Health risk assessment
Encyclopedia
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
Health promotion
Health promotion has been defined by the World Health Organization's 2005 Bangkok Charter for Health Promotion in a Globalized World as "the process of enabling people to increase control over their health and its determinants, and thereby improve their health"...

 and is often the first step in multi-component health promotion programs.

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. 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.

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.”

There are a range of different HRAs available, however most capture information relating to:
  • 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:
  • 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. 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. It wasn't until 1980, when the Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...

 released a publicly available version, that the HRA became widely used, particularly in workplace settings.

The use of HRAs and corporate wellness programs has been most prevalent in the United States, with comparatively slower growth elsewhere. However there has been recent strong growth in corporate wellness outside the US, particularly in Europe and Asia.

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. The report can also provide recommendations on how individuals can reduce their health risks by changing their lifestye.

In addition to individual feedback, HRAs are also used to provide aggregated data reporting for employers and organizations. 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. 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.

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. Other delivery methods include telephone, mail and face-to-face.

The advantages of online HRAs include:
  • 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.
  • Predict health-related costs
  • Measure absenteeism
    Absenteeism
    Absenteeism is a habitual pattern of absence from a duty or obligation. Traditionally, absenteeism has been viewed as an indicator of poor individual performance, as well as a breach of an implicit contract between employee and employer; it was seen as a management problem, and framed in economic...

     and presenteeism
    Presenteeism
    Presenteeism is the act of attending work while sick. A topic that is at times considered its opposite, absenteeism, has historically received extensive attention in the management sciences, but presenteeism has only recently found a place in the research literature...

  • Evaluate the efficacy and return on investment of health promotion
    Health promotion
    Health promotion has been defined by the World Health Organization's 2005 Bangkok Charter for Health Promotion in a Globalized World as "the process of enabling people to increase control over their health and its determinants, and thereby improve their health"...

     strategies


There is also recent evidence to suggest that taking a HRA alone can have a positive effect on health behavior change and health status.

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. 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.

Benefits

The Wellness Councils of America (WELCOA) outlines 10 key benefits of conducting personal health risk assessments. Health risk assessments:
  • 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.

Providers

There are reportedly over 50 different HRA providers in the market, offering a variety of different versions and formats. Major vendors with National Committee of Quality Assurance (NCQA) Health Information Products Certification include Health Media, vielife
Vielife
vielife is a global health & well-being solutions provider. It works with organisations from all over the world in both the private and public sector, as well as health providers, with the aim of improving health & performance...

, Healthways
Healthways
Healthways is a disease management company founded in 1981 and headquartered in Franklin, Tennessee.In 2003, the company topped a list of "America's fastest-growing small companies," based on earnings/share growth, revenue growth, and total return...

, HealthCheck360, OptumHealth, Wellsource and WebMD
WebMD
WebMD is an American corporation which provides health information services. It was founded in 1996 by Jim Clark and Pavan Nigam as Healthscape, later Healtheon, and then acquired WebMD in 1999 to form Healtheon/WebMD...

.
The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
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