I don't believe it, but I'd better do something about it: Patient experiences of online heart age risk calculators

Carissa Bonner, Jesse Jansen, Ben R. Newell, Les Irwig, Paul Glasziou, Jenny Doust, Haryana Dhillon, Kirsten McCaffery

Research output: Contribution to journalArticleResearchpeer-review

23 Citations (Scopus)

Abstract

Background: Health risk calculators are widely available on the Internet, including cardiovascular disease (CVD) risk calculators that estimate the probability of a heart attack, stroke, or death over a 5- or 10-year period. Some calculators convert this probability to "heart age", where a heart age older than current age indicates modifiable risk factors. These calculators may impact patient decision making about CVD risk management with or without clinician involvement, but little is known about how patients use them. Previous studies have not investigated patient understanding of heart age compared to 5-year percentage risk, or the best way to present heart age. Objective: This study aimed to investigate patient experiences and understanding of online heart age calculators that use different verbal, numerical, and graphical formats, based on 5- and 10-year Framingham risk equations used in clinical practice guidelines around the world. Methods: General practitioners in New South Wales, Australia, recruited 26 patients with CVD/lifestyle risk factors who were not taking cholesterol or blood pressure-lowering medication in 2012. Participants were asked to "think aloud" while using two heart age calculators in random order, with semi-structured interviews before and after. Transcribed audio recordings were coded and a framework analysis method was used. Results: Risk factor questions were often misinterpreted, reducing the accuracy of the calculators. Participants perceived older heart age as confronting and younger heart age as positive but unrealistic. Unexpected or contradictory results (eg, low percentage risk but older heart age) led participants to question the credibility of the calculators. Reasons to discredit the results included the absence of relevant lifestyle questions and impact of corporate sponsorship. However, the calculators prompted participants to consider lifestyle changes irrespective of whether they received younger, same, or older heart age results. Conclusions: Online heart age calculators can be misunderstood and disregarded if they produce unexpected or contradictory results, but they may still motivate lifestyle changes. Future research should investigate both the benefits and harms of communicating risk in this way, and how to increase the reliability and credibility of online health risk calculators.

Original languageEnglish
JournalJournal of Medical Internet Research
Volume16
Issue number5
DOIs
Publication statusPublished - 2014

Fingerprint

Life Style
Cardiovascular Diseases
South Australia
New South Wales
Health
Risk Management
Disease Management
Practice Guidelines
Internet
General Practitioners
Decision Making
Stroke
Myocardial Infarction
Cholesterol
Interviews
Blood Pressure

Cite this

Bonner, Carissa ; Jansen, Jesse ; Newell, Ben R. ; Irwig, Les ; Glasziou, Paul ; Doust, Jenny ; Dhillon, Haryana ; McCaffery, Kirsten. / I don't believe it, but I'd better do something about it : Patient experiences of online heart age risk calculators. In: Journal of Medical Internet Research. 2014 ; Vol. 16, No. 5.
@article{9b0021817fcd4d818121bfe26536ee70,
title = "I don't believe it, but I'd better do something about it: Patient experiences of online heart age risk calculators",
abstract = "Background: Health risk calculators are widely available on the Internet, including cardiovascular disease (CVD) risk calculators that estimate the probability of a heart attack, stroke, or death over a 5- or 10-year period. Some calculators convert this probability to {"}heart age{"}, where a heart age older than current age indicates modifiable risk factors. These calculators may impact patient decision making about CVD risk management with or without clinician involvement, but little is known about how patients use them. Previous studies have not investigated patient understanding of heart age compared to 5-year percentage risk, or the best way to present heart age. Objective: This study aimed to investigate patient experiences and understanding of online heart age calculators that use different verbal, numerical, and graphical formats, based on 5- and 10-year Framingham risk equations used in clinical practice guidelines around the world. Methods: General practitioners in New South Wales, Australia, recruited 26 patients with CVD/lifestyle risk factors who were not taking cholesterol or blood pressure-lowering medication in 2012. Participants were asked to {"}think aloud{"} while using two heart age calculators in random order, with semi-structured interviews before and after. Transcribed audio recordings were coded and a framework analysis method was used. Results: Risk factor questions were often misinterpreted, reducing the accuracy of the calculators. Participants perceived older heart age as confronting and younger heart age as positive but unrealistic. Unexpected or contradictory results (eg, low percentage risk but older heart age) led participants to question the credibility of the calculators. Reasons to discredit the results included the absence of relevant lifestyle questions and impact of corporate sponsorship. However, the calculators prompted participants to consider lifestyle changes irrespective of whether they received younger, same, or older heart age results. Conclusions: Online heart age calculators can be misunderstood and disregarded if they produce unexpected or contradictory results, but they may still motivate lifestyle changes. Future research should investigate both the benefits and harms of communicating risk in this way, and how to increase the reliability and credibility of online health risk calculators.",
author = "Carissa Bonner and Jesse Jansen and Newell, {Ben R.} and Les Irwig and Paul Glasziou and Jenny Doust and Haryana Dhillon and Kirsten McCaffery",
year = "2014",
doi = "10.2196/jmir.3190",
language = "English",
volume = "16",
journal = "Journal of Medical Internet Research",
issn = "1438-8871",
publisher = "Journal of medical Internet Research",
number = "5",

}

I don't believe it, but I'd better do something about it : Patient experiences of online heart age risk calculators. / Bonner, Carissa; Jansen, Jesse; Newell, Ben R.; Irwig, Les; Glasziou, Paul; Doust, Jenny; Dhillon, Haryana; McCaffery, Kirsten.

In: Journal of Medical Internet Research, Vol. 16, No. 5, 2014.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - I don't believe it, but I'd better do something about it

T2 - Patient experiences of online heart age risk calculators

AU - Bonner, Carissa

AU - Jansen, Jesse

AU - Newell, Ben R.

AU - Irwig, Les

AU - Glasziou, Paul

AU - Doust, Jenny

AU - Dhillon, Haryana

AU - McCaffery, Kirsten

PY - 2014

Y1 - 2014

N2 - Background: Health risk calculators are widely available on the Internet, including cardiovascular disease (CVD) risk calculators that estimate the probability of a heart attack, stroke, or death over a 5- or 10-year period. Some calculators convert this probability to "heart age", where a heart age older than current age indicates modifiable risk factors. These calculators may impact patient decision making about CVD risk management with or without clinician involvement, but little is known about how patients use them. Previous studies have not investigated patient understanding of heart age compared to 5-year percentage risk, or the best way to present heart age. Objective: This study aimed to investigate patient experiences and understanding of online heart age calculators that use different verbal, numerical, and graphical formats, based on 5- and 10-year Framingham risk equations used in clinical practice guidelines around the world. Methods: General practitioners in New South Wales, Australia, recruited 26 patients with CVD/lifestyle risk factors who were not taking cholesterol or blood pressure-lowering medication in 2012. Participants were asked to "think aloud" while using two heart age calculators in random order, with semi-structured interviews before and after. Transcribed audio recordings were coded and a framework analysis method was used. Results: Risk factor questions were often misinterpreted, reducing the accuracy of the calculators. Participants perceived older heart age as confronting and younger heart age as positive but unrealistic. Unexpected or contradictory results (eg, low percentage risk but older heart age) led participants to question the credibility of the calculators. Reasons to discredit the results included the absence of relevant lifestyle questions and impact of corporate sponsorship. However, the calculators prompted participants to consider lifestyle changes irrespective of whether they received younger, same, or older heart age results. Conclusions: Online heart age calculators can be misunderstood and disregarded if they produce unexpected or contradictory results, but they may still motivate lifestyle changes. Future research should investigate both the benefits and harms of communicating risk in this way, and how to increase the reliability and credibility of online health risk calculators.

AB - Background: Health risk calculators are widely available on the Internet, including cardiovascular disease (CVD) risk calculators that estimate the probability of a heart attack, stroke, or death over a 5- or 10-year period. Some calculators convert this probability to "heart age", where a heart age older than current age indicates modifiable risk factors. These calculators may impact patient decision making about CVD risk management with or without clinician involvement, but little is known about how patients use them. Previous studies have not investigated patient understanding of heart age compared to 5-year percentage risk, or the best way to present heart age. Objective: This study aimed to investigate patient experiences and understanding of online heart age calculators that use different verbal, numerical, and graphical formats, based on 5- and 10-year Framingham risk equations used in clinical practice guidelines around the world. Methods: General practitioners in New South Wales, Australia, recruited 26 patients with CVD/lifestyle risk factors who were not taking cholesterol or blood pressure-lowering medication in 2012. Participants were asked to "think aloud" while using two heart age calculators in random order, with semi-structured interviews before and after. Transcribed audio recordings were coded and a framework analysis method was used. Results: Risk factor questions were often misinterpreted, reducing the accuracy of the calculators. Participants perceived older heart age as confronting and younger heart age as positive but unrealistic. Unexpected or contradictory results (eg, low percentage risk but older heart age) led participants to question the credibility of the calculators. Reasons to discredit the results included the absence of relevant lifestyle questions and impact of corporate sponsorship. However, the calculators prompted participants to consider lifestyle changes irrespective of whether they received younger, same, or older heart age results. Conclusions: Online heart age calculators can be misunderstood and disregarded if they produce unexpected or contradictory results, but they may still motivate lifestyle changes. Future research should investigate both the benefits and harms of communicating risk in this way, and how to increase the reliability and credibility of online health risk calculators.

UR - http://www.scopus.com/inward/record.url?scp=84902002176&partnerID=8YFLogxK

U2 - 10.2196/jmir.3190

DO - 10.2196/jmir.3190

M3 - Article

VL - 16

JO - Journal of Medical Internet Research

JF - Journal of Medical Internet Research

SN - 1438-8871

IS - 5

ER -