An ethnographic account of the benefits and challenges of providing NHS Health Checks at community outreach events Background NHS Health Checks: Vascular disease risk assessment - for all aged 40 -74 Prevention programme → management/lifestyle intervention Aim = to reduce health inequalities Black & minority ethnic populations at greater risk of vascular disease Inner City Health Improvement Team & GP practices → community based health checks aimed to increase uptake within BME communities Methods Observations of community NHS Health Check events (n=4) Interviews with service users and staff (n=20) - NHS Health Checks - Vascular disease (heart disease, stroke, diabetes, kidney disease) Not screening – but given qrisk score – preventative programme – management/lifestyle services Aim to reduce inequalities – but needs to reach all The burden of these conditions falls disproportionately on people living in deprived circumstances and on particular ethnic groups Commissioned through local authority public health – conducted in primary care - conducted HC in community setting such as church halls and community centres -ethnography – observations and interviews Riley, R. Coghill, N. Montgomery, A. Feder, G. & Horwood, J.

Benefits Challenges Reasons for attending Engaging community Valued Family history Proactive/preventative Opportunistic Peers Engaging community Community workers Accessible venues Stepping out of practice Valued Reaffirmed healthy behaviours Information/education/ lifestyle tips Peer engagement in health talk Challenges Barriers to attending Health beliefs Mistrust of institutions Time of day Venue Lack of space Confidentiality Technology Delivery of results/advice Basic Medicalisation rather than prevention Not personal to prompt behaviour change Results Benefits Reason for attending – number of reasons – family history of stroke, diabetes, concerned about health and preventative, waling past, told about it by friends engaging community – health outreach worker – spread the words amongst contacts – driving force, central location, appreciated HC being taken to community - Valued – reinforced healthy lifestyle, gained information, added value – men talking to others about health and HC Challenges Barriers - engagement workers – told not for them, mistrust of imitations – surveillance, during day so workers couldn’t attend Venue – one room, confidentiality for weighing, providing results, Qrisk scores not given to some as internet not working - Delivery results – some wanted more information, felt given a label and did not know what to do about it, general advice on Bhr change which was not personal to them

Conclusions Practices working in collaboration with local community organisations is valuable to engage the target community Community location vital – but venue must be fit for purpose Important to: provide meaningful results/advice not pathologise patients adopt a patient centred approach Important to work with local community/organisations – step out of practice - good to be where people normally go – but has to be fit for purpose - vital to - make the check meaningful – understandable results + personal advice - not to lable patients – prevention rather than screening - be person central – advice and information and services that work for that person – limited time j.horwood@bristol.ac.uk