Utilising Normalisation Process Theory to understand the patient journey for high-risk individuals participating in the NHS Health Check programme

Student thesis: Doctoral Thesis


Background: In 2009 the Department of Health introduced a national cardiovascular risk assessment, management, and reduction programme – the NHS Health Check. The programme aimed to reduce premature morbidity and mortality for those aged 40-74. Individuals who are identified to be at high risk (>20%) of cardiovascular disease are offered lifestyle advice and/or prophylactic medication to reduce their risk. This study aimed to understand the factors that influence individuals’ engagement with the programme. Normalisation Process Theory was used as a theoretical lens to underpin the study and make sense of the findings.Methods: A secondary analysis of data collected through 26 semi-structured interviews was conducted. Purposive sampling was undertaken of patients who had previously been identified, through the NHS Health Check Programme, as being at increased cardiovascular risk. Participants had been identified as high-risk, been offered lifestyle advice, lipid lowering medications, and had attended at least one annual review. Data were initially analysed thematically. Themes were then compared to Normalisation Process Theory constructs to assess if they could provide insight into engagement with the programme.Findings: Findings explore the work undertaken by participants to engage with (or not) each stage of the NHS Health Check journey. Focus is on four main areas, which relate to Normalisation Process Theory constructs; the sense making and working out participation work undertaken to decide to attend the check and understand what it means to be identified as at increased cardiovascular risk, and the doing it and reflecting on it work undertaken to implement lifestyle changes, adhere to medication regimens and engage in surveillance and monitoring activity.Conclusions: Normalisation Process Theory helped to surface important aspects of the NHSHC programme that influence participants’ engagement with the NHSHC and their subsequent journey throughout the process from: attending the assessment, being identified as at-risk, making sense of this ‘diagnosis’, and engaging in lifestyle changes and/or a pharmaceutically aided journey. Evidence from this study suggests that the at-risk individual should be viewed as a participant in a social system, and that this wider social system is integral to engagement, both positively and negatively, with all aspects of the programme.
Date of Award28 Jun 2018
Original languageEnglish
Awarding Institution
  • Teesside University
SupervisorSharon Hamilton (Supervisor)

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