Who uses NHS health checks? Investigating the impact of ethnicity and gender and method of invitation on uptake of NHS health checks

Abstract

BackgroundNHS Health Checks is a national risk assessment prevention programme for all individuals aged 40-74 that reside in England. Through the systematic assessment of an individual’s ten year disease risk, this programme aims to provide early identification and subsequent management of this risk. However, there is limited evidence on how socio-demographic factors impact on uptake and what influence the invitation method has on uptake to this programme.MethodsNHS Health Check data from April 2013 to March 2014 was analysed (N = 50,485) for all 30 GP Practices in Luton, a culturally diverse town in England, UK. Data was collected for age, ethnicity, uptake (attendance and non attendance) and invitation method (letter written, verbal face-to-face, telephone). Actual usage of NHS Health Checks was determined for each ethnic group of the population and compared using Chi-square analysis.ResultsThe overall uptake rate for Luton was 44 %, markedly lower that the set target of 50–75 %. The findings revealed a variation of uptake in relation to age, gender, level of deprivation. Ethnicity and gender variations were also found, with ‘White British’ ‘Black Caribbean’ and ‘Indian’ patients most likely to take up a NHS Health Check.However, patients from ‘Any Other White Background’ and ‘Black African’ were significantly less likely to uptake an NHS Health Check compared to all other ethnic groups. Ethnicity and gender differences were also noted in relation to invitation method.ConclusionsThe findings revealed that different invitation methods were effective for different ethnic and gender groups. Therefore, it is suggested that established protocols of invitation are specifically designed for maximizing the response rate for each population group. Future research should now focus on uncovering the barriers to uptake in particular culturally diverse population groups to determine how public health teams can better engage with these communities.

Delivery and impact of the NHS Health Check in the first 8 years: a systematic review

“…38 Nine further studies reported data on coverage (Table 1). 13,18,[21][22][23][24][29][30][31] Reported coverage. The PHE website reported coverage of 45.6% for the whole of England (2013-2014 to Q2, 2016-2017), ranging from 18.9% in Surrey to 109.2% in Newham.…”

“…22 A further five studies reported coverage for different population subgroups without adjustment for covariates. 18,21,23,29,30 The two that used data from large datasets with nationwide reach during the programme's first 4 years showed higher coverage among females, older people, and those living in more deprived areas. 18,21…”

Inequity in cardiovascular care in the English National Health Service (NHS): a scoping review of the literature

“…Other studies find no ethnic differences in presentation (Patel et al 2006, Labeit et al 2013, Brown et al 2016, while others find higher delays between the onset of symptoms of acute ST-elevation myocardial infarction and arrival time at hospital among South Asians (Kendall et al 2013). Evidence of variations in presentation by black Caribbean populations is also contradictory (Horgan et al 2010, Chang et al 2015, Cook et al 2016.…”

“…A comparison of NHS Health Check coverage (2011)(2012) against expected (APHO) cardiovascular health need found that coverage was significantly higher in PCTs in the most deprived areas compared with the least deprived (Artac et al 2013). Some studies (Donyai & Van den Berg 2009, Labeit et al 2013) agree that people from less advantaged communities are more likely to access CHD risk screening programmes, while others disagree (Horgan et al 2010, Gidlow et al 2015, Chang et al 2015, Cook et al 2016. With respect to age, youth also appears to be a factor lowering rates of presentation and uptake of health checks (Adamson et al 2008, Dalton et al 2011, Cook et al 2016, Robson et al 2016.…”

“…Some studies (Donyai & Van den Berg 2009, Labeit et al 2013) agree that people from less advantaged communities are more likely to access CHD risk screening programmes, while others disagree (Horgan et al 2010, Gidlow et al 2015, Chang et al 2015, Cook et al 2016. With respect to age, youth also appears to be a factor lowering rates of presentation and uptake of health checks (Adamson et al 2008, Dalton et al 2011, Cook et al 2016, Robson et al 2016. Given the significant prevalence of overweight, obesity and associated cardiovascular risk among 45-to 64-year olds in England, the reviewed evidence suggests that preventive action could be more positively targeted at this age group.…”