Abstract
BackgroundThis study was embedded in the Check-In randomised controlled trial that investigated the effectiveness of general practice-based preventive health checks on adverse health behaviour and early detection of non-communicable diseases offered to individuals with low socioeconomic positions. Despite successful recruitment of patients, the intervention had no effect. One reason for the lack of effectiveness could be low rates of referral to behaviour-change programmes in the municipality, resulting in a low dose of the intervention delivered. The aim of this study is to examine the referral pattern of the general practitioners and potential barriers to referring eligible patients to these behaviour-change programmes.MethodsA mixed-method design was used, including patients’ questionnaires, recording sheet from the health checks and semi-structured qualitative interviews with general practitioners. All data used in the study were collected during the time of the intervention. Logistic regressions were used to estimate odds ratios for being eligible and for receiving referrals. The qualitative empirical material was analysed thematically. Emerging themes were grouped, discussed and the material was re-read. The themes were reviewed alongside the analysis of the quantitative material to refine and discuss the themes.ResultsOf the 364 patients, who attended the health check, 165 (45%) were marked as eligible for a referral to behaviour-change programme by their general practitioner and of these, 90 (55%) received referrals. Daily smoking (OR = 3.22; 95% CI:2.01–5.17), high-risk alcohol consumption (OR = 2.66; 95% CI:1.38–5.12), obesity (OR = 2.89; 95% CI:1.61–5.16) and poor lung function (OR = 2.05; 95% CI:1.14–3.70) were all significantly associated with being eligible, but not with receiving referral. Four themes emerged as the main barriers to referring patients to behaviour-change programmes: 1) general practitioners’ responsibility and ownership for their patients, 2) balancing information and accepting a rejection, 3) assessment of the right time for behavioural change and 4) general practitioners’ attitudes towards behaviour-change programmes in the municipality.ConclusionWe identified important barriers among the general practitioners which influenced whether the patients received referrals to behaviour-change programmes in the municipality and thereby influenced the dose of intervention delivered in Check-In. The findings suggest that an effort is needed to assist the collaboration between general practices and the municipalities’ primary preventive services.Trial registrationClinical Trials NCT01979107; October 25, 2013.
Highlights
This study was embedded in the Check-In randomised controlled trial that investigated the effectiveness of general practice-based preventive health checks on adverse health behaviour and early detection of non-communicable diseases offered to individuals with low socioeconomic positions
Women were significantly more referred when compared to men (OR = 2.78; 95% 95% confidence interval (CI):1.48–5.22), while individuals of Western origins were less likely to be referred when compared to individuals of non-Western origins (OR = 0.33; 95% CI:0.13– 0.80)
We found no association between daily smoking, high-risk alcohol consumption, obesity, low forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) or combinations of these factors and receiving a referral to the behaviour-change programmes
Summary
This study was embedded in the Check-In randomised controlled trial that investigated the effectiveness of general practice-based preventive health checks on adverse health behaviour and early detection of non-communicable diseases offered to individuals with low socioeconomic positions. In the Check-In study we examined the effect of preventive health checks on adverse health behaviour and metabolic risk factors and non-communicable diseases, targeting individuals with low levels of education in a randomised controlled design. Patients with metabolic risk conditions such as hypertension, high cholesterol levels or low lung function could be referred to targeted behaviour-change programmes in the municipality. Even though the recruitment strategy in Check-In seemed successful in reaching the target group [7], the intervention had no effect on adverse health behaviour, levels of metabolic risk factors or incidence of non-communicable diseases [8]
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