Protocol for a randomized controlled trial testing the impact of feedback on familial risk of chronic diseases on family-level intentions to participate in preventive lifestyle behaviors.

Carlene J Wilson,Amanda Hutchinson,John Coveney,Donna L Hughes,Ivanka Prichard,Laura M Koehly,Paul Ward,Caroline Miller,Kayla De La Haye

doi:10.1186/s12889-016-3623-7

Abstract

BackgroundCommon disease risk clusters in families due to shared genetics, exposure to environmental risk factors, and because many health behaviours are established and maintained in family environments. This randomised controlled trial will test whether the provision of a family health history (FHH) risk assessment tool increases intentions and engagement in health behaviors. Message distribution and collective behavior change within family networks will be mapped using social network analysis. The relative intervention impact will be compared between families from different ethnic backgrounds.MethodsOne hundred and fifty mothers (50 Anglo-Australian, 50 Italian-Australian, 50 Vietnamese-Australian) will be recruited, with four or more other family members across three generations, including a child (aged 10–18 years). Each family is randomly assigned to intervention or control. At baseline and 6-month follow-up, all participants complete surveys to assess dietary and physical activity intentions and behaviors, attitudes towards food, and perceived disease risk. Intervention families receive a visual pedigree detailing their FHH of diabetes, heart disease, breast and bowel cancer, a health education workbook to ascertain members’ disease risk (i.e. average or above average risk), and screening and primary prevention recommendations. After completion of follow-up assessments, controls will receive their pedigree and workbook. The primary hypothesis is that attitudes and lifestyle behaviors will improve more within families exposed to FHH feedback, although the extent of this improvement may vary between families from different ethnic backgrounds. Additionally, the extent of improvement in the treatment group will be moderated by the level of family disease risk, with above-average risk leading to greater improvement. A secondary aim will explore different family members’ roles in message distribution and collective responses to risk using social network approaches and to compare network functioning between families with different ethnic backgrounds.DiscussionResults will guide future health promotion programs aimed at improving lifestyle factors. This research will assess whether FHH can motivate families to adopt family-level strategies to support health promoting behaviors. Secondary analyses aim to identify change agents within the family who are particularly effective in shifting normative behaviors.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12613001033730. Retrospectively registered: 17 September, 2013.

Highlights

Common disease risk clusters in families due to shared genetics, exposure to environmental risk factors, and because many health behaviours are established and maintained in family environments
The health burden in Australia mirrors this finding, with data suggesting that one third of the nation’s disease burden is linked to poor lifestyle choices [2]. These diseases are etiologically complex. They arise from genetic factors and environments that promote the normalisation of unhealthy food consumption through exploiting human vulnerabilities, be these biological, psychological, social or economic [3,4,5]
The potential utility and acceptability of FHH are supported by data from the US Center for Disease Control which, in 2004, reported that the vast majority of the US population considered that knowledge of family health history was important to their personal health [12]

Summary

Introduction

Common disease risk clusters in families due to shared genetics, exposure to environmental risk factors, and because many health behaviours are established and maintained in family environments. Lifestyle-related diseases including heart disease, stroke, diabetes, obesity, metabolic syndrome, chronic obstructive pulmonary disease, and some types of cancer are endemic in many developed countries. These diseases share some or all of four behavioral risk factors; an unhealthy diet, physical inactivity, alcohol consumption, and smoking. The health burden in Australia mirrors this finding, with data suggesting that one third of the nation’s disease burden is linked to poor lifestyle choices [2] They arise from genetic factors and environments that promote the normalisation of unhealthy food consumption through exploiting human vulnerabilities, be these biological, psychological, social or economic [3,4,5]

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