The NHS Health Check reaches more than a million patients each year. It involves cardiovascular risk assessments, which can be used to develop management strategies to help patients lower their risk of cardiovascular disease. But how often do these checks lead to sustained behaviour change? In this piece, published as part of the Healthy Hearts collection on cardiovascular health, Sophie Griffiths, Dr Brian McMillan, Dr Kiera Bartlett, and Professor David French discuss how new technologies and communication techniques can enhance the effectiveness of the Health Check in improving patients’ cardiovascular outcomes.
- To more effectively incentivise change in patients’ behaviour, the Health Check should focus on providing actionable, personalised advice.
- A digital component of the Health Check may have a role to play in this, allowing patients to access more bespoke information at their own pace.
- The Diabetes Prevention Programme also offers a strong model for how the Health Check can act as a cost-effective ‘front door’ to further support.
In the 2022-2023 period, 1.1 million Health Checks were delivered by the NHS and local authorities to patients aged 40 – 74, who are eligible for a check every five years. These checks involve a cardiovascular risk assessment, alongside risk communication and management strategies for patients. However, these checks do not consistently lead to behaviour change, with patients expressing a need for more tailored, ongoing support to maintain their motivation and adopt long-term changes. Health Checks also often fail to reach the people who may benefit most, who are typically people from marginalised communities.
In the first instance, there is a challenge in determining how many patients act on the advice given during their Health Check. In one study, around 70% of attendees (45 out of 66) who responded to a survey after having received a Health Check reported that they made at least one lifestyle change. However, this figure is likely inflated, and qualitative evidence has found patients face numerous obstacles when attempting to change their behaviour.
One issue is that the funding and monitoring arrangements of the NHS Health Check programme currently focus on the number of checks conducted, resulting in an overemphasis on the volume of checks delivered – but potentially at the expense of the quality of the checks in supporting health behaviour change.
Most health check attendees do not receive any treatment or referral after a check, and statin prescribing in particular is much lower than guidelines recommend. Evidence on behaviour change and improvements in CVD post-check is sparse – but the data that is available indicates the rate at which advice, information and referrals are given varies widely for different risk factors, and appears to fall well below the recommended thresholds for intervention.
Towards more effective risk communication
Research at The University of Manchester has shown that risk communication alone is often ineffective for behaviour change. The main barrier to change is frequently that people lack skills to self-regulate their behaviour, i.e. put their good intentions into action, rather than low motivation. Therefore, a more effective approach to risk communication may be to use it to encourage individuals to join behaviour change programmes, where they can receive structured support to develop essential self-regulatory skills, such as goal setting and self-monitoring.
Changing self-efficacy (the belief in one’s ability to change or perform a behaviour) and helping people understand how behaviour changes will reduce disease risk will make risk communication more effective in driving behaviour change. This can be achieved by providing patients with explicit information on how altering their behaviour can reduce their risk, alongside specific strategies to build self-efficacy. Research at The University of Manchester is exploring how these approaches could be integrated into a digital NHS Health Check to support behaviour change.
It may also be helpful if they are accompanied by other behaviour change techniques, such as adjustments to the social or legislative environment, or those that target self-regulatory processes—like goal setting and planning.
Patients often leave Health Checks feeling reassured, even when risk levels require action. Effective communication should focus on modifiable risk factors rather than current risk scores, encouraging a proactive approach to health. Personalised advice and comparative risk measures, like “heart age,” may motivate preventative actions better than general risk scores. Changes to NICE guidance now recommend lifetime risk assessments to engage those with lower short-term risk scores.
Moving beyond risk communication
Simply explaining cardiovascular risk may not be enough to prompt significant lifestyle changes. NHS Health Checks might benefit from integrating evidence-based psychological strategies, such as enhancing self-efficacy and self-regulation skills. Referrals to structured behaviour change programmes could complement Health Checks for better outcomes.
The NHS Diabetes Prevention Programme (DPP) offers insights into how a CVD prevention programme could operate, due to the similarities in risk factors and management. The NHS-DPP offers patients the option to participate either in group sessions or via digital platforms, helping them to understand the repercussions of type 2 diabetes and make changes to reduce their risk of developing the disease in the future. The programme includes behaviour change strategies that help individuals develop skills to support self-regulation of health behaviours. Research at The University of Manchester found that patients referred to the NHS-DPP had a lower incidence of type 2 diabetes compared to individuals at practices where the programme had not been deployed. It concluded that the introduction of the NHS-DPP reduced population incidence of type 2 diabetes in England for over 20,000 people in those practices that put the DPP in place, and is cost-effective, with a recent analysis showing projected savings close to £72 million over 35 years. Following this model, the NHS Health Check could be used as a referral into a similar prevention programme for CVD.
Digital health checks
The Department for Health and Social Care has announced a digital version of the Health Check. Three local authorities have been selected to pilot the new Health Check, with the aim of scaling it up to one million checks in the first 4 years. While the digital version is intended to complement, rather than replace, the face-to-face health check, policymakers must implement it carefully to avoid widening health inequalities, particularly among individuals with limited digital access or skills—the so-called ‘digital divide’. Delivering Health Checks in community-based settings may be more effective at reaching underserved groups than those offered through GPs, highlighting the role of commissioning decisions in achieving equitable access.
As discussed previously, there is scope for a digital version of the Health Check in providing tailored support for patients. Research at Manchester has shown patients are keen on being signposted to services through a digital component of the face-to-face health check. This approach would allow patients more time to explore their risk information at their own pace and access tailored resources to support behaviour change, creating a more flexible and user-centred pathway to improve health outcomes. Patients have previously expressed dissatisfaction with the generic advice offered through Health Checks, so a more personalised approach delivered via digital platforms could be one way to improve this.
A Health Check for the 21st Century
The majority of cardiovascular disease cases in the UK are preventable, but despite this, CVD costs the NHS £7.4 billion every year. The Health Check offers a reliable, recurring opportunity to identify CVD risks and engage individuals in making healthier changes, and policymakers should ensure every advantage is taken to reduce the danger to these individuals. This means changing how patients are engaged with during and after the check, including more personally-tailored individual support through digital channels, as well as using it as a stepping-stone to other services.
