JMIR Publications

ABSTRACT

Background:

Cardiovascular diseases (CVD) remain a leading cause of morbidity and mortality. In primary prevention, effective communication of individual risk and support for behaviour change are crucial. Interactive risk visualizations can enhance understanding and engagement, while continuous glucose monitoring (CGM) offers immediate feedback on the physiological effects of daily choices.

Objective:

This study explored how patients at increased CVD risk and family medicine nurses perceive CVD risk visualization (Petal-X) and the integration of real-time glucose monitoring, with a focus on perceived person-centred care (PCC), motivation, and lifestyle change. This manuscript reports the qualitative phase of a larger sequential mixed-methods study; the quantitative randomized controlled trial is reported separately.

Methods:

Using total population (census) sampling within a closed, pre-defined trial cohort, we invited every eligible patient who had completed the intervention arm of a parallel randomized controlled trial (RCT) and every eligible registered nurse providing preventive consultations at the same single community health centre in central Slovenia who had been familiarized with the intervention and with the Petal-X dashboard; 6 patients at increased CVD risk who had used the Petal-X dashboard combined with CGM, and 6 nurses familiar with the intervention, took part, and interviews were conducted between September and December 2024. Data were collected through individual, face-to-face semi-structured interviews that explored perceptions of the visualization, real-time glucose monitoring, and lifestyle change. Interviews were audio-recorded, transcribed verbatim, and analysed by inductive qualitative content analysis within a qualitative descriptive design; coding continued until code saturation and data adequacy were judged to have been reached.

Results:

The analysis produced 11 subcategories, which were grouped into four categories, with an overarching theme running across them: visualization and digital tools as support for person-centred care to enhance motivation and lifestyle change in individuals at risk of CVD. Patients and nurses reported that personalized visual displays improved understanding of risk factors, facilitated dialogue and shared decision-making, and increased patients' sense of involvement, responsibility, and control, although the two groups differed in emphasis: patients foregrounded personal meaning and self-regulation, whereas nurses foregrounded communication and fit with the consultation workflow. CGM was perceived as particularly motivating by linking behaviour (food, activity, stress) to real-time glucose changes, encouraging dietary and activity adjustments that some participants maintained after the intervention. Key barriers included variable digital literacy (especially among older users), fear or mistrust of technology, the attentional burden of continuous monitoring, potential information overload, workflow integration needs, and affordability/accessibility of CGM.

Conclusions:

Interactive CVD risk visualization Petal-X, especially when complemented by CGM, was perceived as a meaningful support for PCC and a driver of motivation and lifestyle change in primary prevention. Implementation should address training, usability, integration into routine workflows, and equity of access. Clinical Trial: ClinicalTrials.gov NCT06226948; https://clinicaltrials.gov/study/NCT06226948.