Validity of self-assessment tools for cardiovascular risk behaviors: A systematic review

Background: A healthy lifestyle is crucial in mitigating cardiovascular disease risk. Numerous tools for cardiovascular risk behaviors have been developed that people can use for self-assessment purposes. However, the validity of these tools is insufficiently understood in the context of self-assessment. This systematic review examines the validity of self-assessment tools for cardiovascular risk behaviors, including lack of physical activity (PA), tobacco smoking, excessive alcohol consumption, unhealthy diet, and chronic psychological stress. Methods: The PubMed, Ovid Embase, and the Cochrane Library databases were searched. Studies investigating the validity of tools in the context of self-assessment (i.e., without active involvement of a healthcare professional) were included. We investigated criterion validity (i.e., comparison to a gold standard), convergent validity (comparison to similar measures), face and content validity, and reliability. Results: Thirty-one unique articles reporting on 37 separate validation studies were included, which examined a total of 49 distinct self-assessment tools (with tools for PA (n = 40), nutritional intake (n = 7), psychological stress (n = 1), and multiple domains (n = 1)). No validation studies were found for self-assessment of tobacco smoking or alcohol consumption. All wearable PA intensity assessment–energy expenditure studies demonstrated weak validity, both in laboratory and free-living conditions. Criterion validity was examined for only two nutritional intake tools, showing weak to moderate validity. For psychological stress and tools measuring multiple domains, only convergent validity was examined. Discussion: Behavioral self-assessment tools are predominantly focused on PA and nutritional intake, with limited evidence for good validity. There is a pressing need for developing and validating comprehensive and accurate self-assessment tools.