Pictorial atherosclerosis information linked to better lifestyle adherence over 3 years

Researchers tracked adherence using a lifestyle index based on self-reported physical activity, smoking, diet, and alcohol consumption, scored 4–12 with higher scores indicating healthier habits. After 3 years, the intervention group had an odds ratio of 1.20 (95% CI 1.01–1.42, p=0.03) for maintaining or improving their lifestyle index compared to controls—a modest but statistically significant difference. The effect was consistent across age, sex, and education subgroups. One limitation is reliance on self-reported behaviour rather than objective biomarkers; another is the open-label design, which may have introduced expectancy bias. The finding aligns with earlier research suggesting that visualising disease risk can motivate behaviour change, though the absolute magnitude of improvement was small.

The study's lifestyle index combined four behaviours: physical activity, smoking, diet, and alcohol use—weighted equally. The 20% increase in odds of a healthier index at 3 years came from a single counselling conversation plus follow-up written information, with no repeated intervention required, suggesting the motivational effect of visualisation can persist. Notably, the trial was pragmatic and embedded in routine clinical care in Sweden, increasing real-world applicability, but this same pragmatism meant intervention fidelity was not formally measured. Subgroup analysis revealed no differential response by age (40 vs 50 vs 60), sex, or education—suggesting the pictorial approach may work broadly. However, the effect was relative (comparing odds between groups), and the absolute improvement in the composite lifestyle score was not reported; self-reported behaviour is also prone to recall bias and social desirability bias, particularly when participants know they received an intervention.