Juli­et Usher Smith
November 2018

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

Juli­et Usher Smith
Cancer and Cardiovascular disease prevention
Clinical Senior Research Associate (and GP)
The Primary Care Unit, University of Cambridge
Juliet Usher Smith

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