Influences on NHS Health Check behaviours: a systematic review

Abstract

Background National Health Service Health Checks were introduced in 2009 to reduce cardiovascular disease (CVD) risks and events. Since then, national evaluations have highlighted the need to maximise the programme’s impact by improving coverage and outputs. To address these challenges it is important to understand the extent to which positive behaviours are influenced across the NHS Health Check pathway and encourage the promotion or minimisation of behavioural facilitators and barriers respectively. This study applied behavioural science frameworks to: i) identify behaviours and actors relevant to uptake, delivery and follow up of NHS Health Checks and influences on these behaviours and; ii) signpost to example intervention content. Methods A systematic review of studies reporting behaviours related to NHS Health Check-related behaviours of patients, health care professionals (HCPs) and commissioners. Influences on behaviours were coded using theory-based models: COM-B and Theoretical Domains Framework (TDF). Potential intervention types and behaviour change techniques (BCTs) were suggested to target key influences. Results We identified 37 studies reporting nine behaviours and influences for eight of these. The most frequently identified influences were physical opportunity including HCPs having space and time to deliver NHS Health Checks and patients having money to adhere to recommendations to change diet and physical activity. Other key influences were motivational, such as beliefs about consequences about the value of NHS Health Checks and behaviour change, and social, such as influences of others on behaviour change. The following techniques are suggested for websites or smartphone apps: Adding objects to the environment, e.g. provide HCPs with electronic schedules to guide timely delivery of Health Checks to target physical opportunity, Social support (unspecified), e.g. include text suggesting patients to ask a colleague to agree in advance to join them in taking the ‘healthy option’ lunch at work; Information about health consequences, e.g. quotes and/or videos from patients talking about the health benefits of changes they have made. Conclusions Through the application of behavioural science we identified key behaviours and their influences which informed recommendations for intervention content. To ascertain the extent to which this reflects existing interventions we recommend a review of relevant evidence.

NHS Health Check programme: a protocol for a realist review

“…In addition to these reviews (and their associated academic publications 9 19-21 ), a further three reviews relating to the NHS Health Check have been published to date, [22][23][24] and we have also identified two other systematic reviews focused on participation and patient experience in similar prevention programmes. 25 26 Drawing on the existing evidence, below we summarise what is currently known about the NHS Health Check programme: ► Coverage (proportion eligible who receive a Health Check) is known to vary substantially across regions and settings, but is consistently higher in older people, women and in more deprived populations, although this may reflect targeting.…”

“…Open access including the option to book an appointment during the call may overcome anticipated difficulties in making appointments and offer an opportunity to increase participants' understanding of the Health Check, 32 which may be barriers to uptake. 23 Other barriers may include aversion to preventive medicine, competing priorities and, for community pharmacy and outreach settings, concerns about privacy and confidentiality. 10 11 19 23 Some qualitative evidence highlights the convenience of these settings and the value of community ambassadors.…”

“…10 11 19 23 Some qualitative evidence highlights the convenience of these settings and the value of community ambassadors. 10 23 Providers recognise the difficulty patients face in making sustained behaviour and lifestyle changes, acknowledging the need to take patients' social circumstances and resources into account. 34 35 Professionals have also expressed concerns about limited access to appropriate lifestyle services for onward referrals and about stretched resources and workload in primary care.…”

“…11 More recently, PHE commissioned the University College London Centre for Behaviour Change to conduct a review of barriers and facilitators to behaviours relevant to NHS Health Checks, including those of providers and invitees/attenders; again, this review included only papers published in academic journals. 23 It is now 11 years since the Health Check programme was launched. The amassed evidence from small, local unpublished studies needs to be combined with the published papers, many of which also cover only one locality.…”

What Are the Effective Behaviour Change Techniques Used to Improve General Health Check Attendance: A Systematic Review Protocol

“…The BCTTv1 has been used in systematic reviews on a range of health promotion interventions [20][21][22][23]. A recent study using the BCW, BCTTv1 and Theoretical Domain Framework suggested theoretical effective strategies to improve health check behaviour [24]. These suggested theoretical strategies can either implemented into an existing intervention or to inform future intervention design.…”