Logo: to the web site of Uppsala University

uu.sePublications from Uppsala University
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
The publics’ perspective on cardiovascular risk information: Implications for practice
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.ORCID iD: 0000-0002-7293-3411
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Lay people struggle to understand the implications of cardiovascular risk information. With new advanced testing techniques and the digitalization of personal health information, the communication of cardiovascular risk becomes a challenge. 

The overall aim of the thesis was to investigate the publics’ perspective of cardiovascular risk information through a multi-method approach, including how individuals perceive risk, factors affecting an underestimation of risk, how cardiovascular risk communication affects individuals’ psychosocial health, and their preferences for risk communication. 

In study I, research participants’ perceptions about risk information were explored in five focus group interviews. The participants’ (n=31) perceptions about cardiovascular risk were complex, where multifactorial aspects were disregarded. The communication of cardiovascular risk information did not meet the participants’ need for understanding, support, and guidance regarding what to do with this information. 

Study II was a before-after investigation regarding the impact of cardiovascular risk information on research participants’ health-related quality of life and mental distress. Increased worry and anxiety were observed in individuals referred to hospital because of coronary artery stenosis. 

Study III was a cross-sectional study, which found that individuals with a very good or excellent self-perceived general health and individuals without a family history of CVD were more likely to underestimate their cardiovascular risk compared to participants with poor or fairly good general health and without a family history. 

Study IV was a cross-sectional study, investigating the preferences of the Swedish population for communication of cardiovascular risk information from a health checkup using a Discrete Choice Experiment. Besides cost, consultation time was the most important aspect when communicating cardiovascular risk. 

The findings suggest that cardiovascular risk communication does not reach its fullest potential when it comes to recipients’ perspective of the benefits of CV risk communication. Improvements should aim at increasing the recipients’ personal control and health literacy and furthermore, acknowledge the fact that self-perceived risk is influenced by how a person feels in general and experiences of family history. 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2021. , p. 79
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1710
Keywords [en]
Cardiovascular diseases, Health checks, Risk communication, Cardiovascular risk communication, Optimistic bias, Family history, General health, Preferences, Public perspective, Prevention, Mental distress, Health related quality of life
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-427327DOI: 10.33063/diva-427327ISBN: 978-91-513-1096-1 (print)OAI: oai:DiVA.org:uu-427327DiVA, id: diva2:1509397
Public defence
2021-02-19, Sal IX, Universitetshuset, Biskopsgatan 3, Uppsala, 09:15 (English)
Opponent
Supervisors
Funder
Swedish Heart Lung Foundation, 20150049
Note

https://doi.org/10.33063/diva-427327

Available from: 2021-01-27 Created: 2020-12-13 Last updated: 2024-02-14
List of papers
1. Exploring research participants' perceptions of cardiovascular risk information-Room for improvement and empowerment
Open this publication in new window or tab >>Exploring research participants' perceptions of cardiovascular risk information-Room for improvement and empowerment
Show others...
2019 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 102, no 8, p. 1528-1534Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The objective of this study was to explore research participants' (adults, age 50-65) perceptions of receiving cardiovascular risk information.

METHODS: Five focus group interviews (N = 31) were performed with research participants aged 50-65 who participated in the Swedish CArdioPulmonary BioImage Study (SCAPIS). The interviews were analyzed using qualitative content analysis.

RESULTS: The categories; the complexity of cardiovascular risk; insufficient presentation of test result; emotional responses; and health examinations provides confirmation, emerged. The test results were written in medical terms and lacked recommendations for further action which made it difficult for lay people to understand and use, and for some, also caused unnecessary worry.

CONCLUSION: There was inadequate guidance concerning the implications of the test results, especially for participants without clinical findings. In order to allow research participants to obtain better cognitive and behavioral control, improvements are needed with regard to how personal risk information is communicated in research projects connected to health services.

PRACTICAL IMPLICATIONS: The participants largely relied on physical signs when assessing their own cardiovascular risk. Health examinations are crucial for helping to add nuance to individuals' risk perceptions. For personal health information to have any real value for individuals, it must be designed from a user perspective.

Keywords
Cardiovascular diseases, Cardiovascular risk information, Health examinations, Qualitative research, Risk perception
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-381032 (URN)10.1016/j.pec.2019.03.010 (DOI)000470667500017 ()30928343 (PubMedID)
Funder
Swedish Heart Lung Foundation
Available from: 2019-04-03 Created: 2019-04-03 Last updated: 2021-12-17Bibliographically approved
2. Short-term mental distress in research participants after receiving cardiovascular risk information
Open this publication in new window or tab >>Short-term mental distress in research participants after receiving cardiovascular risk information
Show others...
2019 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 14, no 5, article id e0217247Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Understanding of how cardiovascular risk information influence individuals is critical for the practice of risk assessment and the management of patients with cardiovascular disease.

OBJECTIVES: The objective of this study was to investigate change in mental distress among research participants after undergoing a cardiovascular risk assessment and receiving individual test results.

METHODS: In 2017, a questionnaire measuring mental distress after taking part in a risk assessment was distributed among 615 participants in the Swedish Cardiopulmonary Bio Image Study in Uppsala, Sweden, aged 50-64 years. Outcome measures were re-assessed after three months (30% were lost to follow-up).

RESULTS: There were no differences in outcomes after three months for participants with normal test results or for participants who were referred to primary health care. Mental distress increased in participants who were referred to the hospital, and were further explained by the fact that these participants were diagnosed with coronary artery stenosis.

CONCLUSIONS: CV risk information can be provided to individuals with lower levels of risk without concerns of inducing mental distress. However, in order to prevent unnecessary worry in contexts similar to this study, one should be prepared for different risk outcomes and plan for support for individuals with higher risk. The increased utility of powerful, yet not fully mature, imaging techniques requires careful considerations extending beyond medical risks and benefits; the clinician must also take into account the risk of mental distress and secure support when necessary.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2019
Keywords
cardiovascular risk information, mental distress, health examinations, research participants
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-384225 (URN)10.1371/journal.pone.0217247 (DOI)000468865700025 ()31125371 (PubMedID)
Funder
Swedish Heart Lung Foundation
Available from: 2019-05-31 Created: 2019-05-31 Last updated: 2021-06-14Bibliographically approved
3. Good general health and lack of family history influence the underestimation of cardiovascular risk: A cross sectional study
Open this publication in new window or tab >>Good general health and lack of family history influence the underestimation of cardiovascular risk: A cross sectional study
Show others...
2021 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 20, no 7, p. 676-683Article in journal (Refereed) Published
Abstract [en]

Aims Underestimation of cardiovascular risk may interfere with prevention of cardiovascular diseases (CVDs). We investigate whether general health and family history of myocardial infarction (MI) are associated with underestimation of perceived cardiovascular risk, and if the participants' calculated risk modifies that association.

Methods and results The analysis sample consisted of 526 individuals, 50-64 years old, from a population-based cohort study. Information on general health (poor/fairly good, good, and very good/excellent), family history of MI, and self-perceived risk relative to others of similar age and sex were collected though a web-based survey. Participants were categorized into underestimation (n = 162, 31%), accurate estimation (n = 222, 42%), and overestimation (n = 142, 27%) of cardiovascular risk by comparing calculated Systematic Coronary Risk Estimation (SCORE) with self-perceived risk. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for underestimation vs. accurate estimation of cardiovascular risk were computed using logistic regression (n = 384). Very good general health (OR 2.60, 95% CI 1.10-6.16) and lack of family history (OR 2.27, 95% CI 1.24-4.18) were associated with underestimation of cardiovascular risk. The associations were modified by the participants' calculated risk level; the association was stronger for high-risk individuals; without family history OR 22.57 (95% CI 6.17-82.54); with very good/excellent health OR 15.78 (95% CI 3.73-66.87).

Conclusion A good general health and the lack of family CVD history can obscure the presence of other risk factors and lead to underestimation of cardiovascular risk, especially for high-risk individuals. It is, therefore, crucial to address the fact that the development of CV disease may be silent and multifactorial.

Place, publisher, year, edition, pages
Oxford University Press, 2021
Keywords
cardiovascular diseases; prevention; risk perception; general health; family history of MI
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-427323 (URN)10.1093/eurjcn/zvab019 (DOI)000715384200009 ()
Funder
Swedish Heart Lung Foundation, 20150049
Available from: 2020-12-07 Created: 2020-12-07 Last updated: 2023-02-17Bibliographically approved
4. Communicating test results from a general health checkup: the public’s preferences from a discrete choice experiment survey
Open this publication in new window or tab >>Communicating test results from a general health checkup: the public’s preferences from a discrete choice experiment survey
Show others...
2021 (English)In: Patient Related Outcome Measures, E-ISSN 1179-271X, Vol. 14, no 5, p. 649-660Article in journal (Refereed) Published
Abstract [en]

Background: Health checks can detect risk factors and initiate prevention of cardiovascular diseases but there is no consensus on how to communicate the results. The aim of this study was to investigate the preferences of the general population for communicating health check results.

Methods: A randomly selected sample of the Swedish population aged 40–70 years completed a discrete choice experiment survey that included questions on sociodemographics, lifestyle and health and 15 choice questions consisting of six attributes (written results, notification method, consultation time, waiting time, lifestyle recommendation and cost). Data were analyzed with a latent class analysis (LCA). Relative importance of the attributes and predicted uptake for several scenarios were estimated.

Results: In the analysis, 432 individuals were included (response rate 29.6%). A three-class LCA model best fit the data. Cost was the most important attribute in all classes. Preferences heterogeneity was found for the other attributes; in Class 1, receiving consultation time and the written results were important, respondents in Class 2 dominated on costs and respondents in Class 3 found consultation time, waiting time and lifestyle recommendations to be important. Health literate respondents were more likely to belong to Class 3. The predicted uptake rates ranged from 7 to 88% for different health checks with large differences across the classes.

Conclusions: Cost was most important when deciding whether to participate in a health check. Although cost was the most important factor, it is not sufficient to offer health checks free-of-charge if other requirements regarding how the test results are communicated are not in place; participants need to be able to understand their results.

Place, publisher, year, edition, pages
Springer NatureSpringer Nature, 2021
Keywords
Health check; discrete choice experiment; stated preferences; predicted uptake rate; communication of test results; cardiovascular diseases; prevention
National Category
Health Sciences
Identifiers
urn:nbn:se:uu:diva-427325 (URN)DOI: 10.1007/s40271-021-00512-4 (DOI)000634311100001 ()
Available from: 2020-12-07 Created: 2020-12-07 Last updated: 2024-01-15Bibliographically approved

Open Access in DiVA

fulltext(822 kB)1330 downloads
File information
File name FULLTEXT01.pdfFile size 822 kBChecksum SHA-512
40aa488171380a1fd872c7a9380572afb4b983683561921a0696c5484f705e9e9e3cc2e5a7deaae5dce79f9490877e5676f1680f42bffef453898986e9fe42e4
Type fulltextMimetype application/pdf

Other links

Publisher's full text

Authority records

Grauman, Åsa

Search in DiVA

By author/editor
Grauman, Åsa
By organisation
Centre for Research Ethics and Bioethics
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 1334 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
isbn
urn-nbn

Altmetric score

doi
isbn
urn-nbn
Total: 2043 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf