PURPOSE Despite some recent improvement in knowledge about cholesterol in the United States, patient adherence to cholesterol treatment recommendations remains suboptimal. We undertook a qualitative study that explored patients' perceptions of cholesterol and cardiovascular disease (CVD) risk and their reactions to 3 strategies for communicating CVD risk. METHODS We conducted 7 focus groups inNew England using open-ended questions and visual risk communication prompts. The multidisciplinary study team performed qualitative content analysis through immersion/crystallization processes and analyzing coded reports using NVivo qualitative coding software.RESULTS All participants were aware that "high cholesterol" levels adversely affect health. Many had, however, inadequate knowledge about hypercholesterolemia and CVD risk, and few knew their cholesterol numbers. Many assumed they had been tested and their cholesterol concentrations were healthy, even if their physicians had not mentioned it. Standard visual representations showing statistical probabilities of risk were assessed as confusing and uninspiring. A strategy that provides a cardiovascular risk-adjusted age was evaluated as clear, memorable, relevant, and potentially capable of motivating people to make healthful changes. A few participants in each focus group were concerned that a cardiovascular riskadjusted age that was greater than chronological age would frighten patients.CONCLUSIONS Complex explanations about cholesterol and CVD risk appear to be insuffi cient for motivating behavior change. A cardiovascular risk-adjusted age calculator is one strategy that may engage patients in recognizing their CVD risk and, when accompanied by information about risk reduction, may be helpful in communicating risk to patients. Ann Fam Med 2006;4:205-212. DOI: 10.1370/afm.534. INTRODUCTIOND espite recent advances in the diagnosis and treatment of cardiovascular disease (CVD), it remains the leading cause of death in the United States.1 In 1985 the National Heart, Lung, and Blood Institute launched the National Cholesterol Education Program (NCEP), which issued the Adult Treatment Panel (ATP I, II, and III) clinical guidelines aimed at reducing the burden of CVD through improved cholesterol management.2-4 The NCEP produced educational kits for clinicians and patient-oriented media programming including the "Know Your Cholesterol Numbers, Know Your Risk" campaign. 5,6 Cholesterol knowledge is reported to have improved since the 1980s, 7,8 but important information gaps remain. One study reported that from 1983 to 1995, there was an increase in the percentage of Americans who had heard of high blood cholesterol levels, who had been informed of their levels, and who knew their total cholesterol number. PERC EP T IONS A ND CO M MUNIC AT ION S T R AT E GIESthe percentage of the public who had heard of high blood cholesterol levels rose from 77% to 93%, and the percentage who were told their cholesterol values rose from 21% to 65%. Furthermore, the percentage who r...

Adolescent exposure to concussions is of concern due to the risk imposed on the developing brain and the potential for adverse outcomes later in life. Although a graduated return to play is heavily emphasized in concussion management, researchers need to investigate barriers inhibiting the implementation of return-to-learn protocols. Concussion education should aim to modify indifferent attitudes toward concussive injuries. Additionally, investigators should continue to assess how a history of concussion affects quality of life in recently retired collegiate athletes.

Despite the impact of high-visibility evidence-based clinical practice guidelines, physician adherence to guidelines remains low. This study explored primary care physicians' perceptions of barriers and facilitators in following the National Cholesterol Education Program guidelines. The authors conducted 9 focus groups and performed qualitative content analysis utilizing immersion-crystallization processes, codebooks, and qualitative coding software. Key barriers to implementing guidelines included the complexity and transience of existing cholesterol guidelines as well as perceived threats to multidimensional care of the patient that unifocal single-decision guidelines may create. Key facilitators included growing patient awareness regarding cholesterol, patients' willingness to take cholesterol medication, and technological breakthroughs. These findings have helped identify factors that prevent or enhance the adoption of cholesterol guidelines. While factors considered to be facilitators are significant, barriers may be sufficient to limit adherence. Opportunities may exist for improving adherence to cholesterol guidelines by providing training to providers and developing structural support through patient-physician activation tools.