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“Tools that lack credibility and don’t acknowledge uncertainty will erode people’s trust in the health service and stop important public health messages getting through” wrote Dr Tom Nolan – GP, in The BMJ last month. Whilst Dr Nolan’s evaluation of the NHS heart-age calculator - that it is ill-conceived and poorly executed - is a fair critique, the appeal of such accessible ‘health tools’ shouldn’t necessarily be dismissed out-of-hand. With some tweaks it could be a useful way of engaging the public with preventative interventions.
This summer in July, an event was held in Stoke-on-Trent near the local CCG’s HQ, to mark the NHS’ 70th birthday by promoting digital healthcare directly to the public. A van and a stand were set up outside a Tesco superstore with a few clinicians onboard to promote healthy behavioural change via use of technology-enabled care services (TECS). The event had marvellous success, with over 100 people visiting the stand within a couple of hours. And what was the lure? - “What’s your heart-age?”
Prior to this event, the organising team had attempted several different strategies to try to engage and educate the local public about TECS for their own health and wellbeing. They organised focus groups, ran training sessions; everywhere from universities to housing association blocks, but these traditional methods garnered little interest. Therefore, they weren’t expecting the large numbers this event drew. People were literally queuing out of the van to find out their heart-age. Admittedly some were no doubt incentivised by the free fruit, cake and beverages, and to be entered into a prize-draw, but most were compelled by the prospect of being told their heart-age and were happy to wait to find out.
Thus, this is where Dr Nolan’s assessment falls short of the mark somewhat. Although the heart-age calculator is poorly devised and arguably illegitimately scaremongering, it is rather like ‘the Donald’ of today’s political landscape. It relays all the wrong aspects, backed up by no evidence and yet it draws a massive audience because it speaks to the human attraction to simplistic answers for complex problems. So, the real question is: how can we do away with the falsehoods and still engage the public in healthy behavioural change? The answer perhaps lies in Dr Nolan’s article: acknowledge and broadcast the uncertainty of the results. At the ‘heart-age’ event that is precisely how the clinicians advised all those who completed the public health questionnaire. The danger was sensed that people could be disproportionately shocked and worried by the results they received unless qualified by, as Dr Nolan put it well: “We can’t really look at your heart or see the future, obviously.”
Dr Nolan was also right to question the evidence for using such tools to effect behaviour change in people. Indeed, in a home-setting, in isolation this seems unlikely. However, organised events where trained experts can put the results in context, like the one in Stoke-on-Trent, demonstrates that there is merit in their use as a catalyst in provoking conversations about, for example, using TECS to help people make healthy lifestyle changes. Admittedly, that event was a one-off, but the chance of learning one’s heart-age helped to attract a relatively large number of people to find out more about healthier behaviours and available TECS to aid them. Part of the antidote to the crisis facing primary healthcare services - rising demand for, and falling accessibility to - is preventative medicine. Adopting positive behavioural changes in the population needs to be encouraged, in the right way. The utility of simplistic answers is that they appeal, therefore if used in the right way – applied in the right setting and with results in context – they could be a way forward to start necessary conversations and initiate useful preventative interventions... A kind of ‘Trump appeal’ used for the greater good?
Competing interests:
Mr Beaney works as project evaluator for and with Dr Chambers Clinical Chair of Stoke-on-Trent CCG & Staffordshire STP’s clinical lead for technology enabled care services digital workstream.
16 October 2018
Paul A Beaney
Medical student
Dr Ruth Chambers OBE
Keele Medical School
School of Medicine, David Weatherall Building, University Road, Keele University, Staffordshire, ST5 5BG
NHS heart-age calculator: rather like Trump – it’s often wrong, but it draws a following - the populist appeal of this risk-calculator can be used to encourage behavioural change!
“Tools that lack credibility and don’t acknowledge uncertainty will erode people’s trust in the health service and stop important public health messages getting through” wrote Dr Tom Nolan – GP, in The BMJ last month. Whilst Dr Nolan’s evaluation of the NHS heart-age calculator - that it is ill-conceived and poorly executed - is a fair critique, the appeal of such accessible ‘health tools’ shouldn’t necessarily be dismissed out-of-hand. With some tweaks it could be a useful way of engaging the public with preventative interventions.
This summer in July, an event was held in Stoke-on-Trent near the local CCG’s HQ, to mark the NHS’ 70th birthday by promoting digital healthcare directly to the public. A van and a stand were set up outside a Tesco superstore with a few clinicians onboard to promote healthy behavioural change via use of technology-enabled care services (TECS). The event had marvellous success, with over 100 people visiting the stand within a couple of hours. And what was the lure? - “What’s your heart-age?”
Prior to this event, the organising team had attempted several different strategies to try to engage and educate the local public about TECS for their own health and wellbeing. They organised focus groups, ran training sessions; everywhere from universities to housing association blocks, but these traditional methods garnered little interest. Therefore, they weren’t expecting the large numbers this event drew. People were literally queuing out of the van to find out their heart-age. Admittedly some were no doubt incentivised by the free fruit, cake and beverages, and to be entered into a prize-draw, but most were compelled by the prospect of being told their heart-age and were happy to wait to find out.
Thus, this is where Dr Nolan’s assessment falls short of the mark somewhat. Although the heart-age calculator is poorly devised and arguably illegitimately scaremongering, it is rather like ‘the Donald’ of today’s political landscape. It relays all the wrong aspects, backed up by no evidence and yet it draws a massive audience because it speaks to the human attraction to simplistic answers for complex problems. So, the real question is: how can we do away with the falsehoods and still engage the public in healthy behavioural change? The answer perhaps lies in Dr Nolan’s article: acknowledge and broadcast the uncertainty of the results. At the ‘heart-age’ event that is precisely how the clinicians advised all those who completed the public health questionnaire. The danger was sensed that people could be disproportionately shocked and worried by the results they received unless qualified by, as Dr Nolan put it well: “We can’t really look at your heart or see the future, obviously.”
Dr Nolan was also right to question the evidence for using such tools to effect behaviour change in people. Indeed, in a home-setting, in isolation this seems unlikely. However, organised events where trained experts can put the results in context, like the one in Stoke-on-Trent, demonstrates that there is merit in their use as a catalyst in provoking conversations about, for example, using TECS to help people make healthy lifestyle changes. Admittedly, that event was a one-off, but the chance of learning one’s heart-age helped to attract a relatively large number of people to find out more about healthier behaviours and available TECS to aid them. Part of the antidote to the crisis facing primary healthcare services - rising demand for, and falling accessibility to - is preventative medicine. Adopting positive behavioural changes in the population needs to be encouraged, in the right way. The utility of simplistic answers is that they appeal, therefore if used in the right way – applied in the right setting and with results in context – they could be a way forward to start necessary conversations and initiate useful preventative interventions... A kind of ‘Trump appeal’ used for the greater good?
Competing interests: Mr Beaney works as project evaluator for and with Dr Chambers Clinical Chair of Stoke-on-Trent CCG & Staffordshire STP’s clinical lead for technology enabled care services digital workstream.