Lay constructions of a family history of heart disease: potential for misunderstandings in the clinical encounter?

Background Family history is recognised as a risk factor for coronary heart disease (CHD) by epidemiologists, health professionals, and the public, an d could act either as a spur or barrier to changing health behaviour. Howev er, there has been no systematic investigation of which factors affect whet her people regard themselves as having a family history of CHD or not. Methods We used purposive sampling to select 61 men and women who were midd le class or working class from a large cross-sectional survey. Half the res pondents had indicated in this previous survey that they had heart disease in their family. The range of understanding of the meaning of having a fami ly history was explored in detailed qualitative ssmistructured interviews. Findings Perception of a family history of heart disease depended on knowle dge of the health of family members, the number and closeness of relatives with heart conditions, the age of affected relatives, and the respondent's sex and social class. Men, particularly working-class men, required a great er number of close relatives to be affected to perceive that they had a fam ily history. Even when respondents judged that heart disease ran in their f amily, they did not always perceive themselves as at increased risk because they felt different in crucial ways from affected relatives. Interpretation The factors that people and epidemiologists judge as relevan t to establish presence of a family history can differ. We suggest that the se differences could lead to misunderstandings between doctor and patient, which could undermine advice on CHD risks and associated behavioural change s.