1. Ruth Riley, Nikki Coghill, Alan Montgomery, Gene Feder, Jeremy Horwood School of Social and Community Medicine, University of Bristol NHS Health Checks are currently being offered to patients aged 40-74 years who are not on a relevant disease register. The main aim is to identify those at risk of cardiovascular disease (CVD), kidney disease or diabetes and tackle health inequalities. People from most black, minority ethnic (BME) populations are at greater risk of diabetes and stroke compared to the majority population, yet uptake of health checks is lower in BME communities. Outreach or community based health checks aim to increase uptake within these communities. Aim and Design This study aimed to identify the benefits and challenges of providing NHS health checks to the Afro-Caribbean community in Bristol via outreach events. An ethnographic study using participant observation and interviews with attendees and staff at three outreach events. Interviews explored individuals’ views and experiences of the outreach events. Analyses Detailed field notes were made and annotated. Interviews were audio-recorded, transcribed and imported into NVivo10 and analysed using inductive thematic analysis. Participants (n=20) Attendees (n=16), 9 male, 7 female aged 40-52 yrs & 4 staff (practice nurse, HCA, outreach worker & health worker). Four major themes were identified: Engagement Outreach workers were respected members of the local community who employed a variety of methods to engage people, including: direct contact, leafleting, posters and local radio; they were key in encouraging people to attend. Outreach workers reported some resistance to participation including timing of events, historical mistrust of services/ surveillance medicine, denial/fear of results, reactive not preventative health seeking. Reasons for Attending Family History of CVD. Attendees talked about family members with cardiovascular disease, diabetes, hypertension and stroke. Participants’ understanding and familial experience of these conditions prompted them to attend a health check for preventative reasons: Background Method Findings Conclusions Correspondence to: r.riley@bristol.ac.uk An Ethnographic Account of the Benefits and Challenges of Providing NHS Health Checks at Community Outreach Events ‘I’m over 40, um and have got a family history of the diabetes, high blood pressure and so on, so I thought it would be good for me to have the check.’ (Female, 57 yrs) Proactive, Preventative, Self-Care. Many of the outreach attendees were proactive in their self-care and consequently opted to have the health check for preventative reasons, as this participant indicates: ‘I call it like a little mini MOT... just to make sure everything’s alright...and... maybe if you sort of, catch your warning signs you can sort of like prevent anything sort of more damaging occurring ’ (Female, 51 yrs) Location and Delivery Familiarity, convenience of the location and the ease and expedience of the drop-in health check was often juxtaposed with some attendees’ experience of visiting the doctors : ‘it was quicker than going to the doctors actually because when you go to the doctors, you’ve got an appointment..yeah, it was very quick, very efficient ’ (Female, 44 yrs) Some concerns were raised about the lack of confidentiality in some venues. Staff were viewed as approachable and professional and the health checks event also provided some attendees with the opportunity to raise concerns about other health issues: ‘one guy was saying...“When I go to the toilet there’s um blood when I go to the toilet.’..whatever we provided on that day, it was a safe enough space for him to ask other questions.’ (Outreach Worker) Some attendees also valued the presence of Afro-Caribbean staff in terms of cultural identification and the provision of culturally tailored lifestyle advice. The presence of local practice staff, was also interpreted as an indication of their interest in their local community. ‘ Value of Health Checks. The majority of attendees (46/48) received low CVD risk scores. Most attendees felt relieved with their low risk results which reaffirmed healthy lifestyle behaviours: ‘Doing it made me feel a lot better within myself, knowing that I was alright, and going down the right road, which encourages me to still stay in my gym carrying on doing what I do.’ (Male, 50yrs) Some attendees reported making lifestyle changes post health check: ‘Yeah I’ve started doing a bit more sports...I feel more better for it too.’ (Male, 42 yrs). However, a few attendees were unhappy with their results - one attendee was frustrated about being categorised as obese and the health check did not enhance their self-efficacy for health behaviour change: “Gutted, ‘ cos I don’t know what else I can do ” (Female, 57 yrs) One unexpected benefit was the way in which attendees, particularly men, engaged in self-care talk through discussion with peers. ‘It give you a bit of encouragement, say, “Yeah get along to your doctor and sort it out,”... you compare what you’re doing,..You go to the gym?”... “What do you eat?” “What you not eating?” You know, “Are you drinking?” (Male, 46yrs). The NHS health checks were positively received and conferred a range of benefits to those who attended. The health checks also raised awareness of the challenges and opportunities involved in bringing health checks into a community setting. Consideration needs to be given to: employing local community members/organisations to engage the target community using a range of methods, maintaining confidentiality in community settings, ensuring the purpose of health checks lies in prevention not medicalisation and that results are fed back sensitively to enhance self-efficacy for behaviour change.