Health Risk Assessments

What's a Health Risk Assessment?

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A health risk assessment (HRA) is a questionnaire used to identify factors in individuals that increase their risk of impairments or disabilities and then recommend behavioral modifications to minimize their impact. A health risk assessment may provide an estimate of health risks to which a client or individual may be vulnerable due to genetics, family history, or their own lifestyle choices.

The first Health Risk assessment tool was used during World War II with troops who displayed behavioral disorders. By the early 1980s, nurses began to use HRAs to inquire about health habits specific to social support, emotional health, and spirituality. The genuine purpose of an health risk assessment is to provide a client with an estimate of health threats related to well-being, nutrition, fitness, environmental safety, stress, responsibilities, personal habits, and attitudes.

An HRA can increase a client's knowledge of personal vulnerability to disease and may provoke persons to change their lifestyles to prevent illness and promote overall health. The use of an HRA is a process that involves collecting data, analyzing that data, and producing feedback to encourage behavioral change to improve health and avoid premature mortality. HRAs are often used in wellness programs, since health and lifestyle choices impact work performance and overall health costs.

Although HRAs have been in use for over half a century, their validity and reliability remain questionable. The true validity of the health risk assessment lies in the application of knowledge and information acquired. One reason the HRA is potentially not a valid tool is that the HRA is a self-reported tool and neither anonymous, confidential, nor randomly assigned. This leaves the potential for dishonesty and individuals may be more prone to report acceptable health behaviors to gain social desirability.

Technology has allowed HRA users to engage in formats that promote greater interactivity and individualized counseling for health modifications and motivations. Many HRAs are completed prior to a health care visit and allow for greater discussion between the health care provider and the client.

Health Risk assessments are intended for persons who are free from chronic disease such as cancer or heart disease; they are not meant to diagnose or screen for disease, nor should they be used as substitutes for a complete medical history or medical exam. The Health Risk assessment is used to produce a risk index from which an educational plan to address the vulnerabilities noted.

With any client interaction, the person delivering the HRA must be aware of several ethical principles that apply: confidentiality, voluntary participation, appropriateness for the population targeted, and quality assurance. Culture also influences the understanding of health and wellness and may affect psychological, mental, and emotional health.

Questions that address spiritual, psychological, mental, and emotional health may be notably troubling when using these tools with diverse populations. There have been two primary variants in understanding culture's influence on health: individualism and collectivism.

Health Risk Assessments: The Purpose

Every day, many people mortgage their long-term health with the lifestyle they lead today. Behaviors such as lack of exercise, smoking, poor diet, and not wearing seat belts are among the factors that increase a person's risk of getting sick or dying prematurely.

However, general knowledge of these risks do not always change behavior, and people don't necessarily know which of their risks needs the most attention. Health risk assessments (HRAs) provide a scientific way of turning intuitive knowledge into measurable odds.

Read More: The Purpose of HRAs

HRAs and HIPAA Regulations

In an attempt to control ever-spiraling healthcare costs, many employers and health plans are providing incentives to employees and participants to improve their health status (e.g., lose weight or get in better shape).

Health risk assessments provide a tool for evaluating health status, identifying opportunities for improvement, and provide valuable feedback to the participant regarding personal health and risk factors for chronic diseases such as diabetes or heart disease. Additionally, many health plans and employers also provide incentives for participants completing the health risk assessment.

Read More: HRAs and HIPAA Regulations

Frequently Asked Questions About HRAs

Question: Can a health plan disclose to a sponsor (employer) whether an employee/plan participant has completed a health/wellness assessment? Would this decision be impacted by the employer-provided incentives or premium discounts for participation?

Answer: When the employee/participant has agreed to the terms of the health risk assessment and has elected to complete the assessment, the completion status can be disclosed to the sponsor. This would not be impacted by incentives or premium discounts for participation.

Read More: Frequently Asked Questions About HRAs

A Guide to Health Risk Assessment

The purpose of this guide to health risk assessment is to provide a basic explanation of HRAs for laypeople involved in environmental health issues, including policymakers, businesspeople, members of community groups, news reporters, and others with an interest in the potential health effects of toxic chemicals.