NHS Health Check screening letter and leaflet: Qualitative research
Summary of findings
The draft leaflet and letter worked well to motivate the target audience to consider taking up an NHS Health Check. They were clear and convincing, with most people supportive of the concept of the NHS Health Check. The rationale for having the checks made sense, the tone was friendly and encouraging, and the check seemed simple and straightforward.
The leaflet was clearly written and visually appealing. The use of colour, sub-headings and bullet points to break up the text made it accessible and the font size was easy to read. It was seen as having just the right amount of information. One potential weakness was that the call to action – to have the check – could be obscured by the more general message about healthy lifestyles.
We tested three design routes in the research:
- Tick, which showed a photograph of an older man playing with a child;
- Body, which showed a diagram of the human body indicating where vascular diseases occur;
- Cog, similar to Body but with a more abstract representaiton of the human body.
Body and Tick could be effective, with a slight preference for Body in our sample. Body conveyed the idea of the four diseases more clearly, but Tick was warmer and more appealing.
The letter was clear, well written, easy to read and convincing. It contained a stronger call to action than the leaflet, and was seen as the most important part of the letter-and-leaflet pack by many people.
A minority of our sample were unlikely to take up the check, with a range of reasons offered. Commonly mentioned barriers included:
- I feel fine so I don’t need a health check;
- I’d rather not know if I’m ill;
- The doctor will just tell me I’m overweight/ need to stop smoking.
There was also a minority of our sample who appeared unlikely to respond to any written communications. For this group, other publicity methods and face-to-face communications may be more effective.
Among the Pakistani and Bangladeshi people the leaflet was tested in a bilingual version, and the letter in translation. For these people, the leaflet was not effective and was unlikely to motivate them to take up the check. Some of our sample were not literate in their Mother Tongue, and were therefore dependent on relatives to read the leaflet out to them. But even those who could read their own language were rarely confident or at ease with written materials. They found it difficult to take in the information and only understood it when explained verbally by the researcher. The letter was more successful, because it was concise, clear and was assumed to come from their GP. The messages contained in the leaflet were motivating and relevant, but they would need to be communicated in a different format if they were to have an impact upon older Pakistani and Bangladeshi people.
Overall the letter and leaflet were effective among the general population, and the research recommended only minor changes to the design and copy.
Among the Pakistani and Bangladeshi communities, the leaflet was not successful and the format will need substantial change if it is to be effective. The research recommended:
- Producing a summary with key facts in a bilingual version;
- Using visual imagery more explicitly on the cover and the main content to indicate the content and guide less confident readers;
- Including images of Asian people/ lifestyles/ foods, and adapting the text to emphasise the relevance to Asian communities
- Delivering a stronger call to action to have the check.
The leaflet and letter will also need to be backed up with outreach work in the communities and other forms of marketing, such as ethnic radio and television advertising, to maximise take up of the checks.
To gain reactions to the letter and leaflet, and the alternative design routes; To provide guidance on developing these materials to maximise their effectiveness and impact among the target audience.
The implementation of the NHS Health Check programme was scheduled to begin in 2010. The awareness campaign will include a range of marketing and outreach activities to encourage people to take up the checks. This research was commissioned to gain reactions to the draft screening letter and leaflet produced by the Department of Health to publicise the checks.
The letter and leaflet worked very well in research for most people but the research recommended substantial changes to the letter for South Asian populations.
White British, British Pakistanis, British Bangladeshis
The research methods were entirely qualitative, using mini-focus groups and in-depth interviews. The sample comprised ten mini-focus groups and fourteen in-depth interviews among members of the public
Data collection methodology
64 (10 mini groups and 14 depth interviews)