Engaging with stakeholders to inform the development of a computer model for the NHS Health Check programme: a qualitative study. (November 2018) - Hyseni, Lirije
Abstract: Background: The National Health Service (NHS) Health Check (NHSHC) is a risk-reduction programme offered to all adults in England aged 40–74 years. Previous studies have mainly focused on the delivery of this programme and on patient perspectives of having or not having a health check. Programme costs are substantial. Therefore, a modelling tool (workHORSE) is being developed and co-produced with key stakeholders for local commissioners to quantify effectiveness, cost-effectiveness, and equity of the NHSHC. We aimed to facilitate engagement with stakeholders; develop a shared understanding of current implementation of NHSHC; identify what is working well, less well, and future hopes; and explore features and specifications to include in the tool. Methods: This qualitative study identified key stakeholders across the UK via networking and snowball techniques. The stakeholders spanned local (NHS commissioners, general practitioners, academics), third sector, and national (including Public Health England and the National Institute for Health and Care Excellence) organisations. 15 stakeholders participated in the workshop. Using the Hovmand group model-building approach we engaged participants in a series of pre-piloted, structured, small group exercises, so that stakeholders could share experiences and expertise, had the opportunity for an iterative process to achieve consensus, and could experience first-hand how their knowledge and expertise is informing and directing the project. Framework Analysis was used to analyse responses. Stakeholders provided written informed consent. Ethics approval was granted by the University of Liverpool ethics committee. Findings: Issues discussed reflected stakeholders' perspectives (local, regional, and national) and themes emerged accordingly (ie, in the context of the local or national perspective, or both). There was continued financial and political support for the NHSHC. However, many stakeholders highlighted issues concerning lack of data on processes and outcomes, variability in quality of delivery, and suboptimal public engagement. Stakeholders' hopes included maximising coverage, uptake, and referrals, and producing additional evidence on population health, equity, and economic impacts. Key model suggestions focused on developing good-practice template scenarios, analysis of broader prevention activities at local level, accessible local data, broader economic perspectives, and fit-for-purpose outputs. Interpretation: A shared understanding of the current implementations of the NHSHC was developed. Suggestions for improvement are informing upcoming workHORSE workshops and model development. Ensuring diverse stakeholder inclusion was a challenge. Although this study centres on the NHSHC provided in England, the findings are transferable and will be of interest to the Health Check programme in the rest of the UK because of the cross-section of stakeholders involved. Funding: National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme.