'Check it out!' Decision-making of vulnerable groups about participation in a two-stage cardiometabolic health check: A qualitative study

•Two-stage cardiometabolic screening is potentially cost-effective.•Cost-effectiveness is hampered by a lack of participation among vulnerable groups.•Reasons for not completing a risk factor questionnaire are mainly cognitive.•Reasons for not attending further testing are mainly affective.•Focus should be on promoting informed choices by providing accurate information.

ObjectiveExploring determinants influencing vulnerable groups regarding (non-) participation in the Dutch two-stage cardiometabolic health check, comprising a health risk assessment (HRA) and prevention consultations (PCs) for high-risk individuals.MethodsQualitative study comprising 21 focus groups with non-Western (Surinamese, Turkish, Moroccan) immigrants aged 45-70, adult children from one of these descents, native Dutch with a lower socioeconomic status, and healthcare professionals working with these groups.ResultsReasons for not completing the HRA included (flawed) risk perceptions, health negligence, (health) illiteracy, and language barriers. A face-to-face invitation from a reliable source and community outreach to raise awareness were perceived as facilitating participation. Reasons for not attending the PCs overlapped with completing the HRA but additionally included risk denial, fear about the outcome, its potential consequences (lifestyle changes and medication prescription), and disease-related stigma.ConclusionReasons for not completing the HRA were mainly cognitive, whereas reasons for not attending the PCs were also affective.Practice implicationsWhen designing a two-stage health check, choice of invitation method seems important, as does training healthcare professionals in techniques to effectively handle patients' (flawed) risk perceptions and attitudinal ambivalence. Focus should be on promoting informed choices by providing accurate information.