Accepted for/Published in: JMIR Research Protocols
Date Submitted: Sep 10, 2021
Date Accepted: Nov 16, 2021
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Regional utilisation of preventive services in old age – Study protocol of a mixed methods study
ABSTRACT
Background:
In Germany the proportion of people with chronic diseases and multimorbidity is increasing. To counteract the emergence and worsening of age-related conditions there is a need for preventive care structures and measures. The preventive services that are financed by the statutory health insurance (SHI) (e.g. vaccinations, cancer screening) are only used by part of the German population. There are no current findings about the utilisation of these services by the elderly and older population in the eastern German federal state of Saxony-Anhalt, which is particularly strongly affected by demographic change.
Objective:
The aim of the present study is to investigate the determinants of, reasons for, and barriers to utilisation of preventive services financed by the SHI in Saxony-Anhalt in the 55 plus age group.
Methods:
In the study a mixed methods approach is used. The actual use of preventive services will be shown by means of a claims data analysis looking at data on statutory outpatient medical care from both the Central Research Institute of Ambulatory Health Care in Germany (Zi) and the Association of Statutory Health Insurance Dentists in Saxony-Anhalt (KZV LSA). The determinants, attitudes and behaviours associated with use will be analysed through a cross-sectional survey as well as qualitative data from semi-structured interviews with residents of Saxony-Anhalt and from focus group discussions with physicians. A stocktake and systematic evaluation of digitally available information material on colorectal cancer screening by way of example, provides an insight into the information available as well as its quality. To assess the quality of relevant information material a catalogue of criteria was developed. The conceptual framework of the study is Andersen’s behavioural model of health services use (last modified in 2014).
Results:
The Zi and KZV LSA are currently preparing the requested claims data. The survey was carried out from April to June 2021 in two urban and two rural municipalities (encompassing a small town and surrounding area) in Saxony-Anhalt. In total 3,665 people were contacted, with a response rate of 25.84% (n=954). For the semi-structured interviews 18 participants from the four different study regions were recruited in the same time period. The recruitment of physicians for the focus group discussions is currently ongoing. For the systematic evaluation of existing information material on colorectal cancer screening 37 different information materials were identified on the websites of a total of 16 healthcare actors.
Conclusions:
The study will provide current and reliable data on the use of preventive services in the 55 plus age group in Saxony-Anhalt. It will yield insights into the determinants, reasons and barriers associated with their utilisation. The results will reveal the potential for preventive measures and enable concrete recommendations for action for the target population of the study. Clinical Trial: German Clinical Trials Register, DRKS00024059. Registration date 15/01/2021
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