Background/Purpose : Disclosure of genetic risk information alone has had limited impact on changing health behaviors in research trials. Prior studies have not evaluated whether disclosure of risk personalized to genetics, biomarkers, and lifestyle factors may motivate changes in health behaviors. We performed a randomized controlled trial to test the effect of personalized RA risk disclosure, including genetics and autoantibodies, on willingness to change RA behavioral risk factors among a high-risk population of first-degree relatives (FDRs).

Methods : We developed the Personalized Risk Estimator for RA (PRE-RA) tool as a web-based intervention for use in the PRE-RA Family Study. PRE-RA provides summary estimates of absolute and relative RA risks and educates individuals about their RA risk factors—including HLA-DRB1 genotype results, CCP and RF autoantibody results, lifestyle risk factors (smoking, overweight/obesity, low fish intake, periodontitis), and demographics. We recruited asymptomatic FDRs without RA at a single center and randomized them to receive PRE-RA education alone (n=80) or PRE-RA education with health educator guidance (n=78; total n=158, PRE-RA group), or to receive standard education about RA (n=80, comparison group). We measured willingness to change behaviors based on Prochaska’s Stages of Readiness for Change using validated ladder scales (range 0-10, higher score indicating more willingness to change) at 4 time points: baseline and immediately, 6 weeks, and 6 months after intervention. The primary outcome for willingness to change behaviors was defined as an increase in any ladder scale for 4 modifiable RA risk factors (exercise, diet, dental care, and smoking among current smokers) 6 months after intervention compared to baseline using intention-to-treat (ITT) analysis. Secondary analyses investigated differences among the three study arms.

Results : Among the 238 randomized subjects, 87% were White and 77% were female. The PRE-RA intervention group was older (mean 46.7 years [SD 14.4]) than the comparison group (mean 43.4 years [SD 14.7]). In the primary ITT analysis, 63.9% of the PRE-RA group met the primary outcome, compared to 50.0% in the comparison group (age-adjusted difference 15.8%, 95%CI 2.8-28.8%, p=0.017, Figure). Within the PRE-RA group, the addition of a health educator resulted in no additional effect on willingness to change behaviors beyond the web-based PRE-RA education tool alone (p=0.54 at 6 months after intervention).

Conclusion : Disclosure of RA risk to FDRs personalized to genotype, autoantibody results, and lifestyle risks resulted in increased willingness to change behaviors related to RA. Personalized risk education incorporating factors beyond genetics may motivate health behavior changes in those at risk for chronic disease and could be widely disseminated using a web-based tool.