Working with people from minority ethnic groups to improve uptake of NHS Health Checks

We have been working closely with people from minority ethnic groups in Bristol to see if telephone outreach can improve the uptake of NHS Health Checks among these communities. Vascular diseases such as heart disease, stroke, diabetes and chronic kidney disease are a major cause of early death, ill-health and disability in England. They are more common in deprived populations and some minority ethnic groups, and contribute significantly to inequalities in health.

The NHS Health Checks programme is a required public health service to help prevent vascular conditions. Patients aged between 40 and 74 are invited every five years for a Health Check, to assess their risk of developing vascular conditions. The service also provides support to help reduce risk, through healthier lifestyles, including avoiding tobacco, maintaining a healthy weight, and being active, and where appropriate, drug treatment for patients at high risk. 

In Bristol, amongst other strategies to encourage more people to have their NHS Health Check, ‘telephone outreach’ has been developed in collaboration with the voluntary and community sector partners and GP practices in more deprived areas. In this telephone call the purpose of the NHS Health Check is discussed, and some of the questions about lifestyles needed for the NHS Health Check are asked. Patients may be given information about other services that might help them, for example, local walking groups or help to stop smoking if they want it. If they are willing a book a full face-to-face NHS Health Check with a nurse at the GP practice the appointment can be arranged over the phone.

A team of researchers led by Jeremy Horwood at NHIR CLAHRC West, with others at the University of Bristol, are doing some work to understand what people think of outreach telephone calls for NHS Health Checks. The research project interviewed both the people making the phone calls and patients receiving them to understand their views, attitudes and experiences of telephone outreach for NHS Health Checks.

Why is this project important?

The findings will inform future development of the NHS Health Checks programme in Bristol and beyond, to improve uptake and effectiveness of the NHS Health Checks programme in communities with greater health needs. We also anticipate improved understanding of the potential for telephone outreach in other public health interventions. Preliminary findings have been presented to people who make decisions about health care at both local and national levels.

How did advice and information from Patient and Public Involvement (PPI) help?

It was important that the way we invited people for interviews was acceptable and that the invitation letter and information about the project made sense to those receiving it by post and gave them relevant information. Involvement allowed us to find out if the materials made sense and whether the approach we were thinking of using was culturally appropriate.

Who got involved?

One researcher attended a community meeting of Somali women who had received outreach telephone calls and a subsequent NHS Health Check. Two Somali women volunteered to take part and advise on the study materials and ways to interact with members of the Somali community. A researcher and one of these women met twice to work on the invitation letter, study information for possible participants and the questions for the interview itself. The ideas suggested were used by the research team in revised documents.

The researcher attended another community meeting of people who had been to their NHS Health Check after a telephone outreach call. Two white British women agreed to help from this group and a meeting was arranged for all four women plus a female Somali interpreter to discuss the project. This meeting was held at the University of Bristol with travel expenses paid and high street shopping vouchers given at the end as a thank you. A person independent of the study who had experience of running involvement meetings led the conversation.

What did those involved contribute to the project?

They felt that it was important to state much more clearly in the letter and information that the researchers could not access their medical records. One contributor said that she would never answer a call from a withheld number, but that she would probably answer a call from a mobile number which she did not recognise. The group suggested that the mobile number of the phone used to call participants should be written prominently in the letter.

It was felt that people might be more willing to be interviewed if they were told (in more than one place) how long it was expected to take so that they could plan their time. It would also be good practice to check at the beginning of the interview if people were still willing to go ahead with the interview. Members of the group liked the idea of having the information through the post so that they had time to think about it and discuss it with others.

For more information about the project contact Tracey Stone on tracey.stone@bristol.ac.uk.