Randomised controlled trial comparing uptake of NHS Health Check in response to standard letters, risk-personalised letters and telephone invitations

Christopher J. Gidlow*, Naomi J. Ellis, Victoria Riley, Tim Chadborn, Amanda Bunten, Zafar Iqbal, Aliko Ahmed, Alistair Fisher, David Sugden, David Clark-Carter

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)


Background: NHS Health Check is a primary prevention programme offering cardiovascular disease (CVD) risk assessment to adults in England aged 40-74. Uptake remains a challenge and invitation method is a strong predictor of uptake. There is evidence of low uptake when using invitation letters. Telephone invitations might increase uptake, but are not widely used. We explored the potential to improve uptake through personalising letters to patient's CVD risk, and to compare this with generic letters and telephone invitations. Methods: HEalth Check TRial (HECTR) was a three-arm randomised controlled trial in nine general practices in Staffordshire (UK). Eligible patients were randomised to be invited to a NHS Health Check using one of three methods: standard letter (control); telephone invitation; letter personalised to the patient's CVD risk. The primary outcome was attendance/non-attendance. Data were collected on a range of patient- and practice-level factors (e.g., patient socio-demographics, CVD risk, practice size, Health Checks outside usual working hours). Multi-level logistic regression estimated the marginal effects to explore whether invitation method predicted attendance. Invitation costs were collated from practices to estimate cost benefit. Results: In total, 4614 patients were included in analysis (mean age 50.2 ± 8.0 yr.; 52.4% female). Compared with patients invited by standard letter (30.9%), uptake was significantly higher in those invited by telephone (47.6%, P <.001), but not personalised letter (31.3%, p =.812). In multi-level analysis, compared with the standard letter arm, likelihood of attendance was 18 percentage points higher in the telephone arm and 4 percentage points higher in the personalised letter arm. The effect of telephone calls appeared strongest in patients who were younger and had lower CVD risk. We estimated per 1000 patients invited, risk-personalised letters could result in 40 additional attended Health Checks (at no extra cost) and telephone invitations could result in 180 additional Health Checks at an additional cost of £240. Conclusions: Telephone invitations should be advocated to address the substantial deficit between current and required levels of NHS uptake, and could be targeted at younger and lower CVD risk adults. Risk-personalised letters should be explored further in a larger sample of high risk individuals. Trial registration: Registration number: ISRCTN15840751 date of registration: 24/10/2017.

Original languageEnglish
Article number224
JournalBMC Public Health
Issue number1
Publication statusPublished - 21 Feb 2019

Bibliographical note

Funding Information:
This work was supported by Stoke-on-Trent City Council, Staffordshire County Council and Public Health England. The sponsors had input to the design of the study. Collection, analysis and interpretation of data, writing of the report and the decision to submit the paper for publication were entirely the responsibility of the authors.

Publisher Copyright:
© 2019 The Author(s).


  • Health check
  • Policy implementation
  • Prevention
  • Risk
  • Vascular disease


Dive into the research topics of 'Randomised controlled trial comparing uptake of NHS Health Check in response to standard letters, risk-personalised letters and telephone invitations'. Together they form a unique fingerprint.

Cite this