Primary Drivers of Willingness to Continue to Participate in Community-Based Health Screening for Chronic Diseases

Socioeconomic and behavioral determinants of non-compliance with physician referrals following community screening for diabetes, hypertension and hyperlipidemia: a mixed-methods study

Early detection of undiagnosed diabetes, hypertension or hyperlipidemia through screening could reduce healthcare costs resulting from disease complications. To date, despite ample research on the factors linked to the uptake of community health screening programs, little attention has been directed at delayed or incomplete follow-up after positive outcomes are identified in community screening tests. This study aimed to investigate the socioeconomic and behavioral factors that influence non-compliance with recommendations for primary care physician referrals, following community-based screening for diabetes, hypertension and hyperlipidemia. A parallel mixed-methods study was conducted. For quantitative data, we performed multivariable analysis on community-based chronic disease screening data. The qualitative component involved semi-structured interviews with individuals with both non-compliance and compliance with referral recommendations. Thematic data analysis was undertaken using the Theoretical Domains Framework (TDF). The quantitative analysis showed that older age (OR = 0.92, 95%CI [0.89-0.96]), non-Chinese ethnicity (OR = 0.24; 95% CI [0.08-0.44]) and residing in 5-room public/ private housing (OR = 0.40; 95% CI [0.14-0.74]) were associated with lower odds of non-compliance with referral recommendations. Thematic analysis identified multiple behavioral-level determinants acting as enablers or barriers within 7 TDF domains: awareness of health risks after receiving screening results, self-management orientation and behavioral control, fear of formal diagnosis and concerns about healthcare cost, optimistic belief driven by the lack of symptoms, interpersonal relationship and social obligations, aversion to medication, communication at the result collection and sense of uncertainty regarding self-scheduling of appointment. Findings provide valuable implications for the development of interventions aimed at improving adherence to referral recommendation. Future endeavors should include culturally sensitive outreach, evidence-based information dissemination, family-centered education, positive public health messaging, brief counseling during result collection and an opt-out appointment system to enhance follow-up care.

The Primary Healthcare Physician's Awareness and Engagement in Community-Based Medical Education: A Mixed Qualitative and Quantitative Study

BACKGROUND

Community-based medical education (CBME) is an essential component of medical education, where primary healthcare physicians (PCPs) play a crucial role. This study explores PCPs' awareness and engagement in CBME and investigates the factors influencing their participation.

METHODS

This mixed study was conducted in two phases. In the first phase, a qualitative study was conducted using semi-structured interviews with PCPs as well as thematic analysis related to their awareness and engagement in CBME. In the second phase, a quantitative survey was conducted on 72 PCPs' pre- and post-training programs.

RESULTS

Primary healthcare physicians had a positive attitude toward community-based medical education. The participants had an acceptable level of awareness and engagement, which increased substantially by (p-value = 0.03) and (p-value = 0.003), respectively. Logistical analysis indicated that non-Saudi physicians were more likely to participate in the CBME (p-value = 0.001). Professions and academic experiences influenced their willingness to engage and participate in CBME (OR = 7.5, p-value = 0.001) and (OR = 0.21, p-value = 0.001), respectively.

CONCLUSION

The study findings highlighted the importance of increased awareness and the factors that enhance PCPs' engagement in CBME. This positive perspective of the PCPs will help build effective partnerships and facilitate the extension of the curriculum to apply CBME.

The work of Chinese chronic conditions: adaptation and validation of the Distribution of Co-Care Activities Scale

Purpose

The Distribution of Co-Care Activities Scale was adapted into Chinese for the purposes of this study, and then the psychometric characteristics of the Chinese version of the DoCCA scale were confirmed in chronic conditions.

Methods

A total of 434 patients with chronic diseases were recruited from three Chinese cities. A cross-cultural adaptation procedure was used to translate the Distribution of Co-Care Activities Scale into Chinese. Cronbach's alpha coefficient, split-half reliability, and test-retest reliability were used to verify the scale's reliability. Content validity indices, exploratory factor analysis, and confirmatory factor analysis were used to confirm the scale's validity.

Results

The Chinese DoCCA scale includes five domains: demands, unnecessary tasks, role clarity, needs support, and goal orientation. The S-CVI was 0.964. Exploratory factor analysis yielded a five-factor structure that explained 74.952% of the total variance. According to the confirmatory factor analysis results, the fit indices were within the range of the reference values. Convergent and discriminant validity both met the criteria. Also, the scale's Cronbach's alpha coefficient is 0.936, and the five dimensions' values range from 0.818 to 0.909. The split-half reliability was 0.848, and the test-retest reliability was 0.832.

Conclusions

The Chinese version of the Distribution of Co-Care Activities Scale had high levels of validity and reliability for chronic conditions. The scale can assess how patients with chronic diseases feel about their service of care and provide data to optimize their personalized chronic disease self-management strategies.

Strategies for Improving the Utilization of Preventive Care Services: Application of Importance-Performance Gap Analysis Method

The utilization of preventive care services is limited. Previous studies based on communities have looked at many types of barriers to preventive care (i.e., why not do). This study aimed to gain an insight into the key factors and performance gaps (i.e., why do and how to do) of people who attended a regional teaching hospital to undergo health check-ups using a purposive sampling method to recruit people to complete a self-administered questionnaire. Paired sample t-tests and importance-performance gap and regression analyses were performed. The results indicated that the participants' wish to understand their health status, the quality of medical devices and the completeness of items, and process layout planning were the key factors that affect people's health check-up behavior. Promoting the effectiveness of hospital performance may improve the positive cycle of people's health check-up behavior from the community to the hospital. Continuing to promote the knowledge of preventive care services is necessary, and it is very important for people to have a good experience of undergoing health check-ups in the hospital. Important strategies for improving the utilization of preventive care services may include: meeting the person's personalization needs, improving the quality of medical devices and the completeness of items, and having appropriate process layout planning, a detailed interpretation of the results, and further follow-ups in the hospital.

Building the capacity of community health volunteers for non-communicable disease prevention in low-income urban communities in Malaysia

Background

To address the rising non-communicable diseases (NCDs) in Malaysia, the Better Health Programme Malaysia (BHP MYS) engaged and trained community health volunteers (CHVs) to undertake health promotion activities with poor urban communities in Kuala Lumpur to reduce their NCD risk. This study evaluates the extent that the capacity-building programme achieved the objectives of increasing knowledge and confidence in NCD prevention and adopting personal lifestyle changes.

Methods

A capacity-building programme was designed to emphasise active learning approaches and blended learning (in-person and digital) and was delivered between January to December 2021 (during the Malaysian Government “Movement Control Orders” in response to the COVID-19 pandemic). Thirty CHVs participated in the capacity-building programme. A mixed methods evaluation approach was used, including quantitative surveys and routine data, focus group discussions, and semi-structured interviews.

Findings

Community Health Volunteers increased their NCD knowledge (85.2% provided correct answers in post-programme assessment compared to 43.3% at pre-programme assessment), made changes to their dietary and physical activity practices (100%), and adopted new engagement techniques, particularly a digital social influencer role for NCD behaviour change. The most important factors for sustaining participation were individual motivation and a supportive environment. CHVs were satisfied with the blended in-person-digital approach and perceived that the usefulness and applicability of the health information received was the primary benefit across all delivery modes. Cohort-based, active learning approaches and actionable messages can encourage learning retention and facilitate application. Dedicated technical support and ‘job aid’ tools are required for CHVs to perform and sustain NCD prevention roles effectively.

Conclusions

The capacity-building programme effectively increased CHV capacities to address NCDs in their own lives and communities and was acceptable to CHVs. The findings suggest the value of cohort-based, active learning approaches in building capacity. Expanding on capacity-building and sustaining involvement are important considerations for this cohort and, in general, for health volunteer capacity-building in Malaysia and elsewhere.

Are Wellness Visits a Possible and Effective Cure for the Increasing Cancer Burden in Poland? Example of Women's Preventive Services in the U.S

Background: Cancer is one of the leading causes of death among Polish women in general, and first in women aged 25−64. Contributing to this cancer burden are modifiable behavioral risk factors, including low utilization of cancer screenings. Poland has an urgent need for new systemic solutions that will decrease cancer burden in the female Polish population. This study examined the United States’ implementation of preventive wellness visits as a viable solution for implementation in Poland. Methods: Health insurance claims data for nearly three million women in five states of the U.S. were examined to identify use of mammograms, colorectal cancer screening, and lung cancer screening. Three subgroups of the cohort were assessed for the probability of receipt of screening associated with type of healthcare visit history (women with wellness visits—W; with wellness visits and related preventive services and screenings—W+P; and control group—C). All multiple comparisons were significant (alpha = 0.05) at p < 0.0001, except comparison between subgroups (W vs. P+W) for lung cancer screening. Results: Breast and colorectal cancer screenings had substantially higher participation after W and W+P in comparison with C; moreover, a slight increase after W or P+W was seen for lung cancer as well. Conclusions: Results indicate that wellness visits are an effective tool for increasing cancer screening among women in the U.S. Introduction of a similar solution in Poland could potentially help produce higher screening rates, address cancer prevention needs (not only for secondary cancer prevention), and lower cancer burden.

The Relationship Between Health Changes and Community Health Screening Participation Among Older People

The utilization of health screening and other community health services has been a hot topic in China. Thus, this study examined the effect of health changes (self-rated health, physical health, and mental health) on older people's community health screening participation in China. We derived the data from the 2016 and 2018 waves of the Chinese Longitudinal Aging Social Survey (CLASS). This paper included 10,992 observations in two waves. We tested the causal relationship using the fixed effects model. Approximately 29.56% of the respondents participated in a health screening. Notably, after controlling for covariates, changes in mental and physical health both significantly influenced seniors' participation in health screenings (self-rated health: β = 0.188, 95% CI [−0.037, −0.413]; physical health: β = 0.078, 95% CI [0.032, −0.124]; mental health: β = 0.034, 95% CI [−0.057, −0.002]). The findings showed age, educational level, income level, and family support to be significant factors associated with community health screening participation. Additionally, we identified a partial mediating effect of mental health between self-rated health and health screening participation and a partial mediating effect of depression between physical health and health screening participation. The results highlight the important role of health changes in influencing participation and promoting health screening in China. On this basis, healthcare providers in the community may consider health changes as a screening criterion to promote health screening, guiding other health promotion and prevention programs while promoting healthy aging.

Leveraging online shopping behaviors as a proxy for personal lifestyle choices: New insights into chronic disease prevention literacy

Objective

Ubiquitous internet access is reshaping the way we live, but it is accompanied by unprecedented challenges in preventing chronic diseases that are usually planted by long exposure to unhealthy lifestyles. This paper proposes leveraging online shopping behaviors as a proxy for personal lifestyle choices to improve chronic disease prevention literacy, targeted for times when e-commerce user experience has been assimilated into most people's everyday lives.

Methods

Longitudinal query logs and purchase records from 15 million online shoppers were accessed, constructing a broad spectrum of lifestyle features covering various product categories and buyer personas. Using the lifestyle-related information preceding online shoppers’ first purchases of specific prescription drugs, we could determine associations between their past lifestyle choices and whether they suffered from a particular chronic disease.

Results

Novel lifestyle risk factors were discovered in two exemplars—depression and type 2 diabetes, most of which showed reasonable consistency with existing healthcare knowledge. Further, such empirical findings could be adopted to locate online shoppers at higher risk of these chronic diseases with decent accuracy [i.e. (area under the receiver operating characteristic curve) AUC=0.68 for depression and AUC=0.70 for type 2 diabetes], closely matching the performance of screening surveys benchmarked against medical diagnosis.

Conclusions

Mining online shopping behaviors can point medical experts to a series of lifestyle issues associated with chronic diseases that are less explored to date. Hopefully, unobtrusive chronic disease surveillance via e-commerce sites can grant consenting individuals a privilege to be connected more readily with the medical profession and sophistication.