Non-participation in a targeted prevention program aimed at lifestyle-related diseases: a questionnaire-based assessment of patient-reported reasons

Christian Leick, Lars Bruun Larsen, Anders Larrabee Sonderlund, Nanna Herning Svensson, Jens Sondergaard, Trine Thilsing, Christian Leick, Lars Bruun Larsen, Anders Larrabee Sonderlund, Nanna Herning Svensson, Jens Sondergaard, Trine Thilsing

Abstract

Background: Having an unhealthy lifestyle is associated with a higher risk of developing lifestyle-related diseases. Current evidence suggests that interventions targeting health-risk behaviors can help people improve their lifestyles and prevent lifestyle-related diseases. However, preventive programs are often challenged by low participation rates. Reasons for non-participation include lack of time and/or interest, and/or no perceived need for lifestyle intervention. This study explores causes for non-participation in a sample of people who chose not to take up a targeted preventive program (TOF pilot2 study). Patient-reported reasons as well as sociodemographic characteristics and lifestyle factors are in focus.

Methods: A total of 4633 patients from four Danish GP clinics received an invitation to take part in the TOF pilot2 study. Patients who chose not to participate in the TOF pilot2 study were asked to fill in a questionnaire concerning reasons for non-participation, lifestyle, BMI and self-rated health. Descriptive analyses were used to summarize the results.

Results: A total of 2462 patients (53.1%) chose not to participate in the TOF pilot2 study. Among these, 84 (3.4%) answered the full questionnaire on reasons for not participating, lifestyle, BMI and self-rated health. The most common reasons for non-participation were lack of time, having an already healthy lifestyle, and feeling healthy. Based on their self-reported lifestyle 45 (53.6%) of the non-participants had one or more health-risk behaviors including smoking, unhealthy diet, BMI ≥ 35 and/or sedentary lifestyle and were therefore eligible to receive the targeted intervention at the GP or the MHC in the original TOF pilot2 study.

Conclusion: When planning future preventive programs it is important to know the main reasons for patients to not participate. This study provides rare insight into why people opt out of health interventions and advances the evidence base in this area. Our results may inform efforts to better involve these patients in preventive health programs.

Trial registration: Trial registration number: NCT02797392 .

Keywords: Disease prevention; Health check intervention; Lifestyle; Lifestyle-related diseases; Non-participation; Non-response; Preventive program; Primary care; Risk perception.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart of the TOF pilot2 study population

References

    1. Klatsky A. Alcohol and cardiovascular diseases: where do we stand today? J Intern Med. 2015;278(3):238–250.
    1. Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol. 2011;2(2):1143–1211.
    1. Sami W, Ansari T, Butt NS, Ab Hamid MR. Effect of diet on type 2 diabetes mellitus: A review. Int J Health Sci. 2017;11(2):65.
    1. US Department of Health, Human Services . The health consequences of smoking—50 years of progress: a report of the Surgeon General. Atlanta GA: US Department of Health and Human Services, Centers for Disease; 2014.
    1. Mathers C, Stevens G, Hogan D, Mahanani WR, Ho J. Global and regional causes of death: patterns and trends, 2000–15. 2017.
    1. Ambrosino N, Bertella E. Lifestyle interventions in prevention and comprehensive management of COPD. Breathe. 2018;14(3):186–194.
    1. Schellenberg ES, Dryden DM, Vandermeer B, Ha C, Korownyk C. Lifestyle interventions for patients with and at risk for type 2 diabetes: a systematic review and meta-analysis. Ann Intern Med. 2013;159(8):543–551.
    1. Badenbroek IF, Nielen MM, Hollander M, Stol DM, de Wit NJ, Schellevis FG. Characteristics and motives of non-responders in a stepwise cardiometabolic disease prevention program in primary care. Eur J Public Health. 2021;31(5):991–96.
    1. Groeneveld IF, Proper KI, van der Beek AJ, Hildebrandt VH, van Mechelen W. Factors associated with non-participation and drop-out in a lifestyle intervention for workers with an elevated risk of cardiovascular disease. Int J Behav Nutr Phys Act. 2009;6(1):80.
    1. Cheung KL, Peter M, Smit C, de Vries H, Pieterse ME. The impact of non-response bias due to sampling in public health studies: a comparison of voluntary versus mandatory recruitment in a Dutch national survey on adolescent health. BMC Public Health. 2017;17(1):1–10.
    1. Lakerveld J, IJzelenberg W, Van Tulder MW, Hellemans IM, Rauwerda JA, Van Rossum AC, et al. Motives for (not) participating in a lifestyle intervention trial. BMC Med Res Methodol. 2008;8(1):17.
    1. Larsen LB, Sonderlund AL, Sondergaard J, Thomsen JL, Halling A, Hvidt NC, et al. Targeted prevention in primary care aimed at lifestyle-related diseases: a study protocol for a non-randomised pilot study. BMC Fam Pract. 2018;19(1):124.
    1. Thilsing T, Larsen LB, Sonderlund AL, Andreassen SS, Christensen JR, Svensson NH, et al. Effects of a Co-Design-Based Invitation Strategy on Participation in a Preventive Health Check Program: Randomized Controlled Trial. JMIR Public Health Surveill. 2021;7(3):e25617.
    1. Agency for Digitisation. MoF. 04/03/2021. Available from: .
    1. Murray J, Craigs CL, Hill KM, Honey S, House A. A systematic review of patient reported factors associated with uptake and completion of cardiovascular lifestyle behaviour change. BMC Cardiovasc Disord. 2012;12(1):120.
    1. Harte E, MacLure C, Martin A, Saunders CL, Meads C, Walter FM, et al. Reasons why people do not attend NHS Health Checks: a systematic review and qualitative synthesis. Br J Gen Pract. 2018;68(666):e28–e35.
    1. Toft UN, Kristoffersen LH, Aadahl M, von Huth SL, Pisinger C, Jørgensen T. Diet and exercise intervention in a general population—mediators of participation and adherence: the Inter99 study. Eur J Pub Health. 2007;17(5):455–463.
    1. Petter J, Reitsma-van Rooijen MM, Korevaar JC, Nielen MM. Willingness to participate in prevention programs for cardiometabolic diseases. BMC Public Health. 2015;15(1):44.
    1. Chien S-Y, Chuang M-C, Chen I. Why people do not attend health screenings: Factors that influence willingness to participate in health screenings for chronic diseases. Int J Environ Res Public Health. 2020;17(10):3495.
    1. Christensen J, Sandbæk A, Lauritzen T, Borch-Johnsen K. Population-based stepwise screening for unrecognised Type 2 diabetes is ineffective in general practice despite reliable algorithms. Diabetologia. 2004;47(9):1566–1573.
    1. Martinez FJ, Raczek AE, Seifer FD, Conoscenti CS, Curtice TG, D'Eletto T, et al. Development and initial validation of a self-scored COPD Population Screener Questionnaire (COPD-PS) J Chron Obstruct Pulmon Dis. 2008;5(2):85–95.
    1. European Society of Cardiology. Heartscore webpage [Available from: .
    1. Socialstyrelsen S. Sjukdomsförebyggande metoder Vetenskabeligt underlag för nationella riktlinjer Svenska Socialstyrelsen. 2011.
    1. Danish Health Authority. Sundhedsstyrelsens udmeldinger om alkohol 2019 [cited 2020 Nov 24.]. Available from: .
    1. Wigertz A, Lönn S, Hall P, Feychting M. Non-participant characteristics and the association between socioeconomic factors and brain tumour risk. J Epidemiol Community Health. 2010;64(8):736–743.
    1. Hertzum-Larsen R, Kjær SK, Frederiksen K, Thomsen LT. Participation in cervical cancer screening among immigrants and Danish-born women in Denmark. Prev Med. 2019;123:55–64.
    1. Schinkel S, Schouten BC, Kerpiclik F, Van Den Putte B, Van Weert JC. Perceptions of barriers to patient participation: Are they due to language, culture, or discrimination? Health communication. 2018.
    1. Nielsen JB, Leppin A, e Gyrd-Hansen D, Jarbøl DE, Søndergaard J, Larsen PV. Barriers to lifestyle changes for prevention of cardiovascular disease–a survey among 40–60-year old Danes. BMC Cardiovasc Disord. 2017;17(1):245.
    1. Seguin R, Connor L, Nelson M, LaCroix A, Eldridge G. Understanding barriers and facilitators to healthy eating and active living in rural communities. J Nutr Metab. 2014;2014:146502.
    1. Schröer S, Haupt J, Pieper C. Evidence-based lifestyle interventions in the workplace—an overview. Occup Med. 2014;64(1):8–12.
    1. Cahill K, Lancaster T. Workplace interventions for smoking cessation. Cochrane Database Syst Rev. 2014;(2):CD003440.
    1. Groeneveld IF, Proper KI, van der Beek AJ, Hildebrandt VH, van Mechelen W. Lifestyle-focused interventions at the workplace to reduce the risk of cardiovascular disease-a systematic review. Scand J Work Environ Health. 2010;36(3):202–15.
    1. Nagelhout GE, Abidi L, de Vries H. Reasons for (not) participating in a community-based health promotion program for low-income multi-problem households in the Netherlands: A qualitative study. Health Soc Care Community. 2021;29(1):241–249.
    1. Homko CJ, Santamore WP, Zamora L, Shirk G, Gaughan J, Cross R, et al. Cardiovascular disease knowledge and risk perception among underserved individuals at increased risk of cardiovascular disease. J Cardiovasc Nurs. 2008;23(4):332–337.
    1. Azahar N, Ismail Z, Hassan R, Yusoff K. PS 15–01 Mismatch between actual risk and perceived risk for cardiovascular disease among elderly in a rural population of Malaysia. J Hypertens. 2016;34:e459.
    1. Stol DM, Hollander M, Damman OC, Nielen MM, Badenbroek IF, Schellevis FG, et al. Mismatch between self-perceived and calculated cardiometabolic disease risk among participants in a prevention program for cardiometabolic disease: a cross-sectional study. BMC Public Health. 2020;20:1–9.
    1. Nolan T, Dack C, Pal K, Ross J, Stevenson FA, Peacock R, et al. Patient reactions to a web-based cardiovascular risk calculator in type 2 diabetes: a qualitative study in primary care. Br J Gen Pract. 2015;65(632):e152–e160.
    1. Damman O, van der Beek A, Timmermans D. Employees are ambivalent about health checks in the occupational setting. Occup Med. 2015;65(6):451–458.
    1. Attwood S, Morton K, Mitchell J, Van Emmenis M, Sutton S. Reasons for non-participation in a primary care-based physical activity trial: a qualitative study. BMJ Open. 2016;6(5):e011577.
    1. Metzger MJ. Privacy, trust, and disclosure: Exploring barriers to electronic commerce. J Computer-Mediated Commun. 2004;9(4):JCMC942.
    1. Caine KE, Burnham KE, Fisk AD, Rogers WA, editors. Privacy concerns and disclosure behavior in a health setting. Proceedings of the Human Factors and Ergonomics Society Annual Meeting; 2008: SAGE Publications Sage CA: Los Angeles, CA.
    1. Westin AF. The Dimensions of Privacy: A National Opinion Research Survey of Attitudes Toward Privacy. 1979.
    1. Jenkinson CE, Asprey A, Clark CE, Richards SH. Patients’ willingness to attend the NHS cardiovascular health checks in primary care: a qualitative interview study. BMC Fam Pract. 2015;16(1):1–10.
    1. Burgess C, Wright AJ, Forster AS, Dodhia H, Miller J, Fuller F, et al. Influences on individuals’ decisions to take up the offer of a health check: a qualitative study. Health Expect. 2015;18(6):2437–2448.
    1. Engebretson J, Mahoney JS, Walker G. Participation in community health screenings: a qualitative evaluation. J Community Health Nurs. 2005;22(2):77–92.
    1. Badenbroek IF, Nielen MM, Hollander M, Stol DM, Drijkoningen AE, Kraaijenhagen RA, et al. Mapping non-response in a prevention program for cardiometabolic diseases in primary care: How to improve participation? Preventive Medicine Reports. 2020:101092.
    1. Larsen LB, Sondergaard J, Thomsen JL, Halling A, Sønderlund AL, Christensen JR, et al. Step-wise approach to prevention of chronic diseases in the Danish primary care sector with the use of a personal digital health profile and targeted follow-up–an assessment of attendance. BMC Public Health. 2019;19(1):1–14.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe