“They are saying it's high, but I think it's quite low”: Exploring cardiovascular disease risk communication in NHS Health Checks through video-stimulated recall interviews with patients – A qualitative study

Background
NHS Health Check (NHSHC) is a national cardiovascular disease (CVD) risk identification and management programme. However, evidence suggests a limited understanding of the most used metric to communicate CVD risk with patients (10-year percentage risk). This study used novel application of video-stimulated recall interviews to understand patient perceptions and understanding of CVD risk following an NHSHC that used one of two different CVD risk calculators.
Methods
Qualitative, semi-structured video-stimulated recall interviews were conducted with patients (n=40) who had attended an NHSHC using either the QRISK2 10-year risk calculator (n=19) or JBS3 lifetime CVD risk calculator (n=21). Interviews were transcribed and analysed using reflexive thematic analysis.
Results
Analysis resulted in the development of four themes: variability in understanding, relief about personal risk, perceived changeability of CVD risk, and positive impact of visual displays. The first three themes were evident across the two patient groups, regardless of risk calculator; the latter related to JBS3 only. Patients felt relieved about their CVD risk, yet there were differences in understanding between calculators. Heart age within JBS3 prompted more accessible risk appraisal, yet mixed understanding was evident for both calculators. Event-free survival age also resulted in misunderstanding. QRISK2 patients tended to question the ability for CVD risk to change, while risk manipulation through JBS3 facilitated this understanding. Displaying information visually also appeared to enhance understanding.
Conclusions
Effective communication of CVD risk within NHSHC remains challenging, and lifetime risk metrics still lead to mixed levels of understanding in patients. However, visual presentation of information, alongside risk manipulation during NHSHCs can help to increase understanding and prompt risk-reducing lifestyle changes.

Keywords: Cardiovascular diseases; Risk; Preventive Medicine; Primary Health Care; Qualitative Research
Trial registration: ISRCTN10443908. Registered 7th February 2017.