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‘People like you?’: how people with hypertension make sense of future cardiovascular risk—a qualitative study
  1. Iain J Marshall,
  2. Charles D A Wolfe,
  3. Christopher McKevitt
  1. Population Health and Environmental Sciences, King’s College London, London, UK
  1. Correspondence to Dr Iain J Marshall; iain.marshall{at}kcl.ac.uk

Abstract

Objectives Cardiovascular disease (CVD) prevention guidelines recommend that patients’ future CVD risk (as a percentage) is estimated and used to inform shared treatment decisions. We sought to understand the perspectives of patients with hypertension on their future risk of CVD.

Design Qualitative, semistructured interviews and thematic analysis.

Participants People with hypertension who had not experienced a cardiovascular event recruited from primary care.

Setting Participants were purposively sampled from two primary care practices in South London. Interviews were transcribed, and a thematic analysis was conducted.

Results 24 people participated; participants were diverse in age, sex, ethnicity and socioeconomic status. Younger working-aged people were under-represented. Contrasting with probabilistic risk, many participants understood future CVD as binary and unknowable. Roughly half of participants avoided contemplating future CVD risk; for some, lifestyle change and medication obviated the need to think about CVD risk. Some participants identified with one portion of the probability fraction (‘I’d be one of those ones.’). Comparison with peers (typically partners, siblings and friends of a similar age, including both ‘healthy’ and ‘unhealthy’ people) was most frequently used to describe risk, both among those who engaged with and avoided risk discussion. This contrasts with current risk scores, which describe probabilities in people with similar risk factors; many participants did not identify with such a group, and hence did not find these probabilities meaningful, even where correctly understood.

Conclusions Risk as typically calculated and communicated (eg, the risk of ‘100 people like you’) may not be meaningful for patients who do not identify with the denominator. Comparing an individual’s risk with their peers could be more meaningful.

  • hypertension
  • qualitative research
  • risk management

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Footnotes

  • Contributors Design of study: all authors. Selection and recruitment of participants: IJM. Conducting interviews: IJM. Initial coding of interview transcripts. IJM and CM. Refining of coding framework and thematic analysis: all authors. Initial draft of manuscript: IJM. Review and editing of multiple versions and sign off of final version of manuscript: all authors.

  • Funding IJM is supported by UK Medical Research Council (MRC), through its Skills Development Fellowship programme, grant MR/N015185/1. The research was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King’s College Hospital NHS Foundation Trust (award number NIHR CLAHRC-2013-10022), Prof Charles DA Wolfe (stroke theme lead), http://www.nihr.ac.uk/about-us/how-we-are-managed/our-structure/infrastructure/collaborations-for-leadership-in-applied-health-research-and-care.htm.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study was approved by the Proportionate Review Sub-committee of the NRES Committee London, Wandsworth Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional data available from this study.

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