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Book 3 of The Fehr Family Series. A sequel to More Trouble Than Trouble Creek. Megan noticed that each of her friends was holding a pink card. "What's that?
Table of contents

• A Checklist for Planning Your Next Big Meeting
• Unique Custom Watercolor Wedding Invitations
• Get In Touch
• Empower your team. Delight your audience. Grow your brand.
• A Checklist for Planning Your Next Big Meeting

Other interventions using this method offered shorter deadlines i. The effectiveness of the open-ended letter is supported by its successful use in Medway, where it increased absolute uptake by 4. The different contexts preclude our ability to suggest the additional effects are due to the increased personalisation. Together, the success of the open-ended letter with planning prompt in Medway [ 23 ] and the open-ended and time-limited letters with personalised planning prompts in this trial provide good evidence for the use of planning prompts in NHS HC invitation letters.

The present research also supports findings from other studies using planning prompts to increase attendance at flu vaccination clinics by recording the date and time of the appointment 4. Effect sizes for these studies and the present study are remarkably similar. To increase these effects, further planning prompts could attempt to prompt specific plans to overcome known barriers to attendance such as time off work to attend appointments [ 37 ] or increase planning specificity further with the aim of more in-depth reflective processing leading to a stronger link between plans and future actions, thereby reducing likelihood of procrastination and forgetfulness at the time of the event.

Although the social norms letter was more effective than control when combined with an SMS it did not perform as well as open-ended and time-limited letters which is surprising given the success of social norm interventions in other areas see [ 19 , 21 ]. There is evidence to suggest that the more personalised the norm, the more effective it is [ 33 ]. It is also possible that the testimonials looked like marketing materials, making the letter look more like junk mail. It is of note that this less successful letter did not include a planning prompt.

There was less evidence for the effect of SMS pre-notifications on NHS HC uptake in contrast to evidence on colorectal cancer screening [ 15 , 16 , 17 ]. The superior effect for reminders may be because they are more effective at bridging the intention-behaviour gap, since they are received after the invitation letter and therefore presumably after the intention to make and attend an appointment has been formed. Reminders also suggest proactive behaviour to book an appointment whereas there are no direct actions associated with pre-notifications.

The authors of another recent factorial study explored combinations of behaviourally informed pre-notification and reminder texts to increase return of self-sampling HIV kits [ 38 ]. The most effective combination was the behaviourally informed primers and reminders compared to standard reminders — a 4 percentage point increase was observed.

But, like the present study, despite a primer or pre-notification being included in the most effective combination, further analysis demonstrated that only the behaviourally informed reminders were independently effective and not the primers [ 38 ]. Although not the primary aim of the study, it was possible to observe variation in attendance according to sex, age and ethnicity. As with other studies of NHS HC uptake, the likelihood of attendance increased in female patients [ 23 , 39 , 40 , 41 , 42 ] and with increasing age [ 23 , 39 , 40 , 42 ].

Our findings that those with black ethnicity were more likely to attend and that those whose ethnicity is not recorded were less likely to attend are in accordance with the results of other studies [ 5 , 43 ]. However, findings on the relationship between ethnicity and attendance at health checks are not consistent, and the authors of other studies have found that those with white ethnicity are no more likely to attend than other ethnicities [ 41 ].

In the present study we found no relationship between being South East Asian and attending an NHS HC, which differs from other studies [ 5 , 42 , 43 ]. There appears to be significant practice effects and any effect from deprivation score disappears when practice is included as a random effect, suggesting that any deprivation effect is absorbed by the practice effect.

A similar practice level disparity has been found in previous trials on uptake of NHS HC [ 23 , 40 , 42 ], some of which found that uptake varies by practice size, being lower for smaller practices [ 42 ]. This study has some limitations.

It was carried out with only one borough within central London. As such, the sample and setting are not nationally representative, although there is no reason to believe that people in different areas would respond differently to these interventions. It appears that variation between practices is a stronger influence on uptake. Around patients who did not have mobile numbers were excluded from the trial. It is possible that this group responded differently to the invitation letters from the patients who were included in the trial, or that they came from a particular demographic e.

However, the number of exclusions was relatively small compared to the total number of participants in the trial and they were randomly distributed across the intervention combinations, so they are not expected to have a large effect on the results. There were also differences in demographics across the intervention groups, but when demographics were introduced into the model they did not make much difference to the main effects. The reason for practice variation is also not explored.

The uptake rate even in the best condition of this study remained lower than average One study using observational cohort methodology showed that if a patient is invited by phone or approached verbally in-practice, compared to a letter alone or in addition to a letter, they are three times more likely to attend an NHS HC [ 39 ]. More recently Gidlow et al. This suggests that practices could consider optimising the national template letter with personalised risk information if this is available locally.

This large randomised controlled trial adds further support to the evidence that small, low cost behaviourally informed changes to letter-based invitations can have a substantial impact on NHS HC uptake. There was also an additive effect of an SMS reminder and pre-notification did not add to this effect.

The current national template letter recommends use of the open-ended letter in this study and directs local authority staff to the findings of this study to enable local areas to consider additionally the use of pre-notifications and reminders depending upon local resources.

Data for this study is based on patient-level information collected by local authorities, as part of the NHS HC programme. Public Health England. London: Public Health England; Department of Health. Economic Modelling For Vascular Checks.

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London: Department of Health; Putting prevention first vascular checks: risk assessment and management, impact assessment. Public Health, E.

Artac M, et al. Primary care and population factors associated with NHS Health check coverage: a national cross-sectional study. J Public Health Oxf. Waterall J, et al. Invited debate: NHS Health check: an innovative component of local adult health improvement and well-being programmes in England. J Public Health. Ellis N, et al. A qualitative investigation of non-response in NHS health checks. Archives of Public Health. McLean S, et al. Targeting the use of reminders and notifications for uptake by populations TURNUP : a systematic review and evidence synthesis. Health Services and Delivery Research.

Kerrison R, et al. Text-message reminders increase uptake of routine breast screening appointments: a randomised controlled trial in a hard-to-reach population. Br J Cancer. Free C, et al. The effectiveness of mobile-health technologies to improve health care service delivery processes: a systematic review and meta-analysis. PLoS Med. Guy R, et al. How effective are short message service reminders at increasing clinic attendance?

A meta-analysis and systematic review. Health Serv Res.

Empower your team. Delight your audience. Grow your brand.

Cohen CE, et al. Time to use text reminders in genitourinary medicine clinics. Kharbanda EO, et al.

Text4Health: a qualitative evaluation of parental readiness for text message immunization reminders. Am J Public Health. Baker DW, et al. Comparative effectiveness of a multifaceted intervention to improve adherence to annual colorectal cancer screening in community health centers: a randomized clinical trial.

Cole SR, et al. An advance notification letter increases participation in colorectal cancer screening. J Med Screen. Advance notification letters increase adherence in colorectal cancer screening: a population-based randomized trial. Prev Med. Libby G, et al. Pre-notification increases uptake of colorectal cancer screening in all demographic groups: a randomized controlled trial.

Cronin P, et al. Cost-effectiveness of an advance notification letter to increase colorectal cancer screening. Hallsworth M, et al. The behavioralist as tax collector: using natural field experiments to enhance tax compliance. J Public Econ. Allcott H. Social norms and energy conservation. Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial. Sallis A, et al. Improving child weight management uptake through enhanced National Child Measurement Programmed parental feedback letters: a Cluster Randomised Controlled Trial.

The effectiveness of an enhanced invitation letter on uptake of National Health Service Health Checks in primary care: a pragmatic quasi-randomised controlled trial.

BMC Fam Pract. Sheeran P. Intention—behavior relations: a conceptual and empirical review. Eur Rev Soc Psychol. Milkman KL, et al.

Planning prompts as a means of increasing preventive screening rates. Norman P, Conner M. I thought I would share some with you - and also share some tips for how to avoid making them.