Health Catch-UP!: a realist evaluation of an innovative multi-disease screening and vaccination tool in UK primary care for at-risk migrant patients

doi:10.1186/s12916-024-03713-4

. 2024 Oct 29;22(1):497.

doi: 10.1186/s12916-024-03713-4.

Health Catch-UP!: a realist evaluation of an innovative multi-disease screening and vaccination tool in UK primary care for at-risk migrant patients

Jessica Carter^#^{1

2}, Lucy P Goldsmith^#¹, Felicity Knights^#¹, Anna Deal^{1

3}, Subash Jayakumar⁴, Alison F Crawshaw¹, Farah Seedat⁵, Nathaniel Aspray⁵, Dominik Zenner², Philippa Harris⁶, Yusuf Ciftci^{1

7}, Fatima Wurie⁸, Azeem Majeed⁹, Tess Harris¹⁰, Philippa Matthews¹¹, Rebecca Hall¹², Ana Requena-Mendez¹³, Sally Hargreaves¹⁴

Affiliations

¹ Migrant Health Research Group, Institute for Infection and Immunity, City St George's, University of London, London, UK.
² Wolfson Institute of Population Health, Queen Marys University of London, London, UK.
³ Faculty of Public Health and Policy, LSHTM, London, UK.
⁴ The Stonebridge Practice, Harness PCN South, NHS North West London Integrated Care System, London, UK.
⁵ The Migrant Health Research Group, City St George's, University of London, London, UK.
⁶ Clinical Research Department, London, School of Hygiene and Tropical Medicine and Division of Infection, UCLH, London, UK.
⁷ Experts By Experience (Advisor), London, UK.
⁸ Addiction and Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK.
⁹ Department of Primary Care and Public Health, Imperial College London, London, UK.
¹⁰ Population Health Research Institute, St George's, University of London, London, UK.
¹¹ Islington GP Federation, London, UK.
¹² Guy's and St Thomas' NHS Foundation Trust, London, UK.
¹³ Barcelona Institute for Global Health (IS Global Campus Clinic), Barcelona, Spain.
¹⁴ The Migrant Health Research Group, City St George's, University of London, London, UK. s.hargreaves@sgul.ac.uk.

^# Contributed equally.

PMID: 39468557
PMCID: PMC11520889
DOI: 10.1186/s12916-024-03713-4

Health Catch-UP!: a realist evaluation of an innovative multi-disease screening and vaccination tool in UK primary care for at-risk migrant patients

Jessica Carter et al. BMC Med. 2024.

. 2024 Oct 29;22(1):497.

doi: 10.1186/s12916-024-03713-4.

Authors

Affiliations

¹ Migrant Health Research Group, Institute for Infection and Immunity, City St George's, University of London, London, UK.
² Wolfson Institute of Population Health, Queen Marys University of London, London, UK.
³ Faculty of Public Health and Policy, LSHTM, London, UK.
⁴ The Stonebridge Practice, Harness PCN South, NHS North West London Integrated Care System, London, UK.
⁵ The Migrant Health Research Group, City St George's, University of London, London, UK.
⁶ Clinical Research Department, London, School of Hygiene and Tropical Medicine and Division of Infection, UCLH, London, UK.
⁷ Experts By Experience (Advisor), London, UK.
⁸ Addiction and Inclusion Directorate, Office for Health Improvement and Disparities, Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK.
⁹ Department of Primary Care and Public Health, Imperial College London, London, UK.
¹⁰ Population Health Research Institute, St George's, University of London, London, UK.
¹¹ Islington GP Federation, London, UK.
¹² Guy's and St Thomas' NHS Foundation Trust, London, UK.
¹³ Barcelona Institute for Global Health (IS Global Campus Clinic), Barcelona, Spain.
¹⁴ The Migrant Health Research Group, City St George's, University of London, London, UK. s.hargreaves@sgul.ac.uk.

^# Contributed equally.

PMID: 39468557
PMCID: PMC11520889
DOI: 10.1186/s12916-024-03713-4

Abstract

Background: Migrants to the UK face disproportionate risk of infections, non-communicable diseases, and under-immunisation compounded by healthcare access barriers. Current UK migrant screening strategies are unstandardised with poor implementation and low uptake. Health Catch-UP! is a collaboratively produced digital clinical decision support system that applies current guidelines (UKHSA and NICE) to provide primary care professionals with individualised multi-disease screening (7 infectious diseases/blood-borne viruses, 3 chronic parasitic infections, 3 non-communicable disease or risk factors) and catch-up vaccination prompts for migrant patients.

Methods: We carried out a mixed-methods process evaluation of Health Catch-UP! in two urban primary healthcare practices to integrate Health Catch-UP! into the electronic health record system of primary care, using the Medical Research Council framework for complex intervention evaluation. We collected quantitative data (demographics, patients screened, disease detection and catch-up vaccination rates) and qualitative participant interviews to explore acceptability and feasibility.

Results: Ninety-nine migrants were assessed by Health Catch-UP! across two sites (S1, S2). 96.0% (n = 97) had complete demographics coding with Asia 31.3% (n = 31) and Africa 25.2% (n = 25), the most common continents of birth (S1 n = 92 [48.9% female (n = 44); mean age 60.6 years (SD 14.26)]; and S2 n = 7 [85.7% male (n = 6); mean age 39.4 years (SD16.97)]. 61.6% (n = 61) of participants were eligible for screening for at least one condition and uptake of screening was high 86.9% (n = 53). Twelve new conditions were identified (12.1% of study population) including hepatitis C (n = 1), hypercholesteraemia (n = 6), pre-diabetes (n = 4), and diabetes (n = 1). Health Catch-UP! identified that 100% (n = 99) of patients had no immunisations recorded; however, subsequent catch-up vaccination uptake was poor (2.0%, n = 1). Qualitative data supported acceptability and feasibility of Health Catch-UP! from staff and patient perspectives, and recommended Health Catch-UP! integration into routine care (e.g. NHS health checks) with an implementation package including staff and patient support materials, standardised care pathways (screening and catch-up vaccination, laboratory, and management), and financial incentivisation.

Conclusions: Clinical Decision Support Systems like Health Catch-UP! can improve disease detection and implementation of screening guidance for migrant patients but require robust testing, resourcing, and an effective implementation package to support both patients and staff.

Keywords: Clinical decision support tool; Digital solutions; Infectious disease; Migrant health; Multi-disease; Non-communicable disease; Primary care; Screening; Vaccination.

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Conflict of interest statement

The authors declare no competing interests.

Figures

**Fig. 1**
Initial programme theory for Health Catch-UP!

**Fig. 2**
Flow chart of patient recruitment

**Fig. 3**
Country of origin for recruited patients

See this image and copyright information in PMC

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References

1. Abubakar I, Aldridge RW, Devakumar D, Orcutt M, Burns R, Barreto ML, et al. The UCL–Lancet Commission on migration and health: the health of a world on the move. Lancet. 2018;392(10164):2606–54. - PMC - PubMed
1. Noori T, Hargreaves S, Greenaway C, van der Werf M, Driedger M, Morton RL, et al. Strengthening screening for infectious diseases and vaccination among migrants in Europe: what is needed to close the implementation gaps? Travel Med Infect Dis. 2021;39: 101715. - PubMed
1. European Centre for Disease Prevention and Control. Public health guidance on screening and vaccination for infectious diseases in newly arrived migrants within the EU/EEA. Stockholm: 2018. 10.2900/154411. Available at: Public health guidance on screening and vaccination for infectious disea.... Accessed 23 Oct 2024.
1. Agyemang C, Van Den Born B-J. Non-communicable diseases in migrants: an expert review. J Travel Med. 2019;26(2):tay107. - PubMed
1. Eborall H, Wobi F, Ellis K, Willars J, Abubakar I, Griffiths C, et al. Integrated screening of migrants for multiple infectious diseases: qualitative study of a city-wide programme. EClinMed. 2020;21: 100315. - PMC - PubMed

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[1] Abubakar I, Aldridge RW, Devakumar D, Orcutt M, Burns R, Barreto ML, et al. The UCL–Lancet Commission on migration and health: the health of a world on the move. Lancet. 2018;392(10164):2606–54. - PMC - PubMed

[2] Abubakar I, Aldridge RW, Devakumar D, Orcutt M, Burns R, Barreto ML, et al. The UCL–Lancet Commission on migration and health: the health of a world on the move. Lancet. 2018;392(10164):2606–54. - PMC - PubMed

[3] Noori T, Hargreaves S, Greenaway C, van der Werf M, Driedger M, Morton RL, et al. Strengthening screening for infectious diseases and vaccination among migrants in Europe: what is needed to close the implementation gaps? Travel Med Infect Dis. 2021;39: 101715. - PubMed

[4] Noori T, Hargreaves S, Greenaway C, van der Werf M, Driedger M, Morton RL, et al. Strengthening screening for infectious diseases and vaccination among migrants in Europe: what is needed to close the implementation gaps? Travel Med Infect Dis. 2021;39: 101715. - PubMed

[5] European Centre for Disease Prevention and Control. Public health guidance on screening and vaccination for infectious diseases in newly arrived migrants within the EU/EEA. Stockholm: 2018. 10.2900/154411. Available at: Public health guidance on screening and vaccination for infectious disea.... Accessed 23 Oct 2024.

[6] European Centre for Disease Prevention and Control. Public health guidance on screening and vaccination for infectious diseases in newly arrived migrants within the EU/EEA. Stockholm: 2018. 10.2900/154411. Available at: Public health guidance on screening and vaccination for infectious disea.... Accessed 23 Oct 2024.

[7] Agyemang C, Van Den Born B-J. Non-communicable diseases in migrants: an expert review. J Travel Med. 2019;26(2):tay107. - PubMed

[8] Agyemang C, Van Den Born B-J. Non-communicable diseases in migrants: an expert review. J Travel Med. 2019;26(2):tay107. - PubMed

[9] Eborall H, Wobi F, Ellis K, Willars J, Abubakar I, Griffiths C, et al. Integrated screening of migrants for multiple infectious diseases: qualitative study of a city-wide programme. EClinMed. 2020;21: 100315. - PMC - PubMed

[10] Eborall H, Wobi F, Ellis K, Willars J, Abubakar I, Griffiths C, et al. Integrated screening of migrants for multiple infectious diseases: qualitative study of a city-wide programme. EClinMed. 2020;21: 100315. - PMC - PubMed

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Health Catch-UP!: a realist evaluation of an innovative multi-disease screening and vaccination tool in UK primary care for at-risk migrant patients

Affiliations

Health Catch-UP!: a realist evaluation of an innovative multi-disease screening and vaccination tool in UK primary care for at-risk migrant patients

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