BACKGROUND:

Health Risk Appraisals instruments have provided the field of health promotion with an imaginative motivational and instructional tool to foster personal behavioral change. A HRA typically asked questions about smoking, blood pressure, exercise, medical history, diet and other life style variables. These risk indicators were then compared to epidemiological and mortality data to yield an estimate of an individual or group's risk for disease. They were widely regarded as the most promising new addition to the health promotion armamentarium. The National Health Information Clearinghouse divided them into the following three categories: Computer-Scored HRAs, which were mailed to a central computer facility for batch processing and were usually the more complex and detailed appraisals; Microcomputer-Based HRAs, which c;ould be processed by a microcomputer at home, in schools or at the worksite; and Self-Scored HRAs, which were usually brief, did not involve a computer, and were scored by the user.

Although HRAs were a burgeoning industry in health education, no properly designed and conducted scientific evaluation of them on a sufficiently large and representative sample of the general population had been undertaken in the United States or elsewhere.

DESIGN NARRATIVE:

In the first stage, fourteen HRAs were evaluated by determining the validity of the scoring system for estimating cardiovascular risk as employed in the Framingham Heart Study data base, the accuracy of the reported risk factor scores as measured by physiological values, and the understandability and social acceptability of the instrument format. The second stage of the project was a field test to determine reliability and cost-effectiveness. Ten groups of respondents were formed by randomly assigning eligible adults to one of the five HRA groups and then to reliability and validity status.