Proactive health risk screening for multiple motivational interventions in primary care patients: Methods, design and reach

Background:

Primary care settings provide facilitated access for prevention efforts, and E-health interventions have the potential to serve large populations. However, cost of proactive recruitment is a limiting factor. In addition, most e-health interventions are focused on single behavioral health risks making systematic screening ineffective. We describe methodological details of a proactive multipurpose health risk screening procedure in primary care patients and report data on reach of individuals.

Methods:

Study assistants proactively approached patients between 18 and 64 years from general practices and general hospitals at three sites for a computerized screening on harmful alcohol and tobacco consumption, depressiveness, insufficient fruit/vegetable consumption, physical inactivity and overweight. An automatic scoring algorithm allocated patients to one of five studies depending on their health risk pattern. We analyzed participation rates, participants' characteristics, and selection factors.

Results:

In total 12,757 patients were screened (participation rate: 86%) with 60% reporting at least two health risks. General practice patients reported fewer health risks (1.6 vs. 1.7) but more depressive symptoms (19% vs. 12%) than general hospital patients. Of all screening participants, 30% were eligible for a study (participation rates: 36 – 51%). Screening participation was associated with age and gender; study participation with socio-demographics, number of health risks and risk severity.

Conclusion:

E-health interventions have to be combined with proactive recruitment to achieve sufficient reach among users who were not ready to change behavior yet. Also, most individuals are exposed to multiple health risks. Therefore, screening procedures for multiple health risks are highly adequate. However, greater understanding is needed on how to offer study participation to efficiently increase participation rates, and on intervention strategies for patients presenting multiple health risks.