Health Checks in vulnerable groups: the role of beliefs and expectations.

To compensate for all the commercial, untargeted self tests and health checks,
the NHG guideline 'PreventieConsult, module Cardiometabool' has been developed.
This guideline offers instructions to screen 45 - 70 year olds for
cardiovascular disease, diabetes mellitus type 2, and kidney failure.
Therefore, the PreventieConsult is aimed at people nót diagnosed with these
conditions but possibly having an increased risk.
The PreventieConsult intends to:
- Offer a structured interpretation of prevention in general practice.
- Meet the patient's wish to know more about their risk of certain conditions
and the need to prevent the onset of disease.

The PreventieConsult consists of two parts:
- The Health Risk Assessment (HRA). This is a short questionnaire with which
the risk of cardiometabolic disease can be estimated.
- Two consultations with the GP. These consultations are only for people with
an increased risk according to the HRA. During the consultations,
the GP will perform physical measurements and labwork will be done. People
will receive lifestyle advice and, if necessary, medication.

Experience tells us, and research has demonstrated, that preventive screening -
like the PreventieConsult - reach certain groups better than others. Groups who
respond well are generally health conscious, highly educated, native Dutch.
They are also called the 'worried well' because usually they do not have an
increased risk of cardiometabolic disease. Groups who usually do have an
increased risk and respond less are non-Western immigrants and native Dutch
with a low SES, from now on called 'vulnerable groups'. Possibly, current
preventive health initiatives do not match well with the expectations of these
groups and their health beliefs.

The objective of this study is to develop practical tools for GPs to increase
participation of vulnerable patient populations in both the HRA as well as the
consultations at the GP.
To achieve this, various strategies will be tested to maximize participation in
the PreventieConsult of vulnerable groups. Among these strategies are different
invitation and tailoring strategies (personalized information).

Research questions:
1. What is the participation rate in a (culturally) tailored postal HRA for our
target groups?
2. Can this participation rate in a (culturally) tailored postal HRA be
increased by:
- A telephone call to non-responders?
- A personal approach for subsequent non-responders when they visit their
GP?
3. What are (practical and psychological) determinants of participants versus
non-participants in the postal - telephone - personal HRA?
4. What are (practical and psychological) determinants of participants versus
non-participants in the consultations at the GP after receiving a
test result 'increased risk' from the postal - telephone - personal HRA?

Non-randomized, no control intervention study.

Invitation strategies:
Currently, the HRA is provided by mail or online.
In this study, the effect of three invitation strategies will be tested:
1. The usual strategy: all patients will receive an invitation letter from
their GP to participate in the HRA, either online or by mail.
2. All patients who have not responded to the postal invitation will receive a
telephone call and are invited to participate in the HRA by phone.
3. All patients who have not responded to the telephone call will be approached
in person when they visit their GP for an unrelated consultation and are
invited to participate in the HRA.

Tailoring strategies:
Tailoring strategies are applied to provide individual persons with (parts of)
an intervention. The idea behind this is that characteristics of an
intervention that are individually relevant to a specific person are more
attractive than a generic population-wide intervention. This way, an
intervention is more effective.
Written tailoring strategies (applied during invitation strategy 1) are for
example: personal letter (own name) and cultural lay-out (images / pictures
people with same ethnic background, own language).
Oral tailoring strategies (applied during invitation strategy 2 and 3) are for
example: approach by people with same ethnic background and in their own
language. Also, during a personal conversation we will investigate individual
reasons to participate or not in both the HRA and the consultations at the GP.
We will use these reasons to abate ambivalence in non-participants and doubters
and to motivate them to participate.

Burden mainly consists of time needed to fill out the HRA, a questionnaire, and
possibly for attending consultations at the GP (in case of increased risk).

Risk mainly consists of psychosocial consequences as a result of a
disadvantageous test result of the PreventieConsult; increased risk of
cardiometabolic disease. Participants with a newly found increased risk of
cardiometabolic disease will have the chance to change their (unhealthy)
lifestyle and thus prevent disease at a later age; health benefits.