Applying behavioural science to increase uptake of the NHS Health Check: a randomised controlled trial of gain- and loss-framed messaging in the national patient information leaflet

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.

NHS Health Check programme: a rapid review update

“… 32 Another study implemented new shorter leaflet styles (two vs four pages) but there were no statistically meaningful changes in uptake. 31 Use of SMS reminders and time limited letters did, increase uptake 31 ; confirming the positive results previously reported in a similar study. 34 Telephone invitations also improved uptake compared with the standard letter invitation and a personalised CVD risk.…”

A systematic review of factors influencing NHS health check uptake: invitation methods, patient characteristics, and the impact of interventions

“…This technique has been successful in other areas (e.g., general health checks, influenza vaccinations [29], so its failure to increase NHS Health Check uptake highlights the importance of trialling interventions applied to new areas, even when they have been successful in similar fields. Recently, Gold and colleagues found that providing an enhanced leaflet alongside invitation letters also failed to significantly impact uptake rates [30]. Together, these findings suggest that making enhancements to the invitations directly (instead of to any accompanying materials) may be the most effective strategy to improve uptake.…”

Effectiveness of digital interventions to improve household and community infection prevention and control behaviours and to reduce incidence of respiratory and/or gastro-intestinal infections: A rapid systematic review

“…The searches were conducted on 26 th May 2020. We restricted the searches to studies published since 1 st January 2000, since we did not expect that there would be any digital interventions prior to 2000, which is consistent to the approach taken by previous reviews [9].…”