Impact of cardiovascular risk visualization on motivation to self-manage young-onset type 2 diabetes

To investigate the accessibility, credibility, emotional responses, and impacts of cardiovascular risk visualizations in motivating self-management of young-onset type 2 diabetes (YOD).

We conducted a mixed-methods study among adults with YOD (age at diagnosis < 40 years, disease duration < 10 years) in Ontario, Canada. We created 6 visualizations (5-year risk: linear scale, icon array, bar graph; lifetime risk: bar graph, icon array; cardiovascular age). We measured numeracy, graph literacy, accessibility, credibility, and emotional responses. We used linear regression to measure associations among these variables. We conducted semi-structured interviews to explore impacts on motivation.

We included 31 participants (54.8% women, mean age 37.5 years). The lifetime risk bar graph and icon array received the highest accessibility (P = 0.008), similarly high credibility (P = 0.1), the highest negative emotion (P = 0.004), and similar positive emotion (P = 0.6) scores compared to the other visualizations. The lifetime risk visualizations evoked feelings of urgency or fear, which strongly enhanced motivation. Only the lifetime risk bar graph had high accessibility and credibility scores across all levels of numeracy and graph literacy. Graph literacy was negatively associated with positive emotion.

Lifetime risk visualizations, especially bar graphs, are more accessible and emotionally evocative in potentially motivating self-management of YOD than other visualizations.