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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Public Health 1/2015

Response and participation of underserved populations after a three-step invitation strategy for a cardiometabolic health check

BMC Public Health > Ausgabe 1/2015
Iris Groenenberg, Mathilde R. Crone, Sandra van Dijk, Jamila Ben Meftah, Barend J. C. Middelkoop, Willem J. J. Assendelft, Anne M. Stiggelbout
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12889-015-2139-x) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

MC, SD, WG, and AS filed the proposal for this study. The design, execution, and analysis were mainly done by IG and MC, in close collaboration with the research team. All authors had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. IG is guarantor. All authors read and approved the final manuscript.



Ethnic minority and native Dutch groups with a low socioeconomic status (SES) are underrepresented in cardiometabolic health checks, despite being at higher risk. We investigated response and participation rates using three consecutive inexpensive-to-costly culturally adapted invitation steps for a health risk assessment (HRA) and further testing of high-risk individuals during prevention consultations (PC).


A total of 1690 non-Western immigrants and native Dutch with a low SES (35–70 years) from six GP practices were eligible for participation. We used a ‘funnelled’ invitation design comprising three increasingly cost-intensive steps: (1) all patients received a postal invitation; (2) postal non-responders were approached by telephone; (3) final non-responders were approached face-to-face by their GP. The effect of ethnicity, ethnic mix of GP practice, and patient characteristics (gender, age, SES) on response and participation were assessed by means of logistic regression analyses.


Overall response was 70 % (n = 1152), of whom 62 % (n = 712) participated in the HRA. This was primarily accomplished through the postal and telephone invitations. Participants from GP practices in the most deprived neighbourhoods had the lowest response and HRA participation rates. Of the HRA participants, 29 % (n = 207) were considered high-risk, of whom 59 % (n = 123) participated in the PC. PC participation was lowest among native Dutch with a low SES.


Underserved populations can be reached by a low-cost culturally adapted postal approach with a reminder and follow-up telephone calls. The added value of the more expensive face-to-face invitation was negligible. PC participation rates were acceptable. Efforts should be particularly targeted at practices in the most deprived areas.
Additional file 1: Exclusion criteria. Detailed list of exclusion criteria for study participation. (DOCX 15 kb)
Additional file 2: (Cultural) Adaptations to invitation, HRA, and information brochure. Detailed list of (cultural) adaptations made to invitation, HRA, and information brochure. (DOCX 1971 kb)
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