Objective: "Biological age" calculators are widely used as a way of communicating health risk. This study evaluated the behaviour change techniques (BCTs) within such tools, underlying algorithm differences and suitability for people with varying health literacy.
Methods: Two authors entered terms into Google (eg, biological/heart age) and recorded the first 50 results. A standard patient profile was entered into eligible biological age calculators. Evaluation was based on Michie et al's BCT taxonomy and a readability calculator. Results: From 4000 search results, 20 calculators were identified: 11 for cardiovascular age, 7 for general biological age and 2 for fitness age. The calculators gave variable results for the same 65-year-old profile: biological age ranged from younger to older (57-87 years), while heart age was always older (69-85+ years). Only 11/20 (55%)provided a reference explaining the underlying algorithm. The average reading level was Grade 10 (range 8.7-12.4; SD 1.44). The most common BCTs were salience of consequences, information about health consequences and credible source.Conclusions: Biological age tools have highly variable results, BCTs and readability.Practice Implications: Developers are advised to use validated models, explain the result at the average Grade 8 reading level, and incorporate a clear call to action using evidence-based behaviour change techniques.