Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)




Cardiovascular disease (CVD) remains among the leading causes of death in the United States despite widespread knowledge about risk factors as well as effective primary prevention strategies. Risk perception is a complex phenomenon that plays an important role in how persons view disease and ultimately how they make health behavior choices. This study is supported by the knowledge that few studies have examined how persons perceive cardiovascular risk or the variables thought to contribute to the formation of risk perception.

Purpose: The purpose of this study was to examine how accurately persons perceive personal risk for cardiovascular disease and identify variables that contribute to the formation of risk perception.

Methods: This study used a cross-sectional descriptive correlational design with adults at least forty years old and without known cardiovascular disease. The nonprobability convenience sample was recruited at health screenings held at multiple locations within a single hospital system in Northwest Indiana. One hundred thirteen participants who could read, write, and speak English completed the study booklet containing a compendium of questions regarding knowledge and awareness of CVD from the American Heart Association, as well as established tools to measure the key variables: the Cardiovascular Risk Individual Perception instrument (CRIP) measuring risk perception, the Revised Life Orientation Test (LOT-r) measuring optimism, the Life Engagement Test (LET) measuring life satisfaction, and the Patient Health Questionnaire (PHQ-8) measuring depression. Participants also consented to share physiological measurements and laboratory results from the community screening program. Actual cardiovascular risk was calculated using two tools: the Heart Health Scale (HHS; Wellsource screening tool) that provides information on "current risk", and the Framingham Risk Score (FRS) that "projects one's 10-year risk" for a cardiac event. The study was approved by the institutional review boards from Loyola University Chicago, the hospital where the screenings were held and the university where the investigator is on faculty.

Results: Study participants had a mean age of 58 years, 69% were female, 70% were White Caucasian (non-Hispanic), and the majority were married, well-educated, employed, and had private insurance. Overall the sample recognized heart disease as the leading cause of death for men and women and could identify the key prevention steps to reduce personal risk. While physiological measurements obtained during the screenings revealed a relatively healthy group, with the majority of participants at goal for glucose, LDL-C, HDL-C and triglyceride levels, the majority were also found to be either overweight or obese, and physically inactive. Overall, 80% had two or more self-reported risk factors, and 43% had three or more.

Participants did accurately perceive their personal risk, with the prevalence/number of self-reported risk factors being significantly correlated with higher levels of risk perception as measured by the CRIP (r=.44, p < .01). HHS scores showed that more than 55% of the participants were categorized as either "Needs Improving" or "High Risk", indicating the presence of multiple risk factors. HHS scores were also statistically correlated with risk perception (r=-.40, p < .01). In addition, chi square analysis showed a significant relationship between increased risk (using HHS) and increased risk perception scores (using CRIP). Framingham Risk Scores, a measure of projected future cardiac risk, were not correlated with current risk perception.

The majority of the sample had increased levels of optimism and life satisfaction and low levels of depression. While three variables (having a friend with CVD, optimism, and depression) were correlated with risk perception, depression was found to be the single predictor when entered into multiple regression analysis (B = .278, p = .003).

Implications for Providers: Community based health screenings play an important role in primary prevention strategies. Although persons may accurately recognize that they have risk factors for CVD, this alone may not be enough to prompt positive health behavior changes. Persons often need further counseling to understand the role risk factors play in subsequent subclinical atherosclerosis. While mass media campaigns related to healthy eating, exercise, and heart disease have increased health literacy in this area, health care providers need to be part of this dialogue since they are uniquely positioned to counsel patients on effective methods for promoting positive health behaviors.

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This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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