Interventions using ‘heart age’ for cardiovascular disease risk communication: Systematic review of psychological, behavioural and clinical effects (Preprint)

2021 ◽  
Author(s):  
Carissa Bonner ◽  
Carys Batcup ◽  
Samuel Cornell ◽  
Michael Anthony Fajardo ◽  
Anna L Hawkes ◽  
...  
Keyword(s):  
Risk Communication ◽  
Behaviour Change ◽  
Absolute Risk ◽  
Risk Of Bias ◽  
Behaviour Change Techniques ◽  
Randomised Trials ◽  
Cvd Risk ◽  
Bias Assessment ◽  
Consultation Time ◽  
Heart Age

BACKGROUND Cardiovascular disease (CVD) risk communication is a challenge for clinical practice, where doctors find it difficult to explain the absolute risk of a CVD event to patients with varying health literacy. Converting the probability to ‘heart age’ is increasingly used to promote lifestyle change in a more intuitive way, but a rapid review of biological age interventions found no clear evidence that they motivate behaviour change. OBJECTIVE We aimed to identify the content and effects of heart age interventions in more detail to better understand this finding. METHODS Systematic review of quantitative and qualitative studies presenting heart age interventions to adults for the purpose of CVD risk communication. The review was conducted in April 2020, and updated in March 2021. The Johanna Briggs risk of bias assessment tool was applied to randomised studies. Behaviour change techniques described in the intervention methods were coded using Michie et al.’s taxonomy. RESULTS From 7,926 results, 16 eligible studies were identified: 5 randomised online experiments, 5 randomised clinical trials, 2 mixed methods studies with quantitative outcomes and 4 with qualitative analysis. Direct comparisons between heart age and absolute risk in 5 online experiments included 5,514 consumers and found that heart age: increased positive/negative emotional responses (4/5 studies), risk perception (4/5 studies; but not necessarily more accurate) and recall (4/4 studies), reduced credibility (2/3 studies), and generally had no effect on lifestyle intentions (4/5 studies). One study compared heart age and absolute risk to fitness age, and found reduced lifestyle intentions for fitness age. When heart age was combined with additional strategies (e.g. in person/phone counselling) in applied settings for 9,582 patients, it improved risk control (e.g. reduced cholesterol and absolute risk) compared to usual care in most trials (4/5 studies) up to 1 year. However, clinical outcomes were no different when directly compared to absolute risk (1/1 study). Mixed methods studies echoed the outcomes in the randomised trials, but also identified consultation time and content as an important outcome, as well as differences between receiving an older heart age versus young/equal to current age. The heart age interventions described in these studies included a wide range of behaviour change techniques, and conclusions were sometimes biased in favour of heart age with insufficient supporting evidence. Risk of bias assessment indicated issues with all randomised trials. CONCLUSIONS This review found little evidence that heart age motivates lifestyle behaviour change more than absolute risk, but either format can improve clinical outcomes when combined with other behaviour change strategies. The label for the “heart age” concept can affect outcomes and should be pre-tested with the intended audience. Future research should consider consultation time and differentiate between older and younger heart age results. INTERNATIONAL REGISTERED REPORT RR2-10.1101/2020.05.03.20089938

scholarly journals Behaviour change interventions for the management of Raynaud's phenomenon: a systematic review protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e017039 ◽  
Author(s):  
Jo Daniels ◽  
John D Pauling ◽  
Christopher Eccelston
Keyword(s):  
Systematic Review ◽  
Behaviour Change ◽  
Raynaud’S Phenomenon ◽  
Meta Analysis ◽  
Grey Literature ◽  
Raynaud's Phenomenon ◽  
Risk Of Bias ◽  
Bias Assessment ◽  
Behaviour Change Interventions

IntroductionRaynaud's phenomenon (RP) describes excessive peripheral vasospasm to cold exposure and/or emotional stress. RP episodes are associated with digital colour changes, pain and reduced quality of life. Pharmacological interventions are of low to moderate efficacy and often result in adverse effects such as facial flushing and headaches. Recommended lifestyle and behavioural interventions have not been evaluated. The objectives of the proposed systematic review are to assess the comparative safety and efficacy of behaviour change interventions for RP and identify what we can learn to inform future interventions.Methods and analysisStudies eligible for inclusion include randomised controlled trials testing behaviour change interventions with a control comparator. A comprehensive search strategy will include peer review and grey literature up until 30 April 2017. Search databases will include Medline, Embase, PsychINFO and Cochrane. Initial sifting, eligibility, data extraction, risk of bias and quality assessment will be subject to review by two independent reviewers with a third reviewer resolving discrepancies. Risk of bias assessment will be performed using Cochrane risk of a bias assessment tool with quality of evidence assessed using Grading of Recommendations Assessment, Development and Evaluation(GRADE). A meta-analysis will be performed if there are sufficient data. Two subgroup analyses are planned: primary versus secondary RP outcomes; comparison of theoretically informed interventions with pragmatic interventions.Ethics and disseminationThis review does not require ethical approval as it will summarise published studies with non-identifiable data. This protocol complies with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. Findings will be disseminated in peer-reviewed articles and reported according to PRISMA. This review will make a significant contribution to the management of RP where no review of behaviour-change interventions currently exist. The synopsis and protocol for the proposed systematic review is registered in the International Prospective Register of Systematic Reviews (registration number CRD42017049643).

scholarly journals Cardiovascular disease risk communication in NHS health checks: video-stimulated recall interviews with practitioners

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0049
Author(s):  
Christopher J. Gidlow ◽  
Naomi Jane Ellis ◽  
Victoria Riley ◽  
Lisa Cowap ◽  
Diane Crone ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Risk Communication ◽  
Disease Risk ◽  
Health Check ◽  
Risk Calculator ◽  
Cvd Risk ◽  
Stimulated Recall ◽  
Practitioner Training ◽  
Nhs Health Check ◽  
Heart Age

BackgroundNHS Health Check (NHSHC) is a national programme to identify and manage cardiovascular disease (CVD) risk. Practitioners delivering the programme should be competent in discussing CVD risk, but there is evidence of limited understanding of the recommended 10 year/centage CVD risk scores. Lifetime CVD risk calculators might improve understanding and communication of risk.AimTo explore practitioner understanding, perceptions and experiences of CVD risk communication in NHSHCs when using two different CVD risk calculators.Design & settingQualitative video-stimulated recall (VSR) study with NHSHC practitioners.MethodVSR interviews were conducted with practitioners who delivered NHSHCs using either the QRISK2 10-year risk calculator (n=7) or JBS3 lifetime CVD risk calculator (n=8). Data were analysed using reflexive thematic analysis.ResultsFindings from analysis of VSR interviews with 15 practitioners (9 Healthcare Assistants, 6 General Practice Nurses) are presented by risk calculator. There was limited understanding and confidence of 10-year risk, which was used to guide clinical decisions through determining low/medium/high risk thresholds, rather than as a risk communication tool. Potential benefits of some JBS functions were evident, particularly heart age, risk manipulation and visual presentation of risk.ConclusionsThere is a gap between the expectation and reality of practitioners’ understanding, competencies and training in CVD risk communication for NHS Health Check. Practitioners would welcome heart age and risk manipulation functions of JBS3 to promote patient understanding of CVD risk, but there is a more fundamental need for practitioner training in CVD risk communication.

scholarly journals Behaviour change techniques in personalised care planning for older people: systematic review

2020 ◽  
pp. bjgp20X714017
Author(s):  
Sadia Ahmed ◽  
Anne Heaven ◽  
Rebecca Lawton ◽  
Gregg H Rawlings ◽  
Claire Sloan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older People ◽  
Behaviour Change ◽  
Adult Population ◽  
Risk Of Bias ◽  
Care Practice ◽  
Behaviour Change Techniques ◽  
Planning Problem ◽  
Care Planning ◽  
Long Term Conditions

Abstract Background: Personalised care planning (PCP) interventions have potential to provide better outcomes for older people and are a key focus in primary care practice. Behaviour change techniques (BCTs) can maximise effectiveness of such interventions, but it is uncertain which BCTs are most appropriate in PCP for older adults. Aim: To identify BCTs used in successful PCP interventions for older people aged 65+. Design and setting: Systematic review. Method: We searched 12 databases from date of inception to September 31st 2017. We identified randomised controlled trials (RCTs) of interventions involving participants aged 65+ and contextually related to PCP. Five areas of risk of bias were assessed. The Michie et al. BCT Taxonomy was used for coding. Results: Twenty-three RCTs involving 6489 participants (average age 74) described PCP interventions targeting the general older adult population and older people with specific long-term conditions (e.g. heart disease, diabetes, stroke). Just over half of the studies were deemed low risk of bias. Eleven ‘promising’ BCTs were identified in five trials reporting significant improvements in quality of life (QoL). Six BCTs were reported in all five of these trials: ‘goal setting’, ‘action planning’, ‘problem solving’, ‘social support’, ‘instructions on how to perform a behaviour’ and ‘information on health consequences’. Modes of delivery varied. Conclusion: Future PCP interventions to improve QoL for people aged 65+ may benefit from focusing on six specific BCTs. Better reporting of BCTs would enhance future design and implementation of such interventions.

scholarly journals Group-Based Nutrition Interventions to Promote Health and Mobility in Community-Dwelling Older Adults: A Systematic Review

2021 ◽  
Author(s):  
Kylie Teggart ◽  
Rebecca Ganann ◽  
Davneet Sihota ◽  
Caroline Moore ◽  
Heather Keller ◽  
...  
Keyword(s):  
Older Adults ◽  
Nutrition Education ◽  
Behaviour Change ◽  
Food Access ◽  
Critical Appraisal ◽  
Risk Of Bias ◽  
Community Dwelling ◽  
Behaviour Change Techniques ◽  
Nutrition Interventions ◽  
Community Dwelling Older Adults

Abstract Objective: To identify the efficacy of group-based nutrition interventions to increase healthy eating, reduce nutrition risk, improve nutritional status, and improve physical mobility among community-dwelling older adults.Design: Systematic review. Electronic databases MEDLINE, CINAHL, EMBASE, PsycINFO, and Sociological Abstracts were searched on July 15, 2020, for studies published in English since January 2010. Study selection, critical appraisal (using the Joanna Briggs Institute’s critical appraisal tools), and data extraction were performed in duplicate by two independent reviewers.Setting: Nutrition interventions delivered to groups in community-based settings were eligible. Studies delivered in acute or long-term care settings were excluded.Participants: Community-dwelling older adults aged 55+ years. Studies targeting specific disease populations or promoting weight loss were excluded.Results: Thirty-one experimental and quasi-experimental studies with generally unclear-high risk of bias were included. A broad range of interventions were identified, including nutrition education with behaviour change techniques (e.g., goal setting, interactive cooking demonstrations) (n=21), didactic nutrition education (n=4), interactive nutrition education (n=2), food access (n=2), and nutrition education with behaviour change techniques and food access (n=2). Group-based nutrition education with behaviour change techniques demonstrated the most promise in improving food and fluid intake, nutritional status, and healthy eating knowledge compared to baseline or control. The impact on mobility outcomes was unclear. Conclusions: Our findings should be interpreted with caution related to generally low certainty, unclear-high risk of bias, and high heterogeneity across interventions and outcomes in this body of literature. Quality research in group-based nutrition education for older adults is needed.

scholarly journals Lifestyle behaviour change for preventing the progression of chronic kidney disease: a systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e031625 ◽  
Author(s):  
Nicole Evangelidis ◽  
Jonathan Craig ◽  
Adrian Bauman ◽  
Karine Manera ◽  
Valeria Saglimbene ◽  
...  
Keyword(s):  
Physical Activity ◽  
Social Support ◽  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Goal Setting ◽  
Behaviour Change ◽  
Risk Of Bias ◽  
Behaviour Change Techniques ◽  
Lifestyle Behaviour

ObjectivesModifying lifestyle can prevent the progression of chronic kidney disease (CKD) but the specific elements which lead to favourable behaviour change are not well understood. We aimed to identify and evaluate behaviour change techniques and functions in lifestyle interventions for preventing the progression of CKD.DesignSystematic review.Data sourcesMEDLINE, EMBASE, CINAHL and PsycINFO.Eligibility criteriaTrials of lifestyle behaviour change interventions (including diet, physical activity, smoking and/or alcohol) published to September 2018 in adults with CKD stages 1–5.Data extraction and synthesisTrial characteristics including population, sample size, study setting, intervention, comparator, outcomes and study duration, were extracted. Study quality was independently assessed by two reviewers using the Cochrane risk of bias tool. The Behaviour Change Technique Taxonomy v1 was used to identify behaviour change techniques (eg, goal setting) and the Health Behaviour Change Wheel was used to identify intervention functions (eg, education). Both were independently assessed by three reviewers.ResultsIn total, 26 studies involving 4263 participants were included. Risk of bias was high or unclear in most studies. Interventions involved diet (11), physical activity (8) or general lifestyle (7). Education was the most frequently used function (21 interventions), followed by enablement (18), training (12), persuasion (4), environmental restructuring (4), modelling (2) and incentivisation (2). The most common behaviour change techniques were behavioural instruction (23 interventions), social support (16), behavioural demonstration (13), feedback on behaviour (12) and behavioural practice/rehearsal (12). Eighteen studies (69%) showed a significant improvement in at least one primary outcome, all of which included education, persuasion, modelling and incentivisation.ConclusionLifestyle behaviour change interventions for CKD patients frequently used education, goal setting, feedback, monitoring and social support. The most promising interventions included education and used a variety of intervention functions (persuasion, modelling and incentivisation).PROSPERO registration numberCRD42019106053.

scholarly journals Protocol for a systematic review of qualitative and quantitative effects of cardiovascular disease risk communication using ‘heart age’ concepts

2020 ◽  
Author(s):  
Carissa Bonner ◽  
Carys Batcup ◽  
Samuel Cornell ◽  
Michael Anthony Fajardo ◽  
Jenny Doust ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiovascular Disease ◽  
Risk Communication ◽  
Disease Risk ◽  
Adult Population ◽  
Cardiovascular Disease Risk ◽  
Cvd Risk ◽  
Quantitative Evidence ◽  
Qualitative And Quantitative ◽  
Heart Age

AbstractIntroductionThe concept of ‘heart age’ is increasingly used for health promotion and alongside clinical guidelines for cardiovascular disease (CVD) prevention. These tools have been used by millions of consumers around the world, and many health organisations promote them as a way of encouraging lifestyle change. However, heart age tools vary widely in terms of their underlying risk models and display formats, the effectiveness of these tools compared to other CVD risk communication formats remains unclear, and doctors have raised concerns over their use to expand testing of healthy low risk adults.Methods and analysisWe aim to systematically review both qualitative and quantitative evidence of the effects of heart age when presented to patients or consumers for the purpose of CVD risk communication. Four electronic databases will be search until April 2020 and reference lists from similar review articles will be searched. Studies will be considered eligible if they meet the following criteria: (1) published from the inception of the database to April 2020, in peer-reviewed journals, (2) used an adult population (over 18 years of age) or, if not explicit regarding age, are clear that participants were not children, (3) present the concept of ‘heart age’ to patients or consumers for the purpose of CVD risk communication, (4) report qualitative themes or quantitative outcomes relating to psychological and/or behavioural responses to heart age. Two reviewers will perform study selection, data extraction and quality assessment. Reporting of the review will be informed by Preferred Reporting Items for Systematic Review and Meta-Analysis guidance.Ethics and disseminationEthical approval is not required as it is a protocol for a systematic review. Findings will be disseminated through peer-reviewed publications and conference presentations.

scholarly journals Family-based eHealth interventions to reduce cardiovascular disease risk: a systematic review

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
B Kemp ◽  
DR Thompson ◽  
K Mc Guigan ◽  
CJ Watson ◽  
JV Woodside ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiovascular Disease ◽  
Behaviour Change ◽  
Disease Risk ◽  
Risk Of Bias ◽  
Control Group ◽  
Cvd Risk ◽  
High Quality ◽  
Parents And Children ◽  
Family Based

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Department for the Economy, Northern Ireland Background Family-based eHealth interventions have potential to reduce cardiovascular disease (CVD) risk and improve health of parents and children. Purpose To evaluate the effectiveness of family-based eHealth interventions to reduce parent and child CVD risk. Methods Systematic review. Five electronic databases were searched (CENTRAL; MEDLINE; CINAHL; EMBASE; PsycINFO) up to April 2020. Data extraction included: study design, setting, methodology, eHealth technology, experiment/control group constituents, risk factors, outcomes, incentivisation and limitations. Data were synthesised narratively. Cochrane methodology was used to assess risk of bias and reporting quality. Results In total, 2193 articles were screened and seven trials included for review. The most consistently improved CVD risk factor across parents and children was reduced alcohol use, whilst reduction in BMI the least consistently improved. Behaviour-change theoretical underpinning, extended follow-up duration, interactivity and incentivisation were identified as effective components of these interventions. Four studies were assessed as overall ‘low risk’ of bias and three studies had concerns with randomisation and intention-to-treat analysis. Conclusions: This is the first systematic review to evaluate family-based eHealth interventions to reduce CVD risk. Despite a paucity in high-quality trials, there is evidence of their potential effectiveness. Recommended, more high quality, behaviour-change-theory-based, clearly reported interventions with explicit outcomes.

scholarly journals Evaluating the use of the heart age tool in community pharmacies: a 4-week cluster-randomized controlled trial

2020 ◽  
Vol 30 (6) ◽  
pp. 1139-1145
Author(s):  
Karianne Svendsen ◽  
David R Jacobs ◽  
Lisa T Mørch-Reiersen ◽  
Kjersti W Garstad ◽  
Hege Berg Henriksen ◽  
...  
Keyword(s):  
Risk Communication ◽  
Whole Blood ◽  
Blood Cholesterol ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Pharmacy Staff ◽  
Cluster Randomized ◽  
Heart Age

Abstract Background Joint British Societies have developed a tool that utilizes information on cardiovascular disease (CVD) risk factors to estimate an individual’s ‘heart age’. We studied if using heart age as an add-on to conventional risk communication could enhance the motivation for adapting to a healthier lifestyle resulting in improved whole-blood cholesterol and omega-3 status after 4 weeks. Methods A total of 48 community pharmacies were cluster-randomized to use heart age+conventional risk communication (intervention) or only conventional risk communication (control) in 378 subjects after CVD risk-factor assessment. Dried blood spots were obtained with a 4-week interval to assay whole-blood cholesterol and omega-3 fatty acids. We also explored pharmacy-staff’s (n=27) perceived utility of the heart age tool. Results Subjects in the intervention pharmacies (n=137) had mean heart age 64 years and chorological age 60 years. In these, cholesterol decreased by median (interquartile range) −0.10 (−0.40, 0.35) mmol/l. Cholesterol decreased by −0.20 (−0.70, 0.30) mmol/l (P difference =0.24) in subjects in the control pharmacies (n=120) with mean chronological age 60 years. We observed increased concentrations of omega-3 fatty acids after 4 weeks, non-differentially between groups. Pharmacy-staff (n=27) agreed that heart age was a good way to communicate CVD risk, and most (n=25) agreed that it appeared to motivate individuals to reduce elevated CVD risk factors. Conclusions The heart age tool was considered a convenient and motivating communication tool by pharmacy-staff. Nevertheless, communicating CVD risk as heart age was not more effective than conventional risk communication alone in reducing whole-blood cholesterol levels and improving omega-3 status.

scholarly journals Effect of prosocial public health messages for population behaviour change in relation to respiratory infections: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e044763
Author(s):  
Aikaterini Grimani ◽  
Chris Bonell ◽  
Susan Michie ◽  
Vivi Antonopoulou ◽  
Michael P Kelly ◽  
...  
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Behaviour Change ◽  
Respiratory Infections ◽  
Grey Literature ◽  
Risk Of Bias ◽  
Health Messages ◽  
Research Network ◽  
Behaviour Change Techniques ◽  
Public Health Messages

IntroductionThe COVID-19 pandemic represents a major societal challenge that requires large-scale behaviour change, widespread collective action and cooperation to reduce viral transmission. Existing literature indicates that several messaging approaches may be effective, including emphasising the benefits to the recipient, aligning with the recipient’s moral values and focusing on protecting others. Current research suggests that prosocial public health messages that highlight behaviours linked to societal benefits (eg, protecting ‘each other’), rather than focusing on behaviours that protect oneself (eg, protecting ‘yourself’), may be a more effective method for communicating strategies related to infectious disease. To investigate this we will conduct a systematic review that will identify what messages and behaviour change techniques have the potential to optimise the effect on population behaviour in relation to reducing transmission of respiratory infections.Methods and analysisA systematic literature search of published and unpublished studies (including grey literature) in electronic databases will be conducted to identify those that meet our inclusion criteria. The search will be run in four electronic databases: MEDLINE, EMBASE, PsycINFO and Scopus. We will also conduct supplementary searches in databases of ‘grey’ literature such as PsycEXTRA, Social Science Research Network and OSF PREPRINTS, and use the Google Scholar search engine. A systematic approach to searching, screening, reviewing and data extraction will be applied based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Titles, abstracts and full texts for eligibility will be examined independently by researchers. The quality of the included studies will be assessed using the Cochrane Risk of Bias Tool and the Risk of Bias in Non-randomized Studies-of Interventions tool. Disagreements will be resolved by a consensus procedure.Ethics and disseminationThis protocol has been registered with PROSPERO. No ethical approval is required, as there will be no collection of primary data. The synthesised findings will be disseminated through peer-reviewed publication.PROSPERO registration numberCRD42020198874.

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