title: Method of invitation and geographical proximity as predictors of NHS Health Check uptake.
abstract: BACKGROUND
  Uptake of NHS Health Checks remains below the national target. Better understanding of predictors of uptake can inform targeting and delivery. We explored invitation method and geographical proximity as predictors of uptake in deprived urban communities.
  
  
  METHODS
  This observational cohort study used data from all 4855 individuals invited for an NHS Health Check (September 2010-February 2014) at five general practices in Stoke-on-Trent, UK. Attendance/non-attendance was the binary outcome variable. Predictor variables included the method of invitation, general practice, demographics, deprivation and distance to Health Check location.
  
  
  RESULTS
  Mean attendance (61.6%) was above the city and national average, but varied by practice (47.5-83.3%; P < 0.001). Telephone/verbal invitations were associated with higher uptake than postal invitations (OR = 2.87, 95% CI = 2.26-3.64), yet significant practice-level variation remained. Distance to Health Check was not associated with attendance. Increasing age (OR = 1.04, 95% CI = 1.03-1.04), female gender (OR = 1.48, 95% CI = 1.30-1.68) and living in the least deprived areas (OR = 1.59, 95% CI = 1.23-2.05) were all independent positive predictors of attendance.
  
  
  CONCLUSIONS
  Using verbal or telephone invitations should be considered to improve Health Check uptake. Other differences in recruitment and delivery that might explain remaining practice-level variation in uptake warrant further exploration. Geographical proximity may not be an important predictor of uptake in urban populations.
authors.affiliation: Centre for Research in Sport, Health and Exercise, Staffordshire University, Stoke on Trent ST4 2DF, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Gidlow
authors.affiliation: Centre for Research in Sport, Health and Exercise, Staffordshire University, Stoke on Trent ST4 2DF, UK.
authors.forename: Naomi
authors.initials: N
authors.lastname: Ellis
authors.affiliation: Centre for Research in Sport, Health and Exercise, Staffordshire University, Stoke on Trent ST4 2DF, UK.
authors.forename: Jason
authors.initials: J
authors.lastname: Randall
authors.affiliation: Centre for Research in Sport, Health and Exercise, Staffordshire University, Stoke on Trent ST4 2DF, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Cowap
authors.affiliation: Institute for Environment, Sustainability and Regeneration, Staffordshire University, Stoke on Trent ST4 2DF, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Smith
authors.affiliation: NHS Stoke on Trent, Public Health Directorate, Civic Centre, ST4 1HH, UK.
authors.forename: Zafar
authors.initials: Z
authors.lastname: Iqbal
authors.affiliation: Havering Public Health, Mercury House, Essex RM1 3DW, UK.
authors.forename: Jagdish
authors.initials: J
authors.lastname: Kumar
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D004739:England / Q000453:epidemiology; D005260:Female; D006291:Health Policy; D006292:Health Priorities; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration*; D010342:Patient Acceptance of Health Care; D015980:Public Health Practice; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D018570:Risk Assessment; D012307:Risk Factors; D013222:State Medicine / Q000458:organization & administration*
keywords: chronic disease; population-based and preventative services; screening