Applying behavioural science to increase uptake of the NHS Health Check: a randomised controlled trial of gain- and loss-framed messaging in the national patient information leaflet
Applying behavioural science to increase uptake of the NHS Health Check: a randomised controlled trial of gain- and loss-framed messaging in the national patient information leaflet
复制标题
DOI：
10.1186/s12889-019-7754-5
复制
发表时间：
2019-11-14
影响因子：
4.5
通讯作者：
Chadborn, Tim
中科院分区：
文献类型：
--
作者：
Gold, Natalie;Durlik, Caroline;Chadborn, Tim
背景NHS健康检查(NHSHC)是一项预防非传染性疾病的国家计划。年龄在40-74岁之间且没有心血管相关疾病的患者应每五年邀请一次。吸纳量低于预期。我们评估了两种新的行为增强传单(以当前的国家传单为对照)对摄取的影响，并附上了邀请函：传单的第一次试验。方法采用双盲三臂随机对照试验。新的传单更短(两页，而不是四页)；一张是损失框(“不要错过”)，另一张是收获框(“充分利用生活”)。参与者是来自路易斯汉姆的39家诊所和东北林肯郡的17家诊所的患者，他们被分配到使用随机数字生成器的干预措施中，并在2018年4月至9月期间收到了一份带有邀请函的传单。结果衡量标准是在2018年11月之前采用NHSHC。这项试验的动力是检测2%的影响。结果对照组(n=3677)、丢失框状态(n=3664)和增益框状态(n=3697)的摄取分别为17.6%、17.4%和18.2%。在控制了人口统计学变量的Logistic回归中，小叶类型不是NHSHC摄取率的显著预测因素，全科医生实践是一个随机效应。统计学上显著的摄取预测因素包括地点(在路易斯汉姆摄取较多)、年龄(年龄增加与出勤率增加相关)和性别(女性摄取较多)。将零与条件差异假设进行比较的贝叶斯因数为416，这是支持零假设的极端证据。结论没有证据表明丢失框架或获得框架的行为信息传单类型对接受有意义的影响，这是令人惊讶的，因为行为信息信件改善了NHSHC的接受。人们可能没有注意到用字母围起来的传单，或者传单继续支持知情的决策，但这并不影响理解。
Background The NHS Health Check (NHSHC) is a national programme for the prevention of non-communicable diseases. Patients aged 40-74 without an existing cardiovascular-related condition should be invited quinquennially. Uptake is lower than anticipated. We assessed the impact on uptake of two new behaviourally-enhanced leaflets (with the current national leaflet as a control), enclosed with the invitation letter: the first trial on the leaflet. Methods A double-blind three-armed randomized controlled trial was conducted. The new leaflets were shorter (two pages, instead of four); one was loss-framed ('don't miss out') and the other was gain-framed ('make the most of life'). The participants were patients from 39 practices in Lewisham and 17 practices in NE Lincolnshire, who were allocated to interventions using a random-number generator and received one of the leaflets with their invitation letter from April-September 2018. The outcome measure was uptake of an NHSHC by November 2018. The trial was powered to detect a 2% effect. Results Uptake was 17.6% in the control condition (n = 3677), 17.4% in the loss-framed condition (n = 3664), and 18.2% in the gain-framed condition (n = 3697). Leaflet type was not a significant predictor of NHSHC uptake in a logistic regression that controlled for demographic variables, with GP practice as a random effect. Statistically significant predictors of uptake included location (higher uptake in Lewisham), age (increased age was associated with increased attendance) and sex (higher uptake in females). The Bayes Factor comparing the null to a hypothesis of differences between conditions was 416, which is extreme evidence in favour of the null hypothesis. Conclusion There was no evidence for a meaningful effect of either a loss-framed or gain-framed behaviourally-informed leaflet type on uptake, which is surprising, given that behaviourally informed letters have improved uptake of NHSHCs. It is possible that people do not pay attention to leaflets that are enclosed with letters, or that the leaflet continues to support informed decision-making but this does not affect uptake.