Mismatch between self-perceived and calculated cardiometabolic disease risk among participants in a prevention program for cardiometabolic disease: a cross-sectional study.

BACKGROUND: The rising prevalence of cardiometabolic diseases (CMD) calls for effective prevention programs. Self-assessment of CMD risk, for example through an online risk score (ORS), might induce risk reducing behavior. However, the concept of disease risk is often difficult for people to understand. Therefore, the study objective was to assess the impact of communicating an individualized CMD risk score through an ORS on perceived risk and to identify risk factors and demographic characteristics associated with risk perception among high-risk participants of a prevention program for CMD. METHODS: A cross-sectional analysis of baseline data from a randomized controlled trial conducted in a primary care setting. Seven thousand five hundred forty-seven individuals aged 45-70 years without recorded CMD, hypertension or hypercholesterolemia participated. The main outcome measures were: 1) differences in cognitive and affective risk perception between the intervention group - who used an ORS and received an individualized CMD risk score- and the control group who answered questions about CMD risk, but did not receive an individualized CMD risk score; 2) risk factors and demographic characteristics associated with risk perception. RESULTS: No differences were found in cognitive and affective risk perception between the intervention and control group and risk perception was on average low, even among high-risk participants. A positive family history for diabetes type 2 (ß0.56, CI95% 0.39-0.73) and cardiovascular disease (ß0.28, CI95% 0.13-0.43), BMI ≥25 (ß0.27, CI95% 0.12-0.43), high waist circumference (ß0.25, CI95% 0.02-0.48) and physical inactivity (ß0.30, CI95% 0.16-0.45) were positively associated with cognitive CMD risk perception in high-risk participants. No other risk factors or demographic characteristics were associated with risk perception. CONCLUSIONS: Communicating an individualized CMD risk score did not affect risk perception. A mismatch was found between calculated risk and self-perceived risk in high-risk participants. Family history and BMI seem to affect the level of CMD risk perception more than risk factors such as sex, age and smoking. A dialogue about personal CMD risk between patients and health care professionals might optimize the effect of the provided risk information. TRIAL REGISTRATION: Dutch trial Register number NTR4277, registered 26th Nov 2013.

Employees are ambivalent about health checks in the occupational setting.

BACKGROUND: Employees are increasingly provided with preventive health checks. However, participation rates are low and several ethical issues arise, such as a potential perceived threat to autonomy and privacy. AIMS: To assess what employees think about preventive health checks in the occupational setting. METHODS: Samples of construction workers and the general working population in the Netherlands completed a survey about preventive health checks in the occupational setting. We asked half of each sample about potential benefits and drawbacks of health checks, and the other half about how they should be offered. We employed explorative factor analysis to identify constructs related to perceived benefits and drawbacks, and the way health checks should be provided. We then conducted descriptive analyses and t-tests to compare subgroups of respondents. RESULTS: A total of 482 (27%) of construction workers and 738 (65%) employees from the general population responded. The overall survey response rate was 42% with 41% completing the first questionnaire and 42% the second. We identified three constructs related to perceived benefits and drawbacks: self-control over health, disturbance and negative emotion and lack of autonomy. Participants rated 'self-control over health' as the highest potential benefit (mean = 3.40; SD = 0.69), and 'your employer interfering in your personal life' as the most important potential drawback (mean = 3.27; SD = 1.00). Participants indicated that they would like to receive help from their occupational physician when an increased health risk is identified (mean = 4.02; SD = 0.69). CONCLUSIONS: Employees are ambivalent and hesitant concerning preventive health checks in the occupational setting.