Juliet Usher-Smith

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What do you work on?

I work on the development, validation and implementation of risk scores in Primary Care to promote prevention of cancer and cardiovascular disease.

“Gorilla can do far more than we had ever thought would have been possible”

What did you do using Gorilla?

We have done two related projects using Gorilla.

In the first, we developed an online site that enables individuals to calculate their estimated risk of developing one of the top five potentially preventable cancers based on their lifestyle. The site then displays that risk to them and allows them to see the effect changes in their lifestyle would have on their estimated risk, as well as providing links to online resources to support behaviour change.

We developed the site alongside healthcare professionals and then conducted usability testing to see how user-friendly they felt the site was and the barriers and facilitators to them using the site within consultations within general practice. In the usability testing all participants felt it would be easy to collect the risk information. 91% felt the intervention would enable discussion about cancer risk and facilitate setting targets and believed it had potential to be easily integrated into NHS Health Checks. However, only 36% agreed it could be delivered within 5 minutes and only 45% that there would be sufficient resources to support its incorporation.

We have refined the site following feedback from those healthcare professionals and are now piloting health care assistants using the site within NHS Health Checks at general practices in Cambridge, Hertfordshire and Bedfordshire. The site is embedded as a task within an experiment in Gorilla and we are collecting data from patients before and after their consultations to measure self-report lifestyle; perceived risk of cancer; anxiety; cancer-related worry; intention to change behaviour; and awareness of cancer risk factors.

In the second, we have conducted an online randomised controlled trial. We recruited 1000 participants through Prolific and they were allocated to either a control group receiving cancer-specific lifestyle advice alone or one of three intervention groups receiving the same lifestyle advice alongside their estimated 10-year risk of developing one of the five most common preventable cancers, calculated from self-reported modifiable behavioural risk factors, in one of three different formats (bar chart, pictograph or qualitative scale). We collected data using Gorilla before, immediately after and three months after the intervention on self-report lifestyle as well as a number of other measures, including: perceived risk of cancer; risk conviction; maladaptive behaviours; intention to change behaviour; self-efficacy; response efficacy; anxiety; cancer-related worry; intention to change behaviour; and awareness of cancer risk factors. Over 85% of participants completed the study at the 3 month follow up.

We are still analysing the findings but preliminary analysis suggests differences between the formats of risk presentation on risk perception and risk conviction. We believe this is the first study to demonstrate change in risk conviction following provision of risk information.

Has this study been published?

The protocol for the online trial has been published here.

We are currently completing the analysis and hope to publish that by the end of the year. We have drafted a paper describing the development and feasibility testing of the very brief intervention and hope to publish that in the next few months.

For you, what is the stand-out feature in Gorilla?

The ability to embed complex tasks within online surveys and the user-friendly interface to enable branching and randomisation.

How do you think online research is going to change your field?

In the field of risk communication, online research enables rapid recruitment of large numbers of people to study responses to different formats of risk. This makes our evidence more useful to policy makers.

Why did you choose to use Gorilla?

As soon as we saw a demo of the site it was immediately clear that it was the only suitable platform available and could do far more than we had ever thought would have been possible.

“We believe this is the first study to demonstrate change in risk conviction following provision of risk information.”

Did you include any special features in your study to ensure good quality data? If so, what did you do?

We incorporated an instructional manipulation check, excluding participants who failed that. We also included checks within the task to ensure that responses individuals gave were reasonable – for example, if someone entered a BMI <12 or >50 they saw a screen asking them to check their numbers.

Did you have an issues getting ethics for using Gorilla?

No, none at all.

What science book have your read recently that you’d recommend to others.

Thinking Fast and Slow by Daniel Kahneman




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