Public Health England, PHE Behavioural Insights Team (PHEBI), Research, Translation & Innovation Division, 6th Floor, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK.
University of Exeter, Exeter, UK.
BMC Public Health. 2020 Jan 21;20(1):93. doi: 10.1186/s12889-019-7889-4.
The NHS Health Check (NHSHC) is a risk assessment for those aged 40-74 without a pre-existing condition in England, with the aim of preventing stroke, kidney disease, heart disease, type 2 diabetes and dementia. Uptake has been lower than anticipated. Ensuring that a high percentage of eligible patients receive a NHSHC is key to optimising the clinical and cost effectiveness of the programme. The aim of this systematic review is to highlight interventions and invitation methods that increase the uptake of NHSHCs, and to identify whether the effectiveness of these interact with broader patient and contextual factors.
A systematic review was conducted according to the PRISMA checklist. Papers were eligible if they explored the impact of at least one of (i) interventions, (ii) invitation methods or (iii) broader factors on NHSHC uptake. Ten databases were searched in January 2016 and seven were searched in March 2018. Nine-hundred-and-forty-five papers were identified, 238 were screened and 64 full texts were assessed for eligibility. Nine studies were included in the review.
The nine studies were all from peer reviewed journals. They included two randomised controlled trials, one observational cohort and six cross-sectional studies. Different invitation methods may be more effective for different groups of patients based on their ethnicity and gender. One intervention to enhance invitation letters effectively increased uptake but another did not. In addition, individual patient characteristics (such as age, gender, ethnicity and risk level) were found to influence uptake. This review also finds that uptake varies significantly by GP practice, which could be due either to unidentified practice-level factors or deprivation.
Further research is needed to assess the effectiveness of different invitation methods for different population groups. Research should examine how existing invitation methods can be enhanced to drive uptake whilst reducing health inequalities.
This systematic review was registered with PROSPERO on 22.02.2016. Registration number CRD42016035626.
NHS 健康检查（NHSHC）是针对英格兰年龄在 40-74 岁且无既往疾病的人群进行的风险评估，旨在预防中风、肾脏疾病、心脏病、2 型糖尿病和痴呆症。其参与率低于预期。确保有相当比例的符合条件的患者接受 NHSHC 是优化该计划临床和成本效益的关键。本系统评价的目的是强调提高 NHSHC 参与率的干预措施和邀请方法，并确定这些措施的有效性是否与更广泛的患者和背景因素相互作用。
根据 PRISMA 清单进行了系统评价。如果论文探讨了至少以下之一的影响，则符合条件：（i）干预措施；（ii）邀请方法；或（iii）更广泛的因素对 NHSHC 参与率的影响。2016 年 1 月搜索了 10 个数据库，并于 2018 年 3 月再次搜索了 7 个数据库。共确定了 945 篇论文，筛选了 238 篇，评估了 64 篇全文的资格。共有 9 项研究纳入本综述。
这 9 项研究均来自同行评审期刊。它们包括两项随机对照试验、一项观察性队列研究和六项横断面研究。不同的邀请方法可能因患者的种族和性别而对不同群体更有效。一种增强邀请信的干预措施有效地提高了参与率，但另一种方法则没有。此外，个体患者特征（如年龄、性别、种族和风险水平）也被发现会影响参与率。本综述还发现，参与率因全科医生实践而有很大差异，这可能是由于未识别的实践层面因素或贫困造成的。
需要进一步研究不同邀请方法对不同人群的有效性。研究应研究如何增强现有的邀请方法以提高参与率，同时减少健康不平等。
本系统评价于 2016 年 2 月 22 日在 PROSPERO 上注册。注册号：CRD42016035626。
