Public cholesterol screening: motivation for participation, follow-up outcome, self-knowledge, and coronary heart disease risk factor intervention.

We used a mailed questionnaire and telephone interviews with 1717 shopping center screenees whose total serum cholesterol was greater than 200 mg/dl. Our specific aim was to assess the subjects' motivations for participation in cholesterol screening, their follow-up outcome, their self-knowledge, and any coronary heart disease risk factor intervention. Of 1717 questionnaires mailed, 507 (30%) were returned; 64 of 100 subjects randomly selected for telephone interview could be contacted, and 61 were interviewed. Responses to the questionnaire and telephone interview were congruent, indicating little self-selection response bias. Before the cholesterol screening, 50% and 67% of questionnaire and telephone interview subjects knew their cholesterol levels. The nine most commonly cited reasons for cholesterol screening participation were: a desire to "watch" health (72%), convenience (70%), low cost (64%), to recheck previously measured total cholesterol (54%), publicity (34%), curiosity (30%), a relative with premature coronary heart disease (27%), the subjects' obesity (26%), and a relative's high cholesterol level (25%). As a result of cholesterol screening, 65% and 63% of questionnaire and telephone interview subjects, respectively, followed up with their doctors; 67% and 56%, respectively, had total cholesterol remeasured, but 17% and 18%, respectively, were told to "do nothing." At their doctors' follow-up, 74% and 51% of questionnaire and telephone interview respondents, respectively, began a low-saturated fat, low-cholesterol diet; 10% and 15% started taking a cholesterol-lowering drug. As a result of cholesterol screening, 76% and 85% of questionnaire and telephone interview subjects, respectively, changed their diets; 78% and 84% lowered their dietary cholesterol intakes, 62% and 74% increased their fiber intakes, 49% and 57% tried to lose weight, and 44% and 43% increased their exercise. Of questionnaire subjects, 94% thought that by lowering cholesterol, coronary heart disease risk could be reduced; 95% had become more aware of cholesterol in the last 5 years. Of telephone interview subjects, 91% concluded that cholesterol screening had motivated them to reduce cholesterol levels. Public cholesterol screening is convenient, inexpensive, facilitates self-knowledge about cholesterol, stimulates follow-up, and motivates physician and subject-guided dietary changes to reduce cholesterol levels and coronary heart disease risk.