Reach of Individuals at Risk for Cardiovascular Disease by Proactive Recruitment Strategies in General Practices, Job Centers, and Health Insurance.

Abstract

Reach of individuals at risk for cardiovascular disease (CVD) constitutes a major determinant of the population impact of preventive effort. This study compares three proactive recruitment strategies regarding their reach of individuals with CVD risk factors. Individuals aged 40-65years were invited to a two-stage cardio-preventive program including an on-site health screening and a cardiovascular examination program (CEP) using face-to-face recruitment in general practices (n=671), job centers (n=1049), and mail invitations from health insurance (n=894). The recruitment strategies were compared regarding the following: (1) participation rate; (2) participants' characteristics, i.e., socio-demographics, self-reported health, and CVD risk factors (smoking, physical activity, fruit/vegetable consumption, body mass index, blood pressure, high-density lipoprotein, triglycerides, and glycated hemoglobin); and (3) participation factors, i.e., differences between participants and non-participants. Screening participation rates were 56.0, 32.8, and 23.5% for the general practices, the job centers, and the health insurance, respectively. Among eligible individuals for the CEP, respectively, 80.3, 65.5, and 96.1% participated in the CEP. Job center clients showed the lowest socio-economic status and the most adverse CVD risk pattern. Being female predicted screening participation across all strategies (OR=1.45, 95% CI 1.07-1.98; OR=1.34, 95% CI 1.04-1.74; OR=1.62, 95% CI 1.16-2.27). Age predicted screening participation only within health insurance (OR=1.04, 95% CI 1.01-1.06). Within the general practices and the job centers, CEP participants were less likely to be smokers than non-participants (OR=0.49, 95% CI 0.26-0.94; OR=0.42, 95% CI 0.20-0.89). The recruitment in general practices yielded the highest reach. However, job centers may be useful to reduce health inequalities induced by social gradient.