Family Healthware™

Family Healthware™ is a Web-based research tool that can be used to assess a person’s familial risk for six diseases: heart disease, stroke, diabetes, colorectal cancer, breast cancer, and ovarian cancer. It provides users in research studies with a “prevention plan” containing personalized recommendations for lifestyle changes and screening. For each person, the tool collects data about the following:

• Health behaviors (e.g., smoking and physical activity)
• Screening tests (e.g., blood cholesterol and mammography)
• Health history among his or her first- and second-degree relatives

One set of algorithms in the software analyzes users’ family history data and assesses the user’s familial risk for each of the six diseases. A second set of algorithms uses the data on familial risk, health behaviors, and screening results to generate personalized prevention messages. Family Healthware™ was developed by a multi-disciplinary team with expertise in clinical genetics, behavioral science, health communication, preventive medicine, and epidemiology, with support from a major commercial communications firm and a software development company.

Research and Evaluation

Evaluation of Family Healthware™ was conducted to determine if personalized prevention messages tailored to familial risk would motivate people at risk to change lifestyle behaviors or seek additional medical advice or screening. Three academic research centers at the University of Michigan School of Medicine, Evanston Northwestern Healthcare Research Institute, and Case Western Reserve University School of Medicine, using a network of primary care practices, evaluated this tool. The study began enrolling patients in December 2005, and data collection was completed by the fall of 2007. As a result of this research, a series of papers have been and continue to be published in peer-reviewed journals and presented at various workshops and meetings.

Study findings include

• 82% of participants had strong or moderate familial risk for at least 1 disease
• Strong association between perceived risk or worry and family health history risk
  • Highest for cancers
  • Participants worried most about heart disease (men), breast cancer (women)
  • Heart disease perceived to be the most controllable
  • Cancers perceived to be the least controllable
• Underreporting of paternal family history and lower perceived breast cancer risk if in the paternal lineage
• Family health history intervention increased
  • Daily fruit and vegetable consumption
  • Physical activity
  • Risk perceptions among those who underestimated risk
  • Communication with family among those not communicating
• Family health history intervention decreased or had no effect on cholesterol screening
• Automated, tailored prompts highlighting familial risk did not change clinician behavior (for example, family health history discussions with patients, screening, or referrals)

Family Healthware™ Publications

Zazove P, Plegue MA, Uhlmann WR, Ruffin MT 4th. Prompting Primary Care Providers about Increased Patient Risk As a Result of Family History: Does It Work? J Am Board Fam Med. 2015; 28:334-42.

Wang C, Sen A, Ruffin MT 4th, Nease DE Jr, Gramling R, Acheson LS, O’Neill SM, Rubinstein WS; Family Healthware™ Impact Trial (FHITr) Group. Family History Assessment: Impact on Disease Risk Perceptions. Am J Prev Med. 2012;43:392-8.

Dorman JS, Valdez R, Liu T, Wang C, Rubinstein WS, O’Neill SM, Acheson LS, Ruffin MT 4th, Khoury MJ. Health Beliefs Among Individuals at Increased Familial Risk for Type 2 Diabetes: Implications for Prevention. Diabetes Res Clin Pract. 2012;96:156-62

Ruffin MT, Nease DE. Using Patient Monetary Incentives and Electronically Derived Patient Lists to Recruit Patients to a Clinical Trial. JABFM. 2011; 24(5):569-74.

Rubinstein, W.S., O’Neill, S.M., Acheson, L.S., Ruffin, M.T., IV, Wang, C., & Beaumont, J., for the Family HealthwareTM Impact Trial (FHITr) Group. Clinical Utility of Family History for Cancer Screening and Referral in Primary Care. Genet Med. 2011;13:956-65.

Ruffin, M.T., Nease, D.E., Jr., Pace, W.D., Sen, A., Wang, C., Acheson, L.S., Rubinstein, W., O’Neill, S.M., & Gramling, R., for the Family HealthwareTM Impact Trial (FHITr) Group. Effect of Preventive Messages Tailored to Family History on Health Behaviors: the Family HealthwareTM Impact Trial. Ann Fam Med. 2011; 9, 3-11.

Rubinstein, W.S., O’Neill, S.M., Rothrock, N., Starzjk, E.J., Beaumont, J.L., Acheson, L.S., Wang, C., Gramling, R., Galliher, J.M., & Ruffin, M.T., IV. Components of Family History Associated with Women’s Disease Perceptions for Cancer: A Report from the Family HealthwareTM Impact Trial (FHITr). Genet Med. 2011; 13: 52-62.

Acheson LS, Wang C, Zyzanski SJ, Lynn A, Ruffin MT 4th, Gramling R, Rubinstein WS, O’Neill SM, Nease DE Jr., Family Healthware Impact Trial (FHITr) Group. Family History and Perceptions About Risk and Prevention for Chronic Diseases in Primary Care: A Report from The Family Healthwaretm Impact Trial. Genet Med. 2010; 12:212-8.

O’Neill SM, Rubinstein WS, Wang C, Yoon PW, Acheson LS, Rothrock N, Starzyk EJ, Beaumont JL, Galliher JM, Ruffin MT 4th. Family Healthware Impact Trial group. Familial risk for common diseases in primary care: the Family Healthware Impact Trial. Am J Prev Med. 2009; 36:506-14.

Wang C, O’Neill SM, Rothrock N, Gramling R, Sen A, Acheson LS, Rubinstein WS, Nease DE Jr, Ruffin MT 4th. Family Healthware Impact Trial (FHITr) group. Comparison of Risk Perceptions and Beliefs Across Common Chronic Diseases. Prev Med. 2009; 48:197-202.

Yoon PW, Scheuner MT, Jorgensen C, Khoury MJ. Developing Family Healthware, A Family History Screening Tool to Prevent Common Chronic Diseases. Prev Chronic Dis. 2009;6:A33.