Schoenbach V J, Wagner E H, Beery W L
Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill 27514-6201.
Health Serv Res. 1987 Oct;22(4):553-80.
Since its introduction some two decades ago, health risk appraisal (HRA) has become a standard offering in the health promotion repertoire. The technique's distinctive feature is its use of epidemiologic data to generate quantitative risk messages for the client. Yet despite the dedication and considerable investments that have gone into HRA's development, dissemination, and use, there is only limited empirical evidence that these quantitative risk messages have any effect on clients. There do not appear to be any formal studies of HRA's effect on participation in health promotion programs, although increasing recruitment is regarded as a major benefit of using HRA. There are few indications of HRA effects on health beliefs. Most positive reports of effects on behavior change come from uncontrolled studies; several randomized controlled trials have yielded ambiguous findings. Virtually no data exist concerning the impact of the quantitative risk messages that distinguish HRA from other assessment techniques and that have motivated the substantial efforts toward developing and refining HRA. HRA has evident appeal and is probably a useful health education device for middle-class, middle-aged, nonminority clients. It may well have desirable effects on health-related beliefs, attitudes, and behaviors when accompanied by counseling or education, but available evidence has not established its effectiveness. Given the difficulty of obtaining definitive evidence of the effectiveness of HRA and specifically of its use of quantitative risk projections, the need for such evidence is debatable. An adequately funded and reviewed research program to examine whether projections of absolute risk affect knowledge, beliefs, attitudes, and intention to change is recommended as the most fruitful next step. Epidemiologically based HRA procedures that provide feedback in terms of qualitative statements or relative risk may be a promising approach to prospective health assessment.
自大约二十年前引入以来，健康风险评估（HRA）已成为健康促进方法中的一项标准内容。该技术的独特之处在于利用流行病学数据为客户生成定量风险信息。然而，尽管在HRA的开发、传播和使用方面投入了大量精力和资金，但仅有有限的实证证据表明这些定量风险信息对客户有任何影响。似乎没有关于HRA对参与健康促进项目影响的正式研究，尽管增加招募人数被视为使用HRA的一项主要益处。几乎没有迹象表明HRA对健康观念有影响。关于行为改变效果的大多数积极报告来自非对照研究；几项随机对照试验得出了不明确的结果。几乎没有关于区分HRA与其他评估技术并促使人们大力开发和完善HRA的定量风险信息影响的数据。HRA具有明显的吸引力，对于中产阶级、中年、非少数族裔客户可能是一种有用的健康教育手段。在辅以咨询或教育时，它很可能对与健康相关的观念、态度和行为产生理想的影响，但现有证据尚未证实其有效性。鉴于难以获得HRA有效性的确切证据，尤其是其使用定量风险预测的证据，对这类证据的需求存在争议。建议开展一项资金充足且经过审查的研究项目，以检验绝对风险预测是否会影响知识、观念、态度以及改变的意愿，这是最有成效的下一步。基于流行病学的HRA程序，若以定性陈述或相对风险的形式提供反馈，可能是一种有前景的前瞻性健康评估方法。
