Table 4 Summary of included studies

20

Bletzer, K. V.

1989

Review of a health fair screening program in Mid-Michigan

America

Programme evaluation Evaluation of sociodemographic data on attenders at health fairs over seven years and findings from a survey with a sample of participants

· Women consistently outnumbered men by a ratio of at least 3:2 every year

Health fair Open access 15124 participants

· Older people were more likely to present than younger people, with half of participants older than 50

· 90% of those surveyed had consulted their GP within the past two years

· The number of serious problems identified was low

· The main reason for attendance was “curiosity about health”

21

Culica, D.

2002

Medical checkups: Who does not get them?

America

Telephone survey

· Reduced likelihood of having had health check in the previous 12 months was associated with being: 25-44 or over 65, male, unmarried, a smoker and in those who perceived cost barriers

· Check ups were more likely in people who earned over $75,000, had health insurance, were physically active, had chronic disease and who rated their health as good, fair or poor rather than good or excellent

Sample of 3600 individuals

22

Greenland, P.

2002

Attendance patterns and characteristics of participants in public cholesterol screening

America

Programme evaluation of cholesterol screening programme

· Participants more likely to be white (98.5% v 96.7%), older, female (59.9% v 51.6%) and better educated than the general population

Cholesterol screening

Comparison of participant demographics with local census data

· 22% had previous diagnosis of high cholesterol and came to confirm/monitor previous readings

Open access

· 79% came to the store specifically for screening

10 supermarkets

· Time was an important factor as weekend and weeknights attracted more men and younger people than weekday screenings

8583 people were seen over 4months

· Less than 5% took time off work to participate

23

Waller, D.

1990

Health checks in general practice: Another example of inverse care?

UK

Programme evaluation

· 1458 patients (65.9%) were offered screening

· Of those invited 963 (66%) attended for a health check

Attendance at General Practice health checks over

Medical record audit and postal questionnaire

· Attenders were more likely to be women, aged 45yrs or older, married, non-smokers and of higher social class than the non-responders to the invitation

2211 men and women aged 35-64 were in the target age group

· Relative likelihood for non-attendance was 1.24 for smokers, 1.20 for the overweight, 1.16 for heavy drinkers, 1.28 for those with a less healthy diet

Men were invited opportunistically, women were invited in the context of cervical smear tests

· Frequent GP consulters were more likely to attend

24

Jacobsen, B. K.

1992

The Nordland Health Study - Design of the Study, Description of the Population, Attendance and Questionnaire Response

Norway

Quasiexperimental and survey

· 82% attended the screening

Health screening

· 78% men and 86% women attended

Population screening and questionnaire

· Non-attenders tended to be single

· 84% married men attended screening compared to 65% divorced/single or widowed men

Letter invitation

10497 patients aged 40-42 were invited

· 88% married women attended compared to 79% divorced/single or widowed women

25

Simpson, W. M.

1997

Screening for risk factors for cardiovascular disease: A psychological perspective

UK

1. Quasi-experimental

· Overall uptake 62.4%; 59% at further education college, 28% at council cleansing department, 81% at greetings card factory.

3 studies (only two were relevant to literature review)

Mobile screening programme and prospective questionnaire

· In general attenders were significantly older and more likely to be female than non-attenders

1. Worksite screening at three workplaces:

2. Longitudinal

· Attenders were more likely to have had a definite intention to attend, and were more aware of the availability of the service

Random allocation of invitation type

Further education college

· Non-attenders perceived more barriers to attendance and perceived themselves to be at higher risk of developing serious diseases

Two questionnaires:

Council Cleansing department

One week after screening to assess intention to change behaviour

· The lower uptake at the council was attributed to the higher ratio of male to female employees, a lower education level and the youngest average age of all the workplaces

Greetings card factory

Open access

2. Organisation of a screening programme

· Uptake varied by invitation type

Three months after screening to measure behaviour change

· 100% opportunistic patients, 54% of those invited by letter and 29% personally invited attended the screening clinic

General Practice

Uptake by invitation type:

· The method of offering screening did not affect changes in behaviour but those who engaged opportunistically were more likely to intend to smoke less.

1. Opportunistic screening by GP

2. Invitation and fixed appointment to attend screening with practice nurse

· Patients who engaged after being invited by letter or personally were more likely to eat less fat and take more exercise than those who engaged opportunistically

· Smokers were likely to attend than non-smokers

3. Personal invite by GP to make appointment for screening clinic with practice nurse

210 male patients

26

Thomas, K. J.

1993

Case against targeting long term non-attenders in general practice for a health check.

UK

Quasiexperimental Patient records were randomly sampled to assess attendance over a 3 year period.

· The median proportion of 3 year non-attenders was 23% in inner city practice compared to 9% in other practices

30 General Practices

Mailed invitations

· 310/679 non-attenders were not contactable v 320/379 attenders who were contactable. This was related to last recorded consultation

Random sample of 679 patients who had not attended for 3 years and 379 patients who had attended within this time

A sample of those who had attended in the past 3 years were invited for a health check and were invited to take part in a home interview two weeks before the health check

· Non-attenders were more likely to be female. Female non-attenders were more likely to be older than male non-attenders

· Non-attenders scored significantly better on six measures of perceived health status and used less accident and emergency services and preventive health care than attenders

Age 16-74

Non-attenders were invited to a health check but were not interviewed

27

Wall, M.

2004

Non-participants in a preventive health examination for cardiovascular disease: characteristics, reasons for nonparticipation, and willingness to participate in the future

Sweden

Quasi-experimental

· 237 persons (76.7%) participated

Ockelbo project

Preventive health examination

· Of 72 non-attenders at the health examination, 53 (73.6%) responded to the questionnaire, 14 (19.4%) agreed to a telephone interview and 5 (6.9%) did not respond

309 persons aged 35 or 40yrs were invited to participate in a health examination

Follow up questionnaire mailed to nonparticipants

Follow up telephone interview with non-participants who did not respond to questionnaire

· The proportion of smokers was significantly higher in non-attenders v attenders at the health check (31.3% v 18.6%)

· Reasons for non-attendance included: lack of time or hindrances at work (52%), already in contact with health services (33%), or because they felt healthy (21%)

· However the majority of non-attenders (55%) said they would be interested in attending in the future, 28% said they were not sure, and 16% said they would not be interested

28

Cherrington, A.

2007

Do adults who believe in periodic health examinations receive more clinical preventive services?

America

Telephone survey

· Non-endorsers of periodic health examinations received less preventive services

Telephone survey

Logistic regression analysis of phone survey to assess attitudes towards periodic health examinations and the receipt of preventive services

4879 respondents

· 8.5% (n=374) did not endorse annual periodic health examinations

· Non-endorsers tended to be male (odd ratio (OR) 1.64), younger (OR 0.87), white (OR 2.91), to have at least some college education (OR 1.43) and feel healthy (1.85)

· 56% of non-endorsers had received a cholesterol check in the previous 5 years compared to 81% of endorsers

29

Karwalajtys, T.

2005

A randomized trial of mail vs. telephone invitation to a community-based cardiovascular health awareness program for older family practice patients

Canada

Prospective

· 58.3% of invited patients attended

1 family physician practice

randomised trial of invitation to attend community based by mail or telephone

· Patients invited by phone were more likely to attend than those by mail (72.3% v 44.0%)

5 community pharmacies

· Patients with a family history of cardiovascular disease were significantly more likely to attend

Telephone and mailed invitation

235 patients aged 65+

Health record review

30

Hsu, H.Y.

2001

The relationships between health beliefs and utilization of free health examinations in older people living in a community setting in Taiwan

Taiwan

Cross-sectional survey

· Higher uptake of health examination in those with higher education and socio-economic status, and those with increased family support (6% of users lived alone compared to 13% of non-users)

Free health examination in over 65s

Stratified random systematic sample of 200 men and women were given a 17 item health belief scale to complete

100 participants

· Users perceived a higher level of seriousness and susceptibility to ill health than non-users

100 nonparticipants

31

Bowden, R. G.

2001

Comparisons of cholesterol screening participants and non-participants in a university setting

America

Case–control analysis of participants in worksite screening

· Participants were more likely to be male (68.5% v 53.7%), older (47.0 years v 40.4 years), white (91.9% v 78.7%), have a college degree (85.9% v 51.3%) and have higher mean salaries than nonparticipants ($50,054 v $30,009)

Worksite screening

University

Invite with pay check

· Barriers to uptake in non-attenders were suggested to be cost, less flexible working hours, lack of access to communication methods including email, conspiracy theories around the employer’s motives and that the workers did not feel sick and did not need screened

270 participants

587 random sample of nonparticipants

32

Franks, P.

1991

Barriers to Cholesterol Testing in a Rural- Community

America

Cross-sectional population based survey

· 24% reported prior cholesterol testing

Cholesterol check

· Factors associated with a reduced likelihood of ever having a cholesterol test: age under 45, less than 12 years education, income of less than $10,00, no health insurance, no doctor visit in past year, practicing 3+ cardiovascular risk factors

Invitation by telephone, leaflets and home visits

Logistic regression

557 households contacted 508 (91%) participated Survey of 1063 people

973 (92%) screened for cholesterol

33

Jones, A.

1993

Comparison of risk factors for coronary heart disease among attenders and nonattenders at a screening programme

Wales

Case control

· Non-attenders were more likely to be older, have higher body mass index, cholesterol and blood pressure, and low socio-economic status, a personal/family history of heart disease, be smokers, have low educational level and high alcohol consumption than attenders

General Practice

Random systematic sample of 1398 non-attenders identified 140 individuals who were repeatedly contacted and encouraged to attend a health check.

Mailed open invitation then fixed appointment mailed, telephone call and home visit for nonresponders

· Reasons given for not attending the initial screening programme were varied with 36.7% claiming not to have received the letter and 26.5% citing practical barriers

3800 patients invited for health check

2402 (63.2%) attended

98 non-attenders eventually presented for a health check and their results were compared to initial attenders

Aged 25-55 years

34

Sonne-Holm, S.

1989

Influence of fatness, intelligence, education and sociodemographic factors on response rate in a health survey

Denmark

Case control

· 964 obese (58%) and 1134 controls (75%) attended a health examination

Health examination

Survey of cohort of severely obese men with a randomly selected control group invited to a health examination

· Regardless of study group, the response rate was independently associated with decreasing body mass index and increasing intelligence test score, educational level, social class, age up to 50 years old and proximity of residence to the screening location

362,200 male draftees to Danish military board

Mailed invitation and reminder

1651 identified as severely obese draftees

1504 controls were randomly selected from the remaining population

35

Walker, M.

1987

Non-participation and mortality in a prospective study of cardiovascular disease

UK

British Regional Heart Study

· 7735 men (74.3%) participated in the study

Comparison of characteristics and mortality levels of participants and non-participants in clinical examination

· Non-participants had a significantly higher relative risk of death during the first three years after the screening date

Prospective study of cardiovascular disease in middle aged men

· Non-participants were more likely to be younger, unmarried and less skilled workers than participants

Sample of 10412 men aged 40-59 years

36

Thorogood, M.

1993

Factors affecting response to an invitation to attend for a health check

UK

Quasi-experimental

· 2205 attended (82.3%)

5 General Practices

Postal questionnaire before invite to attend a health check and subsequent record of attendance

· Non-attendance was higher in males than females (21% v 15%)

Invitation by mail or telephone, or opportunistically plus up to 3 reminders

· Non-attenders were more likely to be single than married (24% v 16%), manual rather non-manual workers (21% v 15%), living in rented accommodation rather than homeowners (29% v 16%) and not have access to a car rather than be a car user (27% v 16%)

2678 patients aged 35-64 were invited to attend a health check

· Non-attenders were less healthy than attenders as shown by following odd ratios: 1.74 smokers, 1.07 heavy drinkers, 1.91 less healthy diet, 1.50 for obese patients

· Attenders were more likely to visit their GP frequently and indicate a willingness to change their behaviour

37

Dignan, M. B.

1995

Factors associated with participation in a preventive cardiology service by patients with coronary heart disease

America

Prospective cohort/Qualitative

· 24 patients (39%) attended the clinic

Cardiology clinic

· No statistically significant demographic differences were found between attenders and non-attenders

Face to face open invitation and follow up letter

Telephone interviews

· Patients who attributed their hospitalisation to a heart attack or coronary bypass surgery were more likely to attend the clinic than those who attributed admission to chest pain or for diagnostic reasons

62 patients

Follow up of patients who were hospitalised for heart related conditions to assess reasons for nonattendance at secondary prevention clinic

38

Griffiths, C.

1994

Registration health checks: Inverse care in the inner city?

UK

Survey

· Non-attenders were significantly more likely to be unemployed, African, heavy smokers and of lower social class than attenders.

7 GP practices

Questionnaire analysis

Face to face open invitation

· Demonstrated that invitations to health checks given in an unselected way are least likely to engage with those in most need

356 patients: 101 declined/provided inadequate data

Of the remaining 256 patients, 118 attended a health check (46%)

39

Wilson, S.

1997

Health beliefs of blue collar workers: increasing self efficacy and removing barriers

USA

Cross-sectional, descriptive, expost facto questionnaire

· 151 (75.5%) completed questionnaires

Health beliefs of participants and non-participants in worksite blood pressure and cholesterol screening

· 45 workers (22.5%) subsequently attended a health check

· No significant difference between respondents and participants by age, race, education, gender, marital status, shift or health history

Worksite screening

· Workers who participated in the screening had significantly higher self-efficacy and perceived significantly fewer barriers to participation than non-attenders

Convenience sample 200 blue collar workers

40

Boshuizen, H. C.

2006

Non-response in a survey of cardiovascular risk factors in the Dutch population: Determinants and resulting biases

Netherlands

Logistic regression of determinants of participation in a health examination survey in previous participants in a health interview study

· 28.9% patients participated in a health examination that had participated in an earlier health interview survey

Health examination

3699 participants from a sample of

· Participants were more likely to be male and have high socio-economic status

12786 previous participants

· Participation increased with age until 60 then decreased sharply thereafter

· The rural population were less likely to participate

· There was evidence of the “worried well” with frequent consulters and those with good health more likely to attend

· The unemployed were least likely to attend but participation decreased with increasing hours of work

41

Pill, R.

1985

Invitation to attend a health check in a general practice setting: comparison of attenders and non-attenders

UK

Quasi-experimental

· Attenders were generally better educated, of higher social status, had greater health motivation, fewer ties and commitments, attended church more regularly, employed, performed more health approved practices, had had more recent contact with GP, and accepted the legitimacy of the doctor’s interest in their lifestyle than nonattenders

Health check

Comparison of demographics, attitudes, beliefs, preventive health behaviour and past contact with the practice between attenders and non-attenders

General practice

Mailed invitation

Sample of 259 non-attenders and 216 attenders aged between 20 and 45

· Attenders were more likely to have no children under 5, no dependents and have fewer than 6 contacts a month with friends or relatives than nonattenders

· Non-attendance was associated with greater perceived support from family and friends

42

Persson, L. G.

1994

A Study of Men Aged 33-42 in Habo, Sweden with Special Reference to Cardiovascular Risk-Factors

Sweden

Quasi-experimental

· 652 men (86.1%) had attended after one mail invitation

Health check

Follow up of non-attenders by mailed questionnaire and telephone

Postal invitation plus two reminders

· Of 105 non-participants, 16 were known high consumers of health care, 40 had recently had a health examination (mostly at work) and 49 were not interested in a health check

757 men aged 33-42 were invited to attend for a health check

· Non-attenders were more likely to be single, smokers, on the sick list, on a lower income or more often unemployed than attenders

43

Christensen, B.

1995

Characteristics of attenders and non-attenders at health examinations for ischaemic heart disease in general practice

Denmark

Quasi-experimental study

· Attendance was higher in free health examinations than those which charged a fee (66% v 37%) · Attendance was significantly lower in single men than cohabitants

65 General Practices

Multi-practice study and questionnaires to assess the influence of a fee to attend a health examination

Health examinations for ischaemic heart disease

· Whether the service was free or not was the biggest predictor of attendance as health beliefs of attenders and non-attenders were similar

Letter invitation 2452 men aged 40-49 years were invited to attend

44

Difford, F.

1987

Continuous opportunistic and systematic screening for hypertension with computer help: Analysis of nonresponders

England

Programme evaluation

· 2354 patients (92%) had blood pressure recorded in the previous 5 years after 2 years

General practice

Audit of medical records

Opportunistic hypertension screening

· Those who had been screened have higher consultation rates (6x greater) than non-responders

Analysis of characteristics of 192 nonresponders

· There was no difference by distance to the practice or number of years registered with the practice

2546 patients aged 40-64 years

· The only significant difference was that nonresponders were the only people in a household registered with a practice which was interpreted that they were either single or had a lack of need to identify with the “family” doctor

45

Engebretson,J.

2005

Participation in Community Health Screenings: A Qualitative Evaluation

America

Qualitative Focus groups

· Described domains of motivation for presentation:

Participants in screenings at 5 settings:

5 with attenders

· Self-care orientations (e.g. self-assessment/no perceived need)

1 with nonattenders

· Interpersonal influences (e.g. endorsement by others/fear of embarrassment)

University employees

· Accessibility (e.g. convenience/lack of time)

County fair attendees

· Overlap of facilitators and barriers to participation; what motivated one participant to attend may act as a barrier to another

Senior citizen centre clientele

Local industry employees

University student

Group of non-attenders

46

Harpole, L.H.

2000

Feasibility of a tailored intervention to improve preventive care use in women

America

Survey to identify outstanding preventive health care needs

· 591 women (67%) returned the survey

Survey mailed to 893 women aged 50-55

· 76% were in need of one or more preventive health service

· 16% were in need of 3 or more

· Women with increasing need for preventive health services were more likely to be non-white, earn less, have a lower level of education, and be less satisfied with their health care

47

Norman, P.

1991

Predicting attendance at health screening: Organizational factors and patients’ health beliefs

UK

Programme evaluation

· 131 (59.3%) questionnaires were returned. From this group 98 attended and 33 did not attend the subsequent health check

General Practice

A health belief questionnaire was sent to sample of 221 patients who were subsequently invited for screening

Health check

Mailed fixed appointment or invited opportunistically

· The two invite methods had similar attendance rates but the letter invite was more efficient, as opportunistic screening relied on patients presenting at their GP before they could be invited

325 patients aged between 30 and 50

· Opportunistic screening was slightly biased in favour of females

· Attenders were more likely to report cutting back on daily activities when ill and believe in the seriousness of high blood pressure and weight problems

Health belief questionnaire

11 patients were interviewed directly after their screening appointment

· Non-attenders were found to be more worried about the screening appointment and perceived more barriers to attendance

48

Shiloh, S.

1997

Correlates of health screening utilization: The roles of health beliefs and selfregulation motivation

A convenience sample of 252 asymptomatic individuals were invited to participate in one of four screening programmes: dental check up, blood pressure measurement and cholesterol testing, pap smear or mammography

Quasi-experimental

· 137 (54%) attended and 115 (46%) did not attend

Analysis of participants in a screening programme

· Motivations and health beliefs varied by screening programme

· Non-attenders were more likely to justify their nonattendance behaviour with danger control motivations than fear control ones

Questionnaire tailored to specific screening programme and whether individual attended or did not attend

· 61% non-attenders did not believe in the efficacy of screening in reducing their illness threat whereas 39% were too afraid of the possible results to attend

49

Norman, P.

1993

The role of social cognition models in predicting attendance at health checks

UK

Prospective survey/programme evaluation

· 419 patients were sent open invitations

General Practice

· 399 patients were sent fixed appointments

Mailed invitation with fixed appointment time or open invitation

· 433/818 patients attended a health check; 69.7% of those sent fixed appointments and 37.1% sent open invitations attended

Health belief questionnaires sent before patients received invite letters

· Questionnaire data showed that for those that were sent a fixed appointment, attenders were more likely to place a high value on health, to believe health is influenced by powerful others, to be advised by referent groups to attend, to believe in the positive outcomes of screening and to not be affected by motivational barriers than nonattenders

818 patients aged between 30 and 41 were invited to attend a health check

Health check

Patients randomly allocated to receive either a letter of invitation with either a fixed appointment or an open invitation to make their own appointment

· For those sent an open invitation, intention to attend and perceived control were independent predictors of attendance behaviour

50

Norman, P.

1991

Patients’ views on health screening in general practice

UK

Programme evaluation

· Of the 168 invited by letter, 121 patients (72%) attended a health check

General Practice

Mailed fixed appointment or invited opportunistically

Patients randomly selected to be invited to general health screening in one of two ways:

· Only 83/157 patients had been invited opportunistically, but attendance in those that had been invited was 74.7%

· The remaining patients who had not yet been invited opportunistically were sent a fixed appointment which produced 55.4% attendance

Sample of 379 patients aged 30- 50 years, 325 were invited after exclusion of unsuitable patients

· 159/224 patients returned their questionnaires

Letter with fixed appointment (n=168) or notes were tagged so patient was invited opportunistically to make an appointment for a health check when they presented at the practice for another reason (n=157)

· Those invited opportunistically were most likely to report that keeping their appointment time was easy, and were least likely to change it.

· Those given fixed appointments experienced more difficulty in attending even if they were well motivated

Questionnaire was issued after health check to assess views of health check

11 patients were interviewed

51

Nielsen, K. D. B.

2004

“You can’t prevent everything anyway”: A qualitative study of beliefs and attitudes about refusing health screening in general practice

Denmark

Qualitative

· Reasons for non-attendance: too busy, healthy, recent contact with general practice, don’t want to know if ill, no symptoms, major life events, actual health problems

Health examination

Interview with sample of 18 non-participants in a randomised control populationbased project

6 men

12 women

· They stressed the importance of autonomy, and that they would go to see their doctor when they needed to

Non-participants were sampled using stratified purposeful techniques

52

Norman, P.

1989

Intention to attend a health screening appointment: Some implications for general practice

UK

Cross-sectional survey

· Initial questionnaires were returned by 178 patients (37% response rate)

General Practice

Patients randomly selected from practice list by age/sex bands (25-30, 35-40, 45-50 years)

Questionnaire to assess predictors of intention to attend a health check

· Reminder questionnaire returned a further 97 replies. An additional 29 questionnaires were excluded due to incorrect addresses or being incompletely filled in. Response rate was 57% (n=275)

479 patients aged25-50

· Those who intend to attend a health check placed a high value on their health; believe in their susceptibility to common illnesses and the severity of major illnesses. They believe in the efficacy of doctors and screening, have someone to talk to about problems and are more likely to be married or cohabiting.

Sent questionnaire

· Those who are likely to not attend have different attitudes towards screening and believe it would be too much effort or feel concerned about aspects of screening

53

Williams, A

2001

Cultural sensitivity and day care workers: examination of a worksite based cardiovascular disease prevention project

USA

Programme evaluation of screening initiative over three years

· Participation rates were increased from 26% to 73% over the duration of the project by adapting recruitment strategies to the target group’s cultural values and lifestyles, and building trust

“Healthier people health risk appraisal”

Strategy to recruit child day care workers in a cardiovascular disease screening and risk reduction programme

· 70% of participants cited convenience (because it was offered at their workplace) and the fact that it was free as motivators to attend

Interview with participants

· A lack of knowledge of cardiovascular risk was identified in this population as just over 10% of participants were aware of their blood pressure or blood cholesterol

N=84

· Non-participants had been tested recently or were not interested in the screening at the time it was offered

54

Ornstein, S. M

1993

Barriers to adherence to preventive services reminder letters: the patient’s perspective

USA

Qualitative Telephone survey (n=307)

· 307 patients were surveyed by telephone to assess reasons for non-response to a letter for screening

Cholesterol screening

Reminder letters sent to 1077 patients

Focus groups of non-responders to a reminder letter (n=27)

· 154 (50.2%) did not recall receiving the letter, 84 (27.4%) recalled receiving the letter but not its content, 69 (22.5%) recalled both

· Highlighted the importance of the format and content of reminder letters to improve uptake of cholesterol checks by making them distinguishable from a bill, conveying a personalised message and addressing logistical barriers

55

Pill, R.

1988

Invitation to attend a health check in a general practice setting: the views of a cohort of nonattenders

UK

Qualitative

· 236 (91%) recalled getting the invitation, 3% could not remember and 6% denied ever receiving the invitation

259 men and women aged 20- 45 who did not respond to a mailed invitation for a health check at General Practice

Interview of nonattenders

· Reasons for non-attendance: 44% were not interested, 24% forgot to attend, 26% cited crises at home or work, 11% felt screening was inappropriate

56

Thompson, N. F.

1990

Inviting infrequent attenders to attend for a health check: costs and benefits

UK

Quasi-experimental

· 17/94 patients (18%) attended

General Practice

Audit of sample of practice records (n=1488) to identify all 3- year nonattenders (n=114) an invitation including fixed appointment time was sent to 94 eligible patients

· Of the remaining 77 patients, 3 had moved home, 28 cancelled the appointment and nothing was heard from 45, the final patient had been admitted for a myocardial infarction before the appointment

Mailed fixed appointment

94 patients who had not attended general practice within the previous 3 years were invited for a health check

· Of those who cancelled, 8 were working or studying away from home, 4 found the appointment time unsuitable but did not wish to rearrange and 16 did not need or want an appointment

· Those presenting were in general healthy with low levels of smoking and alcohol consumption and mild hypertension only diagnosed in one patient.

57

Hegarty, V.

1995

Reasons for nonresponse among older adults

UK

Letter to the editor describing study which invited over 75s for a health check

· 847 attended

General practice

· 182 were untraceable (had moved home or were deceased)

1342 invited for a health check

· 44 actively declined

· 142 attended after a follow up telephone call

· 120 did not attend because they had seen their GP within last 12 months

Reasons for nonresponse were assessed with a questionnaire

· 7 did not respond because of ill health

· The variety of reasons for non-response indicated that non-attendance does not always equate to poor health

58

Levine, J. A.

1991

Are patients in favour of general health screening?

UK

Cross-sectional survey

· 315/375 (84%) attenders completed the questionnaire

General Practice

Questionnaire

375 consecutive patients 198 individuals who had not attended general practice for 12 months

· 93/198 (47%) non-attenders completed the questionnaire · A significantly greater proportion of attenders (83%) indicated they would make an appointment and attend for health screening compared to nonattenders (66%)

· 33% of attenders would seek health screening even if not contacted by their doctor v 16% of nonattenders