NHS Health Check programme: a protocol for a realist review
Open accessAbstract
Introduction: The NHS Health Check aims to identify individuals at increased risk of cardiovascular diseases (CVDs) among the adult population in England. The Health Check includes calculation of CVD risk and discussion of pharmacological and lifestyle approaches to manage risk, including referral to lifestyle support services. The programme is commissioned by Local Authorities (LAs) and is delivered by a range of different providers in different settings. There is significant variation in activity, with uptake ranging from 25% to 85% in different areas, and clear evidence of variation in implementation and delivery practice. Methods and analysis: We aim to understand how the NHS Health Check programme works in different settings, for different groups, so that we can recommend improvements to maximise intended outcomes. To do so, we will undertake a realist review and a survey of LA public health teams. Our review will follow Pawson’s five iterative stages: (1) locate existing theories, (2) search for evidence, (3) article selection, (4) extract and organise data and (5) synthesise evidence and draw conclusions. Our review will include documents describing local implementation alongside published research studies. We will recruit a stakeholder group (including Public Health England, commissioners and providers of Health Checks, plus members of the public and patients) to advise us throughout. Our survey will be sent to all 152 LAs in England to gather detailed information on programme delivery (including COVID-19-related changes) and available referral services. This will enable us to map delivery across England and relate these data to programme outcomes. Ethics and dissemination: Ethical approval is not required for this review. For the survey, we have received approval from the University of Kent Research Ethics Committee. Our findings will be used to develop recommendations on tailoring, implementation and design strategies to improve delivery of the NHS Health Check in different settings, for different groups. PROSPERO registration number: CRD42020163822.
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Data from each document were systematically examined by the research team to confirm, refute, or refine the theory using previously reported strategies such as juxtaposition, reconciliation, adjudication, and consolidation.
“Data from each document were systematically examined by the research team to confirm, refute, or refine the theory using previously reported strategies such as juxtaposition, reconciliation, adjudication, and consolidation [37, 38].”
From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [37]
The Methods and analysis passages describe a planned review that will use juxtaposition, reconciliation, adjudication, and consolidation to interpret data and refine programme theory. The source is a protocol: it says the team will carry out this analysis, not that documents were already examined. Page numbers are not supplied in our copy. (LLM, conf=0.86)
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Cites
Realist review - a new method of systematic review designed for complex policy interventions
Pawson, R., Greenhalgh, T., Harvey, G., & Walshe, K. (2005) · Journal of Health Services Research & Policy · doi:10.1258/1355819054308530 · Cited by 3,190 · see citing works
(2014) · Cited by 2,276 · see citing works
Greenhalgh, T., & Peacock, R. (2005) · BMJ · doi:10.1136/bmj.38636.593461.68 · Cited by 2,045 · see citing works
RAMESES publication standards: realist syntheses
Wong, G., Greenhalgh, T., Westhorp, G., Buckingham, J., & Pawson, R. (2013) · BMC Medicine · doi:10.1186/1741-7015-11-21 · Cited by 1,374 · see citing works
Self-citationRAMESES publication standards: realist syntheses
Wong, G., Greenhalgh, T., Westhorp, G., Buckingham, J., & Pawson, R. (2013) · Journal of Advanced Nursing · doi:10.1111/jan.12095 · Cited by 385 · see citing works
Self-citationBooth, A., Harris, J., Croot, E. J., Springett, J., Campbell, F., & Wilkins, E. (2013) · BMC Medical Research Methodology · doi:10.1186/1471-2288-13-118 · Cited by 278 · see citing works
Systematic searching for theory to inform systematic reviews: is it feasible? Is it desirable?
Booth, A., & Carroll, C. (2015) · Health Information & Libraries Journal · doi:10.1111/hir.12108 · Cited by 196 · see citing works
The NHS Health Check in England: an evaluation of the first 4 years
Robson, J., Dostal, I., Sheikh, A., Eldridge, S., Madurasinghe, V., Griffiths, C., Coupland, C., & Hippisley-Cox, J. (2016) · BMJ Open · doi:10.1136/bmjopen-2015-008840 · Cited by 184 · see citing works
Integrated knowledge translation
Bowen, S., & Graham, I. D. (2013) · Wiley eBooks · doi:10.1002/9781118413555.ch02 · Cited by 179 · see citing works
Chatterjee, R., Chapman, T., Brannan, M. G., & Varney, J. (2017) · British Journal of General Practice · doi:10.3399/bjgp17x692513 · Cited by 152 · see citing works
Data Gathering in Realist Reviews: Looking for needles in haystacks
Wong, G. (2018) · SAGE Publications Ltd eBooks · doi:10.4135/9781526451729.n9 · Cited by 114 · see citing works
Self-citationde Waard, A.-K. M., Wändell, P. E., Holzmann, M. J., Korevaar, J. C., Hollander, M., Gornitzki, C., de Wit, N. J., Schellevis, F., Lionis, C. D., Søndergaard, J., et al. (2018) · European Journal of Preventive Cardiology · doi:10.1177/2047487318780751 · Cited by 82 · see citing works
Delivery and impact of the NHS Health Check in the first 8 years: a systematic review
Martin, A., Saunders, C. L., Harte, E., Griffin, S. J., MacLure, C., Mant, J., Meads, C., Walter, F. M., & Usher‐Smith, J. A. (2018) · British Journal of General Practice · doi:10.3399/bjgp18x697649 · Cited by 79 · see citing works
Reasons why people do not attend NHS Health Checks: a systematic review and qualitative synthesis
Harte, E., MacLure, C., Martin, A., Saunders, C. L., Meads, C., Walter, F. M., Griffin, S. J., Mant, J., & Usher‐Smith, J. A. (2017) · British Journal of General Practice · doi:10.3399/bjgp17x693929 · Cited by 74 · see citing works
Alageel, S., & Gulliford, M. C. (2019) · PLoS Medicine · doi:10.1371/journal.pmed.1002863 · Cited by 69 · see citing works
Patel, R. S., Barnard, S., Thompson, K., Lagord, C., Clegg, E., Worrall, R., Evans, T., Carter, S., Flowers, J., Roberts, D., et al. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-042963 · Cited by 69 · see citing works
Shaw, R. L., Holland, C., Pattison, H. M., & Cooke, R. W. I. (2016) · Social Science & Medicine · doi:10.1016/j.socscimed.2016.03.015 · Cited by 61 · see citing works
Interventions to improve antimicrobial prescribing of doctors in training (IMPACT): a realist review
Papoutsi, C., Mattick, K. L., Pearson, M., Brennan, N., Briscoe, S., & Wong, G. (2018) · Health Services and Delivery Research · doi:10.3310/hsdr06100 · Cited by 59 · see citing works
Self-citationNHS Health Check programme: a rapid review update
Tanner, L., Kenny, R., Still, M., et al. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-052832 · Cited by 52 · see citing works
Cook, E., Sharp, C., Randhawa, G., et al. (2016) · International Journal for Equity in Health · doi:10.1186/s12939-016-0303-2 · Cited by 46 · see citing works
Patient experience of NHS health checks: a systematic review and qualitative synthesis
Usher‐Smith, J. A., Harte, E., MacLure, C., Martin, A., Saunders, C. L., Meads, C., Walter, F. M., Griffin, S. J., & Mant, J. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-017169 · Cited by 42 · see citing works
Method of invitation and geographical proximity as predictors of NHS Health Check uptake
Gidlow, C. J., Ellis, N., Randall, J. A., et al. (2014) · Journal of Public Health · doi:10.1093/pubmed/fdu092 · Cited by 40 · see citing works
Bunten, A., Porter, L., Gold, N., & Bogle, V. (2020) · BMC Public Health · doi:10.1186/s12889-019-7889-4 · Cited by 39 · see citing works
Alageel, S., Gulliford, M. C., McDermott, L., & Wright, A. J. (2018) · BMC Family Practice · doi:10.1186/s12875-018-0860-0 · Cited by 38 · see citing works
NHS Health Check Programme rapid evidence synthesis
Usher‐Smith, J. A., Mant, J., Martin, A., Harte, E., MacLure, C., Meads, C., Saunders, C. L., Griffin, S. J., Walter, F. M., Lawrence, K., et al. (2017) · Figshare · Cited by 35 · see citing works
The NHS Health Check programme: insights from a qualitative study of patients
Ismail, H., & Atkin, K. M. (2015) · Health Expectations · doi:10.1111/hex.12358 · Cited by 33 · see citing works
Realist Synthesis: New Protocols for Systematic Review
Pawson, R. (2006) · SAGE Publications Ltd eBooks · doi:10.4135/9781849209120.n4 · Cited by 33 · see citing works
Hardeman, W., Mitchell, J., Pears, S. L., Emmenis, M. V., Theil, F., Gc, V. S., Vasconcelos, J. C., Westgate, K. L., Brage, S., Suhrcke, M., et al. (2020) · PLoS Medicine · doi:10.1371/journal.pmed.1003046 · Cited by 30 · see citing works
Influences on NHS Health Check behaviours: a systematic review
Atkins, L., Stefanidou, C., Chadborn, T., Thompson, K., Michie, S., & Lorencatto, F. (2020) · BMC Public Health · doi:10.1186/s12889-020-09365-2 · Cited by 30 · see citing works
Woringer, M., Cecil, E. V., Watt, H., Chang, K., Hamid, F., Khunti, K. K., Dubois, E., Evason, J., Majeed, A., & Soljak, M. (2017) · BMC Health Services Research · doi:10.1186/s12913-017-2346-5 · Cited by 27 · see citing works
Is complexity just too complex?
Wong, G. (2013) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2013.06.019 · Cited by 22 · see citing works
Self-citationThe Today Programme’s Contribution to Evidence-based Policy
Pawson, R., Owen, L., & Wong, G. (2010) · Evaluation · doi:10.1177/1356389010369636 · Cited by 22 · see citing works
Self-citationMills, K., Harte, E., Martin, A., MacLure, C., Griffin, S. J., Mant, J., Meads, C., Saunders, C. L., Walter, F. M., & Usher‐Smith, J. A. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-018606 · Cited by 20 · see citing works
Palladino, R., Vamos, E. P., Chang, K., Khunti, K. K., Majeed, A., & Millett, C. J. (2020) · Scientific Reports · doi:10.1038/s41598-020-58033-3 · Cited by 19 · see citing works
Nahar, P., van Marwijk, H., Gibson, L. M., Musinguzi, G., Anthierens, S., Ford, E. M., Bremner, S. A., Bowyer, M., Reste, J. Y. L., Sodi, T., et al. (2020) · Global Health Research and Policy · doi:10.1186/s41256-020-0131-1 · Cited by 18 · see citing works
Brangan, E., Stone, T. J., Chappell, A., et al. (2018) · Health Expectations · doi:10.1111/hex.12856 · Cited by 17 · see citing works
Sallis, A., Gold, N., Agbebiyi, A., James, R. J. E., Berry, D., Bonus, A., Vlaev, I., & Chadborn, T. (2019) · Journal of Public Health · doi:10.1093/pubmed/fdz134 · Cited by 17 · see citing works
Alageel, S., Gulliford, M. C., Wright, A. J., Khoshaba, B., & Burgess, C. C. (2019) · Health Expectations · doi:10.1111/hex.12991 · Cited by 16 · see citing works
Evidence of improved uptake of health checks : rapid review
Cooper, A., & Dugdill, L. (2014) · University of Salford Institutional Repository (University of Salford) · Cited by 13 · see citing works
Fidelity of the delivery of NHS Health Checks in general practice: an observational study
Paxton, B., Mills, K., & Usher‐Smith, J. A. (2020) · BJGP Open · doi:10.3399/bjgpopen20x101077 · Cited by 10 · see citing works
Gidlow, C., Ellis, N., Cowap, L., Riley, V., Crone, D., Cottrell, E., Grogan, S., Chambers, R., & Clark-Carter, D. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-037790 · Cited by 10 · see citing works
Nelson, R. (2015) · Cited by 9 · see citing works
NHS Health Check and healthy lifestyle in Leicester, England: analysis of a survey dataset
Chattopadhyay, K., Biswas, M., & Moore, R. (2019) · Perspectives in Public Health · doi:10.1177/1757913919834584 · Cited by 8 · see citing works
Uptake of NHS health check: issues in monitoring
Riley, V., Gidlow, C. J., & Ellis, N. (2018) · Primary Health Care Research & Development · doi:10.1017/s1463423618000592 · Cited by 5 · see citing works
Local authority commissioning of NHS Health Checks: A regression analysis of the first three years
Mason, A., Liu, D., Marks, L., Davis, H. H., Hunter, D. J., Jehu, L. M., Visram, S., & Smithson, J. (2018) · Health Policy · doi:10.1016/j.healthpol.2018.07.010 · Cited by 2 · see citing works
Flagged first, then by citations
Research works printed but not linked: 4
- [4]Public Health England. NHS health check implementation review and action plan summary, 2013.
- [14]Government creates new National Institute for Health Protection [press release] 2020; 2020.
- [50]England PH. NHS Health Check commissioning: Review of commissioner’s current and potential use of weighted financial remuneration, 2018.
- [57]Pawson R. Realist methodology: the building blocks of evidence.: Evidence-based policy: a realist perspective [Internet]. London: SAGE Publications Ltd, 2006. https://methods.sagepub.com/book/evidence-based-policy
Cited by
Sorted by citations
Lawson, L., Cooper, M., Tolley, C., Hand, A., & Nazar, H. (2025) · BMC Geriatrics · doi:10.1186/s12877-025-06123-0 · Cited by 10 · see citing works
“Data from each document were systematically examined by the research team to confirm, refute, or refine the theory using previously reported strategies such as juxtaposition, reconciliation, adjudication, and consolidation [37, 38].”
- Authors
- Duddy, C., Wong, G., Gadsby, E. W., Krska, J., & Hibberd, V.
- Affiliations
- University of Oxford (GB)
- University of Kent (GB)
- Medway School of Pharmacy (GB)
- Corresponding author
- Duddy, Claire
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2021-04
- Volume
- 11
- Issue
- 4
- Pages
- e048937
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC8054100
- OpenAlex
- W3155822095
- Cited by
- 24
- References
- 45
- Citations by year
- 2025: 3 · 2024: 7 · 2023: 6 · 2022: 5 · 2021: 3
- FWCI
- 4.55
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMJ Open (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Kent Academic Repository (University of Kent) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institute for Health and Care Research (NIHR129209)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- NHS Health Check, cardiovascular risk, cardiovascular risk assessment, lifestyle support services, implementation variation, COVID-19 impact on health services, program uptake, health disparities
- MeSH terms
- Heart Disease Risk Factors, Adult, Cardiovascular Diseases, England, Health Promotion, Humans, Review Literature as Topic, State Medicine, Program Evaluation
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