Patients' Perceptions of Cholesterol, Cardiovascular Disease Risk, and Risk Communication Strategies

Abstract

PURPOSE Despite some recent improvement in knowledge about cholesterol in the United States, patient adherence to cholesterol treatment recommendations remains suboptimal. We undertook a qualitative study that explored patients' perceptions of cholesterol and cardiovascular disease (CVD) risk and their reactions to 3 strategies for communicating CVD risk. METHODS We conducted 7 focus groups inNew England using open-ended questions and visual risk communication prompts. The multidisciplinary study team performed qualitative content analysis through immersion/crystallization processes and analyzing coded reports using NVivo qualitative coding software.RESULTS All participants were aware that "high cholesterol" levels adversely affect health. Many had, however, inadequate knowledge about hypercholesterolemia and CVD risk, and few knew their cholesterol numbers. Many assumed they had been tested and their cholesterol concentrations were healthy, even if their physicians had not mentioned it. Standard visual representations showing statistical probabilities of risk were assessed as confusing and uninspiring. A strategy that provides a cardiovascular risk-adjusted age was evaluated as clear, memorable, relevant, and potentially capable of motivating people to make healthful changes. A few participants in each focus group were concerned that a cardiovascular riskadjusted age that was greater than chronological age would frighten patients.CONCLUSIONS Complex explanations about cholesterol and CVD risk appear to be insuffi cient for motivating behavior change. A cardiovascular risk-adjusted age calculator is one strategy that may engage patients in recognizing their CVD risk and, when accompanied by information about risk reduction, may be helpful in communicating risk to patients. Ann Fam Med 2006;4:205-212. DOI: 10.1370/afm.534. INTRODUCTIOND espite recent advances in the diagnosis and treatment of cardiovascular disease (CVD), it remains the leading cause of death in the United States.1 In 1985 the National Heart, Lung, and Blood Institute launched the National Cholesterol Education Program (NCEP), which issued the Adult Treatment Panel (ATP I, II, and III) clinical guidelines aimed at reducing the burden of CVD through improved cholesterol management.2-4 The NCEP produced educational kits for clinicians and patient-oriented media programming including the "Know Your Cholesterol Numbers, Know Your Risk" campaign. 5,6 Cholesterol knowledge is reported to have improved since the 1980s, 7,8 but important information gaps remain. One study reported that from 1983 to 1995, there was an increase in the percentage of Americans who had heard of high blood cholesterol levels, who had been informed of their levels, and who knew their total cholesterol number. PERC EP T IONS A ND CO M MUNIC AT ION S T R AT E GIESthe percentage of the public who had heard of high blood cholesterol levels rose from 77% to 93%, and the percentage who were told their cholesterol values rose from 21% to 65%. Furthermore, the percentage who r...

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