Cardiovascular disease risk communication in NHS Health Checks: a qualitative video-stimulated recall interview study with practitioners

Abstract

Background: NHS Health Check (NHSHC) is a national programme to identify and manage cardiovascular disease (CVD) risk. Practitioners delivering the programme should be competent in discussing CVD risk, but there is evidence of limited understanding of the recommended 10-year percentage CVD risk scores. Lifetime CVD risk calculators might improve understanding and communication of risk.

Aim: To explore practitioner understanding, perceptions, and experiences of CVD risk communication in NHSHCs when using two different CVD risk calculators.

Design & setting: Qualitative video-stimulated recall (VSR) study with NHSHC practitioners in the West Midlands.

Method: VSR interviews were conducted with practitioners who delivered NHSHCs using either the QRISK2 10-year risk calculator (n = 7) or JBS3 lifetime CVD risk calculator (n = 8). Data were analysed using reflexive thematic analysis.

Results: In total, nine healthcare assistants (HCAs) and six general practice nurses (GPNs) were interviewed. There was limited understanding and confidence of 10-year risk, which was used to guide clinical decisions through determining low-, medium-, or high-risk thresholds, rather than as a risk communication tool. Potential benefits of some JBS3 functions were evident, particularly heart age, risk manipulation, and visual presentation of risk.

Conclusion: There is a gap between the expectation and reality of practitioners' understanding, competencies, and training in CVD risk communication for NHSHCs. Practitioners would welcome heart age and risk manipulation functions of JBS3 to promote patient understanding of CVD risk, but there is a more fundamental need for practitioner training in CVD risk communication.

Keywords: cardiovascular diseases; preventive medicine; primary health care; qualitative research; risk.

Figure 1.. Example of Joint British Societies for the prevention of cardiovascular disease (JBS3) outputs. Images borrowed with permission from JBS3. BMI = body mass index. CVD = cardiovascular disease. HDL = high-density lipoprotein.