How do people respond to receiving phenotypic and genetic CHD risk scores and life style advice - A qualitative study

Talk Code: 
EP2F.08
Presenter: 
Guy Shefer
Co-authors: 
Barbora Silarova, Juliet Usher-Smith, Simon Griffin
Author institutions: 
MRC-Epidemiology, University of Cambridge

Problem

Relatively little is known about the impact of providing phenotype and genetic CHD risk scores and in particular about the impact of providing risk scores combined with lifestyle advice. The aim of this study was to explore qualitatively how people respond to both types of risk scores and to interactive lifestyle advice.

Approach

Forty two face to face interviews and two focus groups were conducted across England with participants from the INFORM trial who received a combination of individualised phenotypic and genotypic CHD risk score and web-based lifestyle advice. The risk scores were presented in different formats, including absolute 10 year risk as a percentage, ‘heart age’ and colour visualisation. The lifestyle intervention consisted of three sessions of interactive, tailored information (up to three hours of interventional contact) with goal setting at the end of each session and some interactive information to help participants overcome individual challenges preventing them from changing their lifestyle. Interviews and focus groups explored participants’ understanding and reaction to the risk scores and attempts to change lifestyle during the intervention.

Findings

We identified some limitations of risk scores to generate in the recipients concern about their CHD risk. However some intentions and attempts to make moderate lifestyle changes were prompted by the web-based lifestyle advice regardless of the risk scores. There are some clear advantages to the ‘heart age’ format of risk score presentation in communicating a message of non-optimal lifestyle.

Consequences

A CHD reduction strategy can benefit from using interactive personalised lifestyle advice website. If using risk scores, it should use simplified format of risk score presentation (rather than multiple formats). A 'heart age' score, especially if higher than the chronological age, can communicate a powerful message about the need to change lifestyle.

Submitted by: 
Guy Shefer
Funding acknowledgement: 
INFORM is funded by European Commission Framework 7 EPIC-CVD Grant agreement no: 279233. NHS Blood and Transplant funded the INTERVAL trial. DNA extraction and genotyping in INTERVAL/INFORM was funded by the UK National Institute of Health Research. The coordinating team for INTERVAL/INFORM at the Cardiovascular Epidemiology Unit of the University of Cambridge was supported by core funding from: UK Medical Research Council (G0800270), British Heart Foundation (SP/09/002), British Heart Foundation Cambridge Cardiovascular Centre of Excellence, and UK National Institute for Health Research Cambridge Biomedical Research Centre.