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Randomized Controlled Trial
. 2024 Aug 1;19(8):e0304897.
doi: 10.1371/journal.pone.0304897. eCollection 2024.

Fostering active choice to empower behavioral change to reduce cardiovascular risk: A web-based randomized controlled trial

Lorraine L Landais  1 , Judith G M Jelsma  1 , Olga C Damman  1 , Evert A L M Verhagen  1   2 , Danielle R M Timmermans  1
Affiliations
Randomized Controlled Trial

Fostering active choice to empower behavioral change to reduce cardiovascular risk: A web-based randomized controlled trial

Lorraine L Landais et al. PLoS One. .

Abstract

Objective: To investigate the effect of an active choice (AC) intervention based on creating risk and choice awareness-versus a passive choice (PC) control group-on intentions and commitment to cardiovascular disease (CVD) risk-reducing behavior.

Methods: Adults aged 50-70 (n = 743) without CVD history participated in this web-based randomized controlled trial. The AC intervention included presentation of a hypothetical CVD risk in a heart age format, information about CVD risk and choice options, and a values clarification exercise. The PC group received a hypothetical absolute numerical CVD risk and brief information and advice about lifestyle and medication. Key outcomes were reported degree of active choice, intention strength, and commitment to adopt risk-reducing behavior.

Results: More AC compared to PC participants opted for lifestyle change (OR = 2.86, 95%CI:1.51;5.44), or lifestyle change and medication use (OR = 2.78, 95%CI:1.42;5.46), than 'no change'. No differences were found for intention strength. AC participants made a more active choice than PC participants (β = 0.09, 95%CI:0.01;0.16), which was sequentially mediated by cognitive risk perception and negative affect. AC participants also reported higher commitment to CVD risk-reducing behavior (β = 0.32, 95%CI:0.04;0.60), mediated by reported degree of active choice.

Conclusions: Fostering active choices increased intentions and commitment towards CVD risk-reducing behavior. Increased cognitive risk perception and negative affect were shown to mediate the effect of the intervention on degree of active choice, which in turn mediated the effect on commitment. Future research should determine whether fostering active choice also improves risk-reducing behaviors in individuals at increased CVD risk in real-life settings.

Trial registration: ClinicalTrials.gov: NCT05142280. Prospectively registered.

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Conflict of interest statement

The authors have declared that no competing interests exists

Figures

Fig 1
Fig 1. Participant flow diagram.
Fig 2
Fig 2. A sequential mediation analysis shows the direct (f) and indirect paths by which experimental condition influences the degree of active choice.
Indirect, direct and total (direct + indirect) effects are reported along with their 95% confidence intervals. *p < .05.
Fig 3
Fig 3. A parallel mediation analysis shows the direct (c) and indirect paths by which experimental condition influences commitment.
Indirect, direct and total (direct + indirect) effects are reported along with their 95% confidence intervals. *p < .05.
See this image and copyright information in PMC

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