Effects on cardiovascular disease risk of a web-based health risk assessment with tailored health advice: a follow-up study

Abstract

Introduction: A large proportion of the cardiovascular disease (CVD) burden can potentially be prevented by primary prevention programs addressing major causal risk factors. A Web-based health risk assessment (HRA) with tailored feedback for individual health promotion is a promising strategy. We evaluated the effect on CVD risk of such a program among employees of a Dutch worksite.

Methods: We conducted a prospective follow-up study among 368 employees who voluntarily participated in a Web-based HRA program at a single Dutch worksite in 2008. The program included a multicomponent HRA through a Web-based electronic questionnaire, biometrics, and laboratory evaluation. The results were combined with health behavior change theory to generate tailored motivational and educational health advice. On request, a health counseling session with the program physician was available. Follow-up data on CVD risk were collected 1 year after initial participation. The primary outcome was a change in Framingham CVD risk at 6 months relative to baseline. We checked for a possible background effect of an increased health consciousness as a consequence of program introduction at the worksite by comparing baseline measurements of early program participants with baseline measurements of participants who completed the program 6 months later.

Results: A total of 176 employees completed follow-up measurements after a mean of 7 months. There was a graded relation between CVD risk changes and baseline risk, with a relative reduction of 17.9% (P = 0.001) in the high-risk category (baseline CVD risk ≥ 20%). Changes were not explained by additional health counseling, medication, or an increase in health consciousness within the company.

Conclusions: Voluntary participation in a Web-based HRA with tailored feedback at the worksite reduced CVD risk by nearly 18% among participants at high CVD risk and by nearly 5% among all participants. Web-based HRA could improve CVD risk in similar populations. Future research should focus on the persistence of the effects underlying the CVD risk reduction.

Keywords: cardiovascular disease risk; health risk assessment; primary prevention.

Figures

Figure 1

Study flow. Notes: The HRA program was applied as part of the worksite health management program in a Dutch company worksite in 2008. During this period 2149 employees were invited to complete the HRA. Employees were divided by day and month of birth in an early and late invitation group. Early invitees who participated in the HRA program were invited for follow-up measurements, six months after the initial program invitation. At that same time the late invitation group was invited for their initial participation. The primary outcome was the change in CVD risk between baseline and follow-up among 176 early participants. To account for time trends, baseline variables between early and late participants were compared. Nonresponse bias was checked by comparing baseline values of 176 early participants who attended follow-up with 192 who did not.