title: The response to receiving phenotypic and genetic coronary heart disease risk scores and lifestyle advice - a qualitative study.
abstract: Individuals routinely receive information about their risk of coronary heart disease (CHD) based on traditional risk factors as part of their primary care. We are also able to calculate individual's risk of CHD based on their genetic information and at present genetic testing for common diseases is available to the public. Due to the limitations in previous studies further understanding is needed about the impact of the risk information on individual's well-being and health-behaviour. We aimed to explore the short term response to receiving different forms of CHD risk information and lifestyle advice for risk reduction.
  
  
  
  We conducted fourty-one face-to-face interviews and two focus groups across England with participants from the INFORM trial who received a combination of individualised phenotypic and genotypic CHD risk scores and web-based lifestyle advice. Risk scores were presented in different formats, e.g. absolute 10 year risk was presented as a thermometer and expressed as a percentage, natural frequency and 'heart age'. Interviews and focus groups explored participants' understanding and reaction to the risk scores and attempts to change lifestyle during the intervention. We tape-recorded and transcribed the interviews and focus groups and analysed them using thematic analysis.
  
  
  
  Three main themes were identified: limitations of risk scores to generate concern about CHD risk; the advantages of the 'heart age' format of risk score presentation in communicating a message of sub-optimal lifestyle; and intentions and attempts to make moderate lifestyle changes which were prompted by the web-based lifestyle advice.
  
  
  
  There are a number of limitations to the use of risk scores to communicate a message about the need for a lifestyle change. Of the formats used, the 'heart age', if noticed, appears to convey the most powerful message about how far from optimal risk an individual person is. An interactive, user friendly, goal setting based lifestyle website can act as a trigger to initiate moderate lifestyle changes, regardless of concerns about risk scores.
  
  
  
  Current Controlled Trials ISRCTN17721237 . Registered 12 January 2015.
authors.affiliation: MRC- Epidemiology, University of Cambridge, 7 Cavesson Court, Cambridge, CB43TB, UK. guy.shefer@anglia.ac.uk.
authors.forename: Guy
authors.initials: G
authors.lastname: Shefer
authors.affiliation: MRC- Epidemiology, University of Cambridge, 7 Cavesson Court, Cambridge, CB43TB, UK.
authors.forename: Barbora
authors.initials: B
authors.lastname: Silarova
authors.affiliation: Department of Public Helath and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: Juliet
authors.initials: J
authors.lastname: Usher-Smith
authors.affiliation: Department of Public Helath and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Griffin
mesh_terms: D000328:Adult; D003327:Coronary Disease / Q000235:genetics / Q000517:prevention & control* / Q000523:psychology; D004739:England; D005260:Female; D017144:Focus Groups; D005817:Genetic Counseling / Q000379:methods*; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012307:Risk Factors; D040242:Risk Reduction Behavior
keywords: Cardiovascular disease; Genetics; Health behaviour; Physical activity; Risk assessment