Understanding target group perceptions of the Health Check PLUS Programme Chima Olughu and Sheila Taylor NHS South East London Greenwich Public Health

Greenwich – local context Greenwich currently has one of the highest mortality rates of CVD nationally and is 23% higher than the London average Greenwich England Men 75.8 years (-2.5)78.3 years Women 81.9 years (-0.4)82.3 years

Mortality – why the gap? cancers, especially lung cancer (25.5% of the gap) circulatory diseases, especially coronary heart disease (24.3% of the gap) chronic liver disease and other digestive disorders (14.8% of the gap) respiratory disease, especially COPD (12.6% of the gap) mental disorders and suicide (9.1% of the gap). The rate of deaths due to circulatory disease is about 40% higher in the most deprived areas of Greenwich than in the least deprived, and this is true for both men and women

Aim To evaluate the Health Check PLUS community outreach by assessing perceptions of clients who accessed the service.

Objectives  To understand the motivations and barriers to attending the Health Check PLUS programme  To understand the triggers to positive behaviour change  To make future recommendations to improve service delivery

 Sample selection  Health Check PLUS MEGA Clinics (LES) (attendees & non attendees)  Black and Minority Ethnic Group Outreach (Mosque & Temple)  Qualitative – questionnaires, focus groups, telephone interviews  Quantitative – questionnaires Methodology

Sample DescriptionMethods Recruitment Channel Number Cohort 1 Attendees Patient Satisfaction Questionnaire MEGA clinic540 Depth phone interviews Patient Satisfaction Questionnaire / EHS Data 15 Cohort 2 Non - Attendees Depth phone interviews EHS Data10 Cohort 3 BME Groups In-person questionnaire Shree Kutch Satsang Swaminarayan (SkSS) Temple 33 attendees 15 non-attendees Greenwich Islamic Centre (local Mosque) 7 attendees 17 non-attendees Total 637 respondents

Focus Groups Description DateVenueNumber Cohort 1 Attendees 24/6/11 The Barnfield Project 2 Males 2 Females Cohort 2 BME Male 16/7/11 SkSS Temple 7 Males Cohort 3 BME Female 16/7/11 SkSS Temple 7 Females Totals19 Participants

Methodology (2) Motivators Barriers Attitudes Change incentives

Results - Motivators Concern about future health (29%)

Motivators

Attitudes High satisfaction with Health Check Cohort 1 : 97% Cohort 3: 95% Location- “convenient & preferred” Staff – “Friendly, helpful & professional” Service – “Good, clear & trusted”

What Attendees Liked Most About the Service

Barriers (attendance) Conflicting priorities (cohort 2 & 3) Difficulty finding location (cohort 2) Unwell/poor health (cohort 2) Lack of knowledge (cohort 3) Travelling/time (cohort 3) Dissatisfaction with GP service

Barriers (change) Ingrained behaviours Cod liver oil generation Desensitised to repeated major health problems Lack of trust & relationship with GP Fatalistic outlook Perceived costs

Work Work Cultural diet Cultural diet Male bravado Male bravado Barriers (change)

Triggers for change Family history of illness Milestone age (40, 50, 60) A desire for reassurance or a nagging concern about aspect of health

Results – Change incentives Cohort 1 Cost savings – stop smoking Children/Dependents – no burden Additional support Effortless – not interested in major lifestyle changes Existing health conditions

Cohort 3 Clear difference between men & women MEN – intrinsic motivation of self and AGE WOMEN – children main motivator Ability to work – If healthy then able to work Happiness – “being healthy keeps you happy” Results – Change incentives

Recommendations Think outside the NHS Know the local landscape of opportunities and signpost to services that fit the clients daily lives Focus on Wellness Boost independence, self esteem and overall wellness. Include family and friends Accessible Make the healthy choice the easy choice

Recommendations Cohort 3  Factors encouraging attendance  Local ambassadors (Imam, Priest, Volunteers)  Health check at Mosque or Temple  Separate men & women sessions  Screens for privacy  Information in own language.

Recommendations - cont Effective Messages  Stay healthy for future – enjoy life  Live for today  Clear and simple messages - FAST  Ongoing conversation Publicity and Promotion  Women Stay healthy for future Men Factual and hard hitting  Older People Stay active/Grandchildren  Ethnic Minorities Specific risks/ medical info

Recommendations

QUESTIONS