JMIR Publications

ABSTRACT

Background:

Cardiovascular disease (CVD) risk factors often develop early in adulthood, yet preventive counseling and risk communication remain limited in younger populations, particularly among individuals with lower health literacy. Traditional numeric risk scores are difficult to interpret and may not effectively promote behavior change. Visual risk communication strategies offer a potential approach to improve understanding and engagement but are not well designed for higher-risk populations.

Objective:

To evaluate the comprehensibility, emotional and motivational responses, and user-driven improvement recommendations for visual representations of CVD risk among Medicaid-enrolled Black parents with lower health literacy.

Methods:

We conducted a qualitative study involving focus groups with Black parents of school-aged children recruited from primary care clinics and community organizations in central Ohio (n=44). Participants reviewed three visual representations of risk: (1) numeric values indicating current, lifetime, and ideal CVD risk; (2) longitudinal risk trajectories with and without intervention; and (3) a display of behavioral and biological risk factors using a line number meter. Guided discussions assessed comprehension of and emotional response to these prototype displays before and after explanation; suggested improvements were also provided by participants. Transcripts were analyzed using a hybrid deductive-inductive content analysis with thematic summarization.

Results:

Participants demonstrated variable comprehension across visual formats. Numeric risk displays were frequently misunderstood and required explanation to be meaningful. Longitudinal trajectories were generally perceived as motivating but occasionally confusing, particularly when trajectories fluctuated after interventions. The line number meter was most consistently understood, perceived as less intimidating, and viewed as actionable for behavior change. Across groups, participants emphasized the importance of clear labeling, contextual explanations, and linkage to actionable steps. Participants noted that visualizations would be most effective when paired with clinician guidance rather than used independently.

Conclusions:

Visual representations that emphasize actionable lifestyle behaviors and provide clear context were preferred over abstract numeric risk estimates for communicating CVD risk among populations with lower health literacy. User-centered design approaches that align with behavioral theory can be used to develop visualizations to communicate CVD risk. Future work should integrate such tools into clinician–patient interactions to evaluate improvement in risk communication and primordial prevention efforts in higher-risk populations.