Communicating Heart Disease Risk: Development and testing of a health-literate decision aid for people with low health literacy dataset

Intervention

Intervention code Prevention , Behaviour , Lifestyle

Design: 3x2 factorial design to test the effect of health-literate design (low health literacy, standard, or basic Heart Foundation patient information) and risk format (explaining CVD risk only, or CVD risk + heart age) on understanding, intentions and behaviour. Heart age is determined by using the CVD risk equation to ascertain the age that someone of the same gender as the participant, but with ideal levels of risk factors (e.g. non-smoker) would be if they had the same percentage CVD risk a .... Design: 3x2 factorial design to test the effect of health-literate design (low health literacy, standard, or basic Heart Foundation patient information) and risk format (explaining CVD risk only, or CVD risk + heart age) on understanding, intentions and behaviour. Heart age is determined by using the CVD risk equation to ascertain the age that someone of the same gender as the participant, but with ideal levels of risk factors (e.g. non-smoker) would be if they had the same percentage CVD risk as the participant. Methods: A national sample will be recruited for an online survey through Qualtrics, with stratified education, gender and age groups (45-74 years). Participants will all initially complete a CVD risk assessment. If blood pressure or cholesterol are not known, the average by age/gender based on non-diabetic participants in the Australian Diabetes, Obesity and Lifestyle Study (AusDiab) cohort will be used (accessed via CI Doust), and all participants will be advised to see a GP for a more accurate risk assessment. Participants will then be randomised to see one of six different versions of the results page: either a version aimed at lower health literacy, a standard version, or one as the Heart Foundation present it, and each of those three either with percentage risk of having heart attack or stroke, or percentage risk plus heart age. After this, participants will have the opportunity to look at how their risk will change if they change various factors (decision aid). This again is different based on 3 randomised conditions: 1. Those who saw either of the Heart Foundation results pages will receive a decision aid based on the cvdcheck.org.au website’s calculator, which allows participants to alter any of their risk factors (e.g. blood pressure levels, age, smoking status) and then presents this new result against their actual result. 2. Those who saw their result in the standard version will receive a more interactive decision aid, whereby a menu with various potential changes (e.g. taking medication, improving diet or stopping smoking) are presented to the participant, and they can select one of these in order to see how it will affect their CVD risk. They will also receive information about the change they have selected (e.g. exactly what type of diet they should be eating) and the pros and cons of making this change. They are able to then go back to the menu page again in order to select a different ‘change’ should they wish to. 3. Those who received their result in the low health literacy version will see the same menu page as in the standard version, and will also see their new risk percentage in the same way, however the information provided about each of the changes will be presented in a format suited to the universal precautions approach (e.g. simpler language, images). Following the decision aid, participants will be asked questions regarding their intentions for behaviour change (e.g. will they see their GP to enquire about medications, will they do more exercise) and their reactions to seeing their risk. Finally, there is an ‘action plan’ stage, which again differs between the conditions: 1. Participants who have been seeing the Heart Foundation version will receive the follow-up that the National Heart Foundation of Australia provide to users who complete their Heart Age Calculator online. They can select whether to see information on diet, physical activity or smoking and are then presented with the relevant information. 2. Participants in the standard condition will receive a simple action plan. They will be asked to either make a plan for physical activity, smoking or diet, and then will receive the following prompts: to create a goal, to think about how to monitor their progress, to describe why they feel able to achieve the goal, and when they plan to achieve it by. 3. Participants in the low health literacy condition will receive an action plan which has been tested by one of the investigators. They are also asked to select either physical activity, diet or smoking, and are then guided through the process of creating an action plan based on implementation intentions (if-then). The six conditions that participants can be randomised to are summarised below: 1. low health literacy version of results showing percentage risk and heart age - low health literacy version of decision aid - low health literacy version of action plan 2. low health literacy version of results showing percentage risk only age - low health literacy version of decision aid - low health literacy version of action plan 3. standard version of results showing percentage risk and heart age - standard version of decision aid - standard version of action plan 4. standard version of results showing percentage risk only - standard version of decision aid - standard version of action plan 5. heart foundation version of results showing percentage risk and heart age - heart foundation version of decision aid - heart foundation version of action plan 6. heart foundation version of results showing percentage risk only - heart foundation version of decision aid - heart foundation version of action plan The duration of the survey will differ between groups, however we expect participants to take between 10 and 20 minutes to complete it. We are initially going to run a ‘soft launch’ of the survey, with only a few participants, to get a better understanding of its length. One month following the completion of this intervention, the participants will receive a further survey to determine whether they have indeed changed their behaviour, as well as recall of their percentage risk and heart age results.
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Comparison

Control group Active

The design is 3x2 and therefore participants are randomised to one of six conditions, all of which will be compared against one another

Outcomes

Outcome: Intention to change lifestyle (composite outcome, found by averaging results across: intention to increase physical activity, intention to improve diet, intention to reduce smoking if relevant). This is assessed by the participant's level of agreement/disagreement on a 7-item Likert-type scale to three post-intervention statements: 'I intend to smoke less in the next 4 weeks' (if they indicated they smoke in an earlier question in the survey), 'I intend to improve my di .... Outcome: Intention to change lifestyle (composite outcome, found by averaging results across: intention to increase physical activity, intention to improve diet, intention to reduce smoking if relevant). This is assessed by the participant's level of agreement/disagreement on a 7-item Likert-type scale to three post-intervention statements: 'I intend to smoke less in the next 4 weeks' (if they indicated they smoke in an earlier question in the survey), 'I intend to improve my diet in the next 4 weeks', 'I intend to increase the amount of physical activity I do in the next 4 weeks'
Timepoint: Intentions measured immediately post-intervention
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