Introduction: Cardiovascular disease (CVD) remains the leading cause of death for women in the US, yet many young women are unaware of their lifetime risk of CVD. We employed user-centered design principles to adapt a validated CVD risk prediction tool for young women. Hypothesis: We hypothesized that young women would rate the tool (HerHeart) as user-friendly, be likely to recommend it to their friends, experience a change in their perceived risk of CVD, and report intent to change their health habits after engaging with it. Methods: We recruited 13 young women ages 13-21 from two clinical practices in Atlanta, GA to engage with the HerHeart CVD risk prediction tool. Participants rated the tool’s usability via the Website Analysis and Measurement Inventory (WAMMI), which is scored from 0 to 100. Participants rated their perceived 10-year and lifetime risk of CVD on a visual analog scale from 0 (Never going to happen) to 10 (Definitely will happen) before and after completing the tool. Participants reported their likelihood of recommending the tool to their friends and changing their health habits from 0 (Not likely at all) to 10 (Extremely likely). Results: Participants rated the tool’s usability highly on the WAMMI (M = 78.62 +/- 9.70). Participants’ perceived 10-year risk of a heart attack increased from a mean of 0.85 +/- 0.99 to 1.83 +/- 1.90, and perceived lifetime risk increased from a mean of 2.38 +/- 2.72 to 2.75 +/- 2.63, on the 10-point scale after engaging with the tool. Participants were more than likely to recommend HerHeart to their friends (M = 8.00 +/- 2.22) and to report intent to change their health habits (M = 8.82 +/- 1.47) after completing the tool. Participant data captured in the HerHeart tool are shown in the Table. Conclusions: The HerHeart tool is acceptable to young women and demonstrates potential for changing their risk perception and improving their health habits to reduce their risk of CVD. Recruitment is ongoing and will include input from clinicians on the feasibility of incorporating the tool in clinical practice.

Background Cardiovascular disease (CVD) is the leading cause of death among women in the United States. A considerable number of young women already have risk factors for CVD. Awareness of CVD and its risk factors is critical to preventing CVD, yet younger women are less aware of CVD prevalence, its risk factors, and preventative behaviors compared to older women. Objective The purpose of this study is to assess CVD awareness among adolescent and young adult women and develop a lifestyle-based cardiovascular risk assessment tool for the promotion of CVD awareness among this population. Methods This study used a 3-phase iterative design process with young women and health care practitioners from primary care and reproductive care clinics in Atlanta, Georgia. In phase 1, we administered a modified version of the American Heart Association Women’s Health Survey to young women, aged 15-24 years (n=67), to assess their general CVD awareness. In phase 2, we interviewed young women, aged 13-21 years (n=10), and their health care practitioners (n=10), to solicit suggestions for adapting the Healthy Heart Score, an existing adult cardiovascular risk assessment tool, for use with this age group. We also aimed to learn more about the barriers and challenges to health behavior change within this population and the clinical practices that serve them. In phase 3, we used the findings from the first 2 phases to create a prototype of a new online cardiovascular risk assessment tool designed specifically for young women. We then used an iterative user-centered design process to collect feedback from approximately 105 young women, aged 13-21 years, as we adapted the tool. Results Only 10.5% (7/67) of the young women surveyed correctly identified CVD as the leading cause of death among women in the United States. Few respondents reported having discussed their personal risk (4/67, 6%) or family history of CVD (8/67, 11.9%) with a health care provider. During the interviews, young women reported better CVD awareness and knowledge after completing the adult risk assessment tool and suggested making the tool more teen-friendly by incorporating relevant foods and activity options. Health care practitioners emphasized shortening the assessment for easier use within practice and discussed other barriers adolescents may face in adopting heart-healthy behaviors. The result of the iterative design process was a youth-friendly prototype of a cardiovascular risk assessment tool. Conclusions Adolescent and young adult women demonstrate low awareness of CVD. This study illustrates the potential value of a cardiovascular risk assessment tool adapted for use with young women and showcases the importance of user-centered design when creating digital health interventions.

BACKGROUND Cardiovascular disease (CVD) is the number one cause of death in women in the United States. Awareness of CVD and its risk factors are critical to reversing this trend. OBJECTIVE This project aimed to assess CVD awareness among adolescent and young adult women and develop a lifestyle-based cardiovascular risk assessment tool for use with this population. METHODS This study used a 3-phase iterative design process with young women from primary care and reproductive care clinics in Atlanta, Georgia. In Phase 1, we administered a modified version of the American Heart Association Women’s Health Survey to young women ages 15-24 (n=67) to assess their general CVD awareness. In Phase 2, we interviewed young women ages 13-21 (n=10) and healthcare practitioners (n=10) to solicit suggestions for adapting an existing adult cardiovascular risk assessment tool for this age group. In Phase 3, we employed an iterative user-centered design process to collect feedback from approximately 105 young women as we adapted the adult tool. RESULTS Only 10.5% (n=7) of young women surveyed correctly identified CVD as the leading cause of death among women in the US. Few respondents reported having discussed their personal risk (6%, n=4) or family history of CVD (11.9%, n=8) with a healthcare provider. Young women demonstrated increased CVD awareness and knowledge after completing the adult risk assessment tool and suggested making the tool more teen-friendly by incorporating relevant foods and activity options. The result of the iterative design process was a youth friendly prototype of a CVD risk assessment tool. CONCLUSIONS Adolescent and young adult women demonstrate low awareness of CVD. This study illustrates the potential value of a CVD risk assessment tool adapted for use with young women and showcases the importance of user-centered design when creating digital health interventions.

Purpose: Previous studies have shown that young women have low awareness of heart disease, despite cardiovascular (CV) disease being the number one cause of death in women. While CV risk assessment tools exist for adults, there are no similar tools specifically for adolescents. This project focuses on developing a lifestyle-based CV health prediction tool and behavior intervention for young women. Methods: We report a qualitative case study of four hour-long semi-structured interviews with young women aged 13-21 years participating in a larger study to develop the new CV health tool. Patients were recruited from a primary care practice in Atlanta, GA. Participants completed the Healthy Heart Score survey, an existing web-based CV prediction tool developed for adults, while providing feedback on how to adapt the tool for young women. Topics included conditions to engage with the tool (e.g. at school or doctor’s office), app architecture (including layout, word choice, and use of visuals), and suggestions for improvement of the tool. We used qualitative coding and thematic analyses to synthesize data. Results: Prior to engaging with the Heart Healthy Score tool, participants initially demonstrated minimal knowledge of heart attacks/strokes (“I don’t know about preventing” [heart attacks and strokes]) and of their own risk (“I’ve never associated… young women with [heart disease]”). As participants used the tool, their knowledge of heart healthy choices and awareness of their own choices increased, cueing action (“I definitely need to get my health… together now before it’s too late”). Throughout the survey, teens had varied emotional reactions, from shame/embarrassment about health (“I… got upset because… I shouldn’t be eating this much”), to surprise/shock (“I thought I ate way more fruits and vegetables''), to enthusiasm to engage with app in the future (“I might like to use this tool because it’ll … help me [have] a better way of understanding … what to eat, what is healthy”). Participant recommendations to improve the tool for future use with teens focused on the importance of using examples and visual representations (“All the examples … really help me … figure out … how much I’m eating”, “I don’t really have a good idea of… what ounces really look like… a little visual would help [figure] that out”), and the importance of goal-setting and motivational language to incentivize teens to engage with the tool (“Instead of just telling you what you need to do to become better, they give you… an actual goal”). Conclusions: Through this case study, young women demonstrate a knowledge gap about heart disease risk and healthy choices. Adapting a CV health assessment tool for teens, with added examples, visuals, and motivational language, will allow teens to reflect on their own lifestyle choices, increase awareness of their risk for future heart disease, and ultimately serve as an impetus for behavior change.