in Bedfordshire and aimed to evaluate the effectiveness of health checks by nurses in
general practice in reducing risk factors for cardiovascular disease. All subjects received
an initial health check and the intervention group received an additional follow-up
health check after one year (further results were also collected for subjects over a four-
year period). The health checks involved the nurse recording information about personal
and family history of heart disease, stroke, hypertension, diabetes and cancer. Informa-
tion about smoking history, alcohol consumption and habitual diet, height, weight,
serum cholesterol concentration and blood pressure was also recorded. The nurses were
also instructed to counsel patients about risk factors and to negotiate priorities and
targets for risk reduction. The re-examination was briefer than the original health check
but it involved re-measurement of the same profile and lifestyle factors. The results
showed a lower cholesterol level (by 2.3 per cent) in the intervention group than the
control group, lower systolic (2.5 per cent) and diastolic (2.4 per cent) blood pressure,
and no differences in body mass index, or smoking prevalence or quit rates. The authors
concluded that using health checks to reduce smoking may be ineffective as the
effectiveness of health information may be diluted if the health check attempts to change
too many risk factors at once. They suggested that the reduction in blood pressure
was probably due to an accommodation effect, suggesting that the health checks were
ineffective. Muir et al. (1994: 312) also concluded that, although the health checks did
appear to reduce serum cholesterol concentration, ‘it is disappointing that the difference... was smaller in men than in women in view of the greater effect of cholesterol
concentration on absolute risk in men’ and they questioned whether such a shift in
concentration could be sustained in the long term in the light of a previous trial
in Oxfordshire. Therefore, although the results of the OXCHECK study suggested some
reduction in risk factors for cardiovascular disease, the authors were fairly pessimistic in
their presentation of these reductions.
Both of the above studies suggested that screening and minimal interventions are
not cost-effective, as the possible benefits are not worthy of the amount of time and
money needed to implement the programmes.
The effects of screening on the psychological state of
the individual
The third problem with screening concerns its impact on the individual’s psychological
state.The debates
Early evaluations of screening included an assessment of screening outcome in terms
of the patients’ understanding and recall of their diagnosis, not in terms of possible
negative consequences (Sibinga and Friedman 1971; Reynolds et al. 1974). Recent dis-
cussions of the effects of screening, however, have increasingly emphasized negative
consequences. McCormick (1989), in a discussion of the consequences of screening,
suggested that ‘false positive smears in healthy women cause distress and anxiety
that may never be fully allayed’ (McCormick 1989: 208). Grimes (1988) stated that226 HEALTH PSYCHOLOGY