An Exploratory Study on the Types of Changes in Health Screening Participation and Influencing Factors in People with Disabilities in South Korea

Background and Purpose:
The right to health for people with disabilities—defined as the right to enjoy the highest attainable standard of health without discrimination based on disability—has gained increasing attention. However, people with disabilities often face secondary health conditions that develop over time as a result of their primary disabilities. This highlights the growing importance of preventive care and regular health screening. Therefore, the purpose of this study is to explore the trajectory patterns of health screening participation among people with disabilities and to identify the influencing factors that characterize each pattern.

Methods:
This study used longitudinal data from the Disability and Life Dynamics Panel Survey (Waves 1–5, 2018–2022) conducted by the Korea Disabled People's Development Institute. A total of 4,020 individuals aged 19 and older were included. Missing data were addressed using the Full Information Maximum Likelihood (FIML) method. Key variables were categorized into: Sociodemographic factors (e.g., gender, age, education level, residential area, household type, employment, income), Disability-related factors (e.g., type of disability, severity of disability, presence of multiple disabilities, onset of disability), Health-related factors (e.g., self-rated health, chronic illness, degree of limitations in activities of daily living), Psychological factors (e.g., depression, family strength), Community and service factors (e.g., community accessibility, satisfaction with medical services). To identify distinct utilization patterns over time, Growth Mixture Modeling (GMM) was applied. A three-step approach was then used to examine the predictors of latent class membership while accounting for classification uncertainty.

Results:
Three distinct trajectory groups for health screening participation were identified: High-level stable (53.8%) – consistently high participation in health screenings with a slight decline over time. Moderate-level decreasing (38.2%) – initially moderate participation, followed by gradual decline. Low-level increasing (8.0%) – low initial participation, followed by gradual increase, though rates remained low overall. Comparative analysis using the high-level stable group as the reference revealed the following: Compared to the moderate-level decreasing group, individuals were more likely to belong to the high-level stable group if they were younger, lived in large cities, were unemployed, had mental disabilities, had severe disabilities, had multiple disabilities, experienced greater limitations in daily living, and had lower satisfaction with medical services. Compared to the low-level increasing group, individuals were more likely to be younger, unemployed, have mental disabilities, have severe disabilities, and report lower accessibility to the community.

Conclusions and Implications:
These findings underscore the need for differentiated and tailored support strategies to improve health screening participation among people with disabilities. Enhancing medical accessibility based on individual characteristics and increasing opportunities for people with disabilities to participate in the planning and evaluation of health policies and services are essential. Policy and practical efforts must be strengthened to ensure equitable access and effective health management for individuals with disabilities.