Determinants Of Non-participation Research Articles

Determinants of Participation in a Web-Based Health Risk Assessment and Consequences for Health Promotion Programs

BackgroundThe health risk assessment (HRA) is a type of health promotion program frequently offered at the workplace. Insight into the underlying determinants of participation is needed to evaluate and implement these interventions.ObjectiveTo analyze whether individual characteristics including demographics, health behavior, self-rated health, and work-related factors are associated with participation and nonparticipation in a Web-based HRA.MethodsDeterminants of participation and nonparticipation were investigated in a cross-sectional study among individuals employed at five Dutch organizations. Multivariate logistic regression was performed to identify determinants of participation and nonparticipation in the HRA after controlling for organization and all other variables.ResultsOf the 8431 employees who were invited, 31.9% (2686/8431) enrolled in the HRA. The online questionnaire was completed by 27.2% (1564/5745) of the nonparticipants. Determinants of participation were some periods of stress at home or work in the preceding year (OR 1.62, 95% CI 1.08-2.42), a decreasing number of weekdays on which at least 30 minutes were spent on moderate to vigorous physical activity (ORdayPA0.84, 95% CI 0.79-0.90), and increasing alcohol consumption. Determinants of nonparticipation were less-than-positive self-rated health (poor/very poor vs very good, OR 0.25, 95% CI 0.08-0.81) and tobacco use (at least weekly vs none, OR 0.65, 95% CI 0.46-0.90).ConclusionsThis study showed that with regard to isolated health behaviors (insufficient physical activity, excess alcohol consumption, and stress), those who could benefit most from the HRA were more likely to participate. However, tobacco users and those who rated their overall health as less than positive were less likely to participate. A strong communication strategy, with recruitment messages that take reasons for nonparticipation into account, could prove to be an essential tool for organizations trying to reach employees who are less likely to participate.

Evaluation model of the Mexican national program for early cervical cancer detection and proposals for a new approach.

An evaluation model on cervical cancer (CC) prevention in Mexico was carried out during 1990-95, using three observation units: women at risk, screening providers, and use of health services. A diagnostic procedure of the pitfalls was applied to the following steps of the screening procedure: Pap sampling quality, cytological diagnosis validity, compliance of women, and determinants of nonparticipation. The low effectiveness of screening for CC is due principally to factors associated with quality and coverage. Quality of Pap is deficient; 64 percent of a random sample of specimens lacked endocervical cells. Reading centers presented false negative indices between 10 and 54 percent. Women seek screening in a late stage of disease (55 percent with CC seek care because they have symptoms). In addition, coverage is low; in women between 15 and 49 years of age in Mexico City, 64.2 percent have a history of Pap smears, compared with 30 percent in rural areas. Knowledge of what the Pap is used for strongly determines use of screening. In rural areas, only 40 percent know the purpose of the Pap. This information justifies an intervention to reorganize CC screening in Mexico, through strategies for improving compliance, quality, follow-up, and treatment for abnormal screens.