Journey Wellness References

The Wellness score, indices, and risk calculations are based on international standards, norms, and healthcare professional approved surveys.

Wellness Score

The Wellness Score is calculated based on a combined weighted average of the Heart Health Index, the Mental Health Index, the Morbidity Index, the Nutrition Index, and the Lifestyle Index
One of the key resources of health risk assessment data is Journey’s Health Risk Assessment approved by a group of health professionals, using universal gold standards. These health professionals include general practitioners, registered nurses, biokineticists/exercise physiologists, dieticians and counsellors. All health professionals are registered with the appropriate healthcare bodies in South Africa, which include the Health Professionals Council of South Africa and the South African Nursing Council.

Heart Health Index

The Heart Health Index is calculated based on the Framingham Heart Study (FHS) Cardiovascular Disease (10-year risk) calculations
- https://framinghamheartstudy.org/fhs-risk-functions/cardiovascular-disease-10-year-risk/
- Recommended: 2018 ACSVD 10-year Risk Calculator
  - The Framingham Heart Study recommends the 2018 Prevention Guidelines Tool CV Risk Calculator to calculate to estimate 10-year and lifetime risks for atherosclerotic cardiovascular disease (ASCVD). This 2018 calculator has been provided by the American Heart Association and the American College of Cardiology. The Risk Calculator enables health care providers and patients to estimate 10-year and lifetime risks for atherosclerotic cardiovascular disease (ASCVD), defined as coronary death or nonfatal myocardial infarction, or fatal or nonfatal stroke, based on the Pooled Cohort Equations and the work of Lloyd-Jones, et al., respectively. The information required to estimate ASCVD risk includes age, sex, race, total cholesterol, HDL cholesterol, systolic blood pressure, blood pressure lowering medication use, diabetes status, and smoking status.
- FHS Cardiovascular Disease (10-year risk)
  - Based on
    - D’agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB. General cardiovascular risk profile for use in primary care. Circulation. 2008 Feb 12;117:743-53. PMID:18212285.
  - Outcome
    - CVD (coronary death, myocardial infarction, coronary insufficiency, angina, ischemic stroke, hemorrhagic stroke, transient ischemic attack, peripheral artery disease, heart failure)
  - Duration of follow-up
    - Maximum of 12 years, 10-year risk prediction
  - Population of interest
    - Individuals 30 to 74 years old and without CVD at the baseline examination
  - Predictors:
    - Age
    - Diabetes
    - Smoking
    - Treated and untreated Systolic Blood Pressure
    - Total cholesterol
    - HDL cholesterol
    - BMI replacing lipids in a simpler model

Mental Health Index

The Mental Health Index is calculated based on the Patient Health Questionnaire-9 (PHQ-9) which forms part of Journey’s Health Risk Assessment
- https://www.hiv.uw.edu/page/mental-health-screening/phq-9
- The PHQ-9 is a multi-purpose instrument for screening, diagnosing, monitoring and measuring the severity of depression.
- Provisional Diagnosis and Proposed Treatment Actions
  - PHQ-9 Score:
    - 0 – 4
      - Depression Severity: None-minimal
      - Proposed Treatment Actions: None
    - 5 – 9
      - Depression Severity: Mild
      - Proposed Treatment Actions: Watchful waiting; repeat PHQ-9 at follow-up
    - 10 – 14
      - Depression Severity: Moderate
      - Proposed Treatment Actions: Treatment plan, considering counselling, follow-up and/or pharmacotherapy
    - 15 – 19
      - Depression Severity: Moderately Severe
      - Proposed Treatment Actions: Active treatment with pharmacotherapy and/or psychotherapy
    - 20 – 27
      - Depression Severity: Severe
      - Proposed Treatment Actions: Immediate initiation of pharmacotherapy and, if severe impairment or poor response to therapy, expedited referral to a mental health specialist for psychotherapy and/or collaborative management
    - Sources
      - Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener. Medical Care. 2003;41:1284-92.
      - Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606-13.
      - Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatry Ann. 2002;32:509-21.

Morbidity Index

The Morbidity Index is calculated based on answers given in the Journey Health Risk Assessment. This score is normalized to a score out of ten with 1 being the unhealthiest and 10 being the healthiest scores possible.
This index is set by using clinical measurements as well as two main metrics: (1) whether this person is diagnosed with any chronic disease set out within the survey and (2) whether that person is on medication for said chronic condition. Knowing these two answers, a positive score is allocated for not having a chronic condition and/or not being on medication and a zero score is given for being diagnosed with a chronic medication and/or being medicated for said chronic condition.

Lifestyle Index

The Lifestyle Index is calculated based on answers given in the Journey Health Risk Assessment. This score is normalized to a score out of ten with 1 being the unhealthiest and 10 being the healthiest scores possible.
The lifestyle index is calculated based on the answers given by users in the Health Risk Assessment lifestyle section where good habits are allocated a large positive score and bad habits are allocated a low positive score. These questions and the associated answers that are allocated the healthiest score have been discussed and vetted by the healthcare professional network working with Journey.
This index is built on the following good habits:
- Seven hours sleep per night
- Not being a smoker
- Exercising thirty minutes a day on average per week
- Spending 50 percent or more of their work day standing or moving
- Consuming 3 or less servings of alcohol per week

Nutrition Index

The Nutrition Index is calculated based on answers given in the Journey Health Risk Assessment. This score is normalized to a score out of ten with 1 being the unhealthiest and 10 being the healthiest scores possible.
The Nutrition index is calculated based on the answers given by users in the Health Risk Assessment diet section where good eating habits are allocated a large positive score and bad habits are allocated a low positive score. These questions and the associated answers that are allocated the healthiest score have been discussed and vetted by the healthcare professional network working with Journey.
This index is built on the following good habits:
- Eating three meals per day
- Five portions of Fruit and Vegetables per day
- Avoiding deep fried foods
- Limiting salt intake
- Consuming 2 or more litres of water per day
- Drinking 3 or less servings of alcohol per week

Clinical Measurements

Clinical Measurements are allocated scores relative to the brackets that have been set out as best practice by the healthcare professional network working with Journey. These score allocations are able to contribute to the morbidity index.
- BMI
  - The brackets used for BMI score allocation can be found here: https://www.nhs.uk/common-health-questions/lifestyle/what-is-the-body-mass-index-bmi/. The normal bracket is the healthiest bracket and is allocated the highest score.
  - Other references include ACSM and WHO
- Cholesterol
  - The brackets used for Cholesterol score allocation have been discussed and vetted by the healthcare professional network working with Journey. Other references include Heart Foundation and WHO.
  - The healthy bracket is a cholesterol below 4 (mmol/L)
- Glucose
  - The brackets used for Glucose score allocation have been discussed and vetted by the healthcare professional network working with Journey. Other references include Heart Foundation and WHO.
  - The healthy bracket is a glucose between 4 and 6.1(mmol/L)
- Blood Pressure
  - The brackets used for BP score allocation can be found here: https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings. The healthy bracket is allocated the highest score.
  - Other references include Heart Foundation and WHO.

Lifestyle Risk Factors

Lifestyle risk factors identifies unhealthy behaviors found within both the lifestyle and nutrition index calculations. The lifestyle risk factors identified are as follows:
- Too few meals per day (less than three per day)
- Insufficient Fruit and Vegetable intake (less than five a day)
- Not avoiding deep fried food
- Not limiting salt intake
- Insufficient water intake (less than two litres per day)
- High alcohol intake (more than ten servings per week)
- Insufficient sleep (less than seven hours per night)
- Currently Smoking