A systematic review of factors influencing NHS health check uptake: invitation methods, patient characteristics, and the impact of interventions.

BACKGROUND: The NHS Health Check (NHSHC) is a risk assessment for those aged 40-74 without a pre-existing condition in England, with the aim of preventing stroke, kidney disease, heart disease, type 2 diabetes and dementia. Uptake has been lower than anticipated. Ensuring that a high percentage of eligible patients receive a NHSHC is key to optimising the clinical and cost effectiveness of the programme. The aim of this systematic review is to highlight interventions and invitation methods that increase the uptake of NHSHCs, and to identify whether the effectiveness of these interact with broader patient and contextual factors. METHOD: A systematic review was conducted according to the PRISMA checklist. Papers were eligible if they explored the impact of at least one of (i) interventions, (ii) invitation methods or (iii) broader factors on NHSHC uptake. Ten databases were searched in January 2016 and seven were searched in March 2018. Nine-hundred-and-forty-five papers were identified, 238 were screened and 64 full texts were assessed for eligibility. Nine studies were included in the review. RESULTS: The nine studies were all from peer reviewed journals. They included two randomised controlled trials, one observational cohort and six cross-sectional studies. Different invitation methods may be more effective for different groups of patients based on their ethnicity and gender. One intervention to enhance invitation letters effectively increased uptake but another did not. In addition, individual patient characteristics (such as age, gender, ethnicity and risk level) were found to influence uptake. This review also finds that uptake varies significantly by GP practice, which could be due either to unidentified practice-level factors or deprivation. CONCLUSIONS: Further research is needed to assess the effectiveness of different invitation methods for different population groups. Research should examine how existing invitation methods can be enhanced to drive uptake whilst reducing health inequalities. TRIAL REGISTRATION: This systematic review was registered with PROSPERO on 22.02.2016. Registration number CRD42016035626.

The effectiveness of cognitive behavioural therapy for depressed patients with diabetes: A systematic review.

Depression is common among patients with diabetes, who have a higher risk of diabetes-related complications such as diabetic retinopathy, nephropathy, neuropathy and macrovascular complications. The aim of the systematic review is to determine whether cognitive behavioural therapy is effective in reducing depressive symptoms and improving glycaemic control among depressed diabetic patients. The results reveal diversified application of cognitive behavioural therapy. All studies reported that cognitive behavioural therapy had a positive impact on depressive symptoms; three found an improvement in glycated haemoglobin, and one demonstrated improved self-efficacy and self-concept related to successful diabetes management. There is a need for controlled studies with larger sample sizes and long-term follow-up.

The dieting experience: A Jewish perspective.

Considered to be a chronic recidivist condition, obesity places significant burdens on the society. The search for appropriate interventions remains challenging. Research suggests individuals' environments should be considered when addressing eating behaviours. Nomothetic accounts of the dieting experiences of eight self-selected British Jews within a commercially run, community-based weight-management programme adapted to Jewish participants' cultural needs were explored using interpretative phenomenological analysis. Four themes were identified: 'Me, myself and I', 'behaviour change', 'structural framework' and 'social interaction'. Emergent aspects were social support and structural flexibility to motivate participants to initiate and sustain behaviour change. Implications for future weight-loss interventions are discussed.

Adherence to medication and self-management in stroke patients.

BACKGROUND: Stroke is the third most common cause of mortality and one of the leading causes of adult physical disability in England. Medical treatment is imperative for the management of stroke and the risk reduction of recurrent stroke. The success of a medical treatment is determined largely by adherence. However, research has shown that adherence to medication in patients who have had a stroke is often suboptimal. Self-management interventions have been shown to improve adherence in long-term conditions. The impact of self-management interventions specifically on adherence to stroke medication is unknown. OBJECTIVE: To review systematically the impact that self-management interventions have on adherence to stroke medication. METHOD: The online databases that were systematically searched included PsychINFO, MEDLINE, EMBASE, Scopus, Cochrane Database of Systematic Reviews, CINAHL and Web of Science. Reference lists of retrieved studies were hand-searched. RESULTS: Six studies met the criteria for inclusion in the systematic review. Self-management interventions for stroke patients were effective in improving adherence to stroke medication in the short term. However, in the longer term, these benefits were not maintained. CONCLUSIONS: Applying self-management interventions to improve medication adherence in stroke patients across integrated clinical settings shows promise. However, further development of such interventions and research is recommended, with more stringent methodologies and longer follow-up periods.

Psychological interventions in the treatment of childhood obesity: what we know and need to find out.

This review aims to assess the effectiveness of psychological interventions for treating childhood obesity. Firm conclusions about the effectiveness of psychological interventions to treat childhood obesity remain unclear. Based on current knowledge, the review suggests that a number of interventions may be effective including: multi-component family-based behavioural interventions, interventions aimed at reducing sedentary behaviour and/or increasing physical activity levels as a component of family-based behavioural treatments, in addition to population-based school-wide treatment for girls. Further investment is needed to improve current research and find new, more imaginative ways to research childhood obesity.