Determinants of individuals' participation in integrated chronic disease screening in Singapore.
BACKGROUND
A large pool of patients with chronic diseases remains undiagnosed globally and in Singapore. We explored factors associated with participation in a health screening exercise, using revealed preference, that is, actual attendance, to understand why people remain undiagnosed with chronic diseases.


METHODS
A cross-sectional, community-based sample of Singapore residents was invited to participate in home interviews, and subsequently to attend centre-based health screening, between 2004 and 2007. Determinants of health screening participation were identified using logistic regression models based on Andersen's Behavioral Model.


RESULTS
Of the 6366 participants who completed health interview, 4092 attended the health screening, while 2274 did not. Older age, Chinese or Indian ethnicity, higher education levels, greater intake of monounsaturated fat, greater transport and leisure-time physical activity were the key predisposing factors associated with greater health screening participation. Greater family cohesion was the key associated enabling factor, while previous diagnosis of dyslipidaemia or musculoskeletal conditions, absence of previously diagnosed diabetes or hypertension and lower perceived physical health were the associated need factors.


CONCLUSIONS
Our study suggests that ethnicity, education, family cohesion, healthy behaviour patterns and perceived physical health status were key determinants of health screening participation. Enhancing the cultural competence of preventive health services may help increase participation of these groups in screening efforts and reduce the proportions of undiagnosed chronic disease in the community.
Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
Kavita
K
Venkataraman
Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.|Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore.
Hwee Lin
HL
Wee
Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
Sheryl Hui Xian
SHX
Ng
Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
Salome
S
Rebello
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
E Shyong
ES
Tai
Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
Jeannette
J
Lee
Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
Chuen Seng
CS
Tan
Epidemiology of chronic diseases; HEALTH BEHAVIOUR; SCREENING