The Return of Cardiovascular Information Trial (RECITE)

The Return of Cardiovascular Information Trial (RECITE) is a multi-factorial, adaptive randomized behavioral intervention trial which aims to determine how best to communicate personalized cardiovascular risk information and support behavior change among participants attending the Dallas Heart Study (DHS) fourth visit (DHS-4). This embedded behavioral intervention trial will evaluate two independent intervention components-risk information presentation and personalized action-planning support-to identify communication strategies that most effectively motivate and sustain healthy behavior change. The randomized intervention will be receipt of one of two different cover letter templates for the participant post-visit return-of-results letter.

Intervention Components:

The two primary treatment arms differ only in how one's health data measured during the DHS clinic visit are presented in the cover letter. Each cover letter shows the participant's AHA PREVENT Risk Score results based on assessments performed at the DHS Visit. The risk score representation provides each participant's score compared to the distribution among DHS participants at Visit 3 (2020-2024). Each letter also provides the participant's actual estimated 10-year CVD risk based on the PREVENT Risk Score. To evaluate whether simplified (coarse) or detailed (fine) presentation of risk information better motivates behavior change, participants will be randomized to template cover letters presenting summary risk information as either:

• Arm 1, Coarse Risk Format: Participants receive the standard DHS-4 result report supplemented with visually intuitive risk indicators-such as color-coded categories (green = low risk, red = high risk) and representation of score in a histogram-for outcomes including heart attack, stroke, and diabetes.
• Arm 2, Fine Risk Format: Participants receive the same standard results report, but with precise numerical exact numerical percentile. (e.g., "Your risk of an adverse heart event is higher than 72 percent of DHS participants.") Instead of categorical color cues, there will be a line underlining the risk number that ranges from red "100" to green "0".

Each participant's result letter will be sent to them twice, initially approximately 8 weeks after their DHS Visit 4, and a second time 12 weeks after their visit. All participants will otherwise receive the same clinical test results and observational summaries, preceded by a cover letter, to ensure consistency with standard DHS return-of-results practices.