An insight into the NHS Health Check Programme in Birmingham NHS Health Check National Learning Network 14 th Workshop - London 17 th July 2012

Implementation of NHS Health Checks 91,449 Number who have received an NHS Health Check 286,766147, ,251

Gaining an insight... Aim to provide an insight into people’s experiences of NHS Health Check Programme in Birmingham. Specifically interested in understanding: –How the Health Check programme is working in Birmingham? –What is happening after people attend their appointment? –How effective in leading to lifestyle changes? –Implications for lowering health risks associated with CVD?

Methodology ▪Qualitative approach: semi-structured interviews, prompted to talk about all aspects of NHS Health Checks experience. ▪ Sampling: randomly drawn. Initial response rate was low. Second recruitment drive undertaken. ▪ Response Rate: 345 recruitment letters issued, 21 consent forms returned, 10 participants recruited. ▪ Sample: 8 females, 2 males; mean age 58.4 years; predominately White British.

Transcripts analysed using qualitative analysis. Stepped approach; i) audio interviews copied into written transcripts ii) emerging patterns noted iii) compared amongst sample and developed into themes. Two master themes identified: 1) Awareness & Understanding 2) Reassurance Qualitative Analysis

Awareness & Understanding Understanding of NHS Health Checks Programme Perception of NHS Health Check as Health MOT Meaning of Results

Service User Comments “I thought it would be a good overhaul, you know, an overall body check for everything” “I’d never heard a thing about it” “I expected more, not just the CV bit” “I didn't’ know what 5.8 meant, whether it was high or low and whether I need to be worried” “Results should be explained more clearly”

Reassurance Mechanism Reassurance Confirmatory role of health check Role of Health Professional Selective focus on positive results Immediacy of receiving results Reasons for attending health check

Service User Comments “I just wanted it confirmed” “It was good to underline that everything was fine” “The driving force to go was the intrigue to know I’m ok” “She gave me the impression that everything was ok” “I wanted it confirming that I was doing all the right things”

Summary of key findings Little understanding & awareness of both the existence of and the purpose of the NHS Health Check Programme. NHS Health Check perceived as a ‘general health MOT’ rather than a CVD prevention programme. Need for the meaning of results to be explained and put into context for participants to understand. Both a reassuring and confirmatory role of positive health, as opposed to a communication of risk for CVD.

Recommendations 1. Training for Providers 1. Training for providers 2. Marketing 3. Meaningful Results

Training for Providers ▪ The NHS Health Check needs to be promoted and delivered as a ‘behaviour and lifestyle prevention programme’ as opposed to a ‘check up’. ▪ Equip facilitators with skills and knowledge to begin facilitating behaviour change e.g. language & terminology, development of structured discussion tools. ▪ Embed a self-management model of care. ▪ Concordance not compliance!

Social Marketing ▪ Use of consumer insight to guide local marketing & promotion strategy. ▪ ‘Real life’ experiences are powerful motivators for attending a NHS Health Check. Local residents to ‘champion’ local NHS Health Check Programmes (e.g. In-house health advocate training programme, engagement of survivors families). ▪ Empower local communities to take more ownership of their own health.

Meaningful Results Results need to be understood before they can be acted upon. ▪ Avoid references to ‘% risk’ and numerical values. Instead focus on level of risk of developing specific diseases. ▪ Information alone is not enough not prompt behaviour change. ▪ Results should be made applicable and transferred into concrete goals to prompt positive lifestyle change.

Next Steps.... Nationally… National collaboration of existing qualitative research findings. Commitment to further qualitative research (focus groups, patient experience surveys, follow-up). Locally… Exploration of NHS Health Check providers’ views. Implementation of goal setting & evaluation.

Thank You! Dr Laura Chipchase Health Psychologist Birmingham Public Health