title: Barriers in using cardiometabolic risk information among consumers with low health literacy.
abstract: OBJECTIVE
  To identify the barriers from the perspective of consumers with low health literacy in using risk information as provided in cardiometabolic risk assessments.
  
  
  METHODS
  A qualitative thematic approach using cognitive interviews was employed.
  
  
  METHODS
  We performed interviews with 23 people with low health literacy/health numeracy, who were recruited through (1) several organisations and snowball sampling and (2) an online access panel. Participants completed the risk test of the Dutch national cardiometabolic risk assessment and viewed the personalized information about their risk. They were asked to answer probing questions about different parts of the information. The qualitative data were analysed by identifying main themes related to barriers in using the information, using a descriptive thematic approach.
  
  
  RESULTS
  The four main themes identified were as follows: (1) People did not fully accept the risk message, partly because numerical information had ambiguous meaning; (2) people lacked an adequate framework for understanding their risk; (3) the purpose and setting of the risk assessment was unclear; and (4) current information tells nothing new: A need for more specific risk information.
  
  
  CONCLUSIONS
  The main barriers were that the current presentation seemed to provoke undervaluation of the risk number and that texts throughout the test, for example about cardiometabolic diseases, did not match people's existing knowledge, failing to provide an adequate framework for understanding cardiometabolic risk. Our findings have implications for the design of disease risk information, for example that alternative forms of communication should be explored that provide more intuitive meaning of the risk in terms of good versus bad.
  What is already known on this subject? Online disease risk assessments have become widely available internationally. People with low SES and health literacy tend to participate less in health screening. Risk information is difficult to understand, yet little research has been carried out among people with low health literacy. What does this study add? People with low health literacy do not optimally use risk information in an online cardiometabolic risk assessment. The texts provided in the cardiometabolic risk assessment do not suit to their existing knowledge. The typical risk communication (numbers, bar graph, verbal label) seems to provoke undervaluation of risk.
authors.affiliation: Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Olga C
authors.initials: OC
authors.lastname: Damman
authors.affiliation: Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Nina M M
authors.initials: NM
authors.lastname: Bogaerts
authors.affiliation: Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Diana
authors.initials: D
authors.lastname: van Dongen
authors.affiliation: Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.|National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: Danielle R M
authors.initials: DR
authors.lastname: Timmermans
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis*; D005260:Female; D058015:Health Communication / Q000379:methods*; D057220:Health Literacy; D006801:Humans; D008297:Male; D008659:Metabolic Diseases / Q000175:diagnosis*; D008875:Middle Aged; D018570:Risk Assessment; D012959:Socioeconomic Factors
keywords: decision-making; health literacy; prevention; risk communication; risk perception