title: 'Check it out!' Decision-making of vulnerable groups about participation in a two-stage cardiometabolic health check: a qualitative study.
abstract: OBJECTIVE
  Exploring determinants influencing vulnerable groups regarding (non-) participation in the Dutch two-stage cardiometabolic health check, comprising a health risk assessment (HRA) and prevention consultations (PCs) for high-risk individuals.
  
  
  METHODS
  Qualitative study comprising 21 focus groups with non-Western (Surinamese, Turkish, Moroccan) immigrants aged 45-70, adult children from one of these descents, native Dutch with a lower socioeconomic status, and healthcare professionals working with these groups.
  
  
  RESULTS
  Reasons for not completing the HRA included (flawed) risk perceptions, health negligence, (health) illiteracy, and language barriers. A face-to-face invitation from a reliable source and community outreach to raise awareness were perceived as facilitating participation. Reasons for not attending the PCs overlapped with completing the HRA but additionally included risk denial, fear about the outcome, its potential consequences (lifestyle changes and medication prescription), and disease-related stigma.
  
  
  CONCLUSIONS
  Reasons for not completing the HRA were mainly cognitive, whereas reasons for not attending the PCs were also affective.
  
  
  CONCLUSIONS
  When designing a two-stage health check, choice of invitation method seems important, as does training healthcare professionals in techniques to effectively handle patients' (flawed) risk perceptions and attitudinal ambivalence. Focus should be on promoting informed choices by providing accurate information.
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: i.groenenberg@lumc.nl.
authors.forename: Iris
authors.initials: I
authors.lastname: Groenenberg
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: m.r.crone@lumc.nl.
authors.forename: Mathilde R
authors.initials: MR
authors.lastname: Crone
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: s.van_dijk@lumc.nl.
authors.forename: Sandra
authors.initials: S
authors.lastname: van Dijk
authors.affiliation: Department of Health, Medical, and Neuropsychology, Leiden University, Leiden, The Netherlands. Electronic address: gebhardt@fsw.leidenuniv.nl.
authors.forename: Winnifred A
authors.initials: WA
authors.lastname: Gebhardt
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: j.ben_meftah@lumc.nl.
authors.forename: Jamila
authors.initials: J
authors.lastname: Ben Meftah
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: b.j.c.middelkoop@lumc.nl.
authors.forename: Barend J C
authors.initials: BJ
authors.lastname: Middelkoop
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: a.m.stiggelbout@lumc.nl.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Stiggelbout
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands; Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: w.assendelft@elg.umcn.nl.
authors.forename: Willem J J
authors.initials: WJ
authors.lastname: Assendelft
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003657:Decision Making; D005006:Ethnicity; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D036301:Qualitative Research; D018570:Risk Assessment / Q000379:methods; D012923:Social Class; D035862:Vulnerable Populations; D055815:Young Adult
keywords: Ethnic minorities; Informational, practical, and psychosocial determinants; Lower socioeconomic status; Qualitative study; Two-stage cardiometabolic screening