BACKGROUND AND AIMS: Since cardiometabolic diseases (CMD) are a frequent cause of death worldwide, preventive strategies are needed. Recruiting adults for a health check could facilitate the identification of individuals at risk for CMD. For successful results, participation is crucial. We aimed to identify factors related to unwillingness to participate in CMD health checks. METHODS: We performed a cross-sectional study in the Czech Republic, Denmark, Greece, the Netherlands, and Sweden. A questionnaire was distributed among persons without known CMD consulting general practice between January and July 2017 within the framework of the SPIMEU study. RESULTS: In total, 1354 persons responded. Nine percent was unwilling to participate in a CMD health check. Male gender, smoking, higher self-rated health, never been invited before, and not willing to pay were related to unwillingness to participate. The most mentioned reason for unwillingness to participate was "I think that I am healthy" (57%). Among the respondents who were willing to participate, 94% preferred an invitation by the general practitioner and 66% was willing to pay. CONCLUSION: A minority of the respondents was unwilling to participate in a CMD health check with consistent results within the five countries. This provides a promising starting point to increase participation in CMD health checks in primary care.

1st Faculty of Medicine Institute of General Practice Charles University Prague Czech Republic

Academic Primary Healthcare Centre Department of Primary Health Care Stockholm Region Stockholm Sweden

Clinic of Social and Family Medicine School of Medicine University of Crete Heraklion Greece

Department of General Practice and Elderly Care Medicine Amsterdam Public Health Research Institute VU University Medical Center Amsterdam The Netherlands

Department of General Practice Julius Center University Medical Center Utrecht Utrecht University Utrecht The Netherlands

Division of Family Medicine and Primary Care Department of Neurobiology Care Sciences and Society Karolinska Institutet Stockholm Sweden

Nivel Department of general practice care Utrecht The Netherlands

Research Unit of General Practice Department of Public Health University of Southern Denmark Odense Denmark

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