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Determinants of individuals' participation in integrated chronic disease screening in Singapore
  1. Kavita Venkataraman1,
  2. Hwee Lin Wee1,2,
  3. Sheryl Hui Xian Ng1,
  4. Salome Rebello1,
  5. E Shyong Tai3,
  6. Jeannette Lee1,
  7. Chuen Seng Tan1
  1. 1Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
  2. 2Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
  3. 3Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  1. Correspondence to Dr Tan Chuen Seng, Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, Singapore 117549, Singapore; chuen_seng_tan{at}


Background A large pool of patients with chronic diseases remains undiagnosed globally and in Singapore. We explored factors associated with participation in a health screening exercise, using revealed preference, that is, actual attendance, to understand why people remain undiagnosed with chronic diseases.

Methods A cross-sectional, community-based sample of Singapore residents was invited to participate in home interviews, and subsequently to attend centre-based health screening, between 2004 and 2007. Determinants of health screening participation were identified using logistic regression models based on Andersen's Behavioral Model.

Results Of the 6366 participants who completed health interview, 4092 attended the health screening, while 2274 did not. Older age, Chinese or Indian ethnicity, higher education levels, greater intake of monounsaturated fat, greater transport and leisure-time physical activity were the key predisposing factors associated with greater health screening participation. Greater family cohesion was the key associated enabling factor, while previous diagnosis of dyslipidaemia or musculoskeletal conditions, absence of previously diagnosed diabetes or hypertension and lower perceived physical health were the associated need factors.

Conclusions Our study suggests that ethnicity, education, family cohesion, healthy behaviour patterns and perceived physical health status were key determinants of health screening participation. Enhancing the cultural competence of preventive health services may help increase participation of these groups in screening efforts and reduce the proportions of undiagnosed chronic disease in the community.

  • Epidemiology of chronic diseases

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  • Contributors KV wrote the first draft, interpreted the data, edited and revised the manuscript for submission. HLW contributed to the conception and design of the manuscript, reviewed and revised the manuscript critically. SHXN conducted the statistical analysis. SR supervised data analysis related to dietary factors, and intellectually contributed to manuscript revision. EST and JT conceptualised the larger study, acquired data, reviewed the manuscript and provided critical intellectual inputs for revision. CST conceptualised the manuscript, conducted and supervised statistical analysis, and critically revised the manuscript. All authors approved the final version of the manuscript submitted.

  • Funding This work was supported by a grant from the Biomedical Research Council (grant number: 03/1/27/18/216).

  • Disclaimer The funders had no role in the study design; in the collection, analysis and interpretation of data; in writing of the report; or in the decision to submit the paper for publication.

  • Competing interests None declared.

  • Ethics approval National University of Singapore and the Singapore General Hospital Institutional Review Boards.

  • Provenance and peer review Not commissioned; externally peer reviewed.