Reminder system for health screening in early childhood - an analysis regarding different social circumstances

Children with a low socio-economic position (SEP) participate in prevention and health examinations less often. In order to increase participation, reminder systems have been implemented in Germany since 2009. The aim of the study is to investigate whether this implementation is associated with an increased participation in health examination in early childhood for children in disadvantaged social circumstances.

We used data from the school enrolment examination from 2002 to 2017 from the city of Duesseldorf (n = 64,883 children). With a trend analysis we observed health examination over time and we compared rates of children after implementation of the reminder system (2010 or later) to those who were not exposed to the programme (earlier than 2010). Health examination was measured by participation in the last examination before school entry ("U9") documented by paediatricians. Social circumstances included neighbourhood deprivation (very high to very low), migration background (foreign first language vs. German) and family status (one-parent vs. two-parent families). Poisson regression estimated adjusted Prevalence Ratios (PR) with a 95% confidence interval (CI) of U9 participation by reminder system exposure, both for the total population and within groups of social circumstances. Based on that, we calculated adjusted participation rates (predictive margins) by reminder system exposure for the different social circumstances.

Participation rates increased slightly, but gradually over time. The probability of U9 participation for children exposed to the reminder system is 1.04-fold (1.03-1.04 CI) compared to children who were not exposed to it. The association of the reminder system and U9 participation differs according to social circumstances. Adjusted prevalences increased the most in the group of children from very deprived neighbourhoods, ranging from 84.3 to 91.4% (PR = 1.07; 1.03-1.10 CI); in all language groups; more in children from one-parent families ranging from 82.4 to 88.9% (PR = 1.07; 1.05-1.09 CI).

Our results suggest that reminder systems have a moderate impact on the participation in health examinations in early childhood in the general population. In vulnerable groups, however, they could make a difference. Reminder systems should be combined with further activities of tailored prevention.