Reasons why people do not attend NHS Health Checks: a systematic review and qualitative synthesis

Background The NHS Health Check programme is a prevention initiative offering cardiovascular risk assessment and management advice to adults aged 40–74 years across England. Its effectiveness depends on uptake. When it was introduced in 2009, it was anticipated that all those eligible would be invited over a 5-year cycle and 75% of those invited would attend. So far in the current cycle from 2013 to 2018, 33.8% of those eligible have attended, which is equal to 48.5% of those invited to attend. Understanding the reasons why some people do not attend is important to maximise the impact of the programmes. Aim To review why people do not attend NHS Health Checks. Design and setting A systematic review and thematic synthesis of qualitative studies. Method An electronic literature search was carried out of MEDLINE, Embase, Health Management Information Consortium, Cumulative Index to Nursing and Allied Health Literature, Global Health, PsycINFO, Web of Science, OpenGrey, the Cochrane Library, NHS Evidence, Google Scholar, Google, ClinicalTrials.gov, and the ISRCTN registry from 1 January 1996 to 9 November 2016, and the reference lists of all included papers were also screened manually. Inclusion criteria were primary research studies that reported the views of people who were eligible for but had not attended an NHS Health Check. Results Nine studies met the inclusion criteria. Reasons for not attending included lack of awareness or knowledge, misunderstanding the purpose of the NHS Health Check, aversion to preventive medicine, time constraints, difficulties with access to general practices, and doubts regarding pharmacies as appropriate settings. Conclusion The findings particularly highlight the need for improved communication and publicity around the purpose of the NHS Health Check programme and the personal health benefits of risk factor detection.This work was funded by a grant from Public Health England. Juliet A Usher-Smith was funded by a National Institute for Health Research (NIHR) Clinical Lectureship and Fiona M Walter by an NIHR Clinician Scientist award (RG 68235). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. All researchers were independent of the funding body and the funder had no role in data collection, analysis and interpretation of data; in the writing of the report; or decision to submit the article for publication