Validity of self-assessment tools for cardiovascular risk behaviour: a systematic review
Authors: Goevaerts W F , Nieuwenhuys W W , Van Leunen M M C J , Heutinck J M , Kraal J J , Herkert C , Fruytier L , Kemps H M C , Brouwers R W M 
Published: June 2024

Abstract

Background
In the past decades, numerous self-assessment tools for cardiovascular risk behaviour (e.g. physical inactivity, nicotine smoking, (excessive) alcohol use, unhealthy eating behaviour and psychological stress) have been developed, as a healthy lifestyle plays a crucial role in reducing cardiovascular risk. By accurately measuring these lifestyle parameters via self-assessment, adequate insights in patients’ lifestyle behaviour can be generated, which can be used by healthcare professional to personalize and improve treatment decisions. Secondly, self-assessment of cardiovascular risk behaviour may increase an individual’s awareness, empowerment and, ultimately, behavioural change.

Purpose
The aim of this systematic review is to investigate the validity of self-assessment tools for cardiovascular risk behaviour, i.e. physical (in)activity, smoking, alcohol use, eating behaviour and/or stress.

Methods
The following electronic databases were searched: PubMed, EMBASE and the Cochrane Library. Studies that evaluate validity of self-assessment tools were included. For this review, self-assessment tools for cardiovascular risk behaviour are defined as tools used to assess a person’s behaviour in one of the following domains: physical (in)activity, nicotine smoking, alcohol use, eating behaviour or (psychological) stress. These tools may appear in different forms, for example questionnaires or diaries, mobile or web-based applications, or wearable devices. The tools need to be used by the person whose behaviour is being assessed (i.e. not by a healthcare professional), hence the term self-assessment. Publications concerning a study protocol, systematic review or meta-analysis were excluded. Studies in languages different from English were not included. There were no date restrictions. Studies including adults, healthy or with diseases, were included. Studies including persons under 18 years of age or animal studies were excluded. The risk of bias of the included studies was assessed by two authors independently using 11 items derived from the QUADAS tool.

Results
126 studies of the 3175 citations screened were included in this review. Two searches were performed, in 2017 and 2023. From the 126 studies 55 studies reported on physical activity, 6 studies on nicotine smoking, 10 studies on alcohol use, 32 studies on eating behaviour, 15 studies on psychological stress, and 8 on a combination of lifestyle behaviours. Further data analysis is being conducted.

Conclusion
Insights in cardiovascular risk behaviour via self-assessment has the potential to facilitate improved and personalized treatment decisions in cardiac care and increase patient activation, which may stimulate positive lifestyle behavioural change. Results of this systematic review can facilitate the development of comprehensive self-assessment and monitoring tools for cardiovascular risk behaviour. PRISMA flow diagram.