Comparing an online health check with traditional nurse-led health examinations among the long-term unemployed: A validation study (Preprint)

Abstract

An online health check can be used to screen health behavior risks in the population, help health care professionals with standardized risk estimation for their patients, and motivate a patient to change unhealthy behaviors. The long-term unemployed comprise a particular subgroup with an increased risk of lifestyle-related diseases.

This study aims to investigate the clinical utility of a general online health examination, the STAR Duodecim Health Check and Coaching Program (hereafter, STAR), which was developed in Finland, in the targeted screening of the long-term unemployed. For this purpose, we compared the health challenges identified by an online health check with those identified by a nurse during a face-to-face health check for the unemployed.

In this mixed-methods validation study, 49 unemployed participants attending a health check were recruited from two Finnish primary health care centers. The participants used STAR and attended a nurse’s health check. Data were collected by surveys with multiple-choice and open-ended questions from the participants, nurses, and a study assistant who observed the session. The health challenges identified by STAR were compared with the three most important health challenges identified by the nurses. The health challenges were categorized and the percentages of agreement between STAR and the nurses and the confidence intervals of the percentages were calculated. The health challenges not recognized by STAR were identified.

STAR identified a total of 365 health challenges, an average of 7.4 health challenges per participant (n=49). The nurses noted 160 challenges among the top-three most significant health challenges (n=47). In 53.2% of the cases (25/47), STAR identified all categorized health challenges named by the nurses (95% CI [38.1, 67.9]). In 63.8% of cases (30/47), STAR identified at least 2/3 of the health challenges identified by the nurse (95% CI [48.5, 77.3]). STAR left a total of 89 health challenges, an average of 1.8 per participant, uncategorized, because STAR lacked an answer to the question(s) required for the classification of a certain health challenge. The participants were most often not able to add information on their blood pressure (36/49, 73.5%), cholesterol (22/49, 44.9%), and waist circumference (15/49, 30.6%).

In conclusion, STAR identified most of the health challenges identified by the nurses but missed some essential ones. Unemployed participants did not have information on measurements such as blood pressure and cholesterol values, which are pivotal in assessing cardiovascular risks. Using the tool for screening or as a part of a traditional health check with necessary measurements and dialog with health care professionals may improve the risk assessments and streamline the health checks of the unemployed.

This study was approved by the Ethics Committee of the Expert Responsibility Area of Tampere University Hospital in June 2020 (ETL Code R20067).

RR2-10.2196/27668