Making sense of being at 'high risk' of coronary heart disease within primary prevention

Current NHS policy advocates screening to identify individuals at ‘high risk’ of cardiovascular disease (CHD) in primary care. This paper utilizes the work of Radley to explore how ‘high risk’ of CHD patients make sense of their new risk status. Results are presented here from a nested qualitative study within a quantitative randomized trial of a CHD risk intervention in primary care. ‘Discovery’ interviews were conducted with ‘high risk’ participants (n=38, mean age=55) two weeks after intervention and thematically analyzed. In response to perceived threat, many participants sought to both ‘minimize’ and ‘normalize’ their risk status. They also reported intentions to act, particularly concerning dietary change and exercise, although less so for smoking amongst the lower SES participants. Such perceptions and intentions were contextualized within the lifecourse of later middle-age, so that both being at risk, and being treated for risk, were normalized as part of growing older. Social position, such as gender and SES, was also implicated. CHD risk interventions should be context-sensitive to the life-course and social position of those who find themselves at ‘high risk’ of CHD in later middle-age.