A systematic review of factors influencing nhs health check uptake: Invitation methods, patient characteristics, and the impact of interventions

Amanda Bunten*, Lucy Porter, Natalie Gold, Vanessa Bogle

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    17 Citations (Scopus)
    4 Downloads (Pure)


    Background: 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.

    Method: 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.

    Results: 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.

    Conclusions: 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.

    Trial registration: This systematic review was registered with PROSPERO on 22.02.2016. Registration number CRD42016035626.

    Original languageEnglish
    Article number93
    JournalBMC Public Health
    Publication statusPublished - 21 Jan 2020

    Bibliographical note

    Funding Information: This work was originally conducted as a doctoral assignment by Amanda Bunten. Updated searches and further amendments were made as part of the usual business activities of PHEBI. Therefore, no funding bodies played a role in the design of the study, the collection, analysis or interpretation of the data, or the writing of the manuscript.

    Open Access: This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

    Publisher Copyright: © Crown copyright will apply to Amanda Bunten, Lucy Porter and Natalie Gold. 2020

    Citation: Bunten, A., Porter, L., Gold, N. et al. A systematic review of factors influencing NHS health check uptake: invitation methods, patient characteristics, and the impact of interventions. BMC Public Health 20, 93 (2020).

    DOI: https://doi.org/10.1186/s12889-019-7889-4


    • Attendance
    • Cardiovascular disease
    • General practice
    • Invitation
    • NHS health check
    • Primary prevention
    • Uptake


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