ArticleJMIR cardio2022
The Impact of Health Literacy-Sensitive Design and Heart Age in a Cardiovascular Disease Prevention Decision Aid: Randomized Controlled Trial and End-User Testing.
Article in JMIR cardio, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 3 of them syntheses that pooled it.
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Who cites it
12 citing papers in PubMed, 3 syntheses or guidelines pooled it, 32 citations in OpenAlex.
- Effectiveness of patient decision aids for cardiovascular decisions: systematic review with sex/gender-based analysis.European journal of cardiovascular nursing · 2025Pooled it
- Cardiovascular disease risk communication and prevention: a meta-analysis.European heart journal · 2024Pooled it
- Decision aids for people facing health treatment or screening decisions.The Cochrane database of systematic reviews · 2024Pooled it
- Digital Educational Strategies to Implement Evidence-Based Care for Atherosclerotic Cardiovascular Disease.Current atherosclerosis reports · 2026Review
- The effectiveness of eHealth-based cardiovascular disease risk communication: a systematic review and meta-analysis.NPJ digital medicine · 2025Article
- The Heart Health Yarning Tool: Co-Designing a Shared Decision-Making Tool With Aboriginal and Torres Strait Islander People for Cardiovascular Disease Prevention and Risk Management.Health expectations : an international journal of public participation in health care and health policy · 2025Article
- Implementing decision aids for cardiovascular disease prevention: stakeholder interviews and case studies in Australian primary care.BMC primary care · 2024Article
- Guideline-Based Cardiovascular Risk Assessment Delivered by an mHealth App: Development Study.JMIR cardio · 2023Article
- Assessing readability and comprehension of web-based patient education materials by American Heart Association (AHA) and CardioSmart online platform by American College of Cardiology (ACC): How useful are these websites for patient understanding?American heart journal plus : cardiology research and practice · 2023Article
- Addressing Behavioral Barriers to COVID-19 Testing With Health Literacy-Sensitive eHealth Interventions: Results From 2 National Surveys and 2 Randomized Experiments.JMIR public health and surveillance · 2023Article
- The Impact and Perception of England's Web-Based Heart Age Test of Cardiovascular Disease Risk: Mixed Methods Study.JMIR cardio · 2023Article
- Decision Support Tools for Coronary Artery Calcium Scoring in the Primary Prevention of Cardiovascular Disease Do Not Meet Health Literacy Needs: A Systematic Environmental Scan and Evaluation.International journal of environmental research and public health · 2022Review
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundShared decision-making is an essential principle for the prevention of cardiovascular disease (CVD), where asymptomatic people consider lifelong medication and lifestyle changes.
objectiveThis study aims to develop and evaluate the first literacy-sensitive CVD prevention decision aid (DA) developed for people with low health literacy, and investigate the impact of literacy-sensitive design and heart age.
methodsWe developed a standard DA based on international standards. The standard DA was based on our existing general practitioner DA. The literacy-sensitive DA included simple language, supporting images, white space, and a lifestyle action plan. The control DA used Heart Foundation materials. A randomized trial included 859 people aged 45-74 years using a 3 (DA: standard, literacy-sensitive, control) ×2 (heart age: heart age + percentage risk, percentage risk only) factorial design, with outcomes including prevention intentions and behaviors, gist and verbatim knowledge of risk, credibility, emotional response, and decisional conflict. We iteratively improved the literacy-sensitive version based on end-user testing interviews with 20 people with varying health literacy levels.
resultsImmediately after the intervention (n=859), there were no differences in any outcome among the DA groups. The heart age group was less likely to have a positive emotional response, perceived the message as less credible, and had higher gist and verbatim knowledge of heart age risk but not percentage risk. After 4 weeks (n=596), the DA group had better gist knowledge of percentage risk than the control group. The literacy-sensitive DA group had higher fruit consumption, and the standard DA group had better verbatim knowledge of percentage risk. Verbatim knowledge was higher for heart age than for percentage risk among those who received both.
conclusionsThe literacy-sensitive DA resulted in increased knowledge of CVD risk and increased fruit consumption in participants with varying health literacy levels and CVD risk results. Adding heart age did not increase lifestyle change intentions or behavior but did affect psychological outcomes, consistent with previous findings. This tool will be integrated with additional resources to improve other lifestyle outcomes.
trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12620000806965; https://tinyurl.com/226yhk8a.
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