NHS Health Check Programme rapid evidence synthesis

Background: The NHS Health Check programme is the largest current prevention initiative in England. Since its introduction in 2009 a growing literature has been published evaluating the first eight years of the programme. These have been summarised in reports published by Public Health England but, to date, no synthesis has been performed. There is, therefore, a need for an independent, comprehensive, rapid evidence synthesis to identify what has been learnt about the NHS Health Check programme so far. Aims and Objectives: To provide a rapid synthesis of the published research evidence on NHS Health Checks, specifically addressing the six research questions posed by Public Health England: 1. Who is and who is not having an NHS Health Check? 2. What are the factors that increase take-up among the population and sub-groups? 3. Why do people not take up an offer of an NHS Health Check? 4. How is primary care managing people identified as being at risk of cardiovascular disease or with abnormal risk factor results? 5. What are patients’ experiences of having an NHS Health Check? 6. What is the effect of the NHS Health Check on disease detection, changing behaviours, referrals to local risk management services, reductions in individual risk factor prevalence, reducing cardiovascular disease risk and on statin and antihypertensive prescribing? Design: A systematic review with descriptive synthesis of quantitative data and thematic synthesis of qualitative data. Data sources: Medline, PubMed, Embase, Health Management Information Consortium (HMIC), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Global Health, PsycInfo, Web of Science, the Cochrane Library, NHS Evidence, Google Scholar, Google, OpenGrey, Clinical Trials.gov, the ISRCTN registry, and article reference lists. Study selection: Studies identified by the searches were selected for inclusion in the review by two reviewers in a two-step process. First, studies relevant to the NHS Health Check were identified. These were then screened against predefined inclusion and exclusion criteria for each of the six research questions. Data extraction: At least two researchers assessed eligibility, extracted data, and assessed the quality of the included studies. Key findings: Coverage varies substantially across regions and in different settings. Multiple definitions used interchangeably make comparisons difficult. It is consistently higher in older people, females and more deprived populations but this may reflect targeting. Outreach services in the community can reach particular socio-demographic groups but better descriptions and robust evaluations are needed. There is a lack of national level studies reporting the characteristics of those who take-up the invitation to an NHS Health Check. Regional studies report uptake between 27% and 53%, similar to national reported uptake (48.3%). Older people, women in younger age groups and men in older age groups, and those from least deprived areas are more likely to take up invitations. Promising methods to increase uptake are modifications to the invitation (3-4% increase), and text message invites or reminders (up to 9% increase). There is a lack of quantitative evidence for the effect of community settings on uptake but qualitative evidence highlights their convenience and the value of community ambassadors. People do not take up the offer of an NHS Health Check due to lack of awareness or knowledge, competing priorities, misunderstanding the purpose, an aversion to preventive medicine, difficulty getting an appointment with a GP, and concerns about privacy and confidentiality of pharmacies. Amongst attendees there are high levels of satisfaction (over 80%). Some reported attendance had acted as a wake-up call and precipitant for lifestyle changes. Others were left with feelings of unmet expectations, were confused about or unable to remember their risk scores, and found lifestyle advice too simplistic and un-personalised. There are wide variations in the process, delivery and content of NHS Health Checks across the country, in part due to different local implementation. Regardless of region or setting those delivering NHS Health Checks reported challenges with workload, IT, funding, and training. Amongst general practice professionals there were concerns about inequality of uptake and doubts about the evidence underpinning the programme and the cost-effectiveness. NHS Health Checks are associated with small increases in disease detection. There is very little data on behaviour change or referrals to lifestyle services. NHS Health Checks are associated with a 3-4% increase in prescribing of statins