Abstract
BackgroundThe NHS Health Check (NHS HC) is a cardiovascular risk assessment to prevent cardiovascular disease. Public Health England (PHE) wants to increase uptake.MethodsWe 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 SMS – yes or no) × 4 (letter – national template control, open-ended, time-limited, social norm) × 2 (reminder SMS – yes 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.ResultsData 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.ConclusionsThis 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 registrationRetrospectively Registered (24/01/2014) ISRCTN36027094.
Highlights
The NHS Health Check (NHS National Health Service Health Check (HC)) is a cardiovascular risk assessment to prevent cardiovascular disease
The NHS Health Check (NHS HC) can be used to identify individuals at risk of heart disease, stroke, kidney disease, diabetes and certain types of dementia and offer advice and treatment related to the lifestyle factors that contribute to these conditions, such as obesity, smoking and alcohol consumption [1]
In this research, we aimed to increase uptake of NHS HCs in the inner London Borough of Southwark using invitation letters including (i) open-ended or (ii) timelimited appointment slots, with planning prompts, simplification, behavioural instruction and personal salience or (iii) social norms with simplification, behavioural instruction and personal salience, all sent alongside short message service (SMS) pre-notification and reminders
Summary
The NHS Health Check (NHS HC) is a cardiovascular risk assessment to prevent cardiovascular disease. The NHS Health Check (NHS HC) programme is a population level intervention in England, aimed at reducing the incidence of major cardiovascular disease events. It is estimated that 650 deaths and 9500 non-fatal myocardial infarctions and strokes could be prevented each year as a result of the NHS HC [2]. These figures were modelled on an expected uptake rate of 75% of the eligible population [2, 3]. Improving uptake is a priority for Public Health England (PHE), who aim for an interim uptake of 66%, heading towards an ideal of 75% [6]
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