title: A qualitative investigation of non-response in NHS health checks.
abstract: BACKGROUND
  Improving uptake of NHS Health Checks has become a priority in England, but there is a lack of data on the perceptions of programme non-attenders. This study aimed to explore how non-attenders of NHS Health Checks perceive the programme, identify reasons for non-attendance and inform strategies to improve uptake.
  
  
  METHODS
  This qualitative study involved individuals registered at four general practices in Stoke-on-Trent, UK, who had not taken up their invitation to a NHS Health Check. Semi-structured face-to-face and telephone interviews were audio-recorded and transcribed verbatim for Thematic Analysis.
  
  
  RESULTS
  Interviews were completed with 19 males and 22 females (mean age 52.9 ± 8.5 years), who were socio-demographically representative of the non-attender population. Four main themes identified related to: the positive perception of the Health Check concept among non-attenders; the perceived lack of personal relevance; ineffective invitation method and appointment inconvenience were common barriers; previous experience of primary care can influence uptake.
  
  
  CONCLUSIONS
  Fundamental requirements for improving uptake are that individuals recognise the personal relevance of Health Checks and that attendance is convenient. Incorporating more sophisticated and personalised risk communication as part of the invitation could increase impact and promote candidacy. Flexibility and convenience of appointments should be considered by participating general practices.
authors.affiliation: Centre for Research in Sport, Health and Exercise, Staffordshire University, Leek Road Campus, 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, Leek Road Campus, 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, Leek Road Campus, Stoke-on-Trent, ST4 2DF UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Cowap
authors.affiliation: Centre for Research in Sport, Health and Exercise, Staffordshire University, Leek Road Campus, 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, Leek Road Campus, Stoke-on-Trent, ST4 2DF UK ; Stoke-on-Trent City Council Public Health Directorate, Civic Centre, Glebe Street, Stoke-on-Trent, ST4 1HH UK.
authors.forename: Zafar
authors.initials: Z
authors.lastname: Iqbal
authors.affiliation: Havering Public Health, Mercury House, 12th Floor, Mercury Gardens, Romford, Essex RM1 3DW UK.
authors.forename: Jagdish
authors.initials: J
authors.lastname: Kumar
keywords: Cardiovascular diseases; Health check; Mass screening; Qualitative research
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