Background
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By whom do they prefer to be invited for a health check, and why?
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Where do they prefer to fill out a health check questionnaire, and why?
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By whom do they want to receive (lifestyle)advice, and why?
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What is the preferred way of communicating (lifestyle)advice, and why?
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What is the preference regarding language, and why?
Methods
Original study objective | Original study population | Data collection | Recruitment strategy | Data included in secondary analysis | Relevant topics for secondary analysis | |
---|---|---|---|---|---|---|
Quantitative study
| To get insight into knowledge and perceptions of adults of Turkish and Moroccan origin regarding cardiovascular diseases and its risk factors, and their preferences in order to reach them with health communication. | Individuals of Turkish and Moroccan origin (18 years and older) | Web-based questionnaire | Via TNS NIPObase (database for market research) | 310 respondents, aged 45 and older: • 167 Turks • 143 Moroccans | Health check: • by whom? • where? CVD information: • by whom? • preferred way? • preferred language? |
Face-to-face interviews, using a structured questionnaire | Via research assistants in own network | |||||
Qualitative study I
| To explore determinants influencing vulnerable groups regarding (non-) participation in the Dutch two-stage cardiometabolic health check, comprising a health risk assessment and prevention consultations for high-risk individuals. | Non-Western immigrants and Dutch individuals with low socioeconomic status (45–70 years old) | Focus groups, using a semi-structured interview guide | Via key persons within the community, e.g. educational coordinators or employees of cultural/community organisations | 4 focus groups: • 2 Turkish groups • 2 Moroccan groups | Health check: • by whom? • where? • preferred language? |
Adult children of the non-Western immigrants (18–45 years old) | Focus groups, using a semi-structured interview guide | 5 focus groups: • 3 Turkish groups • 2 Moroccan groups | ||||
Qualitative study II
| To explore factors that play a key role in the uptake and maintenance of behavioural changes in individuals from non-western immigrant populations with a high risk for cardiometabolic disease. Furthermore to get insight in what kind of support is needed to increase the uptake and maintenance of healthy behaviours. | Non-Western immigrants at risk for cardio-metabolic diseases (45–70 years old) | Face-to-face interviews, using a semi-structured interview guide | Via their GP | 4 face-to-face interviews: • 2 Turks • 2 Moroccans | Lifestyle advice: • by whom? • preferred way? • preferred language? |
Adult children of the non-Western immigrants (18–45 years old) | Focus groups, using a semi-structured interview guide | Via community workers and neighbourhood centres | 3 focus groups: • 1 Turkish group • 2 Moroccan groups | |||
Qualitative study III
| To explore perceptions on healthy eating and physical activity of individuals with lower socioeconomic status of different ethnic origin, in order to identify opportunities to make a lifestyle intervention more applicable to the target groups’ realities. | Individuals of Turkish, Moroccan and Dutch origin with low socioeconomic status (45 years and older) | Focus groups, using a semi-structured interview guide | Via local community workers, chairmen of mosques and persons of the target population | 10 focus groups: • 6 Turkish groups • 4 Moroccan groups | Lifestyle advice: • by whom? • preferred way? • preferred language? |
Study population and data collection
Quantitative study | Qualitative study I | Qualitative study II | Qualitative study III | |||||
---|---|---|---|---|---|---|---|---|
Turks | Moroccans | Turks | Moroccans | Turks | Moroccans | Turks | Moroccans | |
Target group |
n = 167 |
n = 143 |
n = 15 |
n = 18 |
n = 2 |
n = 2 |
n = 33 |
n = 33 |
Gender | ||||||||
Males Females | 51 % 49 % | 73 % 27 % | 1 group 1 group | 1 group 1 group | – 2 interviews | – 2 interviews | 3 groups 3 groups | 2 groups 2 groups |
Age (mean years ± SD) | 53 ± 8.1 | 55 ± 8.7 | 52 ± 8.5 | 54 ± 6.8 | 55 ± 3.5 | 48 ± 2.8 | 49 ± 8.5 | 47 ± 11.8 |
Overweight (BMI > 25 kg/m3) | 82 % | 73 % | – | – | – | – | 85 % | 87 % |
Adult children |
n = 22 |
n = 10 |
n = 6 |
n = 13 | ||||
Gender | ||||||||
Males Females Mixed | – – – | – – – | 1 group 2 groups – | – 2 groups – | – – 1 group | 1 group 1 group – | – – – | – – – |
Age (mean years ± SD) | – | – | 34 ± 13.4 | 19 ± 3.6 | 31 ± 12.2 | 28 ± 7.7 | – | – |
Quantitative study
A health check: | Information concerning CVD: |
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• In the future, a new health check will be provided that is scientifically tested. The check starts with a questionnaire. From your answers, it may emerge, for example, that you have an elevated risk of getting diabetes and/or cardiovascular diseases. If so, then you will be advised to visit your GP for further investigation. Would you like to participate in this new health check?
□ Yes, definitely
□ Yes, maybe
□ No, probably not
□ No, definitely not
If ‘Yes, definitely’ or ‘Yes, maybe’: • By whom would you prefer to be invited for this check?
□ GP
□ Specialist/hospital
□ Municipal institution/Community health service
□ Other
□ Don’t know
• Where would you like to fill out this questionnaire?
□ At GP’s office
□ At the specialist’s/in the hospital
□ At community health service
□ At other medical healthcare provider
□ In the community centre
□ In the mosque
□ At home, with pen and paper
□ Via internet
□ Other
□ No preference
| • Suppose that you are interested in information about CVD, where would you get that information? Mention two most important information sources.
□ GP
□ Specialist/hospital
□ Community health service
□ Dutch Heart Foundation
□ Internet
□ Library
□ Other
• What is the preferred way of communicating information about CVD?
□ Written via brochure/paper
□ Internet
□ Oral in a group
□ Oral in person
□ Television
□ Other
• Do you want to receive the information about CVD in Dutch or your native language?
□ Prefer Dutch
□ Prefer native language
□ Does not matter
• Suppose that a person provides information about CVD.Do you consider it important that this person: …is a physician/doctor? …is of the same ethnic origin? …is of the same gender?
□ Very important
□ A little important
□ Not important
□ Not important at all
|
Qualitative study I
Qualitative study II
Qualitative study III
Mixed-methods analysis
Results
Health check
Source of invitation
Turks (n = 142) | Moroccans (n = 102) |
p*
| |
---|---|---|---|
By whom would participants like to be invited for a health check | |||
GP | 50 % (41; 59) | 66 % (57; 76) | 0.001a
|
Specialist/hospital | 41 % (32; 50) | 18 % (10; 25) | |
Municipal institution/Community health service | 2 % (0; 5) | 7 % (2; 12) | |
Other | 0 % | 5 % (1;10) | |
Don’t know | 7 % (3; 12) | 5 % (1;9) | |
Preferred location to fill out a health check questionnaire | |||
At GP’s office | 40 % (32; 48) | 39 % (30; 49) | 0.48b
|
At home, with pen and paper | 23 % (16; 29) | 23 % (15; 30) | |
At the specialist’s/in the hospital | 20 % (14; 27) | 13 % (6; 19) | |
Via internet | 8 % (4; 14) | 9 % (4; 15) | |
In the mosque | 2 % (0; 5) | 2 % (0; 5) | |
In the community centre | 1 % (0; 4) | 0 % | |
At community health service | 0 % | 4 % (1; 8) | |
At other medical healthcare provider | 0 % | 0 % | |
Other | 1 % (0; 2) | 2 % (0; 5) | |
No preference | 5 % (1; 9) | 9 % (3; 15) |
“When you are at the GP, she already starts writing: paracetamol, while you’re telling your story.” (Turkish male)“They send us home with a paracetamol, while it [the complaint] is really more severe. They [my parents] won’t be taken seriously.” (Moroccan female adult child)
“They have to be familiar with it. If it comes from a hospital that they don’t know, I would also say: ‘What do you want from me’. You put it [the invitation] away and you forget about it.” (Turkish female adult child)
Preferred location to fill out the health check questionnaire
“In the waiting room, persons are bored anyway. The GP can provide the questionnaires in the waiting room. Those persons can fill out the questionnaire on site.” (Turkish female adult child)
“Personally I prefer a letter. It is better for people who do not speak Dutch. Why? Because if they receive a letter, they will think: ‘Oh, I received a letter so I will go to my cousin who does speak Dutch and he can read and translate the letter for me’. They will understand the message better.” (Turkish male adult child)
“When I look at my own situation, it does not add any value if it is in Arabic, because my mother is illiterate.” (Moroccan female adult child)
Advice
Preferred way to receive advice
“If you talk about my lifestyle in particular, yes, then it is nice of course [to discuss it on an individual level]. Otherwise, everyone knows ‘oh, he has such a belly, because he eats that and that’. That is not pleasant of course. That advice, when it is about changing my lifestyle for example, then not everyone has to know that.” (Moroccan male)
Turks (n = 167) | Moroccans (n = 143) |
p*
| |
---|---|---|---|
Where would you get information | |||
GP | 78 % (72; 85) | 76 % (70; 82) | 0.68 |
Specialist/hospital | 44 % (37; 52) | 40 % (31; 47) | 0.49 |
Internet | 23 % (17; 29) | 17 % (11; 24) | 0.26 |
Dutch Heart Foundation | 11 % (6; 16) | 8 % (5; 13) | 0.56 |
Community health service | 7 % (4; 12) | 6 % (2; 9) | 0.65 |
Library | 1 % (0; 3) | 1 % (0; 4) | 1.00 |
Other | 4 % (1; 7) | 14 % (9; 20) | 0.004 |
Preferred way of receiving information | |||
Oral in person | 65 % (57; 72) | 51 % (42; 60) | 0.021 |
Written via brochure/paper | 39 % (32; 47) | 43 % (36; 51) | 0.49 |
Oral in a group | 21 % (15; 27) | 12 % (7; 17) | 0.034 |
Internet | 19 % (13; 25) | 23 % (16; 30) | 0.40 |
Television | 13 % (8; 18) | 12 % (7; 17) | 1.00 |
Other | 1 % (0; 2) | 5 % (2; 9) | 0.026 |
Source of advice
“Preferably someone who knows a lot about that, someone who’s professional in that field.” (Turkish female)×
“But the person has to have knowledge about our dietary habits, what we eat and so on. Because if the advice is like a plate cut in thirds with potatoes, meat and vegetables [typical Dutch meal], then it won’t be successful. Not in our culture.” (Turkish male)
“Of Turkish origin is easier, right? Then you understand more, so you will know more. You get more information, right?” (Turkish female)
“At the end of the day, they rather prefer not to have a Moroccan counsellor, because they don’t want to air their dirty laundry in public.” (Moroccan male)
Woman 1: “We think women are always better. Women are also more sociable.”Woman 2: “Being embarrassed for men. Can’t say everything.”Woman 1: “Women do understand each other better than men.” (Turkish females)
Language
Woman 1: “In their own language it is easier, yes.”Woman 2: “They will also take it more seriously, because they hear it themselves, not via another, no, directly.” (Moroccan female adult children)
Discussion
Health check | |
□ |
By whom: Invitation by GP or – mainly in case of Turkish migrants – by a medical specialist |
□ |
Where: At the GP’s office or at home, on paper |
□ |
Language: Provide invitation and questionnaire in both the local language and mother tongue |
Lifestyle advice | |
□ |
How: Consider whether the topic is suitable to discuss in a group or should be discussed one-on-one |
□ |
By whom: A physician/doctor or someone professional in that field, who is also familiar with the target groups’ (eating) behaviour |
□ |
Language: Provide information in both the local language and mother tongue |