Table 1.

Coding themes and representative quotes from 10 adolescent and young adult women (AYA) and 10 health care providers (HCPs) giving feedback on the Healthy Heart Score risk assessment.

Themes	Subthemes	Illustrative quotes
Health knowledge	HCP CVDa knowledge and comfortability Teen knowledge of heart attack and stroke Tool as increasing health awareness Sources of knowledge	“…people’s lack…of awareness of that risk or seriousness of that risk, too, especially for young women. They…may just feel like that’s not a thing they necessarily should be worried about...” HCP “Because I think if I eat healthy and take care of myself right, I don’t think that’s going to happen to me, but I don’t know” AYA “I guess things…that surprised me a little, like my instincts with certain foods like, that didn’t make me think, oh man, I’m going to get like a heart attack. But made me think OK, like maybe I should try a little more on that.” AYA
Content of risk assessment tool	Choices Explanations and examples Layout and design Length Wording Motivating language Reading or content level Teen-friendly Visuals	“I feel like, the reading, like on some of them, like it’s helpful, but it’s also a lot. Like I didn’t read through it.” AYA “Well, [the activity choices] were perfectly fine for my kinds of activities, but I can imagine for kids they need to be different because of organized sports.” HCP “I think the time estimates are maybe going to be hard for some people to make like you have to do a little bit of mental math.” HCP [On what was confusing] “The, like how might categorize [physical activity or food intake] like the one, two, three per week.” AYA “I guess it’d be you wanted to have a Spanish version” HCP
Conditions to tool usage	Honest engagement with tool Initial assessment  Ongoing work Barriers to tool usage  Facilitators to tool usage	“I know a few people my age who do drink. And so, I feel like they wouldn’t answer honestly.” AYA “It would be nice to be able to communicate with [teens that] are feeling the same way that actually want to improve their health […] you can relate to someone in the process.” AYA “Sometimes just due to scheduling and the timing of things, you may not have time enough to complete the survey” HCP “This tool is easy, and with technology now, patients are tired of paper.” – HCP
Emotional reaction	Curiosity about personal results Fear of judgment  Fear of results Shame or embarrassment Sharing personal details Surprise or shock Weight	“I’m scared […] because it’ll probably be like, oh well, you probably need to get better with your health or [you’ll have] a heart attack.” AYA “It was kind of shocking to see the result.” AYA “Especially girls. Like they’d be real self-conscious about [their weight]. And so, with the way society and stuff is, and all the pressure to look a certain way and be a certain size or weight this much.” AYA “It’s just a form of education or awareness…I don’t want to have our teens freaking out once they see that.” HCP
Health behaviors	Barriers to behavior change Facilitators to behavior change Existing teen behavior	“High fiber cold cereal? I really don’t eat cereal like that. I don’t really eat breakfast…” AYA “Affordability is an issue as far as what’s at home, what’s available at home or if the teen is even cooking, or does mom cook every day.” – HCP
Motivation	Tool as cue to action External motivation Internal motivation	“I definitely need to get serious about my weight…and move my body more.” AYA “I have a lot of people in my family that have diabetes, high blood pressure, and high blood sugar.” AYA
HCP role in CVD risk assessment	N/Ab	“One of the focus points of the well visit is to assess people’s risk and to address that either by doing further screenings like checking their cholesterol or based on like the data that you have of what their risk might be kind of talking to them about lifestyle changes that could help prevent cardiovascular disease.” HCP

^aCVD: cardiovascular disease.

^bN/A: not applicable.