title: Can lay health trainers increase uptake of NHS Health Checks in hard-to-reach populations? A mixed-method pilot evaluation.
abstract: BACKGROUND
  The NHS Health Check Programme was launched in England in 2009, offering a vascular risk assessment to people aged 40-74 years without established disease. Socio-economic deprivation is associated with higher risk of cardiovascular disease and lower uptake of screening. We evaluated the potential impact of a community-based health check service that sought to address health inequalities through the involvement of lay health trainers.
  
  
  METHODS
  Key stakeholder discussions (n = 20), secondary analysis of client monitoring data (n = 774) and patient experience questionnaires (n = 181).
  
  
  RESULTS
  The health check programme was perceived as an effective way of engaging people in conversations about their health. More than half (57.6%) of clients were aged under 50 years and a similar proportion (60.5%) were from socio-economically deprived areas. Only 32.7% from the least affluent areas completed a full health check in comparison with 44.4% from more affluent areas. Eligible men were more likely than eligible women to complete a health check (59.4 versus 33.8%).
  
  
  CONCLUSIONS
  A community-based, health trainer-led approach may add value by offering an acceptable alternative to health checks delivered in primary care settings. The service appeared to be particularly successful in engaging men and younger age groups. However, there exists the potential for intervention-generated inequalities.
authors.affiliation: Centre for Public Policy and Health (CPPH), School of Medicine, Pharmacy and Health, Durham University Queen's Campus, Stockton-on-Tees TS17 6BH, UK Fuse (UKCRC Centre for Translational Research in Public Health), Newcastle University, Newcastle-upon-Tyne NE2 4AX, UK.
authors.forename: S
authors.initials: S
authors.lastname: Visram
authors.affiliation: Fuse (UKCRC Centre for Translational Research in Public Health), Newcastle University, Newcastle-upon-Tyne NE2 4AX, UK Department of Public Health and Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Coach Lane Campus, Newcastle-upon-Tyne NE7 7XA, UK.
authors.forename: S M
authors.initials: SM
authors.lastname: Carr
authors.affiliation: Department of Public Health and Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Coach Lane Campus, Newcastle-upon-Tyne NE7 7XA, UK.
authors.forename: L
authors.initials: L
authors.lastname: Geddes
mesh_terms: D000328:Adult; D000368:Aged; D003150:Community Health Workers; D004739:England; D005260:Female; D006291:Health Policy; D006292:Health Priorities; D006293:Health Promotion / Q000458:organization & administration*; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration*; D015980:Public Health Practice; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D018570:Risk Assessment; D013222:State Medicine / Q000458:organization & administration*; D011795:Surveys and Questionnaires
keywords: circulatory disease; public health; screening