The influence of social determinants on the use of prevention and health promotion services: Results of a systematic literature review

BACKGROUND The following analysis aims to determine whether differences in the use of prevention and health promotion services in Germany can be attributed to health inequality between different social status groups measured by education, occupation and income and where certain improvements can be made in health promotion and prevention efforts and research to reduce those differences. METHODS A systematic literature search was conducted using MedPilot to identify relevant articles published between 1998 and 2010 in the Medline, Medizinische Gesundheit, CC Med, Deutsches Ärzteblatt and Sozialmedizin (SOMED) databases, the Hogrefe, Karger, Krause and Pachermegg and Thieme publisher databases, the Cochrane Database of Systematic Reviews (CDSR), the Cochrane Database of Abstracts of Reviews of Effectiveness (DARE), and the Cochrane Central Register of Controlled Trials. RESULTS A total of 23 empirical studies on the topic of "prevention, health prevention and social inequality" met the criteria for inclusion in the review. 20 of the 23 reviewed studies provided relatively clear evidence of a significant association between higher social status and greater use of prevention and health promotion services. According to the reviewed studies, gender tends to have a greater effect on the use of prevention and health promotion services than characteristics of vertical social inequality. No studies were found dealing with tertiary prevention or using qualitative methods to explore their research questions. CONCLUSIONS Overall, the review shows that there is sufficient evidence for the relationship between social status and the use of prevention and health promotion services and that this association is both significant and relevant. There are, however, a few "blind spots" in research on this topic, such as a lack of studies on tertiary prevention, especially with regards to prevention and health promotion services use among men, as well as general studies on health promotion among men and women. There is also a lack of published intervention studies demonstrating how to better reach the socially disadvantaged.