Background
Methods
Search strategy
Types of studies
Inclusion Criteria | Exclusion Criteria |
---|---|
Population: | Population: |
· Western/developed countries | · Children |
· Hard to reach populations | Intervention: |
· High risk groups | · Disease-specific health checks/screening (other than heart disease) |
Intervention: | · Geriatric annual health checks |
· General health checks | Control: |
· Heart disease health checks | · Studies from the developing world |
· General/Heart AND other disease-specific health check | Limits: |
· Studies whose primary outcome was to increase uptake | · Non-English language papers |
· Studies where uptake was documented (of the above interventions) | · Non-empirical opinion papers |
Control: | · Papers published pre 1980 |
· Control group not necessary | |
Outcome: | |
· Initial uptake of screening and/or | |
· Long term engagement with services |
Databases used
# | Search Term |
---|---|
1 | Health services for the aged |
2 | (MH “Health Promotion”) |
3 | (MH “Preventive Health Services”) |
4 | (MH “Primary Prevention”) |
5 | “health check” |
6 | “health examination” |
7 | “health examinations” |
8 | (MH “Family Practice”) |
9 | “general practice” |
10 | “opportunistic” |
11 | “health screening” |
12 | S1 or S2 or S3 or S4 or S5 or S6 or S7 or S8 or S9 or S10 or S11 |
13 | (MH “Health Services Accessibility”) |
14 | (MH “Patient Acceptance of Health Care”) |
15 | (MH “Patient Dropouts”) |
16 | non-respon* |
17 | (poor attend* or non-attend*) |
18 | non-engage* |
19 | non-particip* |
20 | barrier* |
21 | (dropout* or drop* out*) |
22 | hard to reach |
23 | inverse care law |
24 | S13 or S14 or S15 or S16 or S17 or S18 or S19 or S20 or S21 or S22 or S23 |
25 | S12 and S24 |
26 | TI cancer or MW cancer or MJ cancer |
27 | S25 NOT S26 |
28 | S25 NOT S26 (English language) |
29 | S25 NOT S26 (limited 1980–2010) |
Selection process
-
Ran search in databases individually (RD)
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Removed duplicates within databases (RD)
-
Removed duplicates between databases (RD)
-
Papers screened for relevance by title (RD)
-
Papers independently screened for relevance by abstract (RD and CM)
-
Meeting to discuss agreement (RD, CM, BW)
-
Remaining papers screened using full text (RD and BW)
Results
Database | Number of references | Duplicates within own database | Distinct references |
---|---|---|---|
Medline | 8558 | 1 | 8557 |
CINAHL | 3234 | 1 | 3233 |
BNI | 148 | 0 | 148 |
SSCI | 3902 | 1 | 3901 |
PsycINFO | 1945 | 4 | 1941 |
EMBASE | 2379 | 3 | 2376 |
CDSR + DARE | 516 | 0 | 516 |
Total | 20682 | 10 | 20672 |
Reference Number | Primary Author | Year | Title | Setting/Participants | Method | Key Findings |
---|---|---|---|---|---|---|
20 | Bletzer, K. V. | 1989 | Review of a health fair screening program in Mid-Michigan | America | Programme evaluation Evaluation of sociodemographic data on attenders at health fairs over seven years and findings from a survey with a sample of participants | · Women consistently outnumbered men by a ratio of at least 3:2 every year |
Health fair Open access 15124 participants | ||||||
· Older people were more likely to present than younger people, with half of participants older than 50 | ||||||
· 90% of those surveyed had consulted their GP within the past two years | ||||||
· The number of serious problems identified was low | ||||||
· The main reason for attendance was “curiosity about health” | ||||||
21 | Culica, D. | 2002 | Medical checkups: Who does not get them? | America | Telephone survey | · Reduced likelihood of having had health check in the previous 12 months was associated with being: 25-44 or over 65, male, unmarried, a smoker and in those who perceived cost barriers |
· Check ups were more likely in people who earned over $75,000, had health insurance, were physically active, had chronic disease and who rated their health as good, fair or poor rather than good or excellent | ||||||
Sample of 3600 individuals | Analysis of Iowa 1996 Behavioral Risk Factor Surveillance System | |||||
22 | Greenland, P. | 2002 | Attendance patterns and characteristics of participants in public cholesterol screening | America | Programme evaluation of cholesterol screening programme | · Participants more likely to be white (98.5% v 96.7%), older, female (59.9% v 51.6%) and better educated than the general population |
Cholesterol screening | Comparison of participant demographics with local census data | · 22% had previous diagnosis of high cholesterol and came to confirm/monitor previous readings | ||||
Open access | · 79% came to the store specifically for screening | |||||
10 supermarkets | · Time was an important factor as weekend and weeknights attracted more men and younger people than weekday screenings | |||||
8583 people were seen over 4months | ||||||
· Less than 5% took time off work to participate | ||||||
23 | Waller, D. | 1990 | Health checks in general practice: Another example of inverse care? | UK | Programme evaluation | · 1458 patients (65.9%) were offered screening |
· Of those invited 963 (66%) attended for a health check | ||||||
Attendance at General Practice health checks over | Medical record audit and postal questionnaire | · Attenders were more likely to be women, aged 45yrs or older, married, non-smokers and of higher social class than the non-responders to the invitation | ||||
2211 men and women aged 35-64 were in the target age group | · Relative likelihood for non-attendance was 1.24 for smokers, 1.20 for the overweight, 1.16 for heavy drinkers, 1.28 for those with a less healthy diet | |||||
Men were invited opportunistically, women were invited in the context of cervical smear tests | · Frequent GP consulters were more likely to attend | |||||
24 | Jacobsen, B. K. | 1992 | The Nordland Health Study - Design of the Study, Description of the Population, Attendance and Questionnaire Response | Norway | Quasiexperimental and survey | · 82% attended the screening |
Health screening | · 78% men and 86% women attended | |||||
Population screening and questionnaire | ||||||
· Non-attenders tended to be single | ||||||
· 84% married men attended screening compared to 65% divorced/single or widowed men | ||||||
Letter invitation | ||||||
10497 patients aged 40-42 were invited | · 88% married women attended compared to 79% divorced/single or widowed women | |||||
25 | Simpson, W. M. | 1997 | Screening for risk factors for cardiovascular disease: A psychological perspective | UK | 1. Quasi-experimental | · Overall uptake 62.4%; 59% at further education college, 28% at council cleansing department, 81% at greetings card factory. |
3 studies (only two were relevant to literature review) | Mobile screening programme and prospective questionnaire | |||||
· In general attenders were significantly older and more likely to be female than non-attenders | ||||||
1. Worksite screening at three workplaces: | 2. Longitudinal | · Attenders were more likely to have had a definite intention to attend, and were more aware of the availability of the service | ||||
Random allocation of invitation type | ||||||
Further education college | · Non-attenders perceived more barriers to attendance and perceived themselves to be at higher risk of developing serious diseases | |||||
Two questionnaires: | ||||||
Council Cleansing department | ||||||
One week after screening to assess intention to change behaviour | · The lower uptake at the council was attributed to the higher ratio of male to female employees, a lower education level and the youngest average age of all the workplaces | |||||
Greetings card factory | ||||||
Open access | ||||||
2. Organisation of a screening programme | · Uptake varied by invitation type | |||||
Three months after screening to measure behaviour change | · 100% opportunistic patients, 54% of those invited by letter and 29% personally invited attended the screening clinic | |||||
General Practice | ||||||
Uptake by invitation type: | · The method of offering screening did not affect changes in behaviour but those who engaged opportunistically were more likely to intend to smoke less. | |||||
1. Opportunistic screening by GP | ||||||
2. Invitation and fixed appointment to attend screening with practice nurse | · Patients who engaged after being invited by letter or personally were more likely to eat less fat and take more exercise than those who engaged opportunistically | |||||
· Smokers were likely to attend than non-smokers | ||||||
3. Personal invite by GP to make appointment for screening clinic with practice nurse | ||||||
210 male patients | ||||||
26 | Thomas, K. J. | 1993 | Case against targeting long term non-attenders in general practice for a health check. | UK | Quasiexperimental Patient records were randomly sampled to assess attendance over a 3 year period. | · The median proportion of 3 year non-attenders was 23% in inner city practice compared to 9% in other practices |
30 General Practices | ||||||
Mailed invitations | · 310/679 non-attenders were not contactable v 320/379 attenders who were contactable. This was related to last recorded consultation | |||||
Random sample of 679 patients who had not attended for 3 years and 379 patients who had attended within this time | ||||||
A sample of those who had attended in the past 3 years were invited for a health check and were invited to take part in a home interview two weeks before the health check | · Non-attenders were more likely to be female. Female non-attenders were more likely to be older than male non-attenders | |||||
· Non-attenders scored significantly better on six measures of perceived health status and used less accident and emergency services and preventive health care than attenders | ||||||
Age 16-74 | ||||||
Non-attenders were invited to a health check but were not interviewed | ||||||
27 | Wall, M. | 2004 | Non-participants in a preventive health examination for cardiovascular disease: characteristics, reasons for nonparticipation, and willingness to participate in the future | Sweden | Quasi-experimental | · 237 persons (76.7%) participated |
Ockelbo project | Preventive health examination | · Of 72 non-attenders at the health examination, 53 (73.6%) responded to the questionnaire, 14 (19.4%) agreed to a telephone interview and 5 (6.9%) did not respond | ||||
309 persons aged 35 or 40yrs were invited to participate in a health examination | ||||||
Follow up questionnaire mailed to nonparticipants | ||||||
Follow up telephone interview with non-participants who did not respond to questionnaire | · The proportion of smokers was significantly higher in non-attenders v attenders at the health check (31.3% v 18.6%) | |||||
· Reasons for non-attendance included: lack of time or hindrances at work (52%), already in contact with health services (33%), or because they felt healthy (21%) | ||||||
· However the majority of non-attenders (55%) said they would be interested in attending in the future, 28% said they were not sure, and 16% said they would not be interested | ||||||
28 | Cherrington, A. | 2007 | Do adults who believe in periodic health examinations receive more clinical preventive services? | America | Telephone survey | · Non-endorsers of periodic health examinations received less preventive services |
Telephone survey | Logistic regression analysis of phone survey to assess attitudes towards periodic health examinations and the receipt of preventive services | |||||
4879 respondents | · 8.5% (n=374) did not endorse annual periodic health examinations | |||||
· Non-endorsers tended to be male (odd ratio (OR) 1.64), younger (OR 0.87), white (OR 2.91), to have at least some college education (OR 1.43) and feel healthy (1.85) | ||||||
· 56% of non-endorsers had received a cholesterol check in the previous 5 years compared to 81% of endorsers | ||||||
29 | Karwalajtys, T. | 2005 | A randomized trial of mail vs. telephone invitation to a community-based cardiovascular health awareness program for older family practice patients | Canada | Prospective | · 58.3% of invited patients attended |
1 family physician practice | randomised trial of invitation to attend community based by mail or telephone | · Patients invited by phone were more likely to attend than those by mail (72.3% v 44.0%) | ||||
5 community pharmacies | · Patients with a family history of cardiovascular disease were significantly more likely to attend | |||||
Telephone and mailed invitation | ||||||
235 patients aged 65+ | Health record review | |||||
30 | Hsu, H.Y. | 2001 | The relationships between health beliefs and utilization of free health examinations in older people living in a community setting in Taiwan | Taiwan | Cross-sectional survey | · Higher uptake of health examination in those with higher education and socio-economic status, and those with increased family support (6% of users lived alone compared to 13% of non-users) |
Free health examination in over 65s | ||||||
Stratified random systematic sample of 200 men and women were given a 17 item health belief scale to complete | ||||||
100 participants | · Users perceived a higher level of seriousness and susceptibility to ill health than non-users | |||||
100 nonparticipants | ||||||
31 | Bowden, R. G. | 2001 | Comparisons of cholesterol screening participants and non-participants in a university setting | America | Case–control analysis of participants in worksite screening | · Participants were more likely to be male (68.5% v 53.7%), older (47.0 years v 40.4 years), white (91.9% v 78.7%), have a college degree (85.9% v 51.3%) and have higher mean salaries than nonparticipants ($50,054 v $30,009) |
Worksite screening | ||||||
University | ||||||
Invite with pay check | ||||||
· Barriers to uptake in non-attenders were suggested to be cost, less flexible working hours, lack of access to communication methods including email, conspiracy theories around the employer’s motives and that the workers did not feel sick and did not need screened | ||||||
270 participants | ||||||
587 random sample of nonparticipants | ||||||
32 | Franks, P. | 1991 | Barriers to Cholesterol Testing in a Rural- Community | America | Cross-sectional population based survey | · 24% reported prior cholesterol testing |
Cholesterol check | · Factors associated with a reduced likelihood of ever having a cholesterol test: age under 45, less than 12 years education, income of less than $10,00, no health insurance, no doctor visit in past year, practicing 3+ cardiovascular risk factors | |||||
Invitation by telephone, leaflets and home visits | ||||||
Logistic regression | ||||||
557 households contacted 508 (91%) participated Survey of 1063 people | ||||||
973 (92%) screened for cholesterol | ||||||
33 | Jones, A. | 1993 | Comparison of risk factors for coronary heart disease among attenders and nonattenders at a screening programme | Wales | Case control | · Non-attenders were more likely to be older, have higher body mass index, cholesterol and blood pressure, and low socio-economic status, a personal/family history of heart disease, be smokers, have low educational level and high alcohol consumption than attenders |
General Practice | Random systematic sample of 1398 non-attenders identified 140 individuals who were repeatedly contacted and encouraged to attend a health check. | |||||
Mailed open invitation then fixed appointment mailed, telephone call and home visit for nonresponders | ||||||
· Reasons given for not attending the initial screening programme were varied with 36.7% claiming not to have received the letter and 26.5% citing practical barriers | ||||||
3800 patients invited for health check | ||||||
2402 (63.2%) attended | ||||||
98 non-attenders eventually presented for a health check and their results were compared to initial attenders | ||||||
Aged 25-55 years | ||||||
34 | Sonne-Holm, S. | 1989 | Influence of fatness, intelligence, education and sociodemographic factors on response rate in a health survey | Denmark | Case control | · 964 obese (58%) and 1134 controls (75%) attended a health examination |
Health examination | Survey of cohort of severely obese men with a randomly selected control group invited to a health examination | |||||
· Regardless of study group, the response rate was independently associated with decreasing body mass index and increasing intelligence test score, educational level, social class, age up to 50 years old and proximity of residence to the screening location | ||||||
362,200 male draftees to Danish military board | ||||||
Mailed invitation and reminder | ||||||
1651 identified as severely obese draftees | ||||||
1504 controls were randomly selected from the remaining population | ||||||
35 | Walker, M. | 1987 | Non-participation and mortality in a prospective study of cardiovascular disease | UK | British Regional Heart Study | · 7735 men (74.3%) participated in the study |
Comparison of characteristics and mortality levels of participants and non-participants in clinical examination | · Non-participants had a significantly higher relative risk of death during the first three years after the screening date | |||||
Prospective study of cardiovascular disease in middle aged men | ||||||
· Non-participants were more likely to be younger, unmarried and less skilled workers than participants | ||||||
Sample of 10412 men aged 40-59 years | ||||||
36 | Thorogood, M. | 1993 | Factors affecting response to an invitation to attend for a health check | UK | Quasi-experimental | · 2205 attended (82.3%) |
5 General Practices | Postal questionnaire before invite to attend a health check and subsequent record of attendance | · Non-attendance was higher in males than females (21% v 15%) | ||||
Invitation by mail or telephone, or opportunistically plus up to 3 reminders | · Non-attenders were more likely to be single than married (24% v 16%), manual rather non-manual workers (21% v 15%), living in rented accommodation rather than homeowners (29% v 16%) and not have access to a car rather than be a car user (27% v 16%) | |||||
2678 patients aged 35-64 were invited to attend a health check | ||||||
· Non-attenders were less healthy than attenders as shown by following odd ratios: 1.74 smokers, 1.07 heavy drinkers, 1.91 less healthy diet, 1.50 for obese patients | ||||||
· Attenders were more likely to visit their GP frequently and indicate a willingness to change their behaviour | ||||||
37 | Dignan, M. B. | 1995 | Factors associated with participation in a preventive cardiology service by patients with coronary heart disease | America | Prospective cohort/Qualitative | · 24 patients (39%) attended the clinic |
Cardiology clinic | · No statistically significant demographic differences were found between attenders and non-attenders | |||||
Face to face open invitation and follow up letter | ||||||
Telephone interviews | · Patients who attributed their hospitalisation to a heart attack or coronary bypass surgery were more likely to attend the clinic than those who attributed admission to chest pain or for diagnostic reasons | |||||
62 patients | Follow up of patients who were hospitalised for heart related conditions to assess reasons for nonattendance at secondary prevention clinic | |||||
38 | Griffiths, C. | 1994 | Registration health checks: Inverse care in the inner city? | UK | Survey | · Non-attenders were significantly more likely to be unemployed, African, heavy smokers and of lower social class than attenders. |
7 GP practices | Questionnaire analysis | |||||
Face to face open invitation | ||||||
· Demonstrated that invitations to health checks given in an unselected way are least likely to engage with those in most need | ||||||
356 patients: 101 declined/provided inadequate data | ||||||
Of the remaining 256 patients, 118 attended a health check (46%) | ||||||
39 | Wilson, S. | 1997 | Health beliefs of blue collar workers: increasing self efficacy and removing barriers | USA | Cross-sectional, descriptive, expost facto questionnaire | · 151 (75.5%) completed questionnaires |
Health beliefs of participants and non-participants in worksite blood pressure and cholesterol screening | · 45 workers (22.5%) subsequently attended a health check | |||||
· No significant difference between respondents and participants by age, race, education, gender, marital status, shift or health history | ||||||
Worksite screening | ||||||
· Workers who participated in the screening had significantly higher self-efficacy and perceived significantly fewer barriers to participation than non-attenders | ||||||
Convenience sample 200 blue collar workers | ||||||
40 | Boshuizen, H. C. | 2006 | Non-response in a survey of cardiovascular risk factors in the Dutch population: Determinants and resulting biases | Netherlands | Logistic regression of determinants of participation in a health examination survey in previous participants in a health interview study | · 28.9% patients participated in a health examination that had participated in an earlier health interview survey |
Health examination | ||||||
3699 participants from a sample of | · Participants were more likely to be male and have high socio-economic status | |||||
12786 previous participants | · Participation increased with age until 60 then decreased sharply thereafter | |||||
· The rural population were less likely to participate | ||||||
· There was evidence of the “worried well” with frequent consulters and those with good health more likely to attend | ||||||
· The unemployed were least likely to attend but participation decreased with increasing hours of work | ||||||
41 | Pill, R. | 1985 | Invitation to attend a health check in a general practice setting: comparison of attenders and non-attenders | UK | Quasi-experimental | · Attenders were generally better educated, of higher social status, had greater health motivation, fewer ties and commitments, attended church more regularly, employed, performed more health approved practices, had had more recent contact with GP, and accepted the legitimacy of the doctor’s interest in their lifestyle than nonattenders |
Health check | Comparison of demographics, attitudes, beliefs, preventive health behaviour and past contact with the practice between attenders and non-attenders | |||||
General practice | ||||||
Mailed invitation | ||||||
Sample of 259 non-attenders and 216 attenders aged between 20 and 45 | ||||||
· Attenders were more likely to have no children under 5, no dependents and have fewer than 6 contacts a month with friends or relatives than nonattenders | ||||||
· Non-attendance was associated with greater perceived support from family and friends | ||||||
42 | Persson, L. G. | 1994 | A Study of Men Aged 33-42 in Habo, Sweden with Special Reference to Cardiovascular Risk-Factors | Sweden | Quasi-experimental | · 652 men (86.1%) had attended after one mail invitation |
Health check | Follow up of non-attenders by mailed questionnaire and telephone | |||||
Postal invitation plus two reminders | · Of 105 non-participants, 16 were known high consumers of health care, 40 had recently had a health examination (mostly at work) and 49 were not interested in a health check | |||||
757 men aged 33-42 were invited to attend for a health check | ||||||
· Non-attenders were more likely to be single, smokers, on the sick list, on a lower income or more often unemployed than attenders | ||||||
43 | Christensen, B. | 1995 | Characteristics of attenders and non-attenders at health examinations for ischaemic heart disease in general practice | Denmark | Quasi-experimental study | · Attendance was higher in free health examinations than those which charged a fee (66% v 37%) · Attendance was significantly lower in single men than cohabitants |
65 General Practices | Multi-practice study and questionnaires to assess the influence of a fee to attend a health examination | |||||
Health examinations for ischaemic heart disease | · Whether the service was free or not was the biggest predictor of attendance as health beliefs of attenders and non-attenders were similar | |||||
Letter invitation 2452 men aged 40-49 years were invited to attend | ||||||
44 | Difford, F. | 1987 | Continuous opportunistic and systematic screening for hypertension with computer help: Analysis of nonresponders | England | Programme evaluation | · 2354 patients (92%) had blood pressure recorded in the previous 5 years after 2 years |
General practice | Audit of medical records | |||||
Opportunistic hypertension screening | · Those who had been screened have higher consultation rates (6x greater) than non-responders | |||||
Analysis of characteristics of 192 nonresponders | ||||||
· There was no difference by distance to the practice or number of years registered with the practice | ||||||
2546 patients aged 40-64 years | ||||||
· The only significant difference was that nonresponders were the only people in a household registered with a practice which was interpreted that they were either single or had a lack of need to identify with the “family” doctor | ||||||
45 | Engebretson,J. | 2005 | Participation in Community Health Screenings: A Qualitative Evaluation | America | Qualitative Focus groups | · Described domains of motivation for presentation: |
Participants in screenings at 5 settings: | 5 with attenders | · Self-care orientations (e.g. self-assessment/no perceived need) | ||||
1 with nonattenders | · Interpersonal influences (e.g. endorsement by others/fear of embarrassment) | |||||
University employees | ||||||
· Accessibility (e.g. convenience/lack of time) | ||||||
County fair attendees | · Overlap of facilitators and barriers to participation; what motivated one participant to attend may act as a barrier to another | |||||
Senior citizen centre clientele | ||||||
Local industry employees | ||||||
University student | ||||||
Group of non-attenders | ||||||
46 | Harpole, L.H. | 2000 | Feasibility of a tailored intervention to improve preventive care use in women | America | Survey to identify outstanding preventive health care needs | · 591 women (67%) returned the survey |
Survey mailed to 893 women aged 50-55 | · 76% were in need of one or more preventive health service | |||||
· 16% were in need of 3 or more | ||||||
· Women with increasing need for preventive health services were more likely to be non-white, earn less, have a lower level of education, and be less satisfied with their health care | ||||||
47 | Norman, P. | 1991 | Predicting attendance at health screening: Organizational factors and patients’ health beliefs | UK | Programme evaluation | · 131 (59.3%) questionnaires were returned. From this group 98 attended and 33 did not attend the subsequent health check |
General Practice | A health belief questionnaire was sent to sample of 221 patients who were subsequently invited for screening | |||||
Health check | ||||||
Mailed fixed appointment or invited opportunistically | · The two invite methods had similar attendance rates but the letter invite was more efficient, as opportunistic screening relied on patients presenting at their GP before they could be invited | |||||
325 patients aged between 30 and 50 | · Opportunistic screening was slightly biased in favour of females | |||||
· Attenders were more likely to report cutting back on daily activities when ill and believe in the seriousness of high blood pressure and weight problems | ||||||
Health belief questionnaire | 11 patients were interviewed directly after their screening appointment | |||||
· Non-attenders were found to be more worried about the screening appointment and perceived more barriers to attendance | ||||||
48 | Shiloh, S. | 1997 | Correlates of health screening utilization: The roles of health beliefs and selfregulation motivation | A convenience sample of 252 asymptomatic individuals were invited to participate in one of four screening programmes: dental check up, blood pressure measurement and cholesterol testing, pap smear or mammography | Quasi-experimental | · 137 (54%) attended and 115 (46%) did not attend |
Analysis of participants in a screening programme | · Motivations and health beliefs varied by screening programme | |||||
· Non-attenders were more likely to justify their nonattendance behaviour with danger control motivations than fear control ones | ||||||
Questionnaire tailored to specific screening programme and whether individual attended or did not attend | ||||||
· 61% non-attenders did not believe in the efficacy of screening in reducing their illness threat whereas 39% were too afraid of the possible results to attend | ||||||
49 | Norman, P. | 1993 | The role of social cognition models in predicting attendance at health checks | UK | Prospective survey/programme evaluation | · 419 patients were sent open invitations |
General Practice | · 399 patients were sent fixed appointments | |||||
Mailed invitation with fixed appointment time or open invitation | · 433/818 patients attended a health check; 69.7% of those sent fixed appointments and 37.1% sent open invitations attended | |||||
Health belief questionnaires sent before patients received invite letters | ||||||
· Questionnaire data showed that for those that were sent a fixed appointment, attenders were more likely to place a high value on health, to believe health is influenced by powerful others, to be advised by referent groups to attend, to believe in the positive outcomes of screening and to not be affected by motivational barriers than nonattenders | ||||||
818 patients aged between 30 and 41 were invited to attend a health check | ||||||
Health check | ||||||
Patients randomly allocated to receive either a letter of invitation with either a fixed appointment or an open invitation to make their own appointment | ||||||
· For those sent an open invitation, intention to attend and perceived control were independent predictors of attendance behaviour | ||||||
50 | Norman, P. | 1991 | Patients’ views on health screening in general practice | UK | Programme evaluation | · Of the 168 invited by letter, 121 patients (72%) attended a health check |
General Practice | ||||||
Mailed fixed appointment or invited opportunistically | Patients randomly selected to be invited to general health screening in one of two ways: | · Only 83/157 patients had been invited opportunistically, but attendance in those that had been invited was 74.7% | ||||
· The remaining patients who had not yet been invited opportunistically were sent a fixed appointment which produced 55.4% attendance | ||||||
Sample of 379 patients aged 30- 50 years, 325 were invited after exclusion of unsuitable patients | ||||||
· 159/224 patients returned their questionnaires | ||||||
Letter with fixed appointment (n=168) or notes were tagged so patient was invited opportunistically to make an appointment for a health check when they presented at the practice for another reason (n=157) | · Those invited opportunistically were most likely to report that keeping their appointment time was easy, and were least likely to change it. | |||||
· Those given fixed appointments experienced more difficulty in attending even if they were well motivated | ||||||
Questionnaire was issued after health check to assess views of health check | ||||||
11 patients were interviewed | ||||||
51 | Nielsen, K. D. B. | 2004 | “You can’t prevent everything anyway”: A qualitative study of beliefs and attitudes about refusing health screening in general practice | Denmark | Qualitative | · Reasons for non-attendance: too busy, healthy, recent contact with general practice, don’t want to know if ill, no symptoms, major life events, actual health problems |
Health examination | Interview with sample of 18 non-participants in a randomised control populationbased project | |||||
6 men | ||||||
12 women | · They stressed the importance of autonomy, and that they would go to see their doctor when they needed to | |||||
Non-participants were sampled using stratified purposeful techniques | ||||||
52 | Norman, P. | 1989 | Intention to attend a health screening appointment: Some implications for general practice | UK | Cross-sectional survey | · Initial questionnaires were returned by 178 patients (37% response rate) |
General Practice | Patients randomly selected from practice list by age/sex bands (25-30, 35-40, 45-50 years) | |||||
Questionnaire to assess predictors of intention to attend a health check | · Reminder questionnaire returned a further 97 replies. An additional 29 questionnaires were excluded due to incorrect addresses or being incompletely filled in. Response rate was 57% (n=275) | |||||
479 patients aged25-50 | · Those who intend to attend a health check placed a high value on their health; believe in their susceptibility to common illnesses and the severity of major illnesses. They believe in the efficacy of doctors and screening, have someone to talk to about problems and are more likely to be married or cohabiting. | |||||
Sent questionnaire | ||||||
· Those who are likely to not attend have different attitudes towards screening and believe it would be too much effort or feel concerned about aspects of screening | ||||||
53 | Williams, A | 2001 | Cultural sensitivity and day care workers: examination of a worksite based cardiovascular disease prevention project | USA | Programme evaluation of screening initiative over three years | · Participation rates were increased from 26% to 73% over the duration of the project by adapting recruitment strategies to the target group’s cultural values and lifestyles, and building trust |
“Healthier people health risk appraisal” | ||||||
Strategy to recruit child day care workers in a cardiovascular disease screening and risk reduction programme | · 70% of participants cited convenience (because it was offered at their workplace) and the fact that it was free as motivators to attend | |||||
Interview with participants | ||||||
· A lack of knowledge of cardiovascular risk was identified in this population as just over 10% of participants were aware of their blood pressure or blood cholesterol | ||||||
N=84 | · Non-participants had been tested recently or were not interested in the screening at the time it was offered | |||||
54 | Ornstein, S. M | 1993 | Barriers to adherence to preventive services reminder letters: the patient’s perspective | USA | Qualitative Telephone survey (n=307) | · 307 patients were surveyed by telephone to assess reasons for non-response to a letter for screening |
Cholesterol screening | ||||||
Reminder letters sent to 1077 patients | Focus groups of non-responders to a reminder letter (n=27) | · 154 (50.2%) did not recall receiving the letter, 84 (27.4%) recalled receiving the letter but not its content, 69 (22.5%) recalled both | ||||
· Highlighted the importance of the format and content of reminder letters to improve uptake of cholesterol checks by making them distinguishable from a bill, conveying a personalised message and addressing logistical barriers | ||||||
55 | Pill, R. | 1988 | Invitation to attend a health check in a general practice setting: the views of a cohort of nonattenders | UK | Qualitative | · 236 (91%) recalled getting the invitation, 3% could not remember and 6% denied ever receiving the invitation |
259 men and women aged 20- 45 who did not respond to a mailed invitation for a health check at General Practice | Interview of nonattenders | |||||
· Reasons for non-attendance: 44% were not interested, 24% forgot to attend, 26% cited crises at home or work, 11% felt screening was inappropriate | ||||||
56 | Thompson, N. F. | 1990 | Inviting infrequent attenders to attend for a health check: costs and benefits | UK | Quasi-experimental | · 17/94 patients (18%) attended |
General Practice | Audit of sample of practice records (n=1488) to identify all 3- year nonattenders (n=114) an invitation including fixed appointment time was sent to 94 eligible patients | · Of the remaining 77 patients, 3 had moved home, 28 cancelled the appointment and nothing was heard from 45, the final patient had been admitted for a myocardial infarction before the appointment | ||||
Mailed fixed appointment | ||||||
94 patients who had not attended general practice within the previous 3 years were invited for a health check | ||||||
· Of those who cancelled, 8 were working or studying away from home, 4 found the appointment time unsuitable but did not wish to rearrange and 16 did not need or want an appointment | ||||||
· Those presenting were in general healthy with low levels of smoking and alcohol consumption and mild hypertension only diagnosed in one patient. | ||||||
57 | Hegarty, V. | 1995 | Reasons for nonresponse among older adults | UK | Letter to the editor describing study which invited over 75s for a health check | · 847 attended |
General practice | · 182 were untraceable (had moved home or were deceased) | |||||
1342 invited for a health check | ||||||
· 44 actively declined | ||||||
· 142 attended after a follow up telephone call | ||||||
· 120 did not attend because they had seen their GP within last 12 months | ||||||
Reasons for nonresponse were assessed with a questionnaire | ||||||
· 7 did not respond because of ill health | ||||||
· The variety of reasons for non-response indicated that non-attendance does not always equate to poor health | ||||||
58 | Levine, J. A. | 1991 | Are patients in favour of general health screening? | UK | Cross-sectional survey | · 315/375 (84%) attenders completed the questionnaire |
General Practice | Questionnaire | |||||
375 consecutive patients 198 individuals who had not attended general practice for 12 months | · 93/198 (47%) non-attenders completed the questionnaire · A significantly greater proportion of attenders (83%) indicated they would make an appointment and attend for health screening compared to nonattenders (66%) | |||||
· 33% of attenders would seek health screening even if not contacted by their doctor v 16% of nonattenders |