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.
authors.affiliation: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Sydney, Australia.
authors.forename: Carissa
authors.initials: C
authors.lastname: Bonner
authors.forename: Jesse
authors.initials: J
authors.lastname: Jansen
authors.forename: Ben R
authors.initials: BR
authors.lastname: Newell
authors.forename: Les
authors.initials: L
authors.lastname: Irwig
authors.forename: Paul
authors.initials: P
authors.lastname: Glasziou
authors.forename: Jenny
authors.initials: J
authors.lastname: Doust
authors.forename: Haryana
authors.initials: H
authors.lastname: Dhillon
authors.forename: Kirsten
authors.initials: K
authors.lastname: McCaffery
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D002318:Cardiovascular Diseases; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors
keywords: behavior change; cardiovascular disease; lifestyle; prevention; risk assessment; risk calculator; risk perception