{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:54:46Z","timestamp":1791906886027,"version":"4.3.4"},"reference-count":44,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Hum Factors"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Cardiovascular diseases (CVDs) remain a leading cause of morbidity and mortality. In primary prevention, effective communication of individual risk and support for behavior change are crucial. Interactive risk visualizations can enhance understanding and engagement, while continuous glucose monitoring (CGM) offers immediate feedback on the physiological effects of daily choices.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to explore how patients at increased CVD risk and family medicine nurses perceive CVD risk visualization (Petal-X) and the integration of real-time glucose monitoring, with a focus on perceived person-centered care (PCC), motivation, and lifestyle change. This manuscript reports the qualitative phase of a larger sequential mixed methods study; the quantitative randomized controlled trial is reported separately.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Using total population (census) sampling within a closed, predefined trial cohort, we invited every eligible patient who had completed the intervention arm of a parallel randomized controlled trial and every eligible registered nurse providing preventive consultations at the same single community health center in central Slovenia who had been familiarized with the intervention and with the Petal-X dashboard; 6 patients at increased CVD risk who had used the Petal-X dashboard in combination with CGM, and 6 nurses familiar with the intervention, took part, and interviews were conducted between September and December 2024. Data were collected through individual, face-to-face semistructured interviews that explored perceptions of the visualization, real-time glucose monitoring, and lifestyle change. Interviews were audio-recorded, transcribed verbatim, and analyzed by inductive qualitative content analysis within a qualitative descriptive design; coding continued until code saturation and data adequacy were judged to have been reached.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The analysis produced 11 subcategories, which were grouped into 4 categories, with an overarching theme running across them: visualization and digital tools as support for PCC to enhance motivation and lifestyle change in individuals at risk of CVD. Patients and nurses reported that personalized visual displays improved understanding of risk factors, facilitated dialogue and shared decision-making, and increased patients\u2019 sense of involvement, responsibility, and control, although the 2 groups differed in emphasis: patients foregrounded personal meaning and self-regulation, whereas nurses foregrounded communication and fit with the consultation workflow. CGM was perceived as particularly motivating by linking behavior (food, activity, and stress) to real-time glucose changes, encouraging dietary and activity adjustments that some participants maintained after the intervention. Key barriers included variable digital literacy (especially among older users), fear or mistrust of technology, the attentional burden of continuous monitoring, potential information overload, workflow integration needs, and affordability or accessibility of CGM.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Interactive CVD risk visualization Petal-X, especially when complemented by CGM, was perceived as a meaningful support for PCC and a driver of motivation and lifestyle change in primary prevention. Implementation should address training, usability, integration into routine workflows, and equity of access.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/92101","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:41:54Z","timestamp":1791906114000},"page":"e92101-e92101","source":"Crossref","is-referenced-by-count":0,"title":["Risk Visualization With Petal-X and Continuous Glucose Monitoring to Support Person-Centered Care and Lifestyle Change in Cardiovascular Prevention: Qualitative Descriptive Study"],"prefix":"10.2196","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0323-1720","authenticated-orcid":false,"given":"Adrijana","family":"Sven\u0161ek","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2672-0738","authenticated-orcid":false,"given":"Diego","family":"Rojo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7200-5204","authenticated-orcid":false,"given":"Mateja","family":"Lorber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0270-1754","authenticated-orcid":false,"given":"Zalika","family":"Klemenc-Ketis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8742-6594","authenticated-orcid":false,"given":"Lucija","family":"Gosak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6699-7710","authenticated-orcid":false,"given":"Katrien","family":"Verbert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0183-8679","authenticated-orcid":false,"given":"Gregor","family":"\u0160tiglic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"issue":"2","key":"R1","doi-asserted-by":"publisher","DOI":"10.1080\/13814788.2023.2193886","article-title":"Experience and views of primary care physicians involved in reorganisation of care in family medicine practices during COVID-19 pandemic: a qualitative study from Slovenia","volume":"29","author":"Kova\u010dec","journal-title":"Eur J Gen Pract"},{"key":"R2","unstructured":"Mau\u010dec Zakotnik J \u010cu\u0161 B Vrbov\u0161ek S Govc Er\u017een J Medved N . Programme of integrated prevention of chronic non-communicable diseases in adults\u2014description of the preventive pathway of the individual being assessed. In: Govc Er\u017een J Petek \u0160ter M , editors. Handbook for Family Physicians: Implementing Integrated Prevention of Chronic Non-Communicable Diseases in Model Family Medicine Practices. National Institute of Public Health; 2017:10-16. URL: http:\/\/skupajzazdravje.nijz.si\/media\/splet-.zdm.prirocnik.pdf ISBN: 978-961-7002-30-0"},{"issue":"9-10","key":"R3","doi-asserted-by":"publisher","first-page":"478","DOI":"10.6016\/ZdravVestn.3069","article-title":"Treatment of patients with arterial hypertension in family medicine in Slovenia \u2013 assessment of the situation after the introduction of model practices","volume":"90","author":"Petek \u0160ter","journal-title":"ZdravVestn"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2023.1287434","article-title":"Prediction models for major adverse cardiovascular events after percutaneous coronary intervention: a systematic review","volume":"10","author":"Deng","journal-title":"Front Cardiovasc Med"},{"issue":"4","key":"R5","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1097\/EDE.0b013e3181a39056","article-title":"Prognostic models with competing risks: methods and application to coronary risk prediction","volume":"20","author":"Wolbers","journal-title":"Epidemiology"},{"issue":"25","key":"R6","doi-asserted-by":"publisher","first-page":"2439","DOI":"10.1093\/eurheartj\/ehab309","article-title":"SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe","volume":"42","author":"Hageman","journal-title":"Eur Heart J"},{"issue":"1","key":"R7","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-022-13944-w","article-title":"Evaluation of cardiovascular diseases risk calculators for CVDs prevention and management: scoping review","volume":"22","author":"Badawy","journal-title":"BMC Public Health"},{"issue":"6","key":"R8","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1016\/j.ihj.2014.10.399","article-title":"Comparative accuracy of different risk scores in assessing cardiovascular risk in Indians: a study in patients with first myocardial infarction","volume":"66","author":"Bansal","journal-title":"Indian Heart J"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.2196\/60128","article-title":"The role of visualization in estimating cardiovascular disease risk: scoping review","volume":"10","author":"Sven\u0161ek","journal-title":"JMIR Public Health Surveill"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2021.12.001","article-title":"The importance of healthy lifestyle behaviors in the prevention of cardiovascular disease","volume":"70","author":"Kaminsky","journal-title":"Prog Cardiovasc Dis"},{"issue":"5","key":"R11","doi-asserted-by":"publisher","first-page":"102490","DOI":"10.1016\/j.cpcardiol.2024.102490","article-title":"Cardiovascular disease risk communication: strategies, impact, and future directions","volume":"49","author":"Sebastian","journal-title":"Curr Probl Cardiol"},{"issue":"1","key":"R12","doi-asserted-by":"publisher","DOI":"10.1007\/s10916-024-02097-5","article-title":"Evaluating EHR-integrated digital technologies for medication-related outcomes and health equity in hospitalised adults: a scoping review","volume":"48","author":"Murthi","journal-title":"J Med Syst"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.3389\/fdgth.2023.1253050","article-title":"Digital twin for healthcare systems","volume":"5","author":"Vall\u00e9e","journal-title":"Front Digit Health"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.1016\/j.aej.2024.01.021","article-title":"Wearable devices for glucose monitoring: a review of state-of-the-art technologies and emerging trends","volume":"89","author":"Mansour","journal-title":"Alex Eng J"},{"key":"R15","unstructured":"Sven\u0161ek A Gosak L Kopitar L \u0160tiglic G . Using a continuous blood glucose monitor as a form of remote patient care. Vol 2023. Sustainable Digital Future of Healthcare: MI\u201923 Professional Meeting; :32. URL: https:\/\/plus-legacy.cobiss.net\/cobiss\/si\/sl\/bib\/172101123 [Accessed 23-01-2026]"},{"issue":"3","key":"R16","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-026342","article-title":"Shared decision-making about cardiovascular disease medication in older people: a qualitative study of patient experiences in general practice","volume":"9","author":"Jansen","journal-title":"BMJ Open"},{"issue":"1","key":"R17","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-024-02357-w","article-title":"\u201cThey are saying it\u2019s high, but I think it\u2019s quite low\u201d: exploring cardiovascular disease risk communication in NHS health checks through video-stimulated recall interviews with patients - a qualitative study","volume":"25","author":"Cowap","journal-title":"BMC Prim Care"},{"key":"R18","unstructured":"Rojo D Lamqaddam H Gosak L Verbert K . Petal-X: human-centered visual explanations to improve cardiovascular risk communication. arXiv. Preprint posted online on Jun 26, 2024. [doi: 10.48550\/arXiv.2406.18690]"},{"key":"R19","unstructured":"Creswell JW . Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. SAGE Publications; 2014. ISBN: 978-1-0718-1794-0"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.2196\/83488","article-title":"Interactive digital visualization counseling for lifestyle change in patients at risk of cardiovascular diseases: randomized controlled trial","volume":"12","author":"Sven\u0161ek","journal-title":"JMIR Public Health Surveill"},{"issue":"4","key":"R21","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1002\/1098-240x(200008)23:4<334::aid-nur9>3.0.co;2-g","article-title":"Whatever happened to qualitative description?","volume":"23","author":"Sandelowski","journal-title":"Res Nurs Health"},{"issue":"1","key":"R22","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1111\/j.1365-2648.2007.04569.x","article-title":"The qualitative content analysis process","volume":"62","author":"Elo","journal-title":"J Adv Nurs"},{"issue":"2","key":"R23","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.nedt.2003.10.001","article-title":"Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness","volume":"24","author":"Graneheim","journal-title":"Nurse Educ Today"},{"key":"R24","unstructured":"Lincoln YS Guba EG . Naturalistic Inquiry. SAGE Publications; 1985. ISBN: 0803924313"},{"issue":"6","key":"R25","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated Criteria for Reporting Qualitative Research (COREQ): a 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","journal-title":"Int J Qual Health Care"},{"issue":"4","key":"R26","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1177\/1049732316665344","article-title":"Code saturation versus meaning saturation: how many interviews are enough?","volume":"27","author":"Hennink","journal-title":"Qual Health Res"},{"key":"R27","unstructured":"Sven\u0161ek A . Using the visualization for lifestyle change in patients at risk of cardiovascular diseases. ClinicalTrials.gov; 2024. URL: https:\/\/clinicaltrials.gov\/study\/NCT06226948 [Accessed 05-10-2026]"},{"key":"R28","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2015.03.336","article-title":"Person-centred care after acute coronary syndrome, from hospital to primary care - a randomised controlled trial","volume":"187","author":"Fors","journal-title":"Int J Cardiol"},{"issue":"23","key":"R29","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.014021","article-title":"Changing results-engage and activate to enhance wellness: a randomized clinical trial to improve cardiovascular risk management","volume":"8","author":"Iturralde","journal-title":"J Am Heart Assoc"},{"issue":"3","key":"R30","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1002\/ejhf.3134","article-title":"Effect of a transitional care model following hospitalization for heart failure: 3-year outcomes of the Patient-Centered Care Transitions in Heart Failure (PACT-HF) randomized controlled trial","volume":"26","author":"Averbuch","journal-title":"Eur J Heart Fail"},{"issue":"8","key":"R31","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0203031","article-title":"Effects of a person-centred telephone-support in patients with chronic obstructive pulmonary disease and\/or chronic heart failure - a randomized controlled trial","volume":"13","author":"Fors","journal-title":"PLoS ONE"},{"issue":"1","key":"R32","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1145\/3576935","article-title":"Visualization and visual analytics approaches for image and video datasets: a survey","volume":"13","author":"Afzal","journal-title":"ACM Trans Interact Intell Syst"},{"key":"R33","doi-asserted-by":"publisher","DOI":"10.2196\/56466","article-title":"Review and comparative evaluation of mobile apps for cardiovascular risk estimation: usability evaluation using mHealth app usability questionnaire","volume":"13","author":"Sven\u0161ek","journal-title":"JMIR Mhealth Uhealth"},{"key":"R34","unstructured":"Theis S Mertens A Schlick CM . Preliminary results of an exploratory study towards a general task and data model for telemedical visualizations. Presented at: Conference: 19thTriennial Congress of the International Ergonomics Association; Aug 9-14, 2015:1-6; Melbourne. URL: https:\/\/publications.rwth-aachen.de\/record\/659041 [Accessed 25-02-2026]"},{"issue":"4","key":"R35","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1055\/s-0039-1697592","article-title":"A systematic review of patient-facing visualizations of personal health data","volume":"10","author":"Turchioe","journal-title":"Appl Clin Inform"},{"issue":"12","key":"R36","doi-asserted-by":"publisher","DOI":"10.1007\/s10916-021-01776-x","article-title":"A review of mortality risk prediction models in smartphone applications","volume":"45","author":"Fija\u010dko","journal-title":"J Med Syst"},{"issue":"5","key":"R37","doi-asserted-by":"publisher","first-page":"772","DOI":"10.3390\/su9050772","article-title":"Mobile healthcare applications and gamification for sustained health maintenance","volume":"9","author":"Lee","journal-title":"Sustainability"},{"key":"R38","volume":"4","author":"Lohnari","journal-title":"Int J Eng Res Gen Sci"},{"key":"R39","doi-asserted-by":"crossref","unstructured":"Moungui HC Nana-Djeunga HC Anyiang CF Cano M Ruiz-Postigo JA Carrion C . Dissemination of mobile health applications: a systematic review. JMIR Preprints. Preprint posted online on Jun 26, 2023. [doi: 10.2196\/preprints.50293]","DOI":"10.2196\/50293"},{"issue":"1","key":"R40","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1002\/hpja.671","article-title":"Biological age calculators to motivate lifestyle change: environmental scan of online tools and evaluation of behaviour change techniques","volume":"34","author":"Bonner","journal-title":"Health Promot J Austr"},{"issue":"6","key":"R41","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1016\/j.pcad.2016.02.007","article-title":"The Wild Wild West: a framework to integrate mHealth software applications and wearables to support physical activity assessment, counseling and interventions for cardiovascular disease risk reduction","volume":"58","author":"Lobelo","journal-title":"Prog Cardiovasc Dis"},{"issue":"4","key":"R42","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1007\/s11739-019-02206-0","article-title":"The HEART score as a prognostic tool for revascularization","volume":"15","author":"Oliver","journal-title":"Intern Emerg Med"},{"issue":"5","key":"R43","doi-asserted-by":"publisher","DOI":"10.1002\/widm.1379","article-title":"Interpretability of machine learning\u2010based prediction models in healthcare","volume":"10","author":"Stiglic","journal-title":"WIREs Data Min Knowl"},{"issue":"2","key":"R44","doi-asserted-by":"publisher","DOI":"10.2196\/31056","article-title":"Interventions using heart age for cardiovascular disease risk communication: systematic review of psychological, behavioral, and clinical effects","volume":"5","author":"Bonner","journal-title":"JMIR Cardio"}],"container-title":["JMIR Human Factors"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:41:56Z","timestamp":1791906116000},"score":1,"resource":{"primary":{"URL":"https:\/\/humanfactors.jmir.org\/2026\/1\/e92101"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,13]]},"references-count":44,"URL":"https:\/\/doi.org\/10.2196\/92101","relation":{},"ISSN":["2292-9495"],"issn-type":[{"value":"2292-9495","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,13]]},"article-number":"v13i2e92101"}}