A Cross-Sectional Study to Assess the Motivators and Barriers to Preventive Health Checkups Among Adults in Urban Bengaluru

Introduction

Non-communicable diseases (NCDs) cause 41 million deaths each year, accounting for 74% of all deaths worldwide. Each year, 17 million people die from NCDs before the age of 70, with 86% of these premature deaths occurring in low- and middle income countries. Cardiovascular diseases are responsible for the majority of these deaths (17.9 million), followed by cancers (9.3 million), chronic respiratory diseases (4.1 million), and diabetes. These four groups of diseases contribute to 80% of all premature NCD deaths. The use of tobacco, physical inactivity, alcohol consumption, unhealthy diets, and air pollution, significantly increase the risk of dying from a NCD.^1,2

Preventive health checkups facilitate early detection and reduce disease progression through screening. They enable individuals identify health issues during the latent phase and support early intervention, thereby reducing morbidity and mortality.³

Preventive health checkups help detect diseases early and enable timely management. This can improve long-term health outcomes and reduce healthcare costs (World Health Organisation [WHO], 2020). Despite their benefits, many adults do not participate in such check-ups, especially in low- and middle income countries.^4,5

Despite the introduction of preventive health check-up camps aimed at detecting diseases in their preclinical stages, utilization remains very low.^6,7

Proper screening of risk factors can serve as an effective strategy for preventing NCDs. With the rise in sedentary lifestyles and poor dietary habits, especially in urban areas like Bangalore, the prevalence of NCDs has increased. However, there is limited research on the awareness and utilization of preventive health check-ups in Bangalore, India.

Based on this background, the present study aimed to estimate the prevalence of preventive health check-up utilization and to identify the motivators and barriers among adults in the community.

Materials and Methods

Study design

This study employed a cross-sectional design to evaluate the motivators and barriers to preventive health check-up utilization among adults in Bengaluru Urban.

Study setting

The study was conducted in the urban field practice area of Bangalore Medical College and Research Institute (Between September 2024 and November 2024).

Sample size

The sample size was calculated based on a reported 29.82% prevalence of preventive health check-up utilization (Arulselvan G et al.), with an absolute precision of 7% and a 95% confidence interval.8 The f inal estimated sample size was 165.

Study participants

Adults aged 18 years and above, residing in the urban f ield practice area of Bangalore Medical College and Research Institute (BMCRI), Bengaluru.

Inclusion criteria

All adults aged 18 years and above, willing to give informed consent were included in this study.

Exclusion criteria

Individuals with psychiatric or mental illness, as well as those unable to comprehend the study information, were excluded.

After obtaining approval from the institutional ethics committee, individuals meeting the inclusion criteria were enrolled upon providing informed consent. A community-based cross-sectional study was conducted in the urban field practice area of BMCRI. A total sample of 165 adults, aged 18 years and above, was selected.

The urban field practice area of BMCRI consists of three sectors, with a total population of 31,162 (Ward 118). To ensure equal representation, 55 participants were selected from each sector. In each sector, upon entering a street, the first house was chosen using a random number generator. Subsequently, every house was visited to inquire about the presence of eligible adults, and data collection continued until the required number of participants was enrolled from that sector.

If a house was locked or did not have any adults aged 18 years or above, the next house was visited. In cases where a house had two or more eligible adults, one individual was selected using the lottery method for participation in the study.

Assessment tools

A pre-tested, pre-validated, semi-structured questionnaire was administered to the study subjects after obtaining their consent. The questionnaire included details on socio-demographic variables, as well as questions related to motivators and barriers to preventive health check-up utilization. The modified Kuppuswamy’s Scale (2023) was used to assess the socioeconomic status.

Data analysis

The collected data were entered into Microsoft Excel for initial organization and cleaning. Statistical analysis was performed using JAMOVI version 2.4.11, where descriptive statistics were calculated to summarize socio-demographic characteristics and preventive health check-up status.

Results

In this study, only 41 out of 165 subjects (24.85%) had undergone preventive health checkups, while the remaining 124 (75.15%) had not.

Motivators for Availing Preventive Health Checkups

Among the 41 participants (24.85%) who had undergone preventive health checkups, the primary motivating factors are detailed in Table 3.

Barriers to Availing Preventive Health Checkups

The main barriers to availing preventive health checkups, as reported by the 124 participants (75.15%) who had not undergone a preventive health checkup, are presented in Table 4.

Discussion

According to our study conducted in an urban slum in Karnataka, out of 164 participants, 41 (24.85%) had undergone preventive health checkups in the past, while the remaining 124 (75.15%) had not availed any. This is comparable to findings form another study, where 130 participants (29.82%) had undergone preventive health checkups. Such regional variations may be attributed to differences in individual’s perceptions and awareness regarding the importance of preventive health checkups.⁹

Similarly, the study reveals findings suggesting that numeracy may play a significant role in long-term, as opposed to short-term risk assessment in determining the utilization of preventive healthcare services.⁹

The main motivators for undergoing preventive health checkups were having a history of a health condition and the availability of nearby health camps. In contrast, the primary barriers were a lack of awareness and limited time. These findings align with existing research that both individual-focused and community based approaches may be effective in promoting participation in health checkups among community dwelling older adults.¹⁰

Additionally, Yamashita et al., (2020) highlighted the role of numeracy in influencing preventive healthcare utilization in the United States, suggesting that both educational and cognitive factors play a crucial role in shaping health behaviours globally. Based on the results, it is evident that a significant number of disease states were newly identified by a preventive health checkup.^10,11

Various studies have shown that a lack of time, lack of awareness and the perception of being healthy are the common perceived hindrances in availing the health checkups. Few studies have shown that lack of knowledge and attitudes, such as unwillingness or negligence and a low sense of severity of the health conditions could also be barriers.^12,13

Based on this study, 53.4% of participants reported undergoing health checkups at least once every two years, 23.4% reported they go for checkups irregularly, and 23.2% stated that they had never undergone a health checkup.¹⁴

Another study found that majority of individuals (36%) undergo health checkups once a year. Approximately 27% do so based on doctor’s advice, 20% undergo checkups every six months, 11% every three months, while only 6% undergo heath checkup once in two years.¹⁵

Recommendations

Enhance community awareness

Implement targeted awareness campaigns through community meetings, local media, and healthcare workers to educate the population about the importance of preventive health checkups and early disease detection.

Organize regular health camps

Conduct regular free or low-cost health camps in underserved urban areas to increase accessibility and encourage participation in preventive screenings.

Integrate health education in public programs

Include preventive health education in schools, workplaces, and public health programs to instil long term health-seeking behaviour.

Address time constraints

Offer flexible scheduling options for health checkups, such as evening or weekend clinics so as to accommodate working individuals who may be unable to attend during regular hours.

Train local health workers

Train frontline health workers to counsel individuals on the benefits of early diagnosis and to address common fears and misconceptions.

Use technology for reminders and follow-ups

Leverage mobile health (mHealth) platforms to send reminders about checkups and provide follow-up support, especially in urban slum areas.

Collaborate with employers and NGOs

Partner with local businesses and non-governmental organizations to sponsor workplace health checkups and promote preventive care initiatives

Conclusion

In the study, approximately one-fourth of the participants had previously undergone some form of preventive health checkup.

According to the survey, the main motivators for undergoing preventive health checkups were a history of prior health condition and availability of health camps. The primary barriers included a lack of awareness, limited time, and fear of being diagnosed with a disease. This low uptake of preventive health services suggest that preventive health behaviour is not yet well-established in this population, potentially leading to a delayed diagnosis and management of health issues.

The findings underscore the urgent need for community-level interventions to raise awareness, address barriers such as time constraints and lack of knowledge, and promote the benefits of early detection and routine health monitoring. Enhancing participation in preventive health checkups in underserved urban areas is essential to reduce disease burden, improve health outcomes, and increase the overall efficiency of the healthcare system.

Conflict of interest

None

Ethical approval

Ethical clearance has been obtained from the ethics committee of Bangalore Medical College and Research Institute, BMCRI/EC/44/2024