Cardiovascular disease risk perception in a Hungarian community sample: psychometric evaluation of the ABCD Risk Perception Questionnaire

The impact of perception bias for cardiovascular disease risk on physical activity and dietary habits

Objective

Cardiovascular disease (CVD) remains a significant public health challenge in China. Accurate perception of individual CVD risk is crucial for timely intervention and preventive strategies. This study aimed to determine the alignment between CVD risk perception levels and objectively calculated CVD risk levels, then investigate the disparity in physical activity and healthy diet habits among distinct CVD risk perception categories.

Methods

From March to August 2022, a cross-sectional survey was conducted in Zhejiang Province using convenience sampling. Participants aged between 20 and 80 years, without prior diagnosis of CVD were included. CVD risk perception was evaluated with the Chinese version of the Attitude and Beliefs about Cardiovascular Disease Risk Perception Questionnaire, while objective CVD risk was assessed through the Prediction for Atherosclerotic Cardiovascular Disease Risk (China-PAR) model. Participants' demographic information, self-reported physical activity, and healthy diet score were also collected.

Results

A total of 739 participants were included in the final analysis. Less than a third of participants (29.2%) accurately perceived their CVD risk, while 64.5% over-perceived it and 6.2% under-perceived it. Notably, half of the individuals (50.0%) with high CVD risk under-perceived their actual risk. Compared to the accurate perception group, individuals aged 60-80 years old (OR = 6.569), currently drinking (OR = 3.059), and with hypertension (OR = 2.352) were more likely to under-perceive their CVD risk. Meanwhile, participants aged 40-<60 years old (OR = 2.462) and employed (OR = 2.352) were more likely to over-perceive their risk. The proportion of individuals engaging in physical activity was lowest in the under-perception group, although the difference among the three groups was not statistically significant (χ 2 = 2.556, P = 0.278). In addition, the proportion of individuals practicing healthy diet habits was also lowest in the under-perception group, and a significant statistical difference was observed among the three groups (χ 2 = 10.310, P = 0.006).

Conclusion

Only a small proportion of participants accurately perceived their CVD risk, especially among those with high actual CVD risk. Individuals in the under-perceived CVD risk group exhibited the lowest rates of physical activity engagement and healthy diet adherence. Healthcare professionals should prioritize implementing personalized CVD risk communication strategies tailored to specific subgroups to enhance the accuracy of risk perception.

Measuring Cardiovascular Disease Risk Perception: Translation and Validation of the Indonesian ABCD Risk Questionnaire

Background

Cardiovascular diseases (CVDs) are still increasing worldwide contributing to increasing death worldwide. To test CVDs' awareness, the Attitude and Belief about Cardiovascular Disease (ABCD) questionnaire was developed. However, this questionnaire is not available in Indonesia language.

Methods

The original questionnaire was translated in both directions forward and backward. The process is then continued with a content validity index created by three experts. The exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) then determine the factors that support the translated questionnaire. The splitting sample method was applied in both factor analyses. Internal consistency testing of 18 items was performed on 236 samples.

Result

The validity of the entire questionnaire subscale was satisfactory. Three retained factors were supported by the EFA and CFA, namely, risk perception, perceived benefit, and healthy eating intention. The internal consistency was acceptable based on Cronbach alpha and ordinal alpha. The Indonesian version of ABCD questionnaire was statistically valid and reliable to be used.

Conclusion

The Indonesian version of the ABCD questionnaire is a valid questionnaire to access the attitude and belief of CVDs in Indonesia.

The Semmelweis Study: a longitudinal occupational cohort study within the framework of the Semmelweis Caring University Model Program for supporting healthy aging

The Semmelweis Study is a prospective occupational cohort study that seeks to enroll all employees of Semmelweis University (Budapest, Hungary) aged 25 years and older, with a population of 8866 people, 70.5% of whom are women. The study builds on the successful experiences of the Whitehall II study and aims to investigate the complex relationships between lifestyle, environmental, and occupational risk factors, and the development and progression of chronic age-associated diseases. An important goal of the Semmelweis Study is to identify groups of people who are aging unsuccessfully and therefore have an increased risk of developing age-associated diseases. To achieve this, the study takes a multidisciplinary approach, collecting economic, social, psychological, cognitive, health, and biological data. The Semmelweis Study comprises a baseline data collection with open healthcare data linkage, followed by repeated data collection waves every 5 years. Data are collected through computer-assisted self-completed questionnaires, followed by a physical health examination, physiological measurements, and the assessment of biomarkers. This article provides a comprehensive overview of the Semmelweis Study, including its origin, context, objectives, design, relevance, and expected contributions.

Cardiovascular disease risk perception among community adults in South China: a latent profile analysis

Objective

Risk perception, a critical psychological construct, influences health behavior modification and maintenance of individuals with cardiovascular disease (CVD) risk. Little is known about CVD risk perception among Chinese adults. This research examined the profiles of CVD risk perception of community adults in South China, and explored the characteristics and factors that influence their perception of CVD risk.

Method

This cross-sectional study was conducted in Hangzhou, Zhejiang Province, in South China from March to July 2022 and included 692 participants. Risk perception was assessed using the Chinese version of the Attitude and Beliefs about Cardiovascular Disease Risk Questionnaire. Latent profile analysis (LPA) was performed to extract latent classes of CVD risk perception. These classes of CVD risk perception were compared with 10-year CVD risk categories to define correctness of estimation. Chi-square tests and multinomial regression analyses were used to identify differences between these categories.

Results

Three CVD risk perception classes were identified by LPA: low risk perception (14.2% of participants), moderate risk perception (46.8%), high risk perception (39.0%). Individuals who were aged with 40-60 year (OR = 6.94, 95% CI = 1.86-25.84), diabetes (OR = 6.26, 95% CI = 1.34-29.17), married (OR = 4.52, 95% CI = 2.30-8.90), better subjective health status (OR = 3.23, 95% CI = 1.15-9.10) and perceived benefits and intention to change physical activity (OR = 1.16, 95% CI = 1.05-1.27) were more likely to be in the high-risk perception class. Compared to absolute 10-year CVD risk based on China-PAR, a third of participants (30.1%) correctly estimated their CVD risk, 63.3% overestimated it and 6.6% underestimated it. CVD risk underestimation was associated with hypertension (OR = 3.91, 95% CI = 1.79-8.54), drinking (OR = 3.05, 95% CI = 1.22-7.64), better subjective health status (OR = 2.67, 95% CI = 1.18-6.03).

Conclusions

Most adults in South China possess a moderate level of CVD risk perception. Advanced age, higher monthly income, diabetes and better health status were significantly related to higher perceived CVD risk. Individuals with hypertension, drinking and better subjective health status were associated with CVD risk underestimation. Healthcare professionals should pay attention to the indicators for different classes and identify underestimation group as early as possible.

Psychometric evaluation of the 'Attitudes and Beliefs about Cardiovascular Disease (ABCD) Risk Questionnaire' with validation of a previously untested 'Intentions and Beliefs around Smoking' subscale

OBJECTIVES

To provide evidence of validity, reliability and generalisability of results obtained using the Attitudes and Beliefs about Cardiovascular Disease (ABCD) Risk Questionnaire with a sample of the English population surveyed within the 'SPICES' Horizon 2020 Project (Nottingham study site), and to specifically evaluate the psychometric and factor properties of an as-yet untested five-item subscale relating to smoking behaviours.

DESIGN AND SETTING

Community and workplace-based cross-sectional study in Nottingham, UK.

PARTICIPANTS

466 English adults fitting inclusion criteria (aged 18+ years, without known history of cardiovascular disease, not pregnant, able to provide informed consent) participated in the study.

INTERVENTION

We revalidated the ABCD Questionnaire on a sample of the general population in Nottingham to confirm the psychometric properties. Furthermore, we introduced five items related to smoking, which were dropped in the original study due to inadequate valid samples.

PRIMARY AND SECONDARY OUTCOME MEASURES

Psychometric and factor performance of untested five-item 'smoking behaviours' subscale.Psychometric and factorial properties in combination with the remaining 18 items across 3 subscales.

RESULTS

Analyses of the data largely confirmed the validity, reliability and factor structure of the original ABCD Risk Questionnaire. Sufficient participants in our study provided data against additional five smoking-related items to confirm their validity as a subscale and to advocate for their inclusion in future applications of the scale. Exploratory factor analysis and confirmatory factor analysis calculations support some minor changes to the remaining subscales, which may further improve psychometric performance and therefore generalisability of the instrument.

CONCLUSIONS

An amended version of the ABCD Risk Questionnaire would provide public health researchers and practitioners with a brief, easy-to-use, reliable and valid survey tool. The amended tool may assist public health practitioners and researchers to survey patient or public intentions and beliefs around three key areas of individually modifiable risk (physical activity, diet, smoking).

TRIAL REGISTRATION NUMBER

ISRCTN Registry (ISRCTN68334579).

Psychometric properties of the Chinese version of Attitudes and Beliefs about Cardiovascular Disease Risk Perception Questionnaire

Cardiovascular disease (CVD) is the leading cause of global mortality and disease burden. The perceived risk of CVD, a central psychological construct, may affect health behavior change and maintenance, such as lifestyle modification and medication adherence. Risk perception varies based on the knowledge of risk in the context of cultural health-world views. Little is known about CVD-related knowledge and risk perception in China. The aim of this study is to cross-culturally translate, adapt, and evaluate the psychometric properties of the Attitudes and Beliefs about Cardiovascular Disease (ABCD) Risk Perception Questionnaire in Chinese. The translation and cross-cultural adaptation process followed established guidelines. A cross-sectional study of 318 adults between April and May 2022 was conducted in Zhejiang province. The study evaluated the item- and scale-level psychometric properties and validity indices of the ABCD risk perception questionnaire. The exploratory and confirmatory factor analyses of the risk scale supported a three-factor solution that accounts for 69.63% of the total variance, corresponding to risk perception (F1), perceived benefits and intention to change physical activity (F2), and perceived benefits and intention to change dietary habits (F3). Adequate content validity (I-CVI = 0.852-1.00, S-CVI = 946) was ensured by expert panel. The internal consistency of the dimensions showed good results ranging from 0.801 to 0.940 for Cronbach's α, and 0.853 to 0.952 for McDonald's ω. The item analysis of knowledge dimension indicated that the item difficulty index was 0.440 to 0.852, the item discrimination index was 0.572 to 0.707. This study confirmed that the Chinese version of the ABCD risk perception questionnaire has good psychometric properties in terms of measuring CVD-related knowledge and risk perception in the Chinese adult population, which can lead to the development of individually tailored CVD-risk reduction intervention programs or risk communication programs by health providers.

Translation and validation of the Chinese ABCD risk questionnaire to evaluate adults' awareness and knowledge of the risks of cardiovascular diseases

BACKGROUND

Assessment of health beliefs and risk perception is a critical means to prevent coronary heart disease, but there are few such studies on assessment in the Chinese population. Given the demonstrated value and widespread use of the Attitudes and Beliefs about Cardiovascular Disease Risk Questionnaire (ABCD), this study was designed to translate it into Chinese, and to evaluate its reliability and validity in a Chinese population.

METHODS

The Chinese version of the ABCD was created using the Beaton translation model, which included forward and backward translation. The reliability and construct validity of the Chinese ABCD were examined in a sample of 353 adults who participated in the public welfare projects of the Chinese National Center for Cardiovascular Diseases in Guilin city, Guangxi. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to examine the factor structure of the Chinse ABCD. The internal consistency of the questionnaire was assessed using Cronbach's α and corrected item-total correlations.

RESULTS

We deleted item 7 in the knowledge dimension of the Chinese ABCD and added two items about smoking and sleep knowledge, while retaining 25 of the original items, so that it finally included 27 items. The correlations were .20-.90; the correlations between each item and the total score of the ABCD were .34-.86; and the item-level Content Validity Index (I-CVI) was .86-1.00. The results of the EFA showed that all items were close to .40, and the cumulative variance contribution rate was 63.88%. The model fit was acceptable (χ² = 698.79, df = 243, χ²/df = 2.87, P < 0.001, SRMR = 0.06, RMSEA = 0.05, CFI = 0.96, and TLI = 0.94) according to the CFA. The Cronbach' s α of the entire questionnaire was .86, and the α of each of dimension was .65, .90, .88, and .78. The split-half reliability of the entire the ABCD was .67, and the test-retest reliability was .97 (P < 0.05). The questionnaire had good reliability and validity and was associated with sociodemographic and health-related characteristics (smoking and Body Mass Index).

CONCLUSION

The Chinese version of the ABCD has good reliability and validity, and provides a reliable assessment tool for measuring public health beliefs about the risk of cardiovascular disease, promoting the primary prevention of coronary heart disease.

Validation of the Dutch-Flemish translated ABCD questionnaire to measure cardiovascular diseases knowledge and risk perception among adults

Valid and reliable measurement of an individual's knowledge and risk perception is pivotal to monitor and evaluate the effectiveness of interventions aimed at preventing cardiovascular diseases (CVDs). The recently developed Attitudes and Beliefs about Cardiovascular Disease (ABCD) knowledge and risk questionnaire is shown to be valid in England. In this study, we evaluated the psychometric properties of the modified and Dutch (Flemish)-translated ABCD questionnaire using both the classical test and item response theory (IRT) analysis. We conducted a community-based survey among 525 adults in Antwerp city, Belgium. We assessed the item- and scale-level psychometric properties and validity indices of the questionnaire. Parameters of IRT, item scalability, monotonicity, item difficulty and discrimination, and item fit statistics were evaluated. Furthermore, exploratory and confirmatory factorial validity, and internal consistency measures were explored. Descriptive statistics showed that both the knowledge and risk scale items have sufficient variation to differentiate individuals' level of knowledge and risk perception. The overall homogeneity of the knowledge and risk subscales was within the acceptable range (> 0.3). The exploratory and confirmatory factor analyses of the risk scale supported a three-factor solution corresponding to risk perception (F1), perceived benefits and intention to change physical activity (F2), and perceived benefit and intention to change healthy dietary habit (F3). The two parametric logistic (2-PL) and rating scale models showed that the item infit and outfit values for knowledge and risk subscales were within the acceptable range (0.6 to 1.4) for most of the items. In conclusion, this study investigated the Dutch (Flemish) version of the ABCD questionnaire has good psychometric properties to assess CVD related knowledge and risk perception in the adult population. Based on the factor loadings and other psychometric properties, we suggested a shorter version, which has comparable psychometric properties.