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Published on: August 9, 2024
Making sense of being at 'high risk' of coronary heart disease within primary prevention
Hannah Farrimond1, Paula M Saukko, Nadeem Qureshi
1EGENIS, University of Exeter, Exeter, UK. H.R.Farrimond@exeter.ac.uk
Insights
Patients identified as high risk for cardiovascular disease (CVD) often minimize or normalize their status, with intentions to change behaviors like diet and exercise. Interventions should consider individual life stages and social factors.
Area of Science:
- Public Health
- Qualitative Research
- Health Psychology
Background:
- National Health Service policy recommends screening for individuals at high risk of cardiovascular disease (CVD).
- Understanding patient perception of 'high risk' status is crucial for effective intervention.
- Previous work by Radley informs the exploration of patient sense-making regarding CVD risk.
Purpose of the Study:
- To explore how patients identified as 'high risk' for CVD make sense of their new risk status.
- To investigate patient perceptions and intentions following a CVD risk intervention.
- To understand the influence of life-course and social position on CVD risk perception.
Main Methods:
- Nested qualitative study within a quantitative randomized trial of a CVD risk intervention.
- Semi-structured 'discovery' interviews conducted with 38 high-risk participants (mean age 55) two weeks post-intervention.
- Thematic analysis of interview data to identify patterns in risk perception and response.
Main Results:
- Many participants employed strategies to 'minimize' and 'normalize' their perceived CVD risk.
- Reported intentions to modify behaviors, primarily diet and exercise, with less emphasis on smoking cessation, especially in lower socioeconomic groups.
- Perceptions and intentions were influenced by life-course context (later middle-age) and social position (gender, SES), normalizing risk as part of aging.
Conclusions:
- CVD risk perception is complex, influenced by psychological coping mechanisms and socio-demographic factors.
- Patient responses to risk status are shaped by their life-course stage and social context.
- Future CVD risk interventions need to be sensitive to the life-course and social position of individuals identified as high risk.
Abstract:
Current National Health Service policy advocates screening to identify individuals at 'high risk' of cardio-vascular disease (CHD) in primary care. This article utilizes the work of Radley to explore how 'high risk' of CHD patients make sense of their new risk status. Results are presented here from a nested qualitative study within a quantitative randomized trial of a CHD risk intervention in primary care. 'Discovery' interviews were conducted with 'high risk' participants (n = 38, mean age = 55) two weeks after intervention and thematically analysed. In response to perceived threat, many participants sought to both 'minimize' and 'normalize' their risk status. They also reported intentions to act, particularly concerning dietary change and exercise, although less so for smoking amongst the lower socio-economic status participants. Such perceptions and intentions were contextualized within the life-course of later middle-age, so that both being at risk, and being treated for risk, were normalized as part of growing older. Social position, such as gender and SES, was also implicated. CHD risk interventions should be context-sensitive to the life-course and social position of those who find themselves at 'high risk' of CHD in later middle-age.
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