The use of epidemiologic data for personal risk assessment in health hazard/health risk appraisal programs

Health Hazard/Health Risk Appraisal (HHA/HRA) programs employ personal risk assessment as an educational and motivational technique to encourage the adoption of healthier lifestyles by health education clients. We have reviewed the scientific basis of of the risk assessments provided in HHA/HRA. There are severe limitations in both the data and the risk estimation procedures. Various undocumented assumptions enter into the projections; several key aspects are arbitrary. Proposals for improvement of the procedure generally require data that are not available. Attention has largely focused on increasing mathematical sophistication (e.g. adjustment for competing risks) while ignoring problems in accuracy of the client data from which projections are calculated and serious questions about the health education messages implicit in the appraisal results. Health Hazard/Health Risk Appraisal programs should be candid about the limitations of the technique. Use of appraisal results for evaluation purposes is questionable. The health education messages produced by such programs deserve attention, since their appropriateness, especially for clients who are not white, middle class and middle-aged, has not been established.