Table 1 Workshop discussion themes regarding the proposed interventiona
Main theme | Subtheme | Examples |
|---|---|---|
Positive feedback | Benefits to the NHS | • Encourage healthy lifestyles and reduce NHS costs2,4 • Save GP time by ensuring patients better prepared for health check consultation |
Benefits to patients | • Improved patient engagement with health professionals and with own health4 • Improved communication between patients, professionals, family members and carers1,2 • Educational (facilitating informed decision making) • Motivational (providing individualised information and feedback facilitating goal setting)2 • Less confrontational (i.e. impersonal advice from a screen rather than ‘judgemental’ human) • Ability to interact with own health record • Convenience of being able to view health information from a variety of locations in own time1,3,4 | |
Challenges and solutions | Access | • Literacy barriers. Proposed solutions: appropriate reading level, choice of different ‘difficulty’ levels, training sessions in GP practices or community centres, use of ‘community champions’. • Language barriers. Proposed solutions: opportunities to use website at GP surgery with interpreters, provision of information in different languages • Computer access difficulties. Proposed solutions: provide access in GP surgeries or in community • Disabilities. Proposed solutions: variable text size or ‘speak aloud’ options |
Data Security | • Family members accessing record without consent. Proposed solutions: requirement to register for username and password with proof of identity • Insurance companies using data to increase premiums. Proposed solutions: Encryption of data, legal guarantees/assurances regarding security of data | |
Engagement | • Lack of patient motivation to look at results. Proposed solution: community champions • Low awareness of NHSHC programme. Proposed solutions: local and national publicity campaigns • Technology-resistant individuals. Proposed solutions: offer the intervention in different formats, e.g. face to face, provide clear written instructions, use community outreach programmes | |
Negative consequences | • Unreliable self-reports may reduce risk scores (e.g. reported exercise). Proposed solution: link to wearables such as activity trackers • Increasing health inequalities. Proposed solution: gather data on characteristics of users so as to better target the intervention in future • Increased GP workload and costs. Although cost and time savings likely to outweigh these in longer term • Increased patient anxiety. Proposed solution: helpline for patients1 • Patient denial or reactance against results. Proposed solution: careful presentation of results • Concern that website may replace face to face care. Proposed solution: clear explanation that website would serve as an adjunct to, rather than replacing, face to face care. | |
Improvements/alternatives | Population | • Offer website to all patients eligible for NHSHC, rather than just those with a QRISK score ≥ 10% • Expand intervention beyond NHSHC to include risk of other conditions such as diabetes or cancer |
Duration | • Expand duration of availability of platform, i.e. offer access prior to 2nd appointment and in longer term to enable patients to view changes in risk score over time as this would enable patients to view impact of dietary changes on cholesterol levels and QRISK score in longer term2,4 | |
Platform | • Ensure mobile and tablet access also available. • Allow access via an app in addition to a website. • Enable greater interactivity – e.g. allow uploading of data from home BP monitors and activity trackers. • Incorporate signposting to services e.g. smoking cessation, weight loss, blood test explanations3 • Incorporate social support feature, e.g. online forums • Ensure compatibility with other platforms such as Apple Health or Google Fit. • Incorporate reminder features, e.g. to have blood tests done on a specific date |