Increasing uptake of National Health Service Health Checks in primary care: a pragmatic randomized controlled trial of enhanced invitation letters in Northamptonshire, England

Sallis, A.; Gold, N.; Agbebiyi, A.; James, R. J .E.; Berry, D.; Bonus, A.; Vlaev, I.; Chadborn, T.

Abstract

Background
Uptake of NHS Health Checks (NHSHCs) is sub-optimal. This study aimed to increase their uptake using behaviourally informed invitation letters.

Method
Patients registered with 6 general practices in Northamptonshire, England who were eligible for an NHSHC between 10 February 2014 and 31 January 2015 were randomized monthly, using a random number generator, to three trial arms: control (standard invitation), sunk costs (resources already allocated) and counterargument (against common barriers to attendance). The outcome measure was uptake of NHSHC by 12 weeks after 31 January.

Results
In total, 6331 patients were randomized. After exclusions, due to ineligibility for the NHSHC, data were analysed for N = 6313 patients: N = 2123 control; N = 2085 counterargument; N = 2105 sunk costs. Overall, 2364 (37.45%) patients attended an NHSHC. Both intervention letters increased uptake compared to control, by 5.46% using counterargument (adjusted odds ratio (AOR) 1.32, CI 1.162–1.51, p < 0.001) and 4.33% using sunk costs (AOR 1.246, CI 1.10–1.42, p < 0.001), with no significant difference between the two.

Conclusion
Behaviourally informed invitation letters, containing sunk costs or counterargument messages, can improve the uptake of NHSHCs. The trial was registered with the International Standard Randomised Controlled Trial Registration Number Scheme (ISRCTN57110614).

Citation

Sallis, A., Gold, N., Agbebiyi, A., James, R. J. .., Berry, D., Bonus, A., Vlaev, I., & Chadborn, T. (2021). Increasing uptake of National Health Service Health Checks in primary care: a pragmatic randomized controlled trial of enhanced invitation letters in Northamptonshire, England. Journal of Public Health, 43(1), e92–e99. https://doi.org/10.1093/pubmed/fdz134

• Journal Article Type: Article
• Acceptance Date: Sep 19, 2019
• Online Publication Date: Dec 16, 2019
• Publication Date: Mar 1, 2021
• Deposit Date: Feb 12, 2020
• Publicly Available Date: Feb 17, 2020
• Journal: Journal of Public Health
• Print ISSN: 1741-3842
• Electronic ISSN: 1741-3850
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 43
• Issue: 1
• Pages: e92–e99
• DOI: https://doi.org/10.1093/pubmed/fdz134
• Keywords: Public Health, Environmental and Occupational Health; General Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/3951592
• Publisher URL: https://academic.oup.com/jpubhealth/article/43/1/e92/5678725