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Abstract：
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.
CONCLUSIONS: 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.
BACKGROUND: Clinicaltrials.gov, NCT03524131. Registered May 14, 2018. Retrospectively registered.
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.
CONCLUSIONS: 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.
BACKGROUND: Clinicaltrials.gov, NCT03524131. Registered May 14, 2018. Retrospectively registered.
摘要：
背景：NHS健康检查（NHSHC）是一项预防非传染性疾病的国家计划。40-74岁无心血管相关疾病的患者应定期邀请。摄入量低于预期。我们评估了两个新的行为增强传单（以当前的国家传单为对照）对摄取的影响，随函附上:传单上的第一次审判。
方法：进行双盲三臂随机对照试验。新的传单较短(两页，而不是四个）；一个是损失框架（“不要错过”），另一个是收益框架（“充分利用生活”）。参与者是来自Lewisham的39个实践和NE林肯郡的17个实践的患者，从2018年4月至9月，他们被分配到使用随机数发生器的干预措施，并收到其中一张传单以及他们的邀请函。结果指标是在2018年11月之前吸收NHSHC。该试验有能力检测2%的效果。
结果：在对照条件下摄取为17.6%（n=3677），在损失框架条件下为17.4%(n=3664)，在增益框架条件下为18.2%(n=3697)。在控制人口统计学变量的逻辑回归中，小叶类型不是NHSHC摄取的重要预测因子，将GP练习作为随机效应。摄取的统计学显著预测因素包括位置(Lewisham的摄取较高)，年龄（年龄增加与出勤率增加相关）和性别（女性的摄入量较高）。将零与条件之间的差异的假设进行比较的贝叶斯因子为416，这是支持零假设的极端证据。
结论：没有证据表明损失框架或获得框架的行为知情传单类型对摄取有意义的影响，令人惊讶的是，鉴于行为知情信件改善了NHSHCs的摄取。人们可能不注意附以信件的传单，或传单继续支持知情决策，但这并不影响吸收。
背景：Clinicaltrials.gov，NCT03524131。2018年5月14日注册。追溯登记。
方法：进行双盲三臂随机对照试验。新的传单较短(两页，而不是四个）；一个是损失框架（“不要错过”），另一个是收益框架（“充分利用生活”）。参与者是来自Lewisham的39个实践和NE林肯郡的17个实践的患者，从2018年4月至9月，他们被分配到使用随机数发生器的干预措施，并收到其中一张传单以及他们的邀请函。结果指标是在2018年11月之前吸收NHSHC。该试验有能力检测2%的效果。
结果：在对照条件下摄取为17.6%（n=3677），在损失框架条件下为17.4%(n=3664)，在增益框架条件下为18.2%(n=3697)。在控制人口统计学变量的逻辑回归中，小叶类型不是NHSHC摄取的重要预测因子，将GP练习作为随机效应。摄取的统计学显著预测因素包括位置(Lewisham的摄取较高)，年龄（年龄增加与出勤率增加相关）和性别（女性的摄入量较高）。将零与条件之间的差异的假设进行比较的贝叶斯因子为416，这是支持零假设的极端证据。
结论：没有证据表明损失框架或获得框架的行为知情传单类型对摄取有意义的影响，令人惊讶的是，鉴于行为知情信件改善了NHSHCs的摄取。人们可能不注意附以信件的传单，或传单继续支持知情决策，但这并不影响吸收。
背景：Clinicaltrials.gov，NCT03524131。2018年5月14日注册。追溯登记。
