title: Determinants of participation in a cardiometabolic health check among underserved groups.
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.
authors.affiliation: Leiden University Medical Center, Department of Public Health and Primary Care, Hippocratespad 21, PO Box 9600, V0-P, 2300 RC Leiden, The Netherlands.
authors.forename: I
authors.initials: I
authors.lastname: Groenenberg
authors.affiliation: Leiden University Medical Center, Department of Public Health and Primary Care, Hippocratespad 21, PO Box 9600, V0-P, 2300 RC Leiden, The Netherlands.
authors.forename: M R
authors.initials: MR
authors.lastname: Crone
authors.affiliation: 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.
authors.forename: S
authors.initials: S
authors.lastname: van Dijk
authors.affiliation: Leiden University Medical Center, Department of Public Health and Primary Care, Hippocratespad 21, PO Box 9600, V0-P, 2300 RC Leiden, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Ben Meftah
authors.affiliation: Leiden University Medical Center, Department of Public Health and Primary Care, Hippocratespad 21, PO Box 9600, V0-P, 2300 RC Leiden, The Netherlands.
authors.forename: B J C
authors.initials: BJ
authors.lastname: Middelkoop
authors.affiliation: Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, The Netherlands.
authors.forename: W J J
authors.initials: WJ
authors.lastname: Assendelft
authors.affiliation: Leiden University Medical Center, Department of Medical Decision Making, 2300 RC Leiden, The Netherlands.
authors.forename: A M
authors.initials: AM
authors.lastname: Stiggelbout
keywords: Cardiometabolic disease (cardiovascular disease, diabetes, and kidney disease); Participation in two-stage screening; Primary care; Underserved, high-risk populations