Enhanced Invitations Using the Question-Behavior Effect and Financial Incentives to Promote Health Check Uptake in Primary Care

Lisa McDermott; Victoria Cornelius; Alison J Wright; Caroline Burgess; Alice S Forster; Mark Ashworth; Bernadette Khoshaba; Philippa Clery; Frances Fuller; Jane Miller; Hiten Dodhia; Caroline Rudisill; Mark T Conner; Martin C Gulliford

doi:10.1093/abm/kax048

Enhanced Invitations Using the Question-Behavior Effect and Financial Incentives to Promote Health Check Uptake in Primary Care

Lisa McDermott
, Victoria Cornelius
, Alison J Wright
, Caroline Burgess
, Alice S Forster
, Mark Ashworth
, Bernadette Khoshaba
, Philippa Clery
, Frances Fuller
, Jane Miller
, Hiten Dodhia
, Caroline Rudisill
, Mark T Conner
, Martin C Gulliford

Research output: Contribution to journal › Article › peer-review

12 Citations (Scopus)

123 Downloads (Pure)

Abstract

Background
Uptake of health checks for cardiovascular risk assessment in primary care in England is lower than anticipated. The question-behavior effect (QBE) may offer a simple, scalable intervention to increase health check uptake.

Purpose
The present study aimed to evaluate the effectiveness of enhanced invitation methods employing the QBE, with or without a financial incentive to return the questionnaire, at increasing uptake of health checks.

Methods
We conducted a three-arm randomized trial including all patients at 18 general practices in two London boroughs, who were invited for health checks from July 2013 to December 2014. Participants were randomized to three trial arms: (i) Standard health check invitation letter only; (ii) QBE questionnaire followed by standard invitation letter; or (iii) QBE questionnaire with offer of a financial incentive to return the questionnaire, followed by standard invitation letter. In intention to treat analysis, the primary outcome of completion of health check within 6 months of invitation, was evaluated using a p value of .0167 for significance.

Results
12,459 participants were randomized. Health check uptake was evaluated for 12,052 (97%) with outcome data collected. Health check uptake within 6 months of invitation was: standard invitation, 590 / 4,095 (14.41%); QBE questionnaire, 630 / 3,988 (15.80%); QBE questionnaire and financial incentive, 629 / 3,969 (15.85%). Difference following QBE questionnaire, 1.43% (95% confidence interval −0.12 to 2.97%, p = .070); following QBE questionnaire and financial incentive, 1.52% (−0.03 to 3.07%, p = .054).

Conclusions
Uptake of health checks following a standard invitation was low and not significantly increased through enhanced invitation methods using the QBE.

Original language	English
Pages (from-to)	594–605
Journal	Annals of Behavioral Medicine
Volume	52
Issue number	7
Early online date	2 Feb 2018
DOIs	https://doi.org/10.1093/abm/kax048
Publication status	Published - Jul 2018

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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Enhanced Invitations Using the Question_McDERMOTT_Accepted10Aug2017_Firstonline2Feb2018_GOLD VoRFinal published version, 431 KBLicence: CC BY-NC

Cite this

McDermott, L., Cornelius, V., Wright, A. J., Burgess, C., Forster, A. S., Ashworth, M., Khoshaba, B., Clery, P., Fuller, F., Miller, J., Dodhia, H., Rudisill, C., Conner, M. T., & Gulliford, M. C. (2018). Enhanced Invitations Using the Question-Behavior Effect and Financial Incentives to Promote Health Check Uptake in Primary Care. Annals of Behavioral Medicine, 52(7), 594–605. https://doi.org/10.1093/abm/kax048

@article{63dff68efe4c48f38f9a827d252ce6f1,

title = "Enhanced Invitations Using the Question-Behavior Effect and Financial Incentives to Promote Health Check Uptake in Primary Care",

abstract = "Background Uptake of health checks for cardiovascular risk assessment in primary care in England is lower than anticipated. The question-behavior effect (QBE) may offer a simple, scalable intervention to increase health check uptake. Purpose The present study aimed to evaluate the effectiveness of enhanced invitation methods employing the QBE, with or without a financial incentive to return the questionnaire, at increasing uptake of health checks. Methods We conducted a three-arm randomized trial including all patients at 18 general practices in two London boroughs, who were invited for health checks from July 2013 to December 2014. Participants were randomized to three trial arms: (i) Standard health check invitation letter only; (ii) QBE questionnaire followed by standard invitation letter; or (iii) QBE questionnaire with offer of a financial incentive to return the questionnaire, followed by standard invitation letter. In intention to treat analysis, the primary outcome of completion of health check within 6 months of invitation, was evaluated using a p value of .0167 for significance. Results 12,459 participants were randomized. Health check uptake was evaluated for 12,052 (97\%) with outcome data collected. Health check uptake within 6 months of invitation was: standard invitation, 590 / 4,095 (14.41\%); QBE questionnaire, 630 / 3,988 (15.80\%); QBE questionnaire and financial incentive, 629 / 3,969 (15.85\%). Difference following QBE questionnaire, 1.43\% (95\% confidence interval −0.12 to 2.97\%, p = .070); following QBE questionnaire and financial incentive, 1.52\% (−0.03 to 3.07\%, p = .054). Conclusions Uptake of health checks following a standard invitation was low and not significantly increased through enhanced invitation methods using the QBE.",

author = "Lisa McDermott and Victoria Cornelius and Wright, \{Alison J\} and Caroline Burgess and Forster, \{Alice S\} and Mark Ashworth and Bernadette Khoshaba and Philippa Clery and Frances Fuller and Jane Miller and Hiten Dodhia and Caroline Rudisill and Conner, \{Mark T\} and Gulliford, \{Martin C\}",

year = "2018",

month = jul,

doi = "10.1093/abm/kax048",

language = "English",

volume = "52",

pages = "594–605",

journal = "Annals of Behavioral Medicine",

issn = "0883-6612",

publisher = "Springer",

number = "7",

}

McDermott, L , Cornelius, V , Wright, AJ , Burgess, C , Forster, AS , Ashworth, M , Khoshaba, B, Clery, P, Fuller, F, Miller, J, Dodhia, H, Rudisill, C, Conner, MT & Gulliford, MC 2018, 'Enhanced Invitations Using the Question-Behavior Effect and Financial Incentives to Promote Health Check Uptake in Primary Care', Annals of Behavioral Medicine, vol. 52, no. 7, pp. 594–605. https://doi.org/10.1093/abm/kax048

TY - JOUR

T1 - Enhanced Invitations Using the Question-Behavior Effect and Financial Incentives to Promote Health Check Uptake in Primary Care

AU - McDermott, Lisa

AU - Cornelius, Victoria

AU - Wright, Alison J

AU - Burgess, Caroline

AU - Forster, Alice S

AU - Ashworth, Mark

AU - Khoshaba, Bernadette

AU - Clery, Philippa

AU - Fuller, Frances

AU - Miller, Jane

AU - Dodhia, Hiten

AU - Rudisill, Caroline

AU - Conner, Mark T

AU - Gulliford, Martin C

PY - 2018/7

Y1 - 2018/7

N2 - Background Uptake of health checks for cardiovascular risk assessment in primary care in England is lower than anticipated. The question-behavior effect (QBE) may offer a simple, scalable intervention to increase health check uptake. Purpose The present study aimed to evaluate the effectiveness of enhanced invitation methods employing the QBE, with or without a financial incentive to return the questionnaire, at increasing uptake of health checks. Methods We conducted a three-arm randomized trial including all patients at 18 general practices in two London boroughs, who were invited for health checks from July 2013 to December 2014. Participants were randomized to three trial arms: (i) Standard health check invitation letter only; (ii) QBE questionnaire followed by standard invitation letter; or (iii) QBE questionnaire with offer of a financial incentive to return the questionnaire, followed by standard invitation letter. In intention to treat analysis, the primary outcome of completion of health check within 6 months of invitation, was evaluated using a p value of .0167 for significance. Results 12,459 participants were randomized. Health check uptake was evaluated for 12,052 (97%) with outcome data collected. Health check uptake within 6 months of invitation was: standard invitation, 590 / 4,095 (14.41%); QBE questionnaire, 630 / 3,988 (15.80%); QBE questionnaire and financial incentive, 629 / 3,969 (15.85%). Difference following QBE questionnaire, 1.43% (95% confidence interval −0.12 to 2.97%, p = .070); following QBE questionnaire and financial incentive, 1.52% (−0.03 to 3.07%, p = .054). Conclusions Uptake of health checks following a standard invitation was low and not significantly increased through enhanced invitation methods using the QBE.

AB - Background Uptake of health checks for cardiovascular risk assessment in primary care in England is lower than anticipated. The question-behavior effect (QBE) may offer a simple, scalable intervention to increase health check uptake. Purpose The present study aimed to evaluate the effectiveness of enhanced invitation methods employing the QBE, with or without a financial incentive to return the questionnaire, at increasing uptake of health checks. Methods We conducted a three-arm randomized trial including all patients at 18 general practices in two London boroughs, who were invited for health checks from July 2013 to December 2014. Participants were randomized to three trial arms: (i) Standard health check invitation letter only; (ii) QBE questionnaire followed by standard invitation letter; or (iii) QBE questionnaire with offer of a financial incentive to return the questionnaire, followed by standard invitation letter. In intention to treat analysis, the primary outcome of completion of health check within 6 months of invitation, was evaluated using a p value of .0167 for significance. Results 12,459 participants were randomized. Health check uptake was evaluated for 12,052 (97%) with outcome data collected. Health check uptake within 6 months of invitation was: standard invitation, 590 / 4,095 (14.41%); QBE questionnaire, 630 / 3,988 (15.80%); QBE questionnaire and financial incentive, 629 / 3,969 (15.85%). Difference following QBE questionnaire, 1.43% (95% confidence interval −0.12 to 2.97%, p = .070); following QBE questionnaire and financial incentive, 1.52% (−0.03 to 3.07%, p = .054). Conclusions Uptake of health checks following a standard invitation was low and not significantly increased through enhanced invitation methods using the QBE.

UR - https://www.scopus.com/pages/publications/85061360232

U2 - 10.1093/abm/kax048

DO - 10.1093/abm/kax048

M3 - Article

SN - 0883-6612

VL - 52

SP - 594

EP - 605

JO - Annals of Behavioral Medicine

JF - Annals of Behavioral Medicine

IS - 7

ER -

Enhanced Invitations Using the Question-Behavior Effect and Financial Incentives to Promote Health Check Uptake in Primary Care

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