Article Text

Download PDFPDF

Patients' estimations of the importance of preventive health services: a nationwide, population-based cross-sectional study in Portugal
  1. Luísa Sá1,2,
  2. Orquídea Ribeiro3,
  3. Luís Filipe Azevedo3,
  4. Luciana Couto1,
  5. Altamiro Costa-Pereira3,
  6. Alberto Hespanhol1,3,
  7. Paulo Santos1,3,
  8. Carlos Martins1,3
  1. 1Family Medicine Unit, Social Sciences and Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
  2. 2Family Health Unit Nova Via, Porto, Portugal
  3. 3Faculty of Medicine, Centre for Research in Health Technologies and Information Systems (CINTESIS) and Information Sciences and Decision on Health Department (CIDES), University of Porto, Porto, Portugal
  1. Correspondence to Dr Luísa Sá;{at}


Objectives To determine, in the context of primary care preventive health services, the level of importance that Portuguese patients attribute to different preventive activities.

Design Cross-sectional study.

Setting Primary Healthcare, Portugal.

Participants 1000 Portuguese adults selected by a stratified cluster sampling design were invited to participate in a computer-assisted telephone survey. Persons with a cognitive or physical disability that hampered the ability to complete a telephone interview and being a nursing home resident or resident in any other type of collective dwelling were excluded.

Outcomes Mean level of importance assigned to 20 different medical preventive activities, using a scale of 1–10, with 1 corresponding to ‘no importance for you and your health’ and 10 indicating ‘very important’.

Results The mean level of importance assigned to medical preventive activity was 7.70 (95% CI 7.60 to 7.80). Routine blood and urine tests were considered the most important, with an estimated mean of 9.15 (95% CI 9.07 to 9.24), followed by female-specific interventions (Pap smear, mammography and gynaecological and breast ultrasounds), with mean importance ranging from 8.45 (95% CI 8.23 to 8.63) for mammography to 8.56 (95% CI 8.36 to 8.76) for Pap smear. Advice regarding alcohol consumption (6.18; 95% CI 5.96 to 6.39) and tobacco consumption (5.99; 95% CI 5.75 to 6.23) were considered much less important.

Conclusions Our results reveal that Portuguese patients overestimate the importance of preventive medical activities, tend to give more importance to diagnostic and laboratory tests than to lifestyle measures, do not discriminate tests that are important and evidence-based, and seem not be aware of the individualisation of risk. Family physicians should be aware of these optimistic expectations, because these can influence the doctor–patient relationship when discussing these interventions and incorporating personalised risk.

  • prevention
  • overdiagnosis
  • overtesting
  • family medicine
  • Patients values
  • Preventive services

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter Follow Carlos Martins at @mgfamiliarnet

  • Contributors CM and LS developed the original idea for this study. CM, LS and LFA designed the questionnaire, the sampling methodology and drafted, and revised the paper. CM conducted the quality control during the data collection. CM, LS and OR planned, supervised and performed the statistical data analysis, contributed to the paper draft, and revised the paper. PS, LC, AC-P and AH contributed to the questionnaire design and revised the paper.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval São João Health Centre Medical Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.