Usefulness of Home Screening for Promoting Awareness of Impaired Glycemic Status and Utilization of Primary Care in a Low Socio-Economic Setting: A Follow-Up Study in Reunion Island

Document Type : Original Article

Authors

1 INSERM CIC1410, CHU Réunion, Saint-Pierre, France

2 CERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France

3 Service de Diabétologie - Site Sud, CHU de la Réunion, Saint-Pierre, France

4 ADERC, Saint-Pierre, France

Abstract

Background 
Low socio-economic settings are characterized by high prevalence of diabetes and difficulty in accessing healthcare. In these contexts, proximity health services could improve healthcare access for diabetes prevention. Our primary objective was to evaluate the usefulness of home screening for promoting awareness of impaired glycemic status and utilization of primary care among adults aged 18-79 in a low socio-economic setting.

Methods 
This follow-up study was conducted in 2015-2016 in Reunion Island, a French overseas department in the Indian Ocean. Enrollment and screening occurred on the same day at the home of participants (N = 907). Impaired glycemic status was defined as [glycated hemoglobin (HbA1c) ≥5.7%] OR [fasting capillary blood glucose (FCBG) ≥1.10 g/L] OR [HbA1c = 5.5-5.6% and FCBG = 1.00-1.09 g/L]. Medical, socio-cultural, and socio-economic characteristics were collected via a face- to-face questionnaire. A one-month telephone follow-up survey was conducted to determine whether participants had consulted a general practitioner (GP) for confirmation of screening results. A multinomial polytomous logistic regression model was used to identify factors independently associated with non-use of GP consultation for confirmation of screening results and nonresponse to the telephone follow-up survey.

Results 
Prevalence of glycemic abnormalities was 46.0% (95% CI = 42.7-49.2%). Among participants with impaired glycemic status (N = 417), 77.7% (95% CI = 73.7-81.7%) consulted a GP for confirmation of screening results, 12.5% (95% CI = 9.3-15.6%) did not, and 9.8% failed to respond to the follow-up survey. Factors independently associated with nonuse of GP consultation for confirmation of screening results were self-reported unwillingness to consult a GP (adjusted odds ratio [OR]: 4.86, 95% CI = 1.70-13.84), usual GP consultation frequency of less than once a year (adjusted OR: 4.13, 95% CI = 1.56-10.97), and age 18-39 years (adjusted OR: 3.09, 95% CI = 1.46-6.57).

Conclusion 
Home screening for glycemic abnormalities is a useful proximity health service for diabetes prevention in low socio- economic settings. Further efforts, including health literacy interventions, are needed to increase utilization of primary care.

Keywords


  1. Ricketts TC, Goldsmith LJ. Access in health services research: the battle of the frameworks. Nurs Outlook. 2005;53(6):274-280. doi:1016/j.outlook.2005.06.007
  2. Ahrens W, Krickeberg C, Pigeot I. Screening. In: Ahrens W, Pigeot I, eds. Handbook of Epidemiology. 2nd ed. New York: Springer; 2014:24. doi:1007/978-0-387-09834-0
  3. Gillies CL, Lambert PC, Abrams KR, et al. Different strategies for screening and prevention of type 2 diabetes in adults: cost effectiveness analysis. BMJ. 2008;336(7654):1180-1185. doi:1136/bmj.39545.585289.25
  4. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33 Suppl 1:S62-69. doi:2337/dc10-S062
  5. Declaration of Alma-Ata - International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978. https://www.who.int/publications/almaata_declaration_en.pdf. Accessed July 30, 2021.
  6. Frohlich KL, Potvin L. Transcending the known in public health practice: the inequality paradox: the population approach and vulnerable populations. Am J Public Health. 2008;98(2):216-221. doi:2105/ajph.2007.114777
  7. Taylor J, Cottrell C, Chatterton H, et al. Identifying risk and preventing progression to type 2 diabetes in vulnerable and disadvantaged adults: a pragmatic review. Diabet Med. 2013;30(1):16-25. doi:1111/dme.12027
  8. Dahlgren G, Whitehead M. Policies and Strategies to Promote Social Equity in Health. Background document to WHO – Strategy paper for Europe; 1991. https://core.ac.uk/download/pdf/6472456.pdf. Accessed July 30, 2021.
  9. Haschar-Noé N, Lang T. Réduire les inégalités sociales de santé: Une approche interdisciplinaire de l’évaluation. Toulouse: Presses Universitaires du Midi (PUM); 2018.
  10. Lamy S, Ducros D, Diméglio C, et al. Disentangling the influence of living place and socioeconomic position on health services use among diabetes patients: A population-based study. PLoS One. 2017;12(11):e0188295. doi:1371/journal.pone.0188295
  11. Kickbusch I, Pelikan JM, Apfel F, Tsouros AD. Health Literacy. The Solid Facts. Copenhagen, Denmark: World Health Organization; 2013:1-73. https://www.euro.who.int/en/publications/abstracts/health-literacy.-the-solid-facts.
  12. Actif N, Ah-Woane M, Hoarau S, Maillot H. Indicateurs sociaux départementaux - Une situation sociale hors norme. Insee Partenaires. 2013;(25):1-4. https://www.insee.fr/fr/statistiques/fichier/1291838/ip25.pdf. Accessed July 30, 2021.
  13. Favier F, Jaussent I, Moullec NL, et al. Prevalence of type 2 diabetes and central adiposity in La Reunion Island, the REDIA Study. Diabetes Res Clin Pract. 2005;67(3):234-242. doi:1016/j.diabres.2004.07.013
  14. Lenclume V, Favier F. Cohorte RÉDIA2: Suivi des participants de l’enquête RÉDIA sur le diabète de type 2 à La Réunion. Résultats sur données transversales (2006-2009) et longitudinales (1999-2009). Saint-Pierre, La Réunion: CIC-EC de la Réunion; 2014:1-240. https://www.santepubliquefrance.fr/content/download/55663/file/rapport-redia.pdf. Accessed July 30, 2021.
  15. Vaillant Z. La Réunion, koman i lé? Territoires, santé, société. Paris: Presses Universitaires de France; 2008.
  16. Favier F, Fianu A, Naty N, Le Moullec N, Papoz L. Essai de prévention primaire du diabète de type 2 et du syndrome métabolique à la Réunion [Trial for the primary prevention of type-II diabetes mellitus and the metabolic syndrome in La Réunion]. Rev Méd Assur Mal. 2005;36(1):5-13.
  17. Fianu A, Bourse L, Naty N, et al. Long-term effectiveness of a lifestyle intervention for the primary prevention of type 2 diabetes in a low socio-economic community--an intervention follow-up study on Reunion Island. PLoS One. 2016;11(1):e0146095. doi:1371/journal.pone.0146095
  18. Actif N, Levet A, Hoarau S, Maillot H. Cartographie sociale des territoires - Des quartiers inégaux face à la précarité. Insee Partenaires. 2013;(26):1-6. https://www.insee.fr/fr/statistiques/fichier/1292044/ip26.pdf. Accessed July 30, 2021.
  19. Papoz L, Favier F, Sanchez A, et al. Is HbA1c appropriate for the screening of diabetes in general pratice? Diabetes Metab. 2002;28(1):72-77. [French].
  20. WHO, IDF. Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycaemia: Report of a WHO/IDF Consultation. Switzerland: Geneva; 2006:1-50. https://www.who.int/diabetes/publications/diagnosis_diabetes2006/en/.
  21. Labbé É, Moulin JJ, Guéguen R, Sass C, Chatain C, Gerbaud L. Un indicateur de mesure de la précarité et de la «santé sociale»: le score EPICES. L’expérience des Centres d’examens de santé de l’Assurance maladie. La Revue de l'Ires. 2007;1(53):3-49. doi:3917/rdli.053.0003
  22. Lang T, Kelly-Irving M, Delpierre C. Inequalities in health: from the epidemiologic model towards intervention. Pathways and accumulations along the life course. Rev Epidemiol Sante Publique. 2009;57(6):429-435. doi:1016/j.respe.2009.06.008
  23. Susser M, Susser E. Choosing a future for epidemiology: II. From black box to Chinese boxes and eco-epidemiology. Am J Public Health. 1996;86(5):674-677. doi:10.2105/ajph.86.5.674
  24. Barros AJ, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003;3:21. doi:1186/1471-2288-3-21
  25. Rubin DB. Inference and missing data. Biometrika. 1976;63(3):581-592. doi:2307/2335739
  26. Toscano CM, Duncan BB, Mengue SS, et al. Initial impact and cost of a nationwide population screening campaign for diabetes in Brazil: a follow up study. BMC Health Serv Res. 2008;8:189. doi:1186/1472-6963-8-189
  27. Papoz L, Favier F, Clabé A, Sanchez A, Le Moullec N. GHb (HbA1c) is more sensitive than fasting blood glucose as a screening test for diabetes. Diabetes Care. 2000;23(8):1206-1207. doi:2337/diacare.23.8.1206a
  28. Myerson RM, Colantonio LD, Safford MM, Huang ES. Does identification of previously undiagnosed conditions change care-seeking behavior? Health Serv Res. 2018;53(3):1517-1538. doi:1111/1475-6773.12644
  29. Brown-Connolly NE, Concha JB, English J. Mobile health is worth it! economic benefit and impact on health of a population-based mobile screening program in New Mexico. Telemed J E Health. 2014;20(1):18-23. doi:1089/tmj.2013.0080
  30. Thomas JW, Penchansky R. Relating satisfaction with access to utilization of services. Med Care. 1984;22(6):553-568. doi:1097/00005650-198406000-00006
  31. Menke A, Casagrande S, Avilés-Santa ML, Cowie CC. Factors associated with being unaware of having diabetes. Diabetes Care. 2017;40(5):e55-e56. doi:2337/dc16-2626
  32. Lucas-Gabrielli V, Mangeney C. L'accessibilité aux médecins généralistes en Île-de-France: méthodologie de mesures des inégalités infra-communales [Accessibility to General Practitioners in the Ile-de-France Region: A Methodology for Measuring Infra-communal Inequalities]. Working Papers DT80. IRDES Institut for Research and Information in Health Economics; 2019. https://www.irdes.fr/recherche/2019/documents-de-travail.html#DT80.
  33. Lang T, Badeyan G, Cases C, Chauvin P, Duriez M, Gremy I. Les inégalités sociales de santé: sortir de la fatalité. Paris: Haut Conseil de la Santé Publique; 2009.
  34. Boulevart P, Bardot M, Quarch M, Mariotti E. Recours aux soins à la Réunion. In Extenso. 2016;(5):23. http://www.ocean-indien.ars.sante.fr/sites/default/files/2017-01/ARS_InExtenso_Soins_n5_16sept_BD.PDF. Accessed July 30, 2021.
  35. Grignon M, Perronnin M, Lavis JN. Does free complementary health insurance help the poor to access health care? evidence from France. Health Econ. 2008;17(2):203-219. doi:1002/hec.1250
  36. Delgado-Rodríguez M, Llorca J. Bias. J Epidemiol Community Health. 2004;58(8):635-641. doi:1136/jech.2003.008466
  37. Babitsch B, Gohl D, von Lengerke T. Re-revisiting Andersen's Behavioral Model of Health Services Use: a systematic review of studies from 1998-2011. Psychosoc Med. 2012;9:Doc11. doi:3205/psm000089
  38. Dellagi K, Rollot O, Temmam S, et al. Pandemic influenza due to pH1N1/2009 virus: estimation of infection burden in Reunion Island through a prospective serosurvey, austral winter 2009. PLoS One. 2011;6(9):e25738. doi:1371/journal.pone.0025738
  39. Enders CK. Applied Missing Data Analysis. New York: The Guildford Press; 2010. http://hsta559s12.pbworks.com/w/file/fetch/52112520/enders.applied.
  40. House W. Population and Sustainable Development of Small Island Developing States: Challenges, Progress Made and Outstanding Issues. New York: United Nations; 2013:1-60. https://www.un.org/en/development/desa/population/publications/pdf/technical/TP2013-4.pdf. Accessed July 30, 2021.

Articles in Press, Corrected Proof
Available Online from 26 September 2021
  • Receive Date: 02 July 2020
  • Revise Date: 04 August 2021
  • Accept Date: 21 August 2021
  • First Publish Date: 26 September 2021