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Background: The NHS Health Check (NHS HC) is a cardiovascular risk assessment to prevent cardiovascular disease. Public Health England (PHE) wants to increase uptake. Methods: We explored the impact of behaviourally informed invitation letters and pre-notification and reminder SMS on uptake of NHS HCs. Patients at 28 General Practices in the London Borough of Southwark who were eligible to receive an NHS HC between 1st November 2013 and 31st December 2014 were included. A double-blind randomised controlled trial with a mixed 2 (pre-notification SMSyes or no) × 4 (letternational template control, open-ended, time-limited, social norm) × 2 (reminder SMSyes or no) factorial design was used. The open-ended letter used simplification, behavioural instruction and a personalised planning prompt for patients to record the date and time of their NHS HC. The time-limited letter was similar but stated the NHS HC was due in a named forthcoming month. The social norms letter was similar to the open-ended letter but included a descriptive social norms message and testimonials from local residents and no planning prompt. The outcome measure was attendance at an NHS HC. Results: Data for 12, 244 invites were analysed. Uptake increased in almost all letter and SMS combinations compared to the control letter without SMS (Uptake 18%), with increases of up to 12 percentage points for the time-limited letter with pre-notification and reminder (Uptake 30%; Adjusted Odds Ratio AOR 1.86; 95% CI 1.45-2.83; p < 0.00); 10 percentage points for the open-ended letter with reminder (Uptake 27%; AOR 1.68; 95% CI 1.31-2.17; p < 0.00) and a 9 percentage point increase using the time-limited letter with reminder (Uptake 27%; AOR 1.61; 95% CI 1.25-2.10; p < 0.00). The reminder SMS increased uptake for all intervention letters. The pre-notification did not add to this effect. Conclusions: This large randomised controlled trial adds support to the evidence that small, low cost behaviourally informed changes to letter-based invitations can increase uptake of NHS HCs. It also provides novel evidence on the effect of SMS reminders and pre-notification on NHS HC attendance. Trial registration: Retrospectively Registered (24/01/2014) ISRCTN36027094.

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Background: Public Health England wants to increase the uptake of the NHS Health Check (NHSHC), a cardiovascular disease prevention programme. Most invitations are sent by letter, but opportunistic invitations may be issued and verbal invitations have a higher rate of uptake. Prompting staff to issue opportunistic invitations might increase uptake. Aim: To assess the effect on uptake of automated prompts to clinical staff to invite patients to NHSHCs, delivered via primary care computer systems. Design and setting: Pseudo-randomised Controlled Trial of patients eligible for the NHSHC attending GP practices in Southwark, London. Method: Eligible patients were allocated into one of two conditions: (1) No Prompt and (2) Prompt to clinical staff. The primary outcome was attendance at an NHSHC. Results: We recruited 15 of 43 (37%) practices in Southwark; 7564 patients were eligible for an NHSHC, 3778 (49.95%) in the control and 3786 (50.05%) in the intervention. Attendance in the intervention arm was 454 (11.99%) compared to 280 (7.41%) in the control group, a total increase of 4.58% (OR = 2.28; 95% CI = 1.46-3.55; p < 0.001). Regressions found an interaction between intervention and sex (OR= 0.65; 95% CI = 0.44-0.86, p = 0.004), with the intervention primarily effective on men. Comparing the probabilities of attendance for each age category across intervention and control suggests that the intervention was primarily effective for younger patients. Conclusion: Prompts on computer systems in general practice were effective at improving the uptake of the NHSHC, especially for men and younger patients.

The spread of misinformation has generated confusion and uncertainty about how to behave with respect to protective actions during the COVID-19 pandemic, such as social distancing and getting vaccinated. Pennycook et al. (2020) garnered significant press attention when they found that asking people to think about the accuracy of a single headline (i.e., accuracy nudge) improved their discernment in sharing true versus false information related to COVID-19. The present Open Science Framework preregistered experiment sought to replicate the work of Pennycook et al. ( 2020) and test the generalizability of their findings to three different countries: Kyrgyzstan, India, and the United States. The present study also explores whether findings extend to information related to COVID-19 vaccine acceptance, a timely and important topic at the time of data collection. The accuracy nudge's effect did not replicate in the Kyrgyzstan sample (n = 1,049). Results were mixed in India (n = 703) and the United States (n = 829); the nudge decreased willingness to share some misinformation but it did not significantly increase willingness to share true information. We discuss potential explanations for these findings and practical implications for those working to combat the spread of misinformation online.

Multiple studies highlight the link between engagement at work and performance, influencing organizations to put more effort into improving employee engagement levels. In this study, we begin to examine the influence of multiple psychological parameters on employees’ work engagement (WE) within the public sector. The idea is to break the concept of WE down into eight individually measurable parameters that will allow for a better understanding and development of stronger interventions. Based on this analysis, we reproduce the outcome that strategic clarity is the most connected property to WE. More importantly, we introduce a new concept, honest mistakes, and show that having a safe space for making mistakes and learning from it is the second most important property of WE. This result is of interest, as allowing mistakes, even if they were made innocently, is considered taboo in the public sector. These outcomes are based on the reports of n=7682 public sector employees from Brazil. In particular, the analysis shows that these outcomes hold for both professional and management positions across the health, administrative, justice, police, social work, and education offices.

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