Long-term impact of elevated cardiovascular risk detected by screening

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Abstract
Objective. To explore how persons with an elevated cardiovascular risk score (CRS) balanced health-related advice against the life they wanted to live or were able to live. Setting. 2000 Danes aged 30–50 were invited to participate in a health-screening project in general practice. Screenings were conducted at baseline and after one and five years, and included among other screening procedures a calculation of CRS (see Figure 1). Design. Participants with an elevated CRS were asked to participate in a qualitative semi-structured interview. They were selected by stratified purposeful sampling reflecting variations in age, sex. and perceived health. Subjects. Nine men and five women aged 33–50 years. Theoretical frames of reference. Bandura's theory of self-efficacy and the Health Belief Model's consideration of individuals’ cues to act against a health threat supported analysis. Results. Being informed about an elevated CRS had a considerable impact on the informants. They initiated significant lifestyle changes though only to a limited degree when such changes would affect their quality of life adversely. In cases where other results of the multiphasic screening were normal, interpreted as such, or if there were stressful circumstances in the informant's life, the elevated CRS receded into the background. Interpretation. Doctors, who inform individuals about the impact of risk factors, need to know that the consequences and health advice are not always interpreted by laypeople as supposed by the medical culture.