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Absolute risk representation in cardiovascular disease prevention: comprehension and preferences of health care consumers and general practitioners involved in a focus group study

Sophie Hill1*, Janet Spink1, Dominique Cadilhac2, Adrian Edwards3, Caroline Kaufman4, Sophie Rogers5, Rebecca Ryan1 and Andrew Tonkin6

Author Affiliations

1 Centre for Health Communication and Participation, Australian Institute for Primary Care, La Trobe University, Bundoora, Victoria, 3086, Australia

2 Public Health Division, National Stroke Research Institute, Level 1 Neurosciences Building, 300 Waterdale Road, Heidelberg Heights, Victoria, 3081, Australia

3 Department of Primary Care & Public Health, School of Medicine, Cardiff University, 2nd floor Neuadd Meirionnydd, Heath Park, Cardiff, Wales, CF14 4XN, UK

4 University of Texas Southwestern, Austin, 1313 Red River, Ste 303B, Austin, Texas 78701, USA

5 Centre for Eye Research Australia, The University of Melbourne, East Melbourne, Victoria, 3002, Australia

6 Cardiovascular Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3800, Australia

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BMC Public Health 2010, 10:108  doi:10.1186/1471-2458-10-108

Published: 4 March 2010



Communicating risk is part of primary prevention of coronary heart disease and stroke, collectively referred to as cardiovascular disease (CVD). In Australia, health organisations have promoted an absolute risk approach, thereby raising the question of suitable standardised formats for risk communication.


Sixteen formats of risk representation were prepared including statements, icons, graphical formats, alone or in combination, and with variable use of colours. All presented the same risk, i.e., the absolute risk for a 55 year old woman, 16% risk of CVD in five years. Preferences for a five or ten-year timeframe were explored. Australian GPs and consumers were recruited for participation in focus groups, with the data analysed thematically and preferred formats tallied.


Three focus groups with health consumers and three with GPs were held, involving 19 consumers and 18 GPs.

Consumers and GPs had similar views on which formats were more easily comprehended and which conveyed 16% risk as a high risk. A simple summation of preferences resulted in three graphical formats (thermometers, vertical bar chart) and one statement format as the top choices. The use of colour to distinguish risk (red, yellow, green) and comparative information (age, sex, smoking status) were important ingredients. Consumers found formats which combined information helpful, such as colour, effect of changing behaviour on risk, or comparison with a healthy older person. GPs preferred formats that helped them relate the information about risk of CVD to their patients, and could be used to motivate patients to change behaviour.

Several formats were reported as confusing, such as a percentage risk with no contextual information, line graphs, and icons, particularly those with larger numbers.

Whilst consumers and GPs shared preferences, the use of one format for all situations was not recommended. Overall, people across groups felt that risk expressed over five years was preferable to a ten-year risk, the latter being too remote.


Consumers and GPs shared preferences for risk representation formats. Both groups liked the option to combine formats and tailor the risk information to reflect a specific individual's risk, to maximise understanding and provide a good basis for discussion.