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]

Contents 1 Definition 2 History 3 Usage 4 HRA delivery 5 Efficacy 6 Benefits 7 Limitations 8 Providers 9 References

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, HealthCheck360, OptumHealth, Wellsource and WebMD.^[21]

References