NIHR | September 2019| Text message reminders increase attendance at NHS health checks
An RCT assessed the impact of patients receiving a text message reminder as a means of increasing attendance at NHS health checks. Currently, NHS health checks are offered to adults aged 40 to 74 years. Identification and management of cardiovascular risk factors has been shown to save lives. Yet only half of adults attend a check when it is offered.
This trial was conducted across 28 general practices in South London assessed the effect of sending pre- and post-invitation text messages, along with different forms of invitation letter. Patients were first assigned to receive either a pre-notification text or not. They were then assigned to receive one of 4 types of invitation letter:
- standard control letter, detailing the health check in several paragraphs
- open-ended letter, briefly saying their check was due and asking them to call and book
- time-limited letter, as open-ended letter but asking them to attend in a limited time period, such as ‘your check is due in March’
- social-norm letter, as open-ended letter but adding testimonials from patients saying how the health check helped them.
Finally, they were assigned to receive a reminder text or not.
The reminder text appeared to be the most effective addition. For all three intervention letters (open-ended, time-limited and social-norm) fewer people attended a health check when a reminder text was not sent. Although the time-limited letter with both texts was most effective, there was not enough evidence to support the value of the pre-notification text.
Amongst invited patients, 24% attended health checks. This ranged from 18% of those sent the standard control letter with neither text pre-notification nor reminder, to 30% of those sent the time-limited letter with both text pre-notification and reminder. Comparatively, this latter group had almost doubled odds of attending (Source: NIHR).
Sallis, A., et al |2019| Pre-notification and reminder SMS text messages with behaviourally informed invitation letters to improve uptake of NHS Health Checks: a factorial randomised controlled trial| BMC public health| 19|1|P. 1-12.
Background: The NHS Health Check (NHS HC) is a cardiovascular risk assessment to prevent cardiovascular disease. Public Health England (PHE) wants to increase uptake.
Methods: We explored the impact of behaviourally informed invitation letters and pre-notification and reminder SMS on uptake of NHS HCs. Patients at 28 General Practices in the London Borough of Southwark who were eligible to receive an NHS HC between 1st November 2013 and 31st December 2014 were included. A double-blind randomised controlled trial with a mixed 2 (pre-notification SMS – yes or no) x 4 (letter – national template control, open-ended, time-limited, social norm) x 2 (reminder SMS – yes or no) factorial design was used. The open-ended letter used simplification, behavioural instruction and a personalised planning prompt for patients to record the date and time of their NHS HC. The time-limited letter was similar but stated the NHS HC was due in a named forthcoming month. The social norms letter was similar to the open-ended letter but included a descriptive social norms message and testimonials from local residents and no planning prompt. The outcome measure was attendance at an NHS HC.
Results: Data for 12, 244 invites were analysed. Uptake increased in almost all letter and SMS combinations compared to the control letter without SMS (Uptake 18%), with increases of up to 12 percentage points for the time-limited letter with pre-notification and reminder; 10 percentage points for the open-ended letter with reminder and a 9 percentage point increase using the time-limited letter with reminder. The reminder SMS increased uptake for all intervention letters. The pre-notification did not add to this effect.
Conclusions: This large randomised controlled trial adds support to the evidence that small, low cost behaviourally informed changes to letter-based invitations can increase uptake of NHS HCs. It also provides novel evidence on the effect of SMS reminders and pre-notification on NHS HC attendance.
Full article available from BMC Public Health