Trial reportBMC public health2019
Applying behavioural science to increase uptake of the NHS Health Check: a randomised controlled trial of gain- and loss-framed messaging in the national patient information leaflet.
Trial report in BMC public health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03524131 (Randomized Controlled Trial to Compare the Effect of Two New Behaviourally Enhanced NHS Health Check Leaflets and the Current Nationally Recommended Leaflet on Uptake of NHS Health Checks), which is not on this map. Cited by 9 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Randomized Controlled Trial to Compare the Effect of Two New Behaviourally Enhanced NHS Health Check Leaflets and the Current Nationally Recommended Leaflet on Uptake of NHS Health Checks
Who cites it
9 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- A systematic review and meta-analysis of the effectiveness of social norms messaging approaches for improving health behaviours in developed countries.Nature human behaviour · 2025Pooled it
- Pooled it
- A systematic review of factors influencing NHS health check uptake: invitation methods, patient characteristics, and the impact of interventions.BMC public health · 2020Pooled it
- Improving postal survey response using behavioural science: a nested randomised control trial.BMC medical research methodology · 2021Trial
- Increasing uptake of NHS Health Checks: a randomised controlled trial using GP computer prompts.The British journal of general practice : the journal of the Royal College of General Practitioners · 2021Trial
- A randomized controlled trial to test the effect of simplified guidance with visuals on comprehension of COVID-19 guidelines and intention to stay home if symptomatic.BMC public health · 2021Trial
- The effectiveness of interventions used to improve general health check uptake by the older adult population: a systematic review and meta-analysis.PLOS global public health · 2025Article
- NHS Health Check programme: a rapid review update.BMJ open · 2022Review
- Interventions for Adherence Improvement in the Primary Prevention of Cardiovascular Diseases: Expert Consensus Statement.Korean circulation journal · 2022Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe NHS Health Check (NHSHC) is a national programme for the prevention of non-communicable diseases. Patients aged 40-74 without an existing cardiovascular-related condition should be invited quinquennially. Uptake is lower than anticipated. We assessed the impact on uptake of two new behaviourally-enhanced leaflets (with the current national leaflet as a control), enclosed with the invitation letter: the first trial on the leaflet.
methodsA double-blind three-armed randomized controlled trial was conducted. The new leaflets were shorter (two pages, instead of four); one was loss-framed ('don't miss out') and the other was gain-framed ('make the most of life'). The participants were patients from 39 practices in Lewisham and 17 practices in NE Lincolnshire, who were allocated to interventions using a random-number generator and received one of the leaflets with their invitation letter from April-September 2018. The outcome measure was uptake of an NHSHC by November 2018. The trial was powered to detect a 2% effect.
resultsUptake was 17.6% in the control condition (n = 3677), 17.4% in the loss-framed condition (n = 3664), and 18.2% in the gain-framed condition (n = 3697). Leaflet type was not a significant predictor of NHSHC uptake in a logistic regression that controlled for demographic variables, with GP practice as a random effect. Statistically significant predictors of uptake included location (higher uptake in Lewisham), age (increased age was associated with increased attendance) and sex (higher uptake in females). The Bayes Factor comparing the null to a hypothesis of differences between conditions was 416, which is extreme evidence in favour of the null hypothesis.
conclusionThere was no evidence for a meaningful effect of either a loss-framed or gain-framed behaviourally-informed leaflet type on uptake, which is surprising, given that behaviourally informed letters have improved uptake of NHSHCs. It is possible that people do not pay attention to leaflets that are enclosed with letters, or that the leaflet continues to support informed decision-making but this does not affect uptake.
trial registrationClinicaltrials.gov, NCT03524131. Registered May 14, 2018. Retrospectively registered.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.