Community-based health screening in Singapore: eight-year follow-up data from the Eastern Community Health Outreach (ECHO) programme

Introduction: Cardiovascular diseases (CVDs) account for 30% of deaths in Singapore. We described eight years of observational data from the Eastern Community Health Outreach (ECHO) screening programme and its impact on CVD risk, health care beliefs and behavioural changes. Methods: Demographic and health screening data of ECHO participants were collected over eight consecutive years from 20 February 2011 to 9 March 2019. We analysed the impact of ECHO participation on health care beliefs, behavioural changes, outcomes and utilisation, including changes in clinical variables and attendance at general practitioners (GPs) or primary care clinics for follow-up of abnormal results. Results: The ECHO programme screened 28,565 participants over eight years. Of these, 12,762 participants attended their initial screening, with 5977 (46.8%) having abnormal results requiring GP referral, and 56% attended their GP referral within a year. Participants living in lower-cost housing had a significantly higher attendance rate at the GPs than those living in housing and development board four- to five-room units or condominiums (74% vs. 52.5%, P < 0.001). In a multivariable mixed-effects proportional odds model, increased ECHO participation over five years was associated with more positive self-reported healthcare beliefs, behaviours and clinical indicators. Regular health screening attendance was associated with increasing odds of improvement in chronic disease indicators, despite only modest changes in healthcare beliefs. Conclusion: Participation in the community-based ECHO screening programme was associated with sustained improvements in cardiometabolic risk factors and positive health behaviours, despite modest changes in health care beliefs. Repeated community engagement may translate small shifts in beliefs into sustained behavioural change.