In Residence Scheme: A new app to revolutionise the delivery of routine health checks

Tickertest is a new online health app created by Howoco to support people who are not accessing NHS Health Checks through their GP. It’s part of a new project piloted by community organisation Cornwall Neighbourhoods for Change (CN4C) which is working with the NHS to provide digital hubs, physical spaces and greater access to digital health care for those without connectivity, devices or the confidence or skills.

The background

The NHS Health Check is aimed at adults in England aged 40-74 and it’s designed to spot early signs of stroke, kidney disease, heart disease and type 2 diabetes. However, due to the Covid-19 pandemic, most face-to-face GP consultations have been discontinued. Howoco’s digital version of the NHS Health Check seeks to address this issue, as well as deliver health screening to those living in rural remote areas.

Tickertest is accessed through a smartphone, desktop computer or tablet via a secure link sent from the GP’s surgery. It guides the user through a set of questions designed to replicate the face-to-face health check and includes a pin-prick blood test (for assessing cholesterol levels and diabetes) that is posted back and analysed at an NHS-approved laboratory.  

The opportunity

In June 2021, as part of the support provided by Smartline through their In-Residence scheme, CN4C were able to explore probable factors for the acceptance and adoption of their Digital Health Hub innovation concept, using Tickertest as an example of how the hub could provide free and supported access to online health services.

Due to Covid-19 restrictions, an online focus group method was chosen. The Smartline researchers conducted two, two-hour, focus groups with 14 adult participants. The focus group discussion schedule was structured around the Technology Acceptance Model (TAM). The discussion was divided into two, 25 minutes focused on the Digital Health Hub and 25 minutes focused on Tickertest.

Participants were predominately social housing residents from the Camborne, Pool, Illogan and Redruth (CPIR) communities, an area that represents one of the most deprived regions in Cornwall, with one in four residents living in the 20% of most deprived neighbourhoods in England. Smartline was therefore interested to study individual attitudes towards engagement with eHealth technology ­from a demographic most associated with digital exclusion.

Overall, with Covid-19 making essential services adopt online technology, participants viewed the Digital Health Hub and Tickertest as useful and needed innovations.

All participants understood Tickertest’s potential value in disease prevention, they liked the fact that Tickertest is clearly from their GP and therefore scored points from a trusted perspective. Tickertest also scored well on the convenience factor being easily conducted in the participant’s own time and chosen location, rather than having to travel to their GP surgery.

From a critical perspective, the participants regarded Tickertest’s name as being one of its main issues, perceiving it to trivialise the health check, although they did like the animation in the explainer video (top of page) for creating an overall positive attitude. Participants also have concerns, or anxiety, about the security and confidentiality of the data collected. It is recommended that a clearer explanation within the app is required to demonstrate how the data is processed and who has access to it.

Improved communication is also needed around the pin-prick blood test, to reassure users, with specific warnings for those on blood thinners. Overall, the research finding was very positive, with 11 out of 14 participants giving Tickertest a full 10 points, (and two other participants scoring 8 and 9) on the likelihood of using Tickertest if it was made available in the future.

What’s next?

The new knowledge about the acceptability, feasibility and factors which influence the use of CN4C’s proposed innovation of a Digital Health Hub and Tickertest, enabled CN4C and Tickertest to address barriers to use and improve their innovations.

CN4C are now providing integrated hubs along with digital hubs. Due to the many changes in the Integrated Care System, this move aligns CN4C with the population health management and the core 20 plus 5 outcomes.

A digital NHS Health Check is being trialled over the coming months in Cornwall using Tickertest.

Who is involved?

Emma Wooderson from CN4C, Peter Bayliss from Tickertest, William Lilley and Heather Beer from SWAHSN and Prof. Karyn Morrissey, Dr Tim Walker and Emma Seymour from the University of Exeter.