e H e a l t h S t r a t e g y O f f i c e

Online Risk Assessment for the General Public

Liz Heathcote, Dr Larry Goldenberg, Dr Kendall Ho, Marcel Labbe and Bradut Dima

Project funder: Partners:

UBC

Department of

Urologic

Sciences

e H e a l t h S t r a t e g y O f f i c e

The drivers in figures…

76 Life expectancy of Canadian men (years)

4.4 Less years than Canadian women

65 “health expectancy” of Canadian men (years)

e H e a l t h S t r a t e g y O f f i c e

Project Goal

The ultimate project goal is to reduce the burden of preventable disease

in (wo)men in BC

through educating them about their individual health risks and empowering them with evidence-based recommendations for how they can add 10 years to the middle of their lives.

e H e a l t h S t r a t e g y O f f i c e

Project Aims

• Take a gendered lens to health risk assessment and participant reporting;

• Gather data from men and women about their health;

• Inform them about their risks; and

• Educate and motivate them to take positive action to improve their health and reduce their health risks through tailored education on the behavior changes needed and supports available to them.

e H e a l t h S t r a t e g y O f f i c e

Overview of work so far

Literature Review

Requirements Gathering

Expert Input & Review

Design & Functionality

Test Cases

Programming

…and to come

Focus Groups

Testing

Survey validation

Population Datasets

EvaluationRelease Phase 2?

e H e a l t h S t r a t e g y O f f i c e

Challenges

• Evidence base for risks of developing disease

• Expansive for some diseases/ populations, non-existent for others

• Relevant population studies may not exist

• Often contradictory findings

• Multiple dependent variables

• Understandable reticence to assign a risk score

• Will change as further research is conducted

e H e a l t h S t r a t e g y O f f i c e

The end in mind!

At the same time, we should be able to identify those factors that increase risk of preventable diseases more than others

and

this should assist in identifying an individual’s top 3-4 recommendations.

e H e a l t h S t r a t e g y O f f i c e

Risk Continuum – by disease

Inputs: evidence, expert opinion, test cases

Low High

Score = Negative or 0 Score = 100%

e H e a l t h S t r a t e g y O f f i c e

Risk Continuum – by question

Impact of that particular factor (e.g. BMI, exercise, smoking) on the overall disease risk.

Within each factor, relative impact of each variable along the continuum (e.g. non-smoker, social, more than 15 a day)

Low High

Score = Negative or 0

(zero if no risk to that disease)

(Varies)

Should reflect overall risk

compared to other variables

e H e a l t h S t r a t e g y O f f i c e

Design: Relative Importance of Risk Factors

Disease A

Disease B

BMIFamily history

Diet SmokingHealth history

ExerciseEtc. etc

BMI Family history Diet SmokingHealth history

ExerciseEtc. etc

e H e a l t h S t r a t e g y O f f i c e

-2.00%

-1.00%

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

8.00%G

end

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Age

Eth

nic

ity

BM

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ol

BP

Fam

ily: D

iab

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in f

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ree …

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hea

rt d

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1st

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#Pro

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bro

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Men

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Stro

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Frac

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Rad

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c. T

esti

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Low

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tost

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edic

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iet

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Exer

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Low Testosterone

Minimum Risk Effect

Maximum Risk Effect

Chart showing minimum and maximum percentage weighting of the answer variables

e H e a l t h S t r a t e g y O f f i c e

-20

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Ris

k P

erce

nta

ge A

sse

sse

d b

y To

ol

Case Number

Cases - Online Risk Assessment

EDCard.Low TDiab.Prost.Bone Mental

Case 1: A 59-year-old man with no family history of prostate cancer presents with urinary

symptoms lasting one year. He is Caucasian and has mild diabetes, he used to smoke but quit 5

years ago and drinks socially. He enjoys a high carbohydrate/ low fiber diet, does eat a

lot of animal fat and processed meat & he is fairly inactive,exercising less than 3 times per week.

Case 13: 65 year old male, smoker, high bad cholesterol and is on medications for

this, diabetes x 5 years, drink alcohol regularly (at least one drink a day, weekend heavy

use of more than 6 drinks a sitting), occasional cocaine use, has a strong family history of

heart problems, comes in because of chest pain after exercise.

Online Prototype

e H e a l t h S t r a t e g y O f f i c e

Design

Lifestyle/ modifiable factors

1. Determine risk of the 7 diseases;

2. Where risk is medium or high, calculate which lifestyle or modifiable factor would have the most impact on reducing the risk;

3. Recalculate risks using the 3-4 lifestyle suggestions which will have most positive impact.

BMIFamily history

Diet SmokingHealth history

ExerciseEtc. etc

Diet SmokingExerciseEtc. etc

e H e a l t h S t r a t e g y O f f i c e

Lessons so far

• Flexibility in design!

• Dealing with unknowns

• Expert tools

• Keep the ultimate goal uppermost

• Gender aspects

• Iterative design & development

Thanks to the team!

Medical Sponsors/LeadsDr Larry Goldenberg, Dr Kendall Ho

Men’s Health Initiative of BCMarcel Labbe, Wayne Hartrick, Joe Rachert, Dr Larry Mroz

eHealth Strategy Office Programming teamBradut Dima, Peter Chow and Rick Shun