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

¹ Department of Family Medicine, Brown Medical School, Providence, RI
² Center for Primary Care and Prevention, Brown Medical School/Memorial Hospital of Rhode Island, Pawtucket, RI
³ University of California, Berkeley, Berkeley, Calif
⁴ Abacus Management Technologies, LLC, Cranston, RI,
⁵ Health e-Technologies Initiative, Brigham and Women’s Hospital/Harvard Medical School, Boston, Mass

CORRESPONDING AUTHOR: Roberta E. Goldman, PhD, Department of Family Medicine, Brown Medical School, Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02860, roberta_goldman{at}mhri.org

Annals Journal Club selection—see inside back cover.

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 in New 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 risk-adjusted age that was greater than chronological age would frighten patients.

CONCLUSIONS Complex explanations about cholesterol and CVD risk appear to be insufficient 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.

Key Words: Methodological study • qualitative research • hypercholesterolemia • cardiovascular disease • medical decision-making • informatics • communication • patient education • health promotion

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