Table 3. Key findings and implications.

Key finding	Potential implications
Differences in preferences for DHC and F2F pathways among those invited to DHC.	DHC should be considered as a complementary option rather than a replacement to the existing service and offer wider choice for users.
DHC does not reach those who do not engage with F2F health checks.	Strategies are still needed to reach those groups not currently engaging with NHS Health Checks.
Differences in the DHC uptake before and after final the SMS text reminder.	Optimisation of the invitation process may increase the uptake of NHS Health Checks regardless of the pathway chosen.
Poor provision and uptake of physical measures, from which key estimates of CVD and diabetes risk are calculated.	The process for obtaining physical measures requires further development before being assessed for wider use.DHC in its current form could be used to reduce pressure on the NHS and supplement the F2F pathway, for example, by providing pre-health check screening and extending the lifestyle change support offered.
Obtaining updated measures selected as a health priority by some but not all users.	Obtaining physical measures to calculate accurate estimates of CVD and diabetes risk should be a priority, and options should be offered to all users and not left to individual choice.
Despite the interest expressed in obtaining physical measures, very low levels of updated data resulted in very high cost per user.	The complex process from choosing how to obtain measures, the logistics of actually obtaining the measures (sending off for kits, finding kiosks, taking blood samples, returning samples) and then updating and integrating data into existing systems needs to be improved at all stages.
Health priorities indicated a strong demand for support for mental well-being.	Mental well-being is not currently part of the NHS Health Check, but could be considered for inclusion in future.
GP appointments and referrals were lower for DHC indicating poorer follow-up for those on the DHC pathway.	Systems need to ensure that DHC outcomes and any further actions required are automatically passed on to GP surgeries and are followed up by the GP surgery rather than relying on users.

CVDcardiovascular diseaseDHCDigital Health CheckGPgeneral practitionerNHSNational Health Service