Guertler Diana, Meyer Christian, Dörr Marcus, Braatz Janina, Weymar Franziska, John Ulrich, Freyer-Adam Jennis, Ulbricht Sabina
Institute of Social Medicine and Prevention, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany.
DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany.
Int J Behav Med. 2017 Feb;24(1):153-160. doi: 10.1007/s12529-016-9584-5.
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 40-65 years 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.
心血管疾病（CVD）高危个体的覆盖范围是预防工作对人群影响的主要决定因素。本研究比较了三种主动招募策略对有CVD危险因素个体的覆盖范围。
邀请40 - 65岁个体参加一个两阶段的心脏预防项目，该项目包括现场健康筛查和心血管检查项目（CEP），通过在普通诊所（n = 671）、就业中心（n = 1049）进行面对面招募以及由健康保险公司发送邮件邀请（n = 894）。对招募策略在以下方面进行比较：（1）参与率；（2）参与者特征，即社会人口统计学、自我报告的健康状况以及CVD危险因素（吸烟、身体活动、水果/蔬菜摄入量、体重指数、血压、高密度脂蛋白、甘油三酯和糖化血红蛋白）；（3）参与因素，即参与者与非参与者之间的差异。
普通诊所、就业中心和健康保险公司的筛查参与率分别为56.0%、32.8%和23.5%。在符合CEP条件的个体中，分别有80.3%、65.5%和96.1%参与了CEP。就业中心的客户社会经济地位最低，CVD风险模式最不利。在所有策略中，女性是筛查参与的预测因素（比值比[OR]=1.45，95%置信区间[CI]1.07 - 1.98；OR = 1.34，95% CI 1.04 - 1.74；OR = 1.62，95% CI 1.16 - 2.27）。年龄仅在健康保险公司的招募中是筛查参与的预测因素（OR = 1.04，95% CI 1.01 - 1.06）。在普通诊所和就业中心，CEP参与者吸烟的可能性低于非参与者（OR = 0.49，95% CI 0.26 - 0.94；OR = 0.42，95% CI 0.20 - 0.89）。
在普通诊所进行招募的覆盖范围最高。然而，就业中心可能有助于减少社会梯度导致的健康不平等。
