title: Predictors of Adherence to Multiple Clinical Preventive Recommendations among Adults with Diabetes in Spain.
abstract: OBJECTIVE
  This study aims to describe adherence to seven clinical preventive services among Spanish adults with diabetes, to compare adherence with people without diabetes and to identify predictor of adherence to multiple practices among adults with diabetes.
  
  
  METHODS
  Cross-sectional study based on data obtained from the European Health Survey for Spain 2009 and the Spanish National Health Survey 2011. We analyzed those aged 40-69 years (n= 20,948). Diabetes status was self-reported. The study variables included adherence to blood pressure (BP) checkup, cholesterol measurement, influenza vaccination, dental examination, fecal occult blood test (FOBT), mammography and cytology. Independent variables included socio-demographic characteristics, variables related to health status and lifestyle factors.
  
  
  RESULTS
  The study sample included 1,647 subjects with diabetes and 19,301 without. Over 90% had measured their BP and cholesterol in the last year, 44.4% received influenza immunization, 36.4% had a dental checkup within the year and only 8.1% underwent a FOBT. Among diabetic women 75.4% had received a mammography and 52.4% a cytology in the recommended periods. The adherence to BP and cholesterol measurements and influenza vaccination was significantly higher among those suffering diabetes and cytology and dental checkup were lower. Only 63.4% of people with diabetes had fulfilled half or more of the recommended practices. Female sex, higher educational level, being married or cohabiting, higher number of chronic conditions and number of physician visits increased the adherence to multiple preventive practices. For each unhealthy lifestyle reported the probability of having a higher adherence level decreased.
  
  
  CONCLUSIONS
  Acceptable adherence is found for BP and cholesterol checkups and mammography. Unacceptably low rates were found for influenza vaccine, dental care, cytology and FOBT. Moreover, preventive services are provided neither equitably nor efficiently so future research needs to identify individual and organizational factors that allow interventions to reach these subjects with diabetes.
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Comunidad de Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Jimenez-Trujillo
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Comunidad de Madrid, Spain.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Jiménez-García
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Comunidad de Madrid, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Esteban-Hernández
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Comunidad de Madrid, Spain.
authors.forename: Valentin
authors.initials: V
authors.lastname: Hernández-Barrera
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Comunidad de Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Carrasco Garrido
authors.affiliation: Dirección Técnica de Docencia e Investigación, Gerencia Atención Primaria, Madrid, Comunidad de Madrid, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Salinero-Fort
authors.affiliation: Dirección Técnica de Docencia e Investigación, Gerencia Atención Primaria, Madrid, Comunidad de Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Cardenas-Valladolid
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Comunidad de Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: López-de-Andrés
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003729:Dental Care / Q000706:statistics & numerical data; D003920:Diabetes Mellitus; D005260:Female; D006801:Humans; D007252:Influenza Vaccines; D008327:Mammography / Q000706:statistics & numerical data; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D013030:Spain
chemical_list: D007252:Influenza Vaccines