title: Effects on cardiovascular disease risk of a web-based health risk assessment with tailored health advice: a follow-up study.
abstract: BACKGROUND
  A large proportion of the cardiovascular disease (CVD) burden can potentially be prevented by primary prevention programs addressing major causal risk factors. A Web-based health risk assessment (HRA) with tailored feedback for individual health promotion is a promising strategy. We evaluated the effect on CVD risk of such a program among employees of a Dutch worksite.
  
  
  METHODS
  We conducted a prospective follow-up study among 368 employees who voluntarily participated in a Web-based HRA program at a single Dutch worksite in 2008. The program included a multicomponent HRA through a Web-based electronic questionnaire, biometrics, and laboratory evaluation. The results were combined with health behavior change theory to generate tailored motivational and educational health advice. On request, a health counseling session with the program physician was available. Follow-up data on CVD risk were collected 1 year after initial participation. The primary outcome was a change in Framingham CVD risk at 6 months relative to baseline. We checked for a possible background effect of an increased health consciousness as a consequence of program introduction at the worksite by comparing baseline measurements of early program participants with baseline measurements of participants who completed the program 6 months later.
  
  
  RESULTS
  A total of 176 employees completed follow-up measurements after a mean of 7 months. There was a graded relation between CVD risk changes and baseline risk, with a relative reduction of 17.9% (P = 0.001) in the high-risk category (baseline CVD risk ≥ 20%). Changes were not explained by additional health counseling, medication, or an increase in health consciousness within the company.
  
  
  CONCLUSIONS
  Voluntary participation in a Web-based HRA with tailored feedback at the worksite reduced CVD risk by nearly 18% among participants at high CVD risk and by nearly 5% among all participants. Web-based HRA could improve CVD risk in similar populations. Future research should focus on the persistence of the effects underlying the CVD risk reduction.
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Ersen B
authors.initials: EB
authors.lastname: Colkesen
authors.forename: Bart S
authors.initials: BS
authors.lastname: Ferket
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Roderik A
authors.initials: RA
authors.lastname: Kraaijenhagen
authors.forename: Coenraad K
authors.initials: CK
authors.lastname: van Kalken
authors.forename: Ron J G
authors.initials: RJ
authors.lastname: Peters
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D016009:Chi-Square Distribution; D030141:Feedback, Psychological; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D020407:Internet; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009426:Netherlands; D009786:Occupational Health Services; D010353:Patient Education as Topic; D011314:Preventive Health Services; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D013997:Time Factors; D014836:Volition