Abstract
Background: 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).
Methods: 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 nonresponders 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.
Results: 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.
Conclusions: 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. Background Cardiometabolic disease (CMD), namely cardiovascular disease (CVD), diabetes mellitus (DM), and kidney failure, is a leading cause of death in high-income countries [1]. CMD risk is related to low socioeconomic status (SES) and a non-Western origin [2, 3]. In The Netherlands, CVD prevalence and mortality are particularly high among Surinamese and Turkish people [4, 5]. Turkish, Moroccans, and especially Hindustani Surinamese have a higher DM risk [6]. As CMD is largely preventable, focus has shifted towards primary prevention among high-risk individuals and, as a result, health checks have been implemented in various countries [7–9]. A non-Western origin and a low SES are associated with lower health check attendance [10]. This selective non-attendance contributes to inequalities in health gains from screening. Efforts to increase participation of these underserved (difficult-to-reach, high-risk) populations are therefore relevant, and a prerequisite for cost-effectiveness [11, 12]. Attempts to increase participation in health checks in the general population usually compared postal, telephone, and face-to-face strategies in pa