ASSOCIATION BETWEEN ACCESS TO HEALTH-PROMOTING FACILITIES AND PARTICIPATION IN CARDIOVASCULAR DISEASE (CVD) RISK SCREENING AMONG POPULATIONS WITH LOW SOCIOECONOMIC STATUS (SES) IN SINGAPORE

• Published in: Value in health 2017-05, Vol.20 (5), p.A381
• Main Authors: Lim, KK, Lim, C, Kwan, YH, Ostbye, T, Tay, HY, Chan, SY, Fong, W, Tan, CS
• Format: Article
• Language: English
• Subjects: Apartments; Built environment; Cardiovascular disease; Cardiovascular diseases; Clinics; Ethnicity; Health care; Health care access; Health facilities; Health promotion; Housing; Low income groups; Mapping; Medical screening; Minority & ethnic groups; Parks; Parks & recreation areas; Participation; Prioritizing; Socioeconomic status
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.05.005

OBJECTIVES: Little attention has been given to associations between physical environment and screening participation. This study examined associations between minimum distances (proxy of access) to health-promoting facilities and door-to-door, cardiovascular disease risk screening participation, among populations with low socioeconomic status (SES) residing in public rental flats in Singapore. METHODS: We obtained corresponding block screening participation rates from 66 blocks housing a total of 2619 residents, from Health Mapping Exercises conducted from 2013-2015. Uni- and multi-variate negative binomial regression were used to test associations between minimum distances to facilities (private subsidized clinics, certified healthy eateries, polyclinics and parks) and block screening participation rate, adjusting for age, ethnicity, gender and planning region. We also repeated the multi-variate analyses, to test if the associations varied according to regions. RESULTS: Uni-variate analyses showed an association between block screening participation rate and minimum distance to polyclinics - which disappeared in multi-variate analyses. After adjusting for interaction, 3 independent variables, minimum distance to subsidized private clinics (IRR 1.52, 95% CI 1.12-2.05) in the East region, as well as polyclinics (IRR 0.92, 95% CI 0.88-0.96) and parks (IRR 1.42, 95% CI 1.11-1.81) in the North/North-East regions were shown to be significant. No association was observed for healthy eateries for all 3 regions. CONCLUSIONS: These findings could be important considerations in the planning of future door-to-door screenings in urban cities, for efficient prioritisation of resoures. To increase participation rates among this low SES population, access to health-promoting facilities in each region and their perception of such facilities should be considered.