Feasibility and success rates of response enhancing strategies in a stepwise prevention program for cardiometabolic diseases in primary care

Ilse F. Badenbroek, Marcus M. J. Nielen, Monika Hollander, Daphne M. Stol, Roderik A. Kraaijenhagen, Niek J. de Wit, François G. Schellevis

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Background: Prevention programs for cardiometabolic diseases (CMD), including cardiovascular disease, diabetes mellitus and chronic kidney disease are feasible, but evidence for the cost-effectiveness of selective CMD prevention programs is lacking. Response rates have an important role in effectiveness, but methods to increase response rates have received insufficient attention. The aim of the current study is to determine the feasibility and the success rate of a variety of response enhancing strategies to increase the participation in a selective prevention program for CMD. Methods: The INTEGRATE study is a Dutch randomised controlled trial to assess the effectiveness and cost-effectiveness of a stepwise program for CMD prevention. During the INTEGRATE study we developed ten different response enhancing strategies targeted at different stages of non-response and different patient populations and evaluated these in 29 general practices. Results: A face-to-face reminder by the GP increased the response significantly. Digital reminders targeted at patients with an increased CMD risk showed a positive trend towards participation. Sending invitations and reminders by e-mail generated similar response rates, but at lower costs and time investment than the standard way of dissemination. Translated materials, information gatherings at the practice, self-management toolkits, reminders by telephone, information letters, local media attention and SMS text reminders did not increase the response to our program. Conclusions: Inviting or reminding patients by e-mail or during GPs consultation may enhance response rates in a selective prevention program for CMD. Different response-enhancing strategies have different patient target populations and implementation issues, therefore practice characteristics need to be taken into account when implementing such strategies. Trial registration: Dutch trial Register number NTR4277. Registered 26 November 2013.
Original languageEnglish
Article number228
JournalBMC family practice
Issue number1
Publication statusPublished - 1 Dec 2020


  • Cardiovascular diseases
  • General practice
  • Health risk assessment
  • Patient participation rates
  • Primary prevention

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