title: Be SMART: examining the experience of implementing the NHS Health Check in UK primary care.
abstract: BACKGROUND
  The NHS Health Check was designed by UK Department of Health to address increased prevalence of cardiovascular disease by identifying risk levels and facilitating behaviour change. It constituted biomedical testing, personalised advice and lifestyle support. The objective of the study was to explore Health Care Professionals' (HCPs) and patients' experiences of delivering and receiving the NHS Health Check in an inner-city region of England.
  
  
  METHODS
  Patients and HCPs in primary care were interviewed using semi-structured schedules. Data were analysed using Thematic Analysis.
  
  
  RESULTS
  Four themes were identified. Firstly, Health Check as a test of 'roadworthiness' for people. The roadworthiness metaphor resonated with some patients but it signified a passive stance toward illness. Some patients described the check as useful in the theme, Health check as revelatory. HCPs found visual aids demonstrating levels of salt/fat/sugar in everyday foods and a 'traffic light' tape measure helpful in communicating such 'revelations' with patients. Being SMART and following the protocolrevealed that few HCPs used SMART goals and few patients spoke of them. HCPs require training to understand their rationale compared with traditional advice-giving. The need for further follow-up revealed disparity in follow-ups and patients were not systematically monitored over time.
  
  
  CONCLUSIONS
  HCPs' training needs to include the use and evidence of the effectiveness of SMART goals in changing health behaviours. The significance of fidelity to protocol needs to be communicated to HCPs and commissioners to ensure consistency. Monitoring and measurement of follow-up, e.g., tracking of referrals, need to be resourced to provide evidence of the success of the NHS Health Check in terms of healthier lifestyles and reduced CVD risk.
authors.affiliation: School of Life & Health Sciences, Aston University, Birmingham, B4 7ET, UK. r.l.shaw@aston.ac.uk.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Shaw
authors.affiliation: School of Life & Health Sciences, Aston University, Birmingham, B4 7ET, UK. h.m.pattison@aston.ac.uk.
authors.forename: Helen M
authors.initials: HM
authors.lastname: Pattison
authors.affiliation: School of Life & Health Sciences, Aston University, Birmingham, B4 7ET, UK. c.holland1@aston.ac.uk.
authors.forename: Carol
authors.initials: C
authors.lastname: Holland
authors.affiliation: School of Life & Health Sciences, Aston University, Birmingham, B4 7ET, UK. r.cooke@aston.ac.uk.
authors.forename: Richard
authors.initials: R
authors.lastname: Cooke
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D057189:Checklist; D004032:Diet; D058006:General Practice / Q000379:methods / Q000458:organization & administration*; D015438:Health Behavior; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D008019:Life Style; D011320:Primary Health Care / Q000458:organization & administration*; D016730:Program Development; D036301:Qualitative Research; D012307:Risk Factors; D040242:Risk Reduction Behavior; D016540:Smoking Cessation; D013222:State Medicine; D006113:United Kingdom / Q000453:epidemiology