Lorenc, Theo; Sutcliffe, Katy; Stokes, Gillian; Fullbright, Helen; Sowden, Amanda; (2024) Cardiovascular risk communication: Systematic review of qualitative evidence. (Research Report ). EPPI Centre, University College London: London, UK.

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Abstract

This report presents the findings of a systematic review of qualitative evidence commissioned to support policy development for the NHS Health Checks programme. The review focuses on views and experiences of cardiovascular risk assessment and risk communication. We searched four database sources in October 2022 using terms for cardiovascular disease, risk communication, and qualitative research. We included primary qualitative studies focusing on the assessment of cardiovascular risk and the communication of risk scores to individuals conducted in high-income (OECD member) countries. The review included 37 studies. The findings show that many people do not understand the meaning of risk scores, or do not see them as practically relevant. Some people are sceptical about the validity of risk models, and often see risk scores regarded as moderate or high risk in clinical practice as not a cause for concern. Other sources of information – subjective health status, lifestyle behaviours or family history – feed into informal estimates of risk which may lead people to reject the results of clinical risk assessment when the two conflict. Data on the impact of risk communication is mixed: many people report intentions to change lifestyle as a result of learning their risk score, but others report that it makes little difference. Clinicians are broadly positive in their views of risk assessment, but identify several barriers at patient level, including: understanding of probability or risk; excessive anxiety about risk, or indifference to future risks; and low risk scores removing motivation for lifestyle change. They find that individuals vary widely in their reactions and understanding, and have a range of strategies for adapting risk communication accordingly. Both clinicians and individuals have some specific preferences for risk communication, including a preference for: visually engaging formats; heart age rather than absolute risk; and the ability to manipulate data inputs. The findings suggest that people are more likely to understand ways of communicating risk which provide some comparison or reference point beyond a simple probability score. More generally, the broader communication and signposting around risk assessment may be as important in determining the messages received as the detail of risk scoring itself. The findings also arguably point to some gaps in theoretical models of risk communication: in particular, they indicate that the epistemic value of absolute risk to the individual is under-specified in the theory. Risk communication interventions are based on a rationalistic model of decision-making, but as enacted in practice, may be more about appeals to emotion.

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