Key messages
• People decide to get general health checks based on several things, such as being aware of general health checks and getting reminders from family, friends, or healthcare providers. In places where general health checks and treatment are not free, resources like time and money also play a role. Some people avoid general health checks because they are afraid of bad results.
• We found less information about healthcare funders and providers, so we do not fully understand what drives their decisions about funding or delivering general health checks.
• People should think carefully about whether to have a general health check, weighing up the pros and cons and taking into account their own health and situation.
What are general health checks?
General health checks are routine health examinations offered to people who feel healthy, especially in wealthier countries. They include screening for various cancers, and assessing people's risk of getting diabetes or heart disease. These checks are believed to help by spotting risks or diseases early so they can be treated, or so people can make changes to their lifestyle. However, there may be risks. For example, people might receive a wrong screening diagnosis and have to undergo further testing, and possibly unnecessary treatment. General health checks are expensive to provide, and research shows that they may not be effective for preventing heart disease.
What did we want to find out?
Demand for general health checks remains high, but we don't know whether they significantly help to reduce death, cancer and heart disease. We wanted to understand what factors lead policy-makers, healthcare managers and providers, and clients to fund, provide and attend general health checks.
What did we do?
We searched for studies where policy-makers, healthcare managers, healthcare providers and clients shared their views and experiences. We evaluated the quality of each study individually and summarised the findings.
What did we find?
We found 146 studies, and selected 36 of them to analyse. Most studies took place in high-income European countries, with a third from middle-income countries in Eastern Europe, South and Southeast Asia, and Latin America. Most clients, healthcare providers and policy-makers had similar perceptions and experiences of general health checks. We developed 22 findings and judged our confidence in these findings to be high, moderate, low, or very low, indicating how likely the finding represents what we sought to study.
1. We have high confidence in the evidence of the following findings.
• Clients’ perceptions of the disease, prevention and risk affect uptake.
• Both healthcare providers and clients believe that people who provide general health checks need to be skilled and understand the clients' culture.
2. We have moderate confidence in the evidence of the following findings.
• Many clients see general health checks as a way to get an objective health assessment, reassurance from health professionals and motivation for healthier living.
• Clients who fear bad results or who only seek care when they have symptoms are less likely to attend.
• Some clients feel a duty to their families or society to attend health checks, believing it helps maintain or improve their health.
• Interaction with healthcare providers can either encourage or discourage attendance.
• Availability, accessibility and clear information are crucial in clients' decision-making process.
• Factors like time, money and health insurance affect whether people attend.
• Healthcare providers face barriers to delivering general health checks, like time constraints, staff shortages, limited resources, technical issues and complicated reimbursement processes. Some believe offering general health checks in locations like supermarkets or churches might improve access.
• Healthcare funders, managers, providers and clients have different views on how beneficial general health checks actually are.
• Healthcare providers and clients feel that raising awareness of general health checks, including their benefits and risks, requires clear information, effective invitation systems and educational efforts.
3. We have low or very low confidence in the following findings.
• Clients prefer a broad range of tests, while healthcare providers favour more tailored testing, based on the person's needs.
• For clients, clear explanations of test results and recommendations are important. Everyone agrees that follow-up care is essential to make general health checks meaningful.
• Clients report that cultural background, social norms, religion, gender and language shape how people perceive prevention and disease, which influences their decision to attend general health checks.
• Policy-makers believe that a supportive political climate and backing from various groups are necessary to implement general health checks.
What are the limitations of the evidence?
We tried to include a sample of studies representing diverse geographical regions, settings, and people. However, there were gaps in the research, so we could not get a clear picture of everything we were interested in. In particular, information about funders and providers is probably incomplete.
How up-to-date is this evidence?
We searched for studies in January 2022 and August 2022. The studies that we analysed were published between 1995 and 2021.
Despite the lack of effectiveness in the quantitative review, our findings showed that general health checks remain popular amongst clients, healthcare providers, managers and policymakers across countries and settings. Our data did not offer strong evidence on why these are commissioned, but it did point to these interventions being valued in contexts where general health checks have long been established. General health checks fulfil specific wants and needs, and de-implementation strategies may need to offer alternatives before a constructive debate can take place about fundamental changes to this widely popular or, at least, accepted service.
General health checks are integral to preventive services in many healthcare systems. They are offered, for example, through national programmes or commercial providers. Usually, general health checks consist of several screening tests to assess the overall health of clients who present without symptoms, aiming to reduce the population's morbidity and mortality.
A 2019 Cochrane review of effectiveness studies suggested that general health checks have little or no effect on either all-cause mortality, cancer or cardiovascular mortality or cardiovascular morbidity. These findings emphasise the need to explore the values of different stakeholder groups associated with general health checks.
To identify how stakeholders (i.e. healthcare managers or policymakers, healthcare providers, and clients) perceive and experience general health checks and experience influencing factors relevant to the commissioning, delivery and uptake of general health checks. Also, to supplement and contextualise the findings and conclusions of a 2019 Cochrane effectiveness review by Krogsbøll and colleagues.
We searched MEDLINE (Ovid) and CINAHL (EBSCO) and conducted citation-based searches (e.g. reference lists, effectiveness review-associated studies and cited references in our included studies). The original searches cover the period from inception to August 2022. The results from the update search in September 2023 have not yet been incorporated.
We included primary studies that utilised qualitative methods for data collection and analysis. Included studies explored perceptions and experiences of commissioning, delivery and uptake of general health checks. Stakeholders of interest were healthcare managers, policymakers, healthcare providers and adults who participate (clients) or do not participate (potential clients) in general health checks. The general health check had to include screening tests for at least two diseases or risk factors. We considered studies conducted in any country, setting, and language.
We applied a prespecified sampling frame to purposefully sample a variety of eligible studies. This sampling approach allowed us to capture conceptually rich studies that described the viewpoints of different stakeholder groups from diverse geographical regions and different settings.
Using the framework synthesis approach, we developed a framework representing individual, intervention and contextual factors, which guided data extraction and synthesis. We assessed the methodological limitations of each study using an adapted version of the Critical Appraisals Skills Programme (CASP) tool. We applied the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative Research) approach to assess our confidence in each finding.
One hundred and forty-six studies met the inclusion criteria, and we sampled 36 of these for our analysis. While most of the studies were set in high-income countries in Europe, nearly a third (11/36) were set in culturally diverse middle-income countries across Eastern Europe, South and Southeast Asia, and Latin America. Sixteen sampled studies were conducted in primary and community healthcare settings, four in workplace settings and four in community settings. Included studies explored the perceptions and experiences of clients (n = 25), healthcare providers (n = 15) and healthcare managers or commissioners (n = 9).
We grouped the findings at the individual level, intervention level and surrounding context. The findings at the individual level mainly reflect the client’s perspective. General health checks helped motivate most clients to change their lifestyles. They were trusted to assess their health objectively, finding reassurance through professional confirmation (moderate confidence). However, those who feared negative results or relied on symptom-based care were more reluctant to attend (moderate confidence). Perceptions of disease, risk factors and prevention affected uptake (high confidence). Some clients felt an obligation to their families and society to maintain and improve their health through general health checks (moderate confidence). Healthcare providers played a crucial role in motivating participation, but negative experiences with unqualified providers discouraged attendance (moderate confidence). The availability and accessibility of general health checks and awareness systems played significant roles in clients’ decision-making. Factors such as time and concerns that health insurance may not cover potential treatment costs influenced attendance (moderate confidence).
The findings at the intervention level drew on the perspectives of all three stakeholder groups, with a strong focus on the healthcare provider's perspective. Healthcare providers and clients considered it essential that general health check providers were skilled and culturally competent (high confidence). Barriers to delivery included time competition with curative care, staff changes and shortages, resource limitations, technical issues, and reimbursement challenges (moderate confidence). Stakeholders thought innovative and diverse settings might improve access (moderate confidence).
The evidence suggests that clients appreciated a comprehensive approach, with various tests. At the same time, healthcare providers deemed individualised approaches tailored to clients' health risks suitable, focusing on improving rather than abandoning general health checks (low confidence). The perspectives on the effectiveness of general health checks differed among healthcare commissioners, managers, providers, and clients (moderate confidence). Healthcare providers and clients recognised the importance of information, invitation systems, and educational approaches to create awareness of general health check availability and their respective advantages or disadvantages (moderate confidence). Clients considered explaining test results and providing recommendations as key elements of general health checks (low confidence).
We have low or very low confidence in findings related to the contextual level and reasons for commissioning general health checks. The evidence suggests that cultural background, social norms, religion, gender, and language shape the perception of prevention and disease, thereby influencing the uptake of general health checks. Policymakers thought that a favourable political climate and support from various stakeholders are needed to establish general health checks.