Abstract
BackgroundNon-communicable diseases account for a growing proportion of deaths in Armenia, which require early detection to achieve disease control and prevent complications. To increase rates of screening, demand-side interventions of personalized invitations, descriptive social norms, labeled cash transfers, and conditional cash transfers were tested in a field experiment. Our complementary qualitative study explores factors leading to the decision to attend screening and following through with that decision, and experiences with different intervention components.MethodsInformed by the Health Belief Model as our conceptual framework, we collected eighty in-depth interviews with service users and twenty service providers and analyzed them using open coding and thematic analysis.ResultsAn individual’s decision to screen depends on 1) the perceived need for screening based on how they value their own health and perceive hypertension and diabetes as a harmful but manageable condition, and 2) the perceived utility of a facility-based screening, and whether screening will provide useful information on disease status or care management and is socially acceptable. Following through with the decision to screen depends on their knowledge of and ability to attend screenings, as well as any external motivators such as an invitation or financial incentive.ConclusionsPersonalized invitations from physicians can prompt individuals to reconsider their need for screening and can, along with financial incentives, motivate individuals to follow through with the decision to screen. The effect of descriptive social norms in invitations should be further studied. Efforts to increase preventive screenings as an entry point into primary care in Armenia may benefit from implementation of tailored messages and financial incentives.Trial registrationThe protocol was approved on January 11, 2019 by the Institutional Review Board of the Center of Medical Genetics and Primary Health Care in Armenia (02570094). https://www.socialscienceregistry.org/trials/3776.
Highlights
Non-communicable diseases account for a growing proportion of deaths in Armenia, which require early detection to achieve disease control and prevent complications
Globally, over 15 million people die prematurely every year due to non-communicable diseases (NCDs) and around 85% of those deaths occur in low- and middleincome countries (LMICs) [1, 2]
Of the 1.4 billion people living with diabetes globally, only half are aware of their diagnosis and more than 80% of undiagnosed cases live in LMICs [6]
Summary
Non-communicable diseases account for a growing proportion of deaths in Armenia, which require early detection to achieve disease control and prevent complications. Over 15 million people die prematurely every year due to non-communicable diseases (NCDs) and around 85% of those deaths occur in low- and middleincome countries (LMICs) [1, 2]. In addition to its own health consequences such as nerve damage and diabetic retinopathy if improperly managed, joins hypertension in increasing the risk of death from cardiovascular diseases such as heart attack and stroke [3,4,5]. 39.2% of people living with hypertension in LMICs have ever been diagnosed, contributing to the low proportion (10.3%) that achieve control of their blood pressure [7]. Screening of high-risk populations can be cost-effectively delivered in primary care facilities or by community health workers even in LMICs [8, 9]
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