The impact of health message framing on cervical cancer screening uptake is poorly understood. In a prospective randomized control study with 748 females, aged 21–65 years with no Pap smear in the previous 3 years, they randomly received a loss-framed, gain-framed, or neutral health message (control) regarding cervical cancer screening by email. Screening rate in the control group was 9.58 percent (CI: 9.29%–9.87%), 5.71 percent (CI: 5.48%–6.98%) in the gain-framed group, and 8.53 percent (CI: 8.24%–8.81%) in the loss-framed group. Statistically there was no difference between the three screening rates. Framing of health messages may not be a significant consideration when communicating through emails.

Background: Prospect theory suggests that people avoid risks when faced with the benefits of a decision but take risks when faced with the costs of a decision. Screening for diseases can be defined as a ‘risk’, in the context of uncertainty. The outcome can either be a ‘benefit’ of good health or a ‘cost’ of ill health or poor-quality health. Purpose: To assess whether prospect theory can predict screening behavior in the context of a chronic disease diagnosis as well as the exposure to incentives to screen. Methods: A retrospective longitudinal case-control study for the period 2008-2011 was conducted using a random 1% sample of 170,471 health-insured members, assessing screening for cancers, chronic diseases of lifestyle and HIV, some of whom voluntarily join an incentivized wellness program. Results: Individuals diagnosed with a chronic disease screened up to 9.0% less for some diseases over time. Mammogram screening however increased (p<0.001). Where a family member was diagnosed with a chronic disease, individual screening decreased up to 8.6%. Similarly females in families where a member was diagnosed with a chronic disease screened more for breast cancer (p<0.001). Males were more sensitive to incentives only for HIV screening (p<0.001), while the female responses to incentives were inconsistent. Conclusion: A chronic disease diagnosis or the risk of developing a chronic disease resulted in reduced future screening behavior for most diseases. The role of incentives was inconsistent. Prospect theory adequately predicts screening behavior when diagnosed or faced with a possible chronic disease diagnosis for most screening tests except for females screening for breast cancer.

Background: Adherence to screening guidelines has been widely accepted to reduce morbidity, mortality, and cost outcomes. The aim of this study was to identify predictors of adherence to screening guidelines for chronic diseases of lifestyle (CDL), cancers, and HIV in a health-insured population in South Africa, some of whom voluntarily opt into a wellness program that incentivizes screening.Method: A cross-sectional study for the period 2007-2011 was conducted using a random sample of 170,471 health insurance members from a single insurer. Adherence to screening guidelines was calculated from medical claims data.Results: Adherence to screening guidelines ranged from 1.1% for colorectal cancer to 40.9% for cholesterol screening. Members of the wellness program were up to three times more likely to screen for diseases (odds ratio [OR] = 3.2 for HIV screening, confidence interval [CI] = 2.75-3.73). Plan type (full comprehensive plan) was most strongly associated with cholesterol screening (OR = 3.53, CI = 3.27-3.80), and most negatively associated (hospital-only core plan) with cervical cancer screening (OR = 0.44, CI = 0.28-0.70). Gender was a negative predictor for glucose screening (OR = 0.88, CI = 0.82-0.96). Provincial residence was most strongly associated with cervical cancer screening (OR = 1.89, CI = 0.65-5.54).Conclusion: Adherence to screening recommendations was <50%. Plan type, gender, provincial residence, and belonging to an incentivized wellness program were associated with disproportionate utilization of screening services, even with equal payment access.

Background. Screening for asymptomatic diseases can reduce the burden of morbidity and mortality in all population groups. There is widespread geographical variation in the quality of care. Few data are available on national screening rates in South Africa and how these vary across the provinces.Objective. To examine screening rates for chronic diseases of lifestyle (CDL), HIV and cancer in a privately insured population for a single insurer across all nine provinces in South Africa, and to determine whether or not there are any differences between the provinces.Method. Screening rates were calculated as the proportion of eligible members who had received screening tests during 2011 in each province. Mean screening rates were compared between Gauteng and the other eight provinces.Results. Nationwide screening rates were 20.5% for CDL, 8.2% for HIV and 31.9% for cancer. Despite similar insurance coverage, screening rates ranged from 0.3% to 0.95% lower in other provinces compared with Gauteng. Of all the provinces, Gauteng had the highest annual screening rates for CDL, breast cancer, prostate cancer and HIV (p<0.001), while the Western Cape had the highest rate for cervical cancer (p<0.001).Conclusion. There is much variation in preventive care utilisation across the provinces within this health-insured population. Provinces with more abundant healthcare resources have higher screening rates. Further research is required to understand the reasons for the variation, given equal payment access.

Insufficient PA has been shown to cluster with other CVD risk factors including insufficient fruit and vegetable intake, overweight, increased serum cholesterol concentrations and elevated blood pressure. This paper describes the development of Working on Wellness (WOW), a worksite intervention program incorporating motivational interviewing by wellness specialists, targeting employees at risk. In addition, we describe the evaluation the effectiveness of the intervention among employees at increased risk for cardiovascular disease.

PURPOSE: Recent research in South African (SA) worksites reported that 60% of employees who voluntarily participated in health screening were not meeting public health recommendations for health enhancing physical activity (PA). Of those employees who were insufficiently active, 47% and 22% had additional two and three risk factors, respectively. Therefore the main aim of this research study was to determine factors contributing to meeting PA guidelines. We also investigated the relationship between PA and healthcare costs. METHODS: Employees (n-6531) from 70 companies voluntarily participated in a wellness day which included self-reported health behaviour and health status measures. Clinical outcomes included cholesterol finger-prick test, blood pressure and Body Mass Index (BMI). Healthcare cost data were obtained for employees who were clients (n=2789) of the health insurer providing the testing, of which 409 made atleast one medical claim during the previous year. RESULTS: Participants were 36 (SD =10) years and median total annual healthcare expenditure was ZAR 3091. Employees meeting PA guidelines had significantly fewer visits to their General Practitioner (GP) (2.39 verus 2.85; p<0.001) than their inactive counterparts. This resulted in an average cost saving of ZAR 100 per year for GP visits (p<0.01). PA employees also had lower rates of hospitalisation than their sedentary counterparts, however this relationship was not significant. Resutls from a logistic regression showed that factors significantly associated with meeting PA guidelines were BMI (p<0.001), readiness to change PA (p<0.001), self-reported health status (p<0.001) and age (p=0.01). CONCLUSIONS: Meeting PA guidelines of 150 minutes of moderate to vigorous PA per week was associated with reduced doctor visits and associated cost. Furthermore, these resutls support previous findings where employees with lower BMI, better self-reported health status and willingness to change were more likely to meet the PA guidelines. These results provide some insight into the economic benefits that can be obtained by being physically active.