Introduction: An increasing amount of Danes are experiencing poor mental health, thus constituting a major concern to public health. Early detection of individuals experiencing impaired wellbeing is essential in preventing development of mental disorders.
A primary prevention program, Tjek på Trivslen, aims at improving mental health among citizens in the Municipality of Randers. However the intervention can only address the problem of impaired mental health if the target population attends. Participants at Tjek på Trivslen are recruited through a mass screening program, Tjek dit Helbred, where health professionals during health checks are to identify individuals with impaired mental health based on SF-12 and conversation.

Objective: To explore the impact of the interaction between citizens and health professionals, during the health check, on citizen's decision to participate in Tjek på Trivslen. Moreover, how to change health checks so that more citizens identified with low mental health participate in preventative interventions targeted to improve mental health among individuals.

Methods: In a symbolic interactionist perspective, this qualitative case study is based on empirical material from field observations and qualitative interviews. Field observations were conducted exploring interaction during 17 health checks. 4 semi-structured face-to-face interviews were completed with citizens identified with impaired mental health during health checks who declined participation in Tjek på Trivslen. Field notes and interview transcriptions were subjected to a social constructivist analysis inspired by Kathy Charmaz’ Grounded Theory approach using Erving Goffman's concepts as sensitizing concepts.

Results: Five main themes were formed: The stage is created, An exercised focus on physical health, The co-creation of normality, Stigma is avoided and Let me help you.
The frames of Tjek dit Helbred complicates the identification of citizens with impaired mental health. Moreover, health professionals and citizens apply defensive and protective techniques during the interaction to maintain face and the presentation of self. Thus, the identification process during interaction complicates recruitment to Tjek på Trivslen.

Conclusion: The interaction between health professionals and citizens seems to have a big impact on identification of impaired mental health, thus compromising recruitment to Tjek på Trivslen.
Based on the empirical analysis the following proposals are made: Let the citizen help set the stage; Clarify focus on mental health; Attention towards the articulation of 'normal'; Daring to point out low mental health; Let help come from within and Collegial coaching and communication exercises.