[Strategies to improve specific health checkup participation rates: An analysis using the "Health Promotion Programs Chart"].

Objectives To maximize the effectiveness of Specific Health Checkups (SHC), participation rates must be improved. Municipalities have implemented various strategies to achieve these goals. However, these strategies are often not explicitly documented and remain tacit knowledge, resulting in the fragmentation of such knowledge. This study aimed to document and clarify the strategies adopted by municipalities to improve SHC participation rates and to examine the implementation of these strategies in relation to the target population size and participation rates.Methods Strategies to improve SHC participation rates were gathered from the National Health Insurance (NHI) records of all 35 municipalities using a standardized format, the "Health Promotion Programs Chart," and through interviews with two municipalities in the Yamagata Prefecture. These strategies were classified into six categories by specialists in health promotion programs based on workflow processes. A questionnaire containing 47 items across these six categories was administered to all 35 municipalities. Differences between groups based on the target population size and participation rates regarding strategy implementation were statistically analyzed using Fisher's exact test.Results The questionnaire had a 100% response rate. The most frequently reported strategies were those related to encouraging participation (19 items), followed by public awareness initiatives (10 items). Municipalities with larger populations were significantly more likely to "hold regular meetings and discussions with medical associations on program progress and challenges". In contrast, three strategies were significantly more prevalent in municipalities with lower participation rates: "targeted encouragement for specific individuals," "outsourcing of mailing encouragement activities," and "sending participation reminders at least twice" (P ＜ 0.05 for all). However, none of the strategies showed a significant positive correlation with participation rates.Conclusion This study documented and clarified the strategies implemented by municipalities to improve SHC participation rates. This study also highlighted the differences in strategy implementation based on the target population size, providing valuable insights for municipalities to adapt their approaches accordingly. However, no specific strategies were more commonly adopted by municipalities with higher participation rates. As this study was limited to a single prefecture, further research incorporating data from other regions was required to accumulate knowledge and develop effective measures to enhance SHC participation.