Abstract
BackgroundThe NHS Health Check (NHSHC) is a national programme for the prevention of non-communicable diseases. Patients aged 40–74 without an existing cardiovascular-related condition should be invited quinquennially. Uptake is lower than anticipated. We assessed the impact on uptake of two new behaviourally-enhanced leaflets (with the current national leaflet as a control), enclosed with the invitation letter: the first trial on the leaflet.MethodsA double-blind three-armed randomized controlled trial was conducted. The new leaflets were shorter (two pages, instead of four); one was loss-framed (‘don’t miss out’) and the other was gain-framed (‘make the most of life’). The participants were patients from 39 practices in Lewisham and 17 practices in NE Lincolnshire, who were allocated to interventions using a random-number generator and received one of the leaflets with their invitation letter from April–September 2018. The outcome measure was uptake of an NHSHC by November 2018. The trial was powered to detect a 2% effect.ResultsUptake was 17.6% in the control condition (n = 3677), 17.4% in the loss-framed condition (n = 3664), and 18.2% in the gain-framed condition (n = 3697). Leaflet type was not a significant predictor of NHSHC uptake in a logistic regression that controlled for demographic variables, with GP practice as a random effect. Statistically significant predictors of uptake included location (higher uptake in Lewisham), age (increased age was associated with increased attendance) and sex (higher uptake in females). The Bayes Factor comparing the null to a hypothesis of differences between conditions was 416, which is extreme evidence in favour of the null hypothesis.ConclusionThere was no evidence for a meaningful effect of either a loss-framed or gain-framed behaviourally-informed leaflet type on uptake, which is surprising, given that behaviourally informed letters have improved uptake of NHSHCs. It is possible that people do not pay attention to leaflets that are enclosed with letters, or that the leaflet continues to support informed decision-making but this does not affect uptake.Trial registrationClinicaltrials.gov, NCT03524131. Registered May 14, 2018. Retrospectively registered.
Highlights
The National Health Service (NHS) Health Check is a national programme for the prevention of noncommunicable diseases, such as stroke, kidney disease, heart disease, type 2 diabetes, and dementia [1]
Descriptive statistics The final sample included 11,038 patients: 2605 patients from 17 General Practitioner (GP) practices in North East Lincolnshire and 8433 patients from 39 GP practices in Lewisham
In Lewisham, 452 patients in the control group for May were sent both the control leaflet and a second invitation with one of the intervention leaflets, so these patients were removed from the trial and adjustments were made to the trial groups in June, in order to have an even number of patients in each arm
Summary
The National Health Service (NHS) Health Check is a national programme for the prevention of noncommunicable diseases, such as stroke, kidney disease, heart disease, type 2 diabetes, and dementia [1]. All adults between 40 and 74 with no pre-existing vascular condition should receive an invitation to an NHS Health Check every 5 years. The following measures are recorded: age, gender, smoking status, family history of coronary heart disease, ethnicity, body mass index, cholesterol level, physical-activity level, alcohol use, 10 year risk of CVD using QRISK [2]. As a result, those patients with previously undiagnosed conditions can be put on a clinical pathway, and those who are at high risk of developing a condition can be offered lifestyle support and advice, in order to manage their risk. We assessed the impact on uptake of two new behaviourally-enhanced leaflets (with the current national leaflet as a control), enclosed with the invitation letter: the first trial on the leaflet
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