Feasibility study of a digital NHS Health Check

Background
Use of digital methods for remote delivery of the NHS Health Check (NHSHC) is a central to the development of this national cardiovascular disease risk identification and management programme. This study aimed to explore the feasibility of a web-based digital NHSHC implemented across three general practices in Cornwall.

Methods
Feasibility was explored in terms of acceptability, practicability, limited efficacy (response and completion overall, by socio-demographic group), implementation and integration, and patient safety. Quantitative data were non-identifiable participant-level data (n=2036) from the digital providers and online participant surveys (n=109). Qualitative data were gathered through semi-structured one-to-one interviews with participants (37 NHSHC participants, 11 stakeholders).

Results
Of the 2036 individuals invited, 670 responded (32.9%), and 193 (9.5%) completed all parts of the digital NHSHC. Patterns in response and completion indicated that age and gender patterns were similar to those for in-person NHSHC. Survey and interview data confirmed the need for greater promotion to demonstrate the legitimacy of the programme and raise awareness, and to consider alternative methods of cholesterol testing and blood pressure measurement, which were the least acceptable components of the process. Interview participants recognised potential for a digital NHSHC to reduce primary care demand and increase flexibility to patients. But there was a general preference for a hybrid offer combining digital and in-person options. Key practical issues to implementation included a reliance on manual processes (and potential human error) around invitations and participant results (sharing with participant and writing them into primary care records).

Conclusions
To address feasibility issues of this web-based digital NHSHC, we recommend: greater promotion/awareness and credible/trusted invitation methods to improve response rate; flexibility around blood pressure and cholesterol measurement, and possible hybrid options, to improve completion; improvements to participant alert when results are ready or errors occur; and greater automation of processes to mitigate human error and increase efficiency.