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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Family Practice 1/2014

Implementing cardiometabolic health checks in general practice: a qualitative process evaluation

BMC Family Practice > Ausgabe 1/2014
Merijn Godefrooij, Mark Spigt, Wim van der Minne, Georgette Jurrissen, Geert-Jan Dinant, André Knottnerus
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

MG was the main researcher, and was involved in the conception and design of the study, data collection and analysis and was the main author of the various drafts of the manuscript. MS and GJD made significant contributions to the conception and design of the study, the data analysis, and critically commented on various drafts of the manuscript. JAK made significant contributions to the conception and design of the study and critically commented on the final draft of the manuscript. WvdM and GJ were involved as local coordinators of the primary prevention programme in the primary healthcare centre. They were both part of a focus group, critically commented on the summary of the focus groups and also critically commented on the final manuscript. All authors read and approved the final manuscript.



A stepwise screening approach for the detection and management of cardiometabolic disease is proposed in various primary care guidelines. The aim of this study was to explore the implementation of a cardiometabolic health check as perceived by the involved caregivers and patients.


Qualitative process evaluation of the implementation of a cardiometabolic screening programme in a multidisciplinary primary healthcare centre in Eindhoven, the Netherlands, in which 1270 patients had participated. We explored the caregivers’ experiences though focus group discussions and collected patients’ experiences through a written questionnaire containing two open-ended questions. We analyzed our data using a thematic content analysis based on grounded theory principles.


Five general practitioners, three practice nurses and five medical receptionists participated in the focus groups. Additionally we collected experiences of 657 (52% of 1270) participating patients through an open-ended questionnaire.
GPs were enthusiastic about offering a health check and preferred systematic screening over case-finding, both in terms of yield and workload. The level of patient participation was high and most participants were enthusiastic about the health check being offered by their GP. Despite their enthusiasm, the GPs realized that they lacked experience in the design and implementation of a structured, large-scale prevention programme. This resulted in suboptimal instruction of the involved practice nurses and medical receptionists. The recruitment strategy was unnecessarily aggressive. There were shortcomings in communicating the outcomes of the health check to the patients and there was no predefined follow-up programme. Based on our findings we developed a checklist that can be used by designers of similar health checks.


A number of fundamental issues may arise when GPs organize a systematic screening programme in their practice. These issues are related to the preparation of the involved staff, the importance of integration with everyday clinical practice, the approach of healthy patients and the provision of adequate follow-up programmes. The identified challenges and recommendations can be taken into account during future screening programmes.
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