Evaluation of Live Life Better Derbyshire Health Checks with Online booking and text reminders for Wellbeing (ELBOW)

How are the public involved in the evaluation?

Patient and Public Involvement and Engagement (PPIE) was embedded through both PHIRST Connect PIRg input and wider lay and public contributor input. Two members of the PIRg supported project development from the evaluability phase onwards and were embedded as co-researchers within the research team for the project’s duration. Two local public contributors were also recruited. They became members of the project-specific Advisory Group (AG) and also contributed outside the AG by helping to interpret evaluation findings and reach decisions about how best to share outputs. Further involvement of local public contributors in sense-checking findings and providing vital local context to refine recommendations was facilitated through links with local third-sector partners

Lay summary of research

Overview of the project that was evaluated

National Health Service Health Checks (NHSHCs) are available to anyone aged between 40–74 who did not already have a health condition. The health check (HC) is conducted by a healthcare worker and included measurements of:

• Height, weight, waist size
• Blood pressure
• Cholesterol
• Sometimes a blood sugar level test

People who attend a HC were also asked to tell the healthcare worker:

• If their family members had any health problems
• Whether they smoked or drank
• How active they were
• Their demographics (age, gender, ethnicity)

The aim of taking these measurements is to identify people who might be at a higher risk of heart problems. The results of the HC allow healthcare workers to give attendees advice about how to lower their risk or to start them on medication to slow the development of a health problem.

The NHSHC programme is run by Local Authorities (LAs). Some LAs have made changes to the way they deliver the HC to improve the service they offer. Derbyshire County Council is one of the LAs that made changes to their health check service. In ten pilot GP surgeries, an organisation called Live Life Better Derbyshire (LLBD) delivered the health checks using a team of wellbeing and lifestyle experts. The LLBD-run HCs differ in several ways:

• They took longer, allowing for more detailed lifestyle conversations
• Blood sugar levels are tested as standard to look for diabetes risk
• There are extra discussions about smoking, activity levels, weight concerns, emotional wellbeing, and issues with money or work, with referrals to extra support for those who need it
• The experts had specific knowledge of much of the support available in the area

The ten practices also sent letters in the post, and text messages to remind eligible people to book their HC. As well as this, people were able to book their HC online by following a link or QR code in their text message or letter.

Why was this study needed and what did it aim to do?

A lot of research has already been done to investigate how many people take up their invitation for a health check, what stops people taking up the invite, and whether the HC causes a change in people’s lifestyles and health. However, there is little research on whether the person who delivers the health check makes an impact on these things.  

Overall aims

1. To understand the difference that the changes to how the HC is delivered makes to attendance at HCs, outcomes of HCs, and the costs and resources needed to deliver HCs. 
2. To explore staff and clients’ experiences of the changes made to the health checks invitations, booking system, and the sessions themselves.  

Research questions

1. Does using a) text message prompts and reminders and b) a HC online booking option lead to any changes in uptake of the NHS Health Checks (HCs)
2. Does delivery of HCs by LLBD lead to any changes in HC outcomes? 
3. What are staff experiences of the LLBD HC? 
4. What do clients think of the LLBD HC and what difference has it made to them? 
5. What are the costs and resources required for the LLBD HC to be delivered and how do they compare to costs and resources for a HC run by surgery healthcare workers? 

Research design

There were six pieces of work involved in the evaluation (called Workstreams):

• Workstream 1 – Analysis of figures collected about who attended HCs and what difference they made. This helped to understand whether using text messages or offering online booking led to any changes in: a) attendance; b) HC outcomes (e.g., medicine prescribed).
• Workstream 2 – Focus groups with LLBD staff involved in managing and delivering HCs to explore their experiences.
• Workstream 3 – Interviews with GP surgery staff to explore how LLBD HC delivery affected their roles and workload.
• Workstream 4 – Interviews with clients who received a LLBD HC to understand their experiences and the difference it made.
• Workstream 5 – Review of costs and resources needed to run an LLBD HC versus one delivered by surgery healthcare workers.
• Workstream 6 – Brought together all information collected to analyse and identify main findings.

Public/service user involvement

Two Public Involvement in Research group (PIRg) members were part of the core research team throughout the study, and two local public contributors were recruited to help guide the evaluation. Once early findings were available, the team also worked with a Derbyshire consultation group made up of individuals eligible for NHS health checks to sense-check findings and refine recommendations

Evaluation timescales 

• Start of evaluation work: November 2023 
• Draft final report/reporting completed: March 2025 
• Key dissemination activities completed: April 2025 

Some main evaluation findings

• Text message reminders and online booking supported higher uptake of health checks

Sending text messages and offering online booking seems to have made a difference to attendance at NHS Health Checks. Texts were associated with a 5% increase in attendance, and online booking added another 3%.

• Online booking was popular and saved time

People liked booking online because it was quick and easy. But they still wanted other options, like booking by phone. Online booking also reduced the administration work for staff and was much cheaper than telephone booking.

• Invitations and reminders really helped

Many people said they wouldn’t have booked a health check without getting an invite. People said that text message reminders were useful and they were also much cheaper than sending letters.

• People said that health checks were well delivered

People had good things to say about the health checks and praised the friendly and professional staff. They were happy for a service other than the GP practice to deliver the health check, and cared more about the quality of the health check than who provided it.

• Instant test results were helpful

Getting blood test results right away during the appointment made people feel more informed and less anxious.

• Longer, more in-depth checks were valued

The health checks by Live Life Better Derbyshire (LLBD) took longer (about an hour) than standard checks, which people liked. It gave them time to talk, understand results, and look at overall wellbeing. But this approach did cost more than the usual checks run by GP surgeries.

• Community venues were welcomed

People appreciated having health checks in local community spaces, not just GP surgeries. Some said that these places felt more relaxed. But using community spaces came with extra challenges, like making sure the space was private and well-equipped.

• Follow-up support was useful

People liked the advice and referrals they got after their health check. Some said a follow-up call would help them stay motivated to make healthy changes

The value of the findings

The study provided valuable information to help Derbyshire County Council and other local councils improve their health check delivery. For example, it helped them understand more about the difference that text message reminders and online booking options made to whether people booked and kept a health check appointment. It also helped them understand how changing who delivered the health check, and how it was delivered, affected the outcomes of the health check.