Risk Perception, Psychological Well-Being, and Health-Promoting Behaviors in Persons Informed of a Coronary Artery Calcium Score
Background: Cardiovascular disease (CVD) remains the leading cause of adult deaths because individuals continue to engage in behaviors that exacerbate CVD. New technologies such as coronary artery calcium (CAC) screening detect atherosclerosis before clinical disease is manifested. Awareness of an abnormal finding should enhance motivation for change. Objective: To examine how awareness of a CAC score affects risk perception and health-promoting behaviors in persons at high risk for CVD. Methods: This study used a descriptive prospective design with 174 high risk adults (3 or more major risk factors) recruited at a radiology center offering CAC scans in a Chicago suburb. Baseline self-report surveys using the Perception of Risk of Heart Disease Scale, the Quality of Life Index, the Benefits and Barriers Scale and the Health-Promoting Lifestyle Profile II commenced immediately following a screening CAC scan but before results were known. Follow-up occurred three months later using mailed packets. Participants were compared across five CAC scoring groups. Results: Participants' mean age was 58 years old; 62% male, 89% Caucasian, and well-educated. Repeated measures ANOVA indicated that risk perception was not significantly changed over time or between groups, except for significant positive interaction in group with CAC scores of 101-400 (p=0.004). Risk perception scores were significantly higher in the positive (1 to >400) CAC group compared to the 0 CAC group (p=0.045). Quality of Life remained unchanged. Health-promoting behaviors increased in all groups over time (p<0.001). Chi Square analysis indicated that risk reduction medication use increased in all groups, with significant increase in lipid (p<0.001) and aspirin (p<0.001) intake. Predictors of behavior change were perceived barriers (ß=-0.41; p<0.001) and quality of life (ß=0.44; p<0.001). Responses from open-ended questions added validity to quantitative findings. Conclusions: Awareness of a CAC score does impact risk perception for some at risk groups. Knowledge of ones' score did enhance motivation for behavior change. Psychological well-being was not affected by scoring information. It is hoped that through improved understanding of the effect of CAC scoring on behavior change, nurses will be better able to assist patients to modify harmful behaviors during teachable moments.
Coronary artery calcium, Health-promoting behaviors, Psychological well-being, Risk awareness, Risk Perception, Subclinical atherosclerosis, Nursing
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