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

Adrian Fianu (1, 2, 3) , Éric Doussiet (1, 3) , Nadège Naty (1, 3) , Sylvaine Porcherat (1, 3) , Corinne Mussard (1, 3) , Karim Boussaïd (1, 3) , Muriel Cogne (4) , Patrick Gérardin (1, 3) , François Favier (5)

1 CIC 1410 - Centre d'Investigation Clinique de La Réunion - INSERM
2 CERPOP - Centre d'Epidémiologie et de Recherche en santé des POPulations
3 CHU La Réunion - Centre Hospitalier Universitaire de La Réunion
4 CHU Sud Saint Pierre [Ile de la Réunion]
5 ADERC-Réunion - Association pour le Développement de l'Epidémiologie et de la Recherche Clinique à La Réunion, Saint-Pierre, France

Background: Low socioeconomic 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 socioeconomic 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 socioeconomic 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 socioeconomic settings. Further efforts, including health literacy interventions, are needed to increase utilization of primary care.

Mots clés: Diabetes Burden; Social Inequalities; Proximity Health Services; Health Services Research; Social Epidemiology; Reunion Island

Domaines: Santé publique et épidémiologie; Endocrinologie et métabolisme

Adrian Fianu, Éric Doussiet, Nadège Naty, Sylvaine Porcherat, Corinne Mussard, et al.. 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. International journal of health policy and management, 2021, 11 (10), pp.2208-2218. ⟨10.34172/ijhpm.2021.114⟩. ⟨hal-03877149⟩