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Eur J Prev Cardiol. 2018 Aug;25(12):1326-1340. doi: 10.1177/2047487318780751. Epub 2018 Jun 19.

Barriers and facilitators to participation in a health check for cardiometabolic diseases in primary care: A systematic review.

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1 Julius Center for Health Sciences and Primary Care, University Medical Center, the Netherlands.
2 Department of Neurobiology, Care Science and Society, Karolinska Institutet, Sweden.
3 Functional Area of Emergency Medicine, Karolinska University Hospital, Sweden.
4 Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden.
5 NIVEL (Netherlands Institute for Health Services Research), the Netherlands.
6 University Library, Karolinska Institutet, Sweden.
7 Department of General Practice and Elderly Care Medicine, VU University Medical Center, the Netherlands.
8 Clinic of Social and Family Medicine, University of Crete, Greece.
9 Research Unit for General Practice, University of Southern Denmark, Denmark.
10 Department of General Practice, Charles University, Czech Republic.
11 Department of Medical Sciences, Uppsala University, Sweden.


Background Health checks for cardiometabolic diseases could play a role in the identification of persons at high risk for disease. To improve the uptake of these health checks in primary care, we need to know what barriers and facilitators determine participation. Methods We used an iterative search strategy consisting of three steps: (a) identification of key-articles; (b) systematic literature search in PubMed, Medline and Embase based on keywords; (c) screening of titles and abstracts and subsequently full-text screening. We summarised the results into four categories: characteristics, attitudes, practical reasons and healthcare provider-related factors. Results Thirty-nine studies were included. Attitudes such as wanting to know of cardiometabolic disease risk, feeling responsible for, and concerns about one's own health were facilitators for participation. Younger age, smoking, low education and attitudes such as not wanting to be, or being, worried about the outcome, low perceived severity or susceptibility, and negative attitude towards health checks or prevention in general were barriers. Furthermore, practical issues such as information and the ease of access to appointments could influence participation. Conclusion Barriers and facilitators to participation in health checks for cardiometabolic diseases were heterogeneous. Hence, it is not possible to develop a 'one size fits all' approach to maximise the uptake. For optimal implementation we suggest a multifactorial approach adapted to the national context with special attention to people who might be more difficult to reach. Increasing the uptake of health checks could contribute to identifying the people at risk to be able to start preventive interventions.


Health check; attendance; cardiometabolic disease; cardiovascular disease; diabetes; general practitioner; participation; prevention; primary care

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