Image of Do adults who believe in periodic health examinations receive more clinical preventive services?

Do adults who believe in periodic health examinations receive more clinical preventive services?

  • April 05, 2026
  • |
  • Relife Malaysia

Introduction


Clinical preventive services (CPS) uptake remains suboptimal despite scientific advances in disease prevention, with system barriers (cost, access) well studied but personal health beliefs underrecognized as a key factor. Prior research shows adults who have periodic health examinations (PHEs) have higher CPS rates than those who only seek care for illness, but the role of patient beliefs about PHEs in this disparity was unexamined—particularly in the U.S. rural South, a region with the lowest primary/secondary prevention rates nationwide. This study aimed to: (1) assess if negative/ambivalent PHE beliefs predict lower CPS uptake; (2) identify sociodemographic traits of PHE non-endorsers; (3) test if PHE beliefs mediate sociodemographic differences in CPS receipt.

Methods


Study Population & Data


Data from the Robert Wood Johnson Foundation’s Southern Regional Access Program (SRAP)telephone survey (2002–2003) of adults (≥18 years) in 150 rural counties across 8 southeastern U.S. states (51% participation rate, n=4,879). Survey methods mirrored the CDC’s Behavioral Risk Factor Surveillance Survey (BRFSS).

Key Definitions


  • PHE Attendance: Self-reported routine check-up (excluding emergency care/blood pressure checks) in the past year.
  • PHE Belief: Dichotomized from a 5-point Likert scale response to “Even if healthy, one should get an annual physical” (endorse: strongly agree/agree; not endorse: disagree/strongly disagree/no opinion).
  • CPS Uptake: Analyzed for age/gender-eligible groups (per USPSTF 1996 guidelines): mammography (women ≥50), Pap smear (women 18–64), cholesterol screening (men 35–69/women 45–69), colonoscopy/sigmoidoscopy (≥50).

Statistical Analysis


Analyses (Stata 8.0) were weighted to account for sampling probabilities and sociodemographic stratification (race/ethnicity, age, income, gender). Bivariate chi-square assessed unadjusted PHE belief-CPS associations; multivariable logistic regression adjusted for age, gender, race, self-reported health, insurance, and education. Regression models were stratified by recent PHE attendance to separate the effects of PHE belief vs PHE receipt itself, and mediation analysis tested if PHE beliefs explained sociodemographic CPS disparities.

Results


Sociodemographic Characteristics


Weighted sample: mean age 46 years, 54% female, 63% white, 36% Black, 43% with household income <$25,000, 31% uninsured, 50.3% high school education or less. 91.5% endorsed PHEs; 8.5% (n=374) did not. PHE non-endorsers were independently more likely to be: younger (OR=0.87 per 10 years, 95%CI:0.79–0.96), male (OR=1.59, 95%CI:1.20–2.09), white (OR=2.92, 95%CI:1.91–4.46), and uninsured (OR=1.39, 95%CI:1.02–1.90) (adjusted model, p<0.0001).

PHE Belief and CPS Uptake


  • Unadjusted differences: Non-endorsers had 16–32% lower CPS rates than endorsers (all p<0.001), with the largest gap for mammography (32% difference).
  • Adjusted odds ratios: Endorsers had significantly higher odds of all CPS (Table 3a); PHE belief was the strongest predictor of CPS uptake for adults who did not have a recent PHE (Table 3c), with adjusted ORs ranging from 2.37 (Pap smear) to 3.70 (mammography).
  • Stratification by PHE attendance: For adults with a recent PHE, CPS rates were similar between endorsers and non-endorsers (no significant differences except mammography, OR=2.79); for those without a recent PHE, PHE belief remained a significant, independent predictor of all CPS (all p<0.05).
  • Mediation analysis: Adding PHE belief to regression models did not alter sociodemographic ORs for CPS uptake, meaning PHE beliefs do not explain sociodemographic disparities in preventive service receipt.

Discussion


This study identified that 8.5% of rural southeastern U.S. adults do not endorse annual PHEs—a small but population-relevant group (tens of millions nationally) with drastically lower CPS uptake. Key findings:

  1. PHE beliefs drive CPS uptake for non-PHE attendees: For adults who do not have routine check-ups, belief in PHEs is the strongest predictor of receiving CPS (e.g., during acute/chronic care visits or community screenings), aligning with the idea that PHE belief reflects a general orientation toward disease prevention.
  2. PHE attendance mitigates belief-based CPS disparities: Adults who have a recent PHE receive CPS at similar rates regardless of PHE beliefs, highlighting the value of PHEs as a delivery platform for preventive care.
  3. At-risk non-endorser groups: Younger adults and males (groups with known low health-seeking behavior) are the most likely to reject PHEs—ironically, the groups that benefit most from preventive care.
  4. Medical skepticism: PHE non-endorsement may reflect broader skepticism of conventional medical care’s ability to prevent disease, a trait linked to lower preventive service use in prior research.

Notably, CPS belief gaps varied by service (16–32%), likely due to baseline uptake rates (e.g., high Pap smear rates left less room for disparity) and contextual factors (e.g., chronic disease care may drive cholesterol screening independent of PHE beliefs).

Limitations


  1. Cross-sectional design: Cannot establish causality between PHE beliefs and CPS uptake.
  2. Self-reported data: CPS and PHE attendance measures may be subject to recall bias.
  3. 51% response rate: Similar to national surveys (e.g., BRFSS) but may introduce non-response bias.
  4. Limited CPS scope: Only assessed technology-based screening (no counseling, risk screenings, or health education).
  5. Rural southern cohort: Findings may not generalize to the broader U.S. population (national PHE non-endorsement rates may be higher).
  6. Unmeasured barriers: Did not account for external CPS barriers (transportation, financial burden).

Conclusion


Adults who do not endorse periodic health examinations (PHEs) are a high-risk group for low clinical preventive service (CPS) uptake, with lower rates of PHE attendance and all recommended screenings (mammography, Pap smear, cholesterol, colon cancer). This group is disproportionately younger, male, white, and uninsured, and PHE beliefs are the strongest predictor of CPS uptake for those who do not have routine check-ups.

Since PHE non-endorsers rarely seek routine care, community- and population-level interventions(e.g., public education campaigns, workplace screening mandates, insurer requirements) are needed to boost their CPS uptake—rather than clinic-based interventions alone. Further research into the underlying health beliefs and medical skepticism of PHE non-endorsers will help design targeted strategies to improve preventive care for this at-risk group. Understanding patient attitudes toward PHEs and prevention more broadly is critical to closing persistent gaps in CPS uptake across the U.S. population.