Health risk assessment
A health risk assessment (also referred to as a health risk appraisal and health & well-being assessment) is one of the most widely used screening tools in the field of health promotion and is often the first step in multi-component health promotion programs.[1][2][3]
Definition
A health risk assessment (HRA) is a health questionnaire, used to provide individuals with an evaluation of their health risks and quality of life.[4] Commonly a HRA incorporates three key elements– an extended questionnaire, a risk calculation or score, and some form of feedback i.e. face-to-face with a health advisor or an automatic online report.[3][4]
The Centers for Disease Control and Prevention define a HRA as: “a systematic approach to collecting information from individuals that identifies risk factors, provides individualised feedback, and links the person with at least one intervention to promote health, sustain function and/or prevent disease.” [5]
There are a range of different HRAs available, however most capture information relating to:[3][5][6]
- Demographic characteristics– age, sex
- Lifestyle– exercise, smoking, alcohol intake, diet
- Personal and family medical history (in the US, due to the current interpretation of the Genetic Information Non-discrimination Act, questions regarding family medical history are not permitted if there is any incentive attached to taking a HRA)
- Physiological data– weight, height, blood pressure, cholesterol
- Attitudes and willingness to change behaviour in order to improve health
The main objectives of a HRA are to:[4]
- Assess health status
- Estimate the level of health risk
- Inform and provide feedback to participants to motivate behaviour change to reduce health risks
History
The original concept of the HRA can be traced back to Dr Lewis C. Robbins and his work on preventive medical practice.[7] This culminated in the publication of How to Practice Prospective Medicine in 1970 – a guide for practising physicians, which outlined the health risk assessment questionnaire, risk computations and patient feedback strategies.[6][7] It wasn't until 1980, when the Centers for Disease Control and Prevention released a publicly available version, that the HRA became widely used, particularly in workplace settings.[4]
The use of HRAs and corporate wellness programs has been most prevalent in the United States, with comparatively slower growth elsewhere.[6][8] However there has been recent strong growth in corporate wellness outside the US, particularly in Europe and Asia.[9]
Usage
Once an individual completes a HRA, they usually receive a report, detailing their health rating or score, often broken down into specific sub scores and areas such as stress, nutrition and fitness.[3] The report can also provide recommendations on how individuals can reduce their health risks by changing their lifestye.[7]
In addition to individual feedback, HRAs are also used to provide aggregated data reporting for employers and organizations.[6][8] These reports include demographic data of participants, highlight health risk areas and often include cost projections and savings in terms of increased healthcare, absence and productivity.[6] Organization-level reports can then be used to provide a first step by which organizations can target and monitor appropriate health interventions within their workforce.[8]
HRA delivery
The delivery of HRAs has changed over the years in conjunction with advances in technology. Initially distributed as paper-based, self-scoring questionnaires through on-site workplace health promotion sessions, HRAs are now most commonly implemented online.[4] Other delivery methods include telephone, mail and face-to-face.[4][5]
The advantages of online HRAs include:[4]
- Tailoring – online HRAs can adapt content based on an individual’s answers to the HRA questionnaire to provide a personalised, relevant and interactive user experience.
- Improved data management
- Reduced administrative costs
- Instant feedback
Efficacy
Extensive research has shown that HRAs can be used effectively to:
- Identify health risk factors.[1][10][11][12]
- Predict health-related costs[1][10][11][12]
- Measure absenteeism and presenteeism[13][14]
- Evaluate the efficacy and return on investment of health promotion strategies [15][16]
There is also recent evidence to suggest that taking a HRA alone can have a positive effect on health behavior change and health status.[17][18]
However, it is generally accepted that HRAs are most effective at promoting behavior change when they form part of an integrated, multi-component health promotion program.[3][6][19] Applied in this way, the HRA is used primarily as a tool to identify health risks within a population and then target health interventions and behavior change programs to address these areas.[4]
Benefits
The Wellness Councils of America (WELCOA) outlines 10 key benefits of conducting personal health risk assessments. Health risk assessments:[20]
- Provide employees with a snapshot of their current health status.
- Enable individuals to monitor their health status over time.
- Provide employees with concrete information thus preparing them for lifestyle change.
- Help individuals get involved with health coaching.
- Provide important information concerning employees' readiness to change.
- Help employers measure and monitor population health status.
- Provide employers with important information that can help them build results-oriented health promotion programmes.
- Can provide employers with important information on productivity.
- Allow employers to evaluate changes in health behaviour and health risks over time.
- Engage both employers and employees in the health management process.
Limitations
The limitations of a HRA are largely related to its usage and it is important to recognise that a HRA highlights health risks but does not diagnose disease and should not replace consultation with a medical or health practitioner.[3]
Providers
There are reportedly over 50 different HRA providers in the market, offering a variety of different versions and formats.[3] Major vendors with National Committee of Quality Assurance (NCQA) Health Information Products Certification include Health Media, vielife, Healthways, Optum Health, Wellsource and WebMD.[21]
References
- ^ a b c Yen L, McDonald T, Hirschland D, Edington DW (2003). "Association between wellness score from a health risk appraisal and prospective medical claims costs". Journal of Occupational and Environmental Medicine. 45 (10): 1049–57. doi:10.1097/01.jom.0000088875.85321.b9. PMID 14534445.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Gazmararian JA, Foxman B, Yen LT, Morgenstern H, Edington DW (1991). "Comparing the predictive accuracy of health risk appraisal: the Centers for Disease Control versus Carter Center program". American Journal of Public Health. 81 (10): 1296–301. doi:10.2105/AJPH.81.10.1296. PMC 1405330. PMID 1656798.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ a b c d e f g Alexander G (2000). "Health risk appraisal" (PDF). The International Electronic Journal of Health Education. 3 (Special): 133–137.
- ^ a b c d e f g h Baker K, DeJoy D, and Wilson M. Using online health risk assessments, The Journal of Employee Assistance. April 2007.
- ^ a b c Centers for Disease Control and Prevention. Health Risk Appraisals, Visited 9 October 2009.
- ^ a b c d e f Warshaw, L. Chapter 15: Health risk appraisal, International Labour Organization’s Encyclopaedia of Occupational Health and Safety 4th ed. 1998
- ^ a b c Schoenbach VJ (1987). "Appraising health risk appraisal". American Journal of Public Health. 77 (4): 409–11. doi:10.2105/AJPH.77.4.409. PMC 1646957. PMID 3826457.
{{cite journal}}: Unknown parameter|month=ignored (help) - ^ a b c Mills PR (2005). "The development of a new corporate specific health risk measurement instrument, and its use in investigating the relationship between health and well-being and employee productivity". Environmental Health. 4 (1): 1. doi:10.1186/1476-069X-4-1. PMC 548523. PMID 15679885.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ^ Working well: A global survey of health promotion and workplace wellness strategies (PDF). Buck Consultants. 2008.
{{cite book}}: Unknown parameter|month=ignored (help)[page needed] - ^ a b Yen L, Schultz A, Schnueringer E, Edington DW (2006). "Financial costs due to excess health risks among active employees of a utility company". Journal of Occupational and Environmental Medicine. 48 (9): 896–905. doi:10.1097/01.jom.0000235987.75368.d0. PMID 16966956.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ a b Anderson DR, Whitmer RW, Goetzel RZ; et al. (2000). "The relationship between modifiable health risks and group-level health care expenditures. Health Enhancement Research Organization (HERO) Research Committee". American Journal of Health Promotion. 15 (1): 45–52. PMID 11184118.
{{cite journal}}: Explicit use of et al. in:|author=(help)CS1 maint: multiple names: authors list (link) - ^ a b Burton WN, Chen CY, Conti DJ, Schultz AB, Edington DW (2003). "Measuring the relationship between employees' health risk factors and corporate pharmaceutical expenditures". Journal of Occupational and Environmental Medicine. 45 (8): 793–802. doi:10.1097/01.jom.0000079090.95532.db. PMID 12915781.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Boles M, Pelletier B, Lynch W (2004). "The relationship between health risks and work productivity". Journal of Occupational and Environmental Medicine. 46 (7): 737–45. doi:10.1097/01.jom.0000131830.45744.97. PMID 15247814.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Loeppke R, Taitel M, Richling D; et al. (2007). "Health and productivity as a business strategy". Journal of Occupational and Environmental Medicine. 49 (7): 712–21. doi:10.1097/JOM.0b013e318133a4be. PMID 17622843.
{{cite journal}}: Explicit use of et al. in:|author=(help); Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Mills PR, Kessler RC, Cooper J, Sullivan S (2007). "Impact of a health promotion program on employee health risks and work productivity". American Journal of Health Promotion. 22 (1): 45–53. PMID 17894263.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Burton WN, Chen CY, Conti DJ, Schultz AB, Edington DW (2006). "The association between health risk change and presenteeism change". Journal of Occupational and Environmental Medicine. 48 (3): 252–63. doi:10.1097/01.jom.0000201563.18108.af. PMID 16531829.
{{cite journal}}: Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Ozminkowski RJ, Dunn RL, Goetzel RZ, Cantor RI, Murnane J, Harrison M (1999). "A return on investment evaluation of the Citibank, N.A., health management program". American Journal of Health Promotion. 14 (1): 31–43. PMID 10621522.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Ozminkowski RJ, Goetzel RZ, Wang F; et al. (2006). "The savings gained from participation in health promotion programs for Medicare beneficiaries". Journal of Occupational and Environmental Medicine. 48 (11): 1125–32. doi:10.1097/01.jom.0000240709.01860.8a. PMID 17099448.
{{cite journal}}: Explicit use of et al. in:|author=(help); Unknown parameter|month=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Anderson DR, Staufacker MJ (1996). "The impact of worksite-based health risk appraisal on health-related outcomes: a review of the literature". American Journal of Health Promotion. 10 (6): 499–508. PMID 10163313.
- ^ WELCOA Special Report. 2008. The 10 Benefits of Conducting a Personal Health Assessment., Visited 9 October 2009.
- ^ National Committee of Quality Assurance. Health Information Products (HIP) Certification, Thursday 1 October 2009. Visited 9 October 2009.