Implementation of health risk assessments with family health history: barriers and benefits

Abstract

Health risk assessments provide an opportunity to emphasise health promotion and disease prevention for individuals and populations at large. A key component of health risk assessments is the detailed collection of family health history information. This information is helpful in determining risk both for common chronic conditions and more rare diseases as well. While the concept of health risk assessments has been around since the Framingham Heart Study was launched in the 1950s, and such assessments are commonly performed in the workplace today, the US healthcare system has been slow to embrace them and the emphasis on prevention that they represent. Before wider implementation of health risk assessments within healthcare can be seen, several concerns must be addressed: (1) provider impact, (2) patient impact, (3) validity of patient-entered data and (4) health outcomes effect. Here, we describe recent developments in health risk assessment design that are helping to address these issues.

Applying theory to characterize impediments to dissemination of community-facing family health history tools: a review of the literature

“…Four compared multiple tools as part of the study design (Thompson et al 2013) (Arar et al 2013) (Moore et al 2012) (Wang et al 2015a), while the other 23 studies evaluated a single tool. Studies commonly introduced FHH tools as part of broader health-related interventions or education efforts (Thompson et al 2013;Moore et al 2012;Beadles et al 2014;Newcomb et al 2014;Ruffin et al 2011;Wallace et al 2009;Kaphingst et al 2011;Imes et al 2015;Orlando et al 2013;Wang et al 2015b), or assessed the impact of tool use on referrals and attendance to clinical practice (Buchanan et al 2015;Hulse et al 2011;Murray et al 2013;Wu and Orlando 2015;Yoon et al 2009). Other studies used FHH as part of a broader risk assessment for multiple diseases (Orlando et al 2016;Murthy et al 2011;Koehly et al 2011;Arar et al 2013;Acheson et al 2010).…”

“…Five studies used MeTree (n = 5, 19%) (Beadles et al 2014;Buchanan et al 2015;Orlando et al 2016;Orlando et al 2013;Wu and Orlando 2015), which is a patient-facing web-based tool designed by the Duke Center for Applied Genomics and Precision Medicine. In addition to collecting information on over 20 different diseases, the tool also directs the user to collect personal history on health behaviors in order to calculate risk scores (e.g., Framingham risk score).…”

“…Trialability was not commonly described. In one study, participants were allowed to examine the tools prior to choosing which they would use (Wu and Orlando 2015). Two studies included measures related to observability: one publically provided the results of a previous evaluation of the tool (Murray et al 2013) and the second mentioned user's prior observations of the tool.…”

“…Finally, we identified how often studies measured user perceptions of the quality and utility of the tools. Six studies (22%) included an evaluation of individual's perceived quality of FHH tools (e.g., satisfaction, user experience) (Thompson et al 2013;Arar et al 2011;Koehly et al 2011;Imes et al 2015;Wu and Orlando 2015;Koehly et al 2015). These measures assessed facilitators of use, whether the tool enabled an accurate representation of the family, information seeking intentions spurred by the tool, and specific reactions to the tool (e.g., ease of use, ease of understanding).…”

“…For example, one study determined perceived quality of the tool by assessing the likelihood of sharing information collected with a health care provider (Koehly et al 2011). Other studies assessed the quality of the tool over another tool or previous practice and whether the tool was considered easy to use, understand, and navigate (Thompson et al 2013;Wu et al 2015). Although participants had positive reactions to the tools, these perceptions did not necessarily lead to better uptake of FHH information.…”