Evaluation of a cardiovascular disease risk assessment tool for the promotion of healthier lifestyles

Background Although percentage risk formats are commonly used to convey cardiovascular disease (CVD) risk, people find it difficult to understand these representations. Aims To compare the impact of providing a CVD risk message in either a traditional format (% risk) or using an analogy of risk (Heart-Age) on participants' risk perceptions and intention to make lifestyle changes. Methods Four hundred and thirteen men and women were randomly allocated to one of two conditions; CVD risk as a percentage or as a Heart-Age score (a cardiovascular risk adjusted age). Results There was a graded relationship between perceived and actual CVD risk only in those participants receiving a Heart-Age message (P<0.05). Heart-Age was more emotionally impactful in younger individuals at higher actual CVD risk (P<0.01). Self-reported emotional reactions further mediated the relationship between risk perception and intention to make lifestyle changes. Conclusion This study found that the Heart-Age message significantly differed from percentage CVD risk score in risk perceptions and was more emotionally impactful in those participants at higher actual CVD risk levels.

[1]  B. Rimer,et al.  General Performance on a Numeracy Scale among Highly Educated Samples , 2001, Medical decision making : an international journal of the Society for Medical Decision Making.

[2]  Lisa M. Schwartz,et al.  Assessing Values for Health: Numeracy Matters , 2001, Medical decision making : an international journal of the Society for Medical Decision Making.

[3]  A. Manstead,et al.  Evaluating and extending the theory of planned behaviour , 1995 .

[4]  Melissa L. Finucane,et al.  Risk as Analysis and Risk as Feelings: Some Thoughts about Affect, Reason, Risk, and Rationality , 2004, Risk analysis : an official publication of the Society for Risk Analysis.

[5]  N. Unwin,et al.  Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Detection, Evaluation, and Treatment of High Blood Cholesterol Education Program (NCEP) Expert Panel on Executive Summary of the Third Report of the National , 2009 .

[6]  Eugene Borgida,et al.  The Differential Impact of Abstract vs. Concrete Information on Decisions , 1977 .

[7]  Gerd Gigerenzer,et al.  How to Improve Bayesian Reasoning Without Instruction: Frequency Formats , 1995 .

[8]  A. Kruglanski,et al.  The Social Psychology of Knowledge , 2010 .

[9]  Marten van Dijk,et al.  Affect, attitudes and decisions: Let's be more specific. , 1997 .

[10]  Philip Greenland,et al.  Risk factor burden in middle age and lifetime risks for cardiovascular and non-cardiovascular death (Chicago Heart Association Detection Project in Industry). , 2007, The American journal of cardiology.

[11]  Lawrence Joseph,et al.  Patient knowledge of coronary risk profile improves the effectiveness of dyslipidemia therapy: the CHECK-UP study: a randomized controlled trial. , 2007, Archives of internal medicine.

[12]  T. Marteau,et al.  Genetic risk and behavioural change , 2001, BMJ : British Medical Journal.

[13]  Rebecca T. Cover,et al.  Patients’ Perceptions of Cholesterol, Cardiovascular Disease Risk, and Risk Communication Strategies , 2006, The Annals of Family Medicine.

[14]  J. Gibbs,et al.  JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice , 2005, Heart.

[15]  P. Slovic,et al.  Violence Risk Assessment and Risk Communication: The Effects of Using Actual Cases, Providing Instruction, and Employing Probability Versus Frequency Formats , 2000, Law and human behavior.

[16]  M. Pencina,et al.  General Cardiovascular Risk Profile for Use in Primary Care: The Framingham Heart Study , 2008, Circulation.

[17]  I. Lipkus Numeric, Verbal, and Visual Formats of Conveying Health Risks: Suggested Best Practices and Future Recommendations , 2007, Medical decision making : an international journal of the Society for Medical Decision Making.

[18]  R. Petty,et al.  Measuring the Affective and Cognitive Properties of Attitudes: Conceptual and Methodological Issues , 1994 .

[19]  Peter Murray,et al.  Using Hypothetical Data to Assess the Effect of Numerical Format and Context on the Perception of Coronary Heart Disease Risk , 2008, American journal of health promotion : AJHP.

[20]  Paul Slovic,et al.  Affect, risk, and decision making. , 2005, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[21]  G Gigerenzer,et al.  Using natural frequencies to improve diagnostic inferences , 1998, Academic medicine : journal of the Association of American Medical Colleges.

[22]  Lidewij Henneman,et al.  Presenting health risk information in different formats: the effect on participants' cognitive and emotional evaluation and decisions. , 2008, Patient education and counseling.

[23]  G. Gigerenzer,et al.  Simple tools for understanding risks: from innumeracy to insight , 2003, BMJ : British Medical Journal.

[24]  Trudy van der Weijden,et al.  Improving cardiovascular risk management: a randomized, controlled trial on the effect of a decision support tool for patients and physicians , 2007, European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology.

[25]  A. Stiggelbout,et al.  Different formats for communicating surgical risks to patients and the effect on choice of treatment. , 2004, Patient education and counseling.

[26]  D. A. Kenny,et al.  The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. , 1986, Journal of personality and social psychology.

[27]  T. Greenhalgh,et al.  Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial , 2008, BMJ : British Medical Journal.

[28]  J. Rempel,et al.  Attitudes: A new look at an old concept. , 1988 .

[29]  Glyn Elwyn,et al.  General practice registrar responses to the use of different risk communication tools in simulated consultations: a focus group study , 1999, BMJ.

[30]  T. Tymstra,et al.  The psychosocial impact of mass screening for cardiovascular risk factors. , 1987, Family practice.

[31]  S. Epstein,et al.  Conflict between intuitive and rational processing: when people behave against their better judgment. , 1994, Journal of personality and social psychology.