Method of invitation and geographical proximity as predictors of NHS Health Check uptake

Abstract

BackgroundUptake of NHS Health Checks remains below the national target. Better understanding of predictors of uptake can inform targeting and delivery. We explored invitation method and geographical proximity as predictors of uptake in deprived urban communities.MethodsThis observational cohort study used data from all 4855 individuals invited for an NHS Health Check (September 2010–February 2014) at five general practices in Stoke-on-Trent, UK. Attendance/non-attendance was the binary outcome variable. Predictor variables included the method of invitation, general practice, demographics, deprivation and distance to Health Check location.ResultsMean attendance (61.6%) was above the city and national average, but varied by practice (47.5–83.3%; P < 0.001). Telephone/verbal invitations were associated with higher uptake than postal invitations (OR = 2.87, 95% CI = 2.26–3.64), yet significant practice-level variation remained. Distance to Health Check was not associated with attendance. Increasing age (OR = 1.04, 95% CI = 1.03–1.04), female gender (OR = 1.48, 95% CI = 1.30–1.68) and living in the least deprived areas (OR = 1.59, 95% CI = 1.23–2.05) were all independent positive predictors of attendance.ConclusionsUsing verbal or telephone invitations should be considered to improve Health Check uptake. Other differences in recruitment and delivery that might explain remaining practice-level variation in uptake warrant further exploration. Geographical proximity may not be an important predictor of uptake in urban populations.

Pre-notification and reminder SMS text messages with behaviourally informed invitation letters to improve uptake of NHS Health Checks: a factorial randomised controlled trial

“…Although not the primary aim of the study, it was possible to observe variation in attendance according to sex, age and ethnicity. As with other studies of NHS HC uptake, the likelihood of attendance increased in female patients [23,[39][40][41][42] and with increasing age [23,39,40,42]. Our findings that those with black ethnicity were more likely to attend and that those whose ethnicity is not recorded were less likely to attend are in accordance with the results of other studies [5,43].…”

“…The uptake rate even in the best condition of this study remained lower than average (48.5%) suggesting other techniques should be used alongside letters and SMS. One study using observational cohort methodology showed that if a patient is invited by phone or approached verbally in-practice, compared to a letter alone or in addition to a letter, they are three times more likely to attend an NHS HC [39]. Similarly, amongst 30 GP practices in Luton, England highest uptake was found for verbal face-to-face NHS HC offers (71.9%), followed by telephone invitation (43%) and finally by letter invitation (29.5%) [44].…”

Enhanced invitation methods and uptake of health checks in primary care: randomised controlled trial and cohort study using electronic health records

“…In the context of health checks, an observational study found significantly higher uptake at practices using telephone or verbal health check invitations, either singly or in combination with letters. 34 Telephone or face-to-face invitations to promote health check uptake may be difficult to implement on a large scale, as would be required for the national Health Check programme.…”

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

“…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.…”