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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