Background Cardiovascular disease (CVD) is the leading cause of death in the UK. The national CVD prevention strategy centres on the NHS Health Check Programme, which involves offering a vascular risk assessment to those aged 40-74 years without established disease. It is estimated that the programme could prevent 9,500 cardiovascular events and 2,000 deaths each year, if there is universal uptake. Durham County Council commissioned a health check service to be delivered in the community by health trainers. Socioeconomic deprivation is associated with higher risk of CVD, yet response rates for screening programmes tend to be lower in deprived areas. The service targets those who would not usually access screening and offers them tailored lifestyle support, thereby addressing health inequalities.
Methods A mixed methods design was used to evaluate the implementation, acceptability and impact of this service, involving:
i) Secondary analysis of monitoring data from all clients between January and June 2012 (n = 774). Descriptive and summary statistics were produced.
ii) Interviews and focus groups with a purposive sample of staff and key stakeholders (n = 20). A thematic content approach was used to analyse all transcripts and field notes.
iii) Summary data obtained from anonymous patient experience questionnaires (n = 181).
Results Women who accessed the service were more likely than men to be eligible for a health check (34% vs. 27%); yet eligible men were more likely to attend the health check (59.4% vs. 33.8%). More than half (57.6%) of clients were under the age of 50 and a similar proportion (60.5%) were from socioeconomically deprived areas. However, only 32.7% of those from the least affluent areas accepted the offer of a health check, in comparison with 44.4% from more affluent areas. More than half (57.4%) of the health checks resulted in a low CVD risk score, whereas 12.9% were high risk. Stakeholders perceived the service to be an effective way of engaging people from target communities in conversations about their health. It was felt that many clients would not have accessed support regarding their cardiovascular health from other providers. The vast majority (99%) of respondents to the patient experience questionnaire were satisfied with the service.
Discussion A community-based, health trainer-led service can add value by offering an alternative to health checks delivered in primary care settings. The service appears to be successful in engaging men and younger age groups. However, there is the potential for intervention-generated inequalities.
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