This section discusses the respondents’ measure of agreement with the researcher’s conclusions and recommendations on periodic health check-ups as a promotive health care service to the community.
5.3.1 Periodic health check-up/examination
A periodic health examination is a general physical examination of patients, not an examination for a specific injury, illness, or condition, which is to be provided for patients in a regular period of time (e.g., every 1-2 years).
The findings from phase1 were presented to the experts as 63% (n=14) of the health facilities did not provide periodic health examinations. Asked about their previous experience, 77.9% (n=651) of the patient respondents had not been going for routine check-ups of their health (periodic medical check-ups).
Having this background, during the Delphi round 1, the experts’ opinions were sought on whether periodic health check-ups for healthy individuals for general check-ups or certain diseases screening in the Ethiopian context is recommended. All the experts (100%; n=20) agreed with the recommendation that periodic health examinations for patients who were apparently not sick, should be performed in the Ethiopian context (see Table 5.1). Such strong agreement of experts on the importance of having periodic health check-ups signals the need to have specific periodic public health check-up programmes identified and ratified for the Ethiopian context.
Table 5.1 Delphi first round: experts’ agreement on having periodic health check- ups in Ethiopia (n=20)
For the experts who either strongly agreed or agreed on having periodic health check- ups, an additional question enquired whether it is advisable to include the periodic general health check-ups, including annual general health check-ups, in the community or individual insurance system. The community-based health insurance strategy initiated since 2011 is designed to promote equitable access to sustainable quality health care, increase financial protection, and enhance social inclusion for the majority of Ethiopian families (Feleke, Mitiku, Zelelew & Ashagari 2015:4). Of the experts, 95% (n=19) advised that it was good to include the periodic health check-ups in the community or individual insurance system (see Table 5.2). The experts’ recommendation is very important when viewed in light of the existing community or individual insurance systems that mainly focus on curative health care and do not endorse most promotive or preventive health care services, such as periodic health check-ups.
Table 5.2 Delphi first round: experts’ agreement on including periodic health check-ups in community or individual insurance system (n=20)
Including periodic health check-ups in community or
individual insurance system n Percent
Strongly agree 13 65.0 Agree 6 30.0 Neutral 1 5.0 Disagree 0 0.0 Strongly disagree 0 0.0 Total 20 100.0
Once agreed upon the importance of having the periodic health check-ups and reaching consensus on including these in the community or individual insurance system, the
Periodic health check-ups n Percent
Strongly agree 16 80.0 Agree 4 20.0 Neutral 0 0.0 Disagree 0 0.0 Strongly disagree 0 0.0 Total 20 100.0
experts were required to select the specific conditions which should be screened during the periodic check-ups that are feasible to be conducted in the Ethiopian context from a given list of screening processes. Of the 18 conditions listed, the experts chose and reached consensus on eight (above 75% agreement) while the remaining ten processes did not reach the 75% consensus level.
Of the experts, 95% (n=19) agreed on having periodic check-ups on screening for hypertension and its complications; 95% (n=19) agreed on screening for diabetes for patients with hypertension or BMI>25; 85% (n=17) agreed on measuring blood cholesterol level and counselling on healthy diet and obesity; 85% (n=17) agreed on Pap smear screening every 3 years beginning at age 21; 80% (n=16) agreed on clinical breast examination every 1-2 years for women over 50 years; 80% (n=16) agreed on STI screening and counselling; 80.00% (n=16) agreed on visual acuity screening using Snellen sight chart, and 75% (n=15) agreed on counselling on physical activity (see Table 5.3). The experts’ agreement on having periodic health check-up on these eight conditions/areas calls on the need to include these interventions in the country’s health care strategies for the population segment that need these periodic health check-ups.
Table 5.3 Delphi first round: experts’ agreement on specific screening activities during periodic health check-up areas in the Ethiopian context (n=20)
Screening activities during periodic health check-up n Percent Screening for hypertension and its complications 19 95.0 Screening for diabetes for patients with hypertension or BMI>25 19 95.0 Measuring blood cholesterol level and counselling on healthy diet
and obesity 17 85.0
Pap smear screening every 3 years beginning age 21 17 85.0 Clinical breast examination every 1-2 years for women over 50 years 16 80.0
STI screening and counselling 16 80.0
Visual acuity screening using Snellen sight chart 16 80.0
Counselling on physical activity 15 75.0
Vaccination for HPV for both sexes between age 9-26 years 13 65.0 Screening on road safety and counselling on seat-belt use, drinking
and driving 13 65.0
Screening mammography examination every 1-2 years for women
over 40 years 12 60.0
Screening to detect alcohol abuse and counselling for adult
population 12 60.0
Screening activities during periodic health check-up n Percent Colorectal cancer screening annually for patients over 50 using
faecal occult blood testing 10 50.0
Tobacco use screening and cessation counselling 9 45.0
Screening adults for depression 8 40.0
Screening postmenopausal women for osteoporosis 7 35.0 Vaccination for adults (MMR, Varicella, Pneumococcus, Influenza,
Diphtheria) 6 30.0
Periodic health check-ups on which more than 50% experts agreed but which did not reach the consensus cut-off point of 75% were set forward for the second round of experts’ views. During the second round, 85% (n=17) of the experts agreed on including screening for mammography examination of women over 40 years every 1-2 years, and 80% (n=16) agreed on screening for colorectal cancer for patients over 50 years using faecal occult blood testing.
Table 5.4 Delphi second round: experts’ agreement on additional screening activities during periodic health check-ups (n-20)
Agreement on additional screening activities during periodic
health check-ups n Percent
Vaccination for HPV for both sexes between age 9-26 years 8 40.0 Screening on Road safety and counselling on seat-belt use, drinking
and driving 11 55.0
Screening Mammography examination every 1-2 years for women
over 40 years 17 85.0
Screening for Domestic violence against women 7 35.0 Colorectal cancer screening for patient over 50 with annual faecal
occult blood testing 16 80.0
During the first round some experts (n=5) who were in favour of conducting periodic health check-ups recommended that at least an annual check-up was feasible as patients who have risk factors for certain diseases, such as cardiovascular disease, can benefit highly from the periodic health-check approach. The following was also noted:
Public health education on the importance of having periodic health check-ups can be provided easily using mass media; private and public set-ups can be utilised, and guidelines and protocols can be prepared on specific screening activities pertaining to check-up activities.
Periodic health check-up should be linked to the insurance system, as patients who have positive results upon screening and who cannot afford the treatment should have the health insurance system to support their specific health problem. Health facilities need to allocate funds for health promotive purposes.
There could be a strong possibility of cost problems related to the services, given the high out-of-pocket health expenditure existing in the country.
Health facilities and health professionals should be adequately ready in terms of number, skill, equipment and supplies to provide such promotive and preventive activities.
In the second round, the experts were asked if they still agree with the recommendations and precautions on providing periodic health check-ups stated above. Their opinion was further sought on whether they had any comments on the descriptions put forward from the first round. Of the experts, 90% (n=18) agreed on the first round recommendations and precautionary measures noted pertaining to the periodic health check-ups. The experts commented further that the implementation of periodic health check-ups should not be applied in the form of a mandatory service, but should be aligned with increasing community awareness on the use of regular medical check-ups; health system re- orientation on the provision of periodic health check-up services also needed to be put in place; assessing the family or domestic and social impact on patients’ health needed to be linked with the check-up; disease burden assessment needed to be conducted regularly to be integrated into the periodic check-up activities, and the serious lack of providing health education required promotion specialists in the country to prioritise the coordination, planning and implementation of such interventions.
Table 5.5 Delphi second round: experts’ agreement on recommendations and precautions made on periodic check-ups during the first round assessment (n=20)
Agreement on recommendations and precautions made on
periodic check-ups during the first round assessment n Percent
Strongly agree 13 65 Agree 5 25 Neutral 2 10 Disagree 0 0 Strongly disagree 0 0 Total 20 100