***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVE To test the efficacy of interventions based on the question -behavior effect in promoting the adoption of disease prevention behaviors . DESIGN In Study 1 , adults from the general public were r and omly allocated to complete a question naire about health checks ( question -behavior effect condition ) or not ( control ) and later received an invitation to attend for screening . In Study 2 , health care professionals were r and omly allocated to complete a question naire about influenza vaccination or not and later had the opportunity to receive a vaccination . MAIN OUTCOME MEASURES We objective ly assessed health check attendance ( Study 1 ) and influenza vaccination ( Study 2 ) . RESULTS In Study 1 , intention-to-treat analyses indicated that health check attendance was significantly higher in the question -behavior effect condition ( 68.3 % ) compared with the control condition ( 53.5 % ) . In Study 2 , intention-to-treat analyses indicated that  influenza vaccination  was significantly higher among participants in the question -behavior effect condition ( 42.0 % ) compared with the control condition ( 36.3 % ) , and this effect persisted after controlling for demographic variables . Explanatory analyses indicated that the effects in both studies were attributable to completing rather than merely receiving the question naire and were stronger for those with positive attitudes or intentions about the target behavior . CONCLUSION The question -behavior effect represents a simple , cost-effective means to increase disease prevention behaviors among the general public and health professionals . Implication s for promoting health behaviors are discussed Background The National Health Service Health Check ( NHS HC ) is a population level public health programme . It is a primary prevention initiative offering cardiovascular risk assessment and management for adults aged 40–74 years ( every five years ) . It was design ed to reduce the incidence of major vascular disease events by preventing or delaying the onset of diabetes , heart and kidney disease , stroke and vascular dementia . Effectiveness of the programme has been modelled on a national uptake of 75 % however in 2012/13 uptake , nationally , was 49 % . Ensuring a high percentage of those offered an NHS HC actually receive one is key to optimising the clinical and cost effectiveness of the programme . Methods A pragmatic quasi-r and omised controlled trial was conducted in four general practitioner practice s in Medway , Engl and with r and omisation of 3511 patients . The aim was to compare attendance at the NHS HC using the st and ard national invitation template letter ( control ) compared to an enhanced invitation letter using insights from behavioural science ( intervention ) . The intervention letter includes i ) simplification - reducing letter content for less effortful processing ii ) behavioural instruction - action focused language iii ) personal salience - appointment due rather than invited and iv ) addressing implementation intentions with a tear off slip to record the date , time and location of the appointment . Logistic Regression explored the association between control and intervention group and attendance at a health check . Results 29.3 % of patients who received the control letter  and 33.5 % of those who received the intervention letter  attended their NHS HC ( adjusted odds ratio 1.26 , 95 % confidence interval 1.09–1.47 , p < 0.01 ) . This was an absolute difference in uptake of 4.2 percentage points for those receiving the intervention letter . Conclusions An invitation letter applying behavioural insights was more effective than the existing national template letter at encouraging attendance at an NHS HC . Making small , no cost behaviourally informed changes to letter invitations can improve uptake of the NHS HC . Further research is required to replicate the effect with more robust methodology and powered for sub-group analysis including socio-economic status . Trial Registration Current Controlled Trials IS RCT N66757664 , date of registration 28/3/2014 Abstract Background Uptake of health checks for cardiovascular risk assessment in primary care in Engl and is lower than anticipated . The question -behavior effect ( QBE ) may offer a simple , scalable intervention to increase health check uptake . Purpose The present study aim ed to evaluate the effectiveness of enhanced invitation methods employing the QBE , with or without a financial incentive to return the question naire , at increasing uptake of health checks . Methods We conducted a three-arm r and omized trial including all patients at 18 general practice s in two London boroughs , who were invited for health checks from July 2013 to December 2014 . Participants were r and omized to three trial arms : ( i ) St and ard health check invitation letter only ; ( ii ) QBE question naire followed by st and ard invitation letter ; or ( iii ) QBE question naire with offer of a financial incentive to return the question naire , followed by st and ard invitation letter . In intention to treat analysis , the primary outcome of completion of health check within 6 months of invitation , was evaluated using a p value of .0167 for significance . Results 12,459 participants were r and omized .  Health check uptake was evaluated for 12,052 ( 97 % ) with outcome data collected . Health check uptake within 6 months of invitation was : st and ard invitation , 590 / 4,095 ( 14.41 % ) ; QBE question naire , 630 / 3,988 ( 15.80 % ) ; QBE question naire and financial incentive , 629 / 3,969 ( 15.85 % ) . Difference following QBE question naire , 1.43 % ( 95 % confidence interval −0.12 to 2.97 % , p = .070 ) ; following QBE question naire and financial incentive , 1.52 % ( −0.03 to 3.07 % , p = .054 ) . Conclusions Uptake of health checks following a st and ard invitation was low and not significantly increased through enhanced invitation methods using the QBE Background NHS Health Check is a primary prevention programme offering cardiovascular disease ( CVD ) risk assessment to adults in Engl and aged 40–74 . Uptake remains a challenge and invitation method is a strong predictor of uptake . There is evidence of low uptake when using invitation letters . Telephone invitations might increase uptake , but are not widely used . We explored the potential to improve uptake through personalising letters to patient ’s CVD risk , and to compare this with generic letters and telephone invitations . Methods HEalth Check TRial ( HECTR ) was a three-arm r and omised controlled trial in nine general practice s in Staffordshire ( UK ) . Eligible patients were r and omised to be invited to a NHS Health Check using one of three methods : st and ard letter ( control ) ; telephone invitation ; letter personalised to the patient ’s CVD risk . The primary outcome was attendance/non-attendance . Data were collected on a range of patient- and practice -level factors ( e.g. , patient socio-demographics , CVD risk , practice size , Health Checks outside usual working hours ) . Multi-level logistic regression estimated the marginal effects to explore whether invitation method predicted attendance . Invitation costs were collated from practice s to estimate cost benefit . Results In total , 4614 patients were included in analysis ( mean age 50.2 ± 8.0 yr . ; 52.4 % female ) . Compared with patients invited by st and ard letter ( 30.9 % ) , uptake was significantly higher in those invited by telephone ( 47.6 % , P < .001 ) , but not personalised letter ( 31.3 % , p = .812 ) . In multi-level analysis , compared with the st and ard letter arm , likelihood of attendance was 18 percentage points higher in the telephone arm and 4 percentage points higher in the personalised letter arm . The effect of telephone calls appeared strongest in patients who were younger and had lower CVD risk . We estimated per 1000 patients invited , risk-personalised letters could result in 40 additional attended Health Checks ( at no extra cost ) and telephone invitations could result in 180 additional Health Checks at an additional cost of £ 240 . Conclusions Telephone invitations should be advocated to address the substantial deficit between current and required levels of NHS uptake , and could be targeted at younger and lower CVD risk adults .  Risk-personalised letters should be explored further in a larger sample of high risk individuals . Trial registration Registration number : IS RCT N15840751 date of registration : 24/10/2017 Background The National Health Service ( NHS ) in Engl and introduced a population -wide programme for cardiovascular disease ( CVD ) prevention in 2009 , known as NHS Health Checks . This research aim ed to measure the cardiovascular risk management and cardiovascular risk factor outcomes of the health check programme during six years ’ follow-up . Methods and findings A controlled interrupted time series study was conducted . Participants were registered with general practice s in the Clinical Practice Research Data link ( CPRD ) in Engl and and received health checks between 1 April 2010 and 31 December 2013 . Control participants , who did not receive a health check  , were matched for age , sex , and general practice . Outcomes were blood pressure , body mass index ( BMI ) , smoking , and total cholesterol ( TC ) and high-density lipoprotein cholesterol ( HDL ) . Analyses estimated the net effect of health check by year , allowing for the underlying trend in risk factor values and baseline differences between cases and controls , adjusting for age , sex , deprivation , and clustering by general practice . There were 127,891 health check participants and 322,910 matched controls . Compared with controls , health check participants had lower BMI ( cases mean 27.0 , SD 4.8 ; controls 27.3 , SD 5.6 , Kg/m2 ) , systolic blood pressure ( SBP ) ( cases 129.0 , SD 14.3 ; controls 129.3 , SD 15.0 , mm Hg ) , and smoking ( 21 % in health check participants versus 27 % in controls ) , but total and HDL cholesterol were similar . Health check participants were more likely to receive weight management advice ( adjusted hazard ratio [ HR ] 5.03 , 4.98 to 5.08 , P < 0.001 ) , smoking cessation interventions ( HR 3.20 , 3.13 to 3.27 , P < 0.001 ) , or statins ( HR 1.24 , 1.21 to 1.27 , P < 0.001 ) . There were net reductions in risk factor values up to six years after the check for BMI ( −0.30 , −0.39 to −0.20 Kg/m2 , P < 0.001 ) , SBP ( −1.43 , −1.70 to −1.16 mm Hg , P < 0.001 ) , and smoking ( 17 % in health check participants versus 25 % in controls ; odds ratio 0.90 , 0.87 to 0.94 , P < 0.001 ) . The main study limitation was that residual confounding may be present because r and omisation was not employed ; health check – associated measurement introduced differential recording that might cause bias . Conclusions Our results suggest that people who take up a health check generally have lower risk factor values than controls and are more likely to receive risk factor interventions .  Risk factor values show net reductions up to six years following a health check in BMI , blood pressure , and smoking , which may be of public health importance The NHS Health Check ( NHS HC ) is a cardiovascular risk assessment to prevent cardiovascular disease . Public Health Engl and ( PHE ) wants to increase uptake . We explored the impact of behaviourally informed invitation letters and pre-notification and reminder SMS on uptake of NHS HCs . Patients at 28 General Practice s in the London Borough of Southwark who were eligible to receive an NHS HC between 1st November 2013 and 31st December 2014 were included . A double-blind r and omised controlled trial with a mixed 2 ( pre-notification SMS – yes or no ) × 4 ( letter – national template control , open-ended , time-limited , social norm ) × 2 ( reminder SMS – yes or no ) factorial design was used . The open-ended letter used simplification , behavioural instruction and a personalised planning prompt for patients to record the date and time of their NHS HC . The time-limited letter was similar but stated the NHS HC was due in a named forthcoming month . The social norms letter was similar to the open-ended letter but included a descriptive social norms message and testimonials from local residents and no planning prompt . The outcome measure was attendance at an NHS HC .  Data for 12 , 244 invites were analysed . Uptake increased in almost all letter and SMS combinations compared to the control letter without SMS ( Uptake 18 % ) , with increases of up to 12 percentage points for the time-limited letter with pre-notification and reminder ( Uptake 30 % ; Adjusted Odds Ratio AOR 1.86 ; 95 % CI 1.45–2.83 ; p < 0.00 ) ; 10 percentage points for the open-ended letter with reminder ( Uptake 27 % ; AOR 1.68 ; 95 % CI 1.31–2.17 ; p < 0.00 ) and a 9 percentage point increase using the time-limited letter with reminder ( Uptake 27 % ; AOR 1.61 ; 95 % CI 1.25–2.10 ; p < 0.00 ) . The reminder SMS increased uptake for all intervention letters . The pre-notification did not add to this effect . This large r and omised controlled trial adds support to the 
    Output:
    
Different invitation methods may be more effective for different groups of patients based on their ethnicity and gender .
This review also finds that uptake varies significantly by GP practice , which could be due either to unidentified practice -level factors or deprivation .