiveness of a stepwise program for CMD prevention. During the INTEGRATE study we developed ten different response enhancing strategies targeted at different stages of non-response and different patient populations and evaluated these in 29 general practices. Results A face-to-face reminder by the GP increased the response significantly. Digital reminders targeted at patients with an increased CMD risk showed a positive trend towards participation. Sending invitations and reminders by e-mail generated similar response rates, but at lower costs and time investment than the standard way of dissemination. Translated materials, information gatherings at the practice, self-management toolkits, reminders by telephone, information letters, local media attention and SMS text reminders did not increase the response to our program. Conclusions Inviting or reminding patients by e-mail or during GPs consultation may enhance response rates in a selective prevention program for CMD. Different response-enhancing strategies have different patient target populations and implementation issues, therefore practice characteristics need to be taken into account when implementing such strategies. Trial registration Dutch trial Register number NTR4277. Registered 26 November 2013. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12875-020-01293-9.
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Affiliation(s)
- Ilse F Badenbroek
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500, BN, Utrecht, the Netherlands. .,JULIUS CENTER FOR HEALTH SCIENCES AND PRIMARY CARE, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands.
| | - Marcus M J Nielen
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500, BN, Utrecht, the Netherlands
| | - Monika Hollander
- JULIUS CENTER FOR HEALTH SCIENCES AND PRIMARY CARE, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands
| | - Daphne M Stol
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500, BN, Utrecht, the Netherlands.,JULIUS CENTER FOR HEALTH SCIENCES AND PRIMARY CARE, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands
| | - Roderik A Kraaijenhagen
- NDDO Institute for Prevention and Early Diagnostics (NIPED), Naritaweg 70, 1043, BZ, Amsterdam, The Netherlands
| | - Niek J de Wit
- JULIUS CENTER FOR HEALTH SCIENCES AND PRIMARY CARE, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands
| | - François G Schellevis
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500, BN, Utrecht, the Netherlands.,Department of General Practice & Elderly Care Medicine, EMGO Institute for health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
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Stol DM, Hollander M, Badenbroek IF, Nielen MMJ, Schellevis FG, de Wit NJ. Uptake and detection rate of a stepwise cardiometabolic disease detection program in primary care-a cohort study. Eur J Public Health 2020; 30:479-484. [PMID: 31722402 PMCID: PMC7292350 DOI: 10.1093/eurpub/ckz201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Early detection and treatment of cardiometabolic diseases (CMD) in high-risk patients is a promising preventive strategy to anticipate the increasing burden of CMD. The Dutch guideline ‘the prevention consultation’ provides a framework for stepwise CMD risk assessment and detection in primary care. The aim of this study was to assess the outcome of this program in terms of newly diagnosed CMD. Methods A cohort study among 30 934 patients, aged 45–70 years without known CMD or CMD risk factors, who were invited for the CMD detection program within 37 general practices. Patients filled out a CMD risk score (step 1), were referred for additional risk profiling in case of high risk (step 2) and received lifestyle advice and (pharmacological) treatment if indicated (step 3). During 1-year follow-up newly diagnosed CMD, prescriptions and abnormal diagnostic tests were assessed. Results Twelve thousand seven hundred and thirty-eight patients filled out the risk score of which 865, 6665 and 5208 had a low, intermediate and high CMD risk, respectively. One thousand seven hundred and fifty-five high-risk patients consulted the general practitioner, in 346 of whom a new CMD was diagnosed. In an additional 422 patients a new prescription and/or abnormal diagnostic test were found. Conclusions Implementation of the CMD detection program resulted in a new CMD diagnosis in one-fifth of high-risk patients who attended the practice for completion of their risk profile. However, the potential yield of the program could be higher given the considerable number of additional risk factors—such as elevated glucose, blood pressure and cholesterol levels—found, requiring active follow-up and presumably treatment in the future.
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Affiliation(s)
- Daphne M Stol
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Correspondence: Daphne M. Stol, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands, Tel: +31 887568181, e-mail:
| | - Monika Hollander
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ilse F Badenbroek
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Mark M J Nielen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - François G Schellevis
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (Location VUmc), Amsterdam, The Netherlands
| | - Niek J de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Kamstrup-Larsen N, Dalton SO, Broholm-Jørgensen M, Larsen LB, Thomsen JL, Johansen C, Tolstrup JS. Using general practitioners to recruit individuals with low socioeconomic position to preventive health checks is feasible: a cross sectional study. Scand J Prim Health Care 2019; 37:294-301. [PMID: 31286817 PMCID: PMC6713093 DOI: 10.1080/02813432.2019.1639901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/31/2019] [Indexed: 02/03/2023] Open
Abstract
Objective: To test whether demographic and health-related characteristics are associated with non-attendance of preventive health checks offered to individuals with low levels of education using proactive recruitment by the general practitioners. Design: A cross-sectional study. Setting: 32 general practice clinics in Copenhagen, Denmark. Subjects: A total of 549 individuals aged 45-64, with low levels of education, enrolled in the intervention group of a randomised controlled trial on preventive health checks offered by general practitioner. Main outcome measures: Non-attendance of the preventive health checks. Methods: (i) Descriptive characteristics of attendees and non-attendees and (ii) crude and adjusted multi-level logistic regression to examine associations of individual characteristics with non-attendance of preventive health checks. Results: Overall, 33% did not attend the prescheduled preventive health checks at their general practitioners. Non-attendees were more likely to live without a partner, be of non-Western origin, be daily smokers, have poor self-rated health, have higher pulmonary symptoms score, have increased level of stress, have low levels of self-efficacy, have metabolic risk factors or non-communicable diseases and have had no contact with their general practitioner within the past year. Conclusion: The findings suggest that, it is feasible to use general practitioners for recruiting individuals for preventive health checks. However, even in a trial targeting individuals with low levels of education, there are differences between attendees and non-attendees, with a more adverse health behaviour profile and worse health status observed among the non-attendees. KEY POINTS Current awareness • Non-attendance of preventive health checks offered to the general population is associated with low socioeconomic position and adverse health behaviours. Main statements • It is feasible to use general practitioners proactively in recruitment to preventive health checks offered to individuals with low socioeconomic positions. • In a trial targeting individuals with low levels of education, there were differences between attendees and non-attendees. • Non-attendance was associated with daily smoking, poor self-rated health, high stress and no contact with the general practitioner within the last year.
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Affiliation(s)
- Nina Kamstrup-Larsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship Research Unit, the Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | | | - Lars Bruun Larsen
- Research Unit of General Practice in Odense, University of Southern Denmark, Denmark
| | - Janus Laust Thomsen
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Christoffer Johansen
- Survivorship Research Unit, the Danish Cancer Society Research Center, Copenhagen, Denmark
- Late Effect Research Unit CASTLE, Finsen Center, Rigshospitalet, Copenhagen, Denmark
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de Waard AKM, Wändell PE, Holzmann MJ, Korevaar JC, Hollander M, Gornitzki C, de Wit NJ, Schellevis FG, Lionis C, Søndergaard J, Seifert B, Carlsson AC. Barriers and facilitators to participation in a health check for cardiometabolic diseases in primary care: A systematic review. Eur J Prev Cardiol 2018; 25:1326-1340. [PMID: 29916723 PMCID: PMC6097107 DOI: 10.1177/2047487318780751] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Health checks for cardiometabolic diseases could play a role in the identification of persons at high risk for disease. To improve the uptake of these health checks in primary care, we need to know what barriers and facilitators determine participation. Methods We used an iterative search strategy consisting of three steps: (a) identification of key-articles; (b) systematic literature search in PubMed, Medline and Embase based on keywords; (c) screening of titles and abstracts and subsequently full-text screening. We summarised the results into four categories: characteristics, attitudes, practical reasons and healthcare provider-related factors. Results Thirty-nine studies were included. Attitudes such as wanting to know of cardiometabolic disease risk, feeling responsible for, and concerns about one’s own health were facilitators for participation. Younger age, smoking, low education and attitudes such as not wanting to be, or being, worried about the outcome, low perceived severity or susceptibility, and negative attitude towards health checks or prevention in general were barriers. Furthermore, practical issues such as information and the ease of access to appointments could influence participation. Conclusion Barriers and facilitators to participation in health checks for cardiometabolic diseases were heterogeneous. Hence, it is not possible to develop a ‘one size fits all’ approach to maximise the uptake. For optimal implementation we suggest a multifactorial approach adapted to the national context with special attention to people who might be more difficult to reach. Increasing the uptake of health checks could contribute to identifying the people at risk to be able to start preventive interventions.
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Affiliation(s)
- Anne-Karien M de Waard
- 1 Julius Center for Health Sciences and Primary Care, University Medical Center, the Netherlands
| | - Per E Wändell
- 2 Department of Neurobiology, Care Science and Society, Karolinska Institutet, Sweden
| | - Martin J Holzmann
- 3 Functional Area of Emergency Medicine, Karolinska University Hospital, Sweden.,4 Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joke C Korevaar
- 5 NIVEL (Netherlands Institute for Health Services Research), the Netherlands
| | - Monika Hollander
- 1 Julius Center for Health Sciences and Primary Care, University Medical Center, the Netherlands
| | | | - Niek J de Wit
- 1 Julius Center for Health Sciences and Primary Care, University Medical Center, the Netherlands
| | - François G Schellevis
- 5 NIVEL (Netherlands Institute for Health Services Research), the Netherlands.,7 Department of General Practice and Elderly Care Medicine, VU University Medical Center, the Netherlands
| | - Christos Lionis
- 8 Clinic of Social and Family Medicine, University of Crete, Greece
| | - Jens Søndergaard
- 9 Research Unit for General Practice, University of Southern Denmark, Denmark
| | - Bohumil Seifert
- 10 Department of General Practice, Charles University, Czech Republic
| | - Axel C Carlsson
- 2 Department of Neurobiology, Care Science and Society, Karolinska Institutet, Sweden.,11 Department of Medical Sciences, Uppsala University, Sweden
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6
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Larsen LB, Sandbaek A, Thomsen JL, Bjerregaard AL. 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. BMC Public Health 2018; 18:585. [PMID: 29720162 PMCID: PMC5932768 DOI: 10.1186/s12889-018-5506-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 04/25/2018] [Indexed: 11/10/2022] Open
Abstract
Background Poor uptake among socio-economically disadvantaged and susceptible populations is a well-known challenge of general health check interventions, and is widely cited as one of the reasons for the lack of population level effects seen in many studies. We report on patient characteristics among attendees and non-attendees of health checks made available to residents in the social housing sector of the municipality of Aarhus. We focus on this general population, as well as a particular sub-group living in an exceptionally deprived social housing area, and discuss the properties of intervention uptake that we need to be aware of to qualify and compare the effects of general versus targeted health checks in socially deprived areas. Methods Cross-sectionally in a sample of 6650 residents of the Aarhus social housing sector who were invited for a health check in the first year of the ‘Your Life – Your Health’ program. The analyses consisted of 1) descriptive analysis of the characteristics of attenders/non-attenders, 2) unadjusted and adjusted Poisson regression to examine associations of patient characteristics and uptake of health checks, and 3) decision tree analyses (CHAID) to examine interaction and homogeneity in patient characteristics among attenders. Results Of the overall population 30% attended. In a nested cohort of people residing in a particularly deprived social housing settlement, 25% attended. Further, in the overall population, we found an association between the likelihood of taking up a health check and age, sex, country of origin, educational attainment, cohabitation, occupational status, and past medical treatment. In the nested cohort the association between uptake and medical treatment was non-significant, while the association between uptake and occupation was limited to people who were employed. These results resonate with past evidence on health check attendance. Conclusions Attendance in the ‘Your Life – Your Health’ program is higher among people of a higher socio-economic status. This should be taken into consideration when analysing and interpreting the overall study effects. Moreover, the results suggest that a targeted approach in the social housing sector could be more effective than a mass screening approach. However, more information is required to make such assertion definitive. Electronic supplementary material The online version of this article (10.1186/s12889-018-5506-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lars Bruun Larsen
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark.
| | - Annelli Sandbaek
- Department of Public Health, Section of General Practice, Aarhus University, Aarhus, Denmark.,The Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Janus Laust Thomsen
- Department of Clinical Medicine, Research Unit for General Practice, Aalborg University, Aalborg, Denmark
| | - Anne-Louise Bjerregaard
- Department of Public Health, Section of General Practice, Aarhus University, Aarhus, Denmark
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7
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Korfage IJ, de Kwaadsteniet EW, van Voorst A, Stiggelbout AM, de Vries M, Pieterse AH. Preferences for cervical cancer screening: The role of implicit associations. PATIENT EDUCATION AND COUNSELING 2018; 101:310-317. [PMID: 28781115 DOI: 10.1016/j.pec.2017.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 07/11/2017] [Accepted: 07/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Implicit associations influence behaviour, but their impact on cancer screening intentions is unknown. METHODS We assessed implicit associations with cervical cancer screening using an evaluative priming task. Participants were shown primes ('Pap test', neutral or non-word) followed by positive or negative target words. The test is based on the assumption that response times are shorter if primes and targets are strongly associated in the participant's mind. The Dutch screening program targets women aged 30-60, 226 of them completed online assessments twice. Prior to the second assessment participants were randomized to reading versus not reading the leaflet about the cervical screening program. RESULTS After controlling for knowledge and screen history, response times for 'Pap test' no longer differed between positive and negative targets. Implicit associations were not correlated with explicit attitudes or screening intentions. Reading the screening leaflet resulted in improved knowledge levels (p<0.001), but implicit associations, explicit attitudes, and screening intentions remained similar. CONCLUSION Cervical cancer screening intentions were related to explicit attitudes, but not to implicit associations. The screening leaflet did not affect screening intentions. PRACTICE IMPLICATIONS We recommend achieving a deepened interest in the screening program among risk groups, e.g. by adapting the information leaflet.
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Affiliation(s)
- Ida J Korfage
- Erasmus University Medical Center, Department of Public Health, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Erik W de Kwaadsteniet
- Leiden University, Faculty of Social Sciences, Social and Organizational Psychology, Leiden, The Netherlands
| | | | - Anne M Stiggelbout
- Leiden University Medical Center, Department of Medical Decision Making, Leiden, The Netherlands
| | - Marieke de Vries
- Leiden University Medical Center, Department of Medical Decision Making, Leiden, The Netherlands; Radboud University, Behavioural Science Institute, Institute for Computing and Information Sciences (iCIS) & Social and Cultural Psychology, Nijmegen, The Netherlands
| | - Arwen H Pieterse
- Leiden University Medical Center, Department of Medical Decision Making, Leiden, The Netherlands
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Groenenberg I, Crone MR, van Dijk S, Ben Meftah J, Middelkoop BJC, Assendelft WJJ, Stiggelbout AM. Determinants of participation in a cardiometabolic health check among underserved groups. Prev Med Rep 2016; 4:33-43. [PMID: 27413659 PMCID: PMC4929048 DOI: 10.1016/j.pmedr.2016.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 04/24/2016] [Accepted: 04/29/2016] [Indexed: 11/24/2022] Open
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. Participation is lowest in GP practices with a predominant non-Western population. Patients are positive about a health check, whether they participate or not. Still, about one quarter of patients does not participate in the health check. These patients do not want to know their risk and lack control over staying healthy. Telephone follow-up is crucial as patients forget receiving the written invitation.
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Affiliation(s)
- I Groenenberg
- Leiden University Medical Center, Department of Public Health and Primary Care, Hippocratespad 21, PO Box 9600, V0-P, 2300 RC Leiden, The Netherlands
| | - M R Crone
- Leiden University Medical Center, Department of Public Health and Primary Care, Hippocratespad 21, PO Box 9600, V0-P, 2300 RC Leiden, The Netherlands
| | - S van Dijk
- Leiden University, Department of Social Sciences, Institute for Psychology, Health, Medical, and Neuropsychology, Pieter de la Court Building, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
| | - J Ben Meftah
- Leiden University Medical Center, Department of Public Health and Primary Care, Hippocratespad 21, PO Box 9600, V0-P, 2300 RC Leiden, The Netherlands
| | - B J C Middelkoop
- Leiden University Medical Center, Department of Public Health and Primary Care, Hippocratespad 21, PO Box 9600, V0-P, 2300 RC Leiden, The Netherlands
| | - W J J Assendelft
- Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - A M Stiggelbout
- Leiden University Medical Center, Department of Medical Decision Making, 2300 RC Leiden, The Netherlands
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