title: Reach of Individuals at Risk for Cardiovascular Disease by Proactive Recruitment Strategies in General Practices, Job Centers, and Health Insurance.
abstract: Reach of individuals at risk for cardiovascular disease (CVD) constitutes a major determinant of the population impact of preventive effort. This study compares three proactive recruitment strategies regarding their reach of individuals with CVD risk factors.
  
  
  
  Individuals aged 40-65 years were invited to a two-stage cardio-preventive program including an on-site health screening and a cardiovascular examination program (CEP) using face-to-face recruitment in general practices (n = 671), job centers (n = 1049), and mail invitations from health insurance (n = 894). The recruitment strategies were compared regarding the following: (1) participation rate; (2) participants' characteristics, i.e., socio-demographics, self-reported health, and CVD risk factors (smoking, physical activity, fruit/vegetable consumption, body mass index, blood pressure, high-density lipoprotein, triglycerides, and glycated hemoglobin); and (3) participation factors, i.e., differences between participants and non-participants.
  
  
  
  Screening participation rates were 56.0, 32.8, and 23.5 % for the general practices, the job centers, and the health insurance, respectively. Among eligible individuals for the CEP, respectively, 80.3, 65.5, and 96.1 % participated in the CEP. Job center clients showed the lowest socio-economic status and the most adverse CVD risk pattern. Being female predicted screening participation across all strategies (OR = 1.45, 95 % CI 1.07-1.98; OR = 1.34, 95 % CI 1.04-1.74; OR = 1.62, 95 % CI 1.16-2.27). Age predicted screening participation only within health insurance (OR = 1.04, 95 % CI 1.01-1.06). Within the general practices and the job centers, CEP participants were less likely to be smokers than non-participants (OR = 0.49, 95 % CI 0.26-0.94; OR = 0.42, 95 % CI 0.20-0.89).
  
  
  
  The recruitment in general practices yielded the highest reach. However, job centers may be useful to reduce health inequalities induced by social gradient.
authors.affiliation: Institute of Social Medicine and Prevention, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany. diana.guertler@uni-greifswald.de.|DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany. diana.guertler@uni-greifswald.de.
authors.forename: Diana
authors.identifier: 0000-0002-2533-5347
authors.initials: D
authors.lastname: Guertler
authors.affiliation: Institute of Social Medicine and Prevention, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany.|DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Meyer
authors.affiliation: DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany.|Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Dörr
authors.affiliation: Institute of Social Medicine and Prevention, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany.|DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany.|Department of Neurology, University of Luebeck, Luebeck, Germany.
authors.forename: Janina
authors.initials: J
authors.lastname: Braatz
authors.affiliation: Institute of Social Medicine and Prevention, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany.|DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Weymar
authors.affiliation: Institute of Social Medicine and Prevention, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany.|DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: John
authors.affiliation: Institute of Social Medicine and Prevention, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany.|DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany.
authors.forename: Jennis
authors.initials: J
authors.lastname: Freyer-Adam
authors.affiliation: Institute of Social Medicine and Prevention, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany.|DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany.
authors.forename: Sabina
authors.initials: S
authors.lastname: Ulbricht
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D015444:Exercise; D005260:Female; D058006:General Practice; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D012923:Social Class; D012959:Socioeconomic Factors
keywords: Cardiovascular risk factors; Non-clinical care; Participation; Reach; Recruitment strategy