Lay beliefs about risk: relation to risk behaviors and to probabilistic risk perceptions

Gaps in awareness and practice of healthy lifestyles among individuals at high risk of colorectal cancer: A qualitative evidence synthesis

AIMS

To systematically examine and review relevant qualitative studies exploring the current lifestyle among individuals at high risk of colorectal cancer (CRC), and their awareness of the role of a healthy lifestyle in CRC prevention.

BACKGROUND

The increasing incidence and mortality of CRC have presented a serious threat against the health and life of people. As the major population affected by CRC, the lifestyle of individuals at a high risk of CRC is attracting increasing attention.

DESIGN

A qualitative evidence synthesis using the Thomas and Harden method and the PRISMA 2020 checklist provided by the EQUATOR network were used.

DATA SOURCES

Literature was retrieved from PubMed, Web of Science, the Cochrane Library, Embase, CINAHL and PsycINFO from the inception to December 2021.

REVIEW METHODS

Two reviewers independently screened the titles and abstracts and identified the eligible studies. Critical appraisals of each included study were performed. Thematic analysis was used to guide the data synthesis.

RESULTS

The data from nine articles were analysed. Three interpretive themes were extracted that formed an overarching synthesis of the experience with healthy lifestyles among high-risk individuals of CRC. The findings suggested that these individuals with limited awareness of CRC and personal risks lacked sufficient knowledge about the relationship between lifestyle and CRC, and their attitudes and practices towards the role of a healthy lifestyle in CRC prevention were also diversified.

CONCLUSION

Professionals can potentially provide personalised guidance for healthy lifestyles based on knowledge of prevention, the actual background and social support of individuals at high risk of CRC.

IMPACT

Considering that knowledge gaps and health beliefs among these individuals are the premise blocking their adoption of a healthy lifestyle, the findings of this review may make contributions to the design and content of public health policy and prevention programs. No patient or public contribution.

Measurement of Perceived Risk of Developing Diabetes Mellitus: A Systematic Literature Review

BACKGROUND

This systematic review describes approaches to measuring perceived risk of developing type 2 diabetes among individuals without diagnoses and describes the use of theories, models, and frameworks in studies assessing perceived risk. While a systematic review has synthesized perceived risk of complications among individuals with diabetes, no reviews have systematically assessed how perceived risk is measured among those without a diagnosis.

METHODS

Medline, PubMed, PsycINFO, and CINAHAL databases were searched for studies conducted through October 2022 with measures of perceived risk among adults ≥ 18 years without a diabetes diagnosis. Extracted data included study characteristics, measures, and health behavior theories, models, or frameworks used.

RESULTS

Eighty-six studies met inclusion criteria. Six examined perceived risk scales' psychometric properties. Eighty measured perceived risk using (1) a single item; (2) a composite score from multiple items or subconstructs; and (3) multiple subconstructs but no composite score. Studies used items measuring "comparative risk," "absolute or lifetime risk," and "perceived risk" without defining how each differed. Sixty-four studies used cross-sectional designs. Twenty-eight studies mentioned use of health behavior theories in study design or selection of measures.

DISCUSSION

There was heterogeneity in how studies operationalized perceived risk; only one third of studies referenced a theory, model, or framework as guiding design or scale and item selection. Use of perceived lifetime risk, absolute risk, or comparative risk limits comparisons across studies. Consideration of context, target population, and how data are utilized is important when selecting measures; we present a series of questions to ask when selecting measures for use in research and clinical settings. This review is the first to categorize how perceived risk is measured in the diabetes prevention domain; most literature focuses on perceived risk among those with diabetes diagnoses. Limitations include exclusion of non-English and gray literature and single reviewer screening and data extraction.

Lay perceptions of diabetes mellitus and prevention costs and benefits among adults undiagnosed with the condition in Singapore: a qualitative study

Background

Therapeutic lifestyle changes can reduce individual risk of type 2 diabetes (T2D) by up to 58%. In Singapore, rates of preventive practices were low, despite a high level of knowledge and awareness of T2D risk and prevention. The study explored the context of the discrepancy between knowledge and practices in T2D prevention among adults undiagnosed with the condition.

Methods

In-depth interviews with 41 adults explored lay beliefs of T2D and the sources of these perceptions, subjective interpretation of how T2D may impact lives, and perceived costs and benefits of practising preventative behaviours. Purposive sampling was used to maximise the variability of participants in demographic characteristics. Thematic analysis was conducted to identify themes related to the domains of inquiry.

Results

Participants’ risk perceptions were influenced by familial, social, and cultural contexts of the representation and management of T2D conditions. The adverse effects of T2D were often narrated in food culture. The cost of adopting a healthy diet was perceived at a high cost of life pleasure derived from food consumption and social interactions. Inconveniences, loss of social functions, dependency and distress were the themes related to T2D management. Participants’ motivation to preventive practices, such as exercise and weight loss, were influenced by short-term observable benefits.

Conclusions

T2D risk communication needs to be addressed in emotionally impactful and interpersonally salient ways to increase the urgency to adopt preventative behaviours. Shifting perceived benefits from long-term disease prevention to short-term observable wellbeing could reduce the response cost of healthy eating.

Effect of Superstitious Beliefs and Risk Intuitions on Genetic Test Decisions

INTRODUCTION

Moving beyond numeric representations of risk perceptions, we examine cognitive causation, or superstitious thinking, and negative affect in risk as predictors of MC1R (i.e., moderate v. high risk) skin cancer genetic testing and responses to this testing.

METHODS

Participants (N = 496) completed baseline assessments using validated measures of cognitive causation (beliefs that thinking about cancer risk increases cancer likelihood) and negative affect in risk (negative feelings generated during risk perception) and subsequently received a test offer. Participants could access a website to learn about and request genetic testing. Those who tested (n = 167) completed assessments of cognitive and affective reactions 2 wk after testing, including the Impact of Events-Revised Intrusive thoughts subscale.

RESULTS

Those with higher negative affect in risk were less likely to return a saliva sample for testing (odds ratio = 0.98, 95% confidence interval = 0.96-0.99). Those with higher cognitive causation reported more fear (b = 0.28-0.31; P's < 0.05). Higher negative affect in risk was associated with more emotion-laden test responses, particularly in those receiving higher-risk as compared with average-risk results.

CONCLUSION

Negative affect in risk did not hamper test information seeking, although it did inhibit the uptake of genetic testing. Those with higher cognitive causation showed more fear regarding their test result, as indicated by higher distress in those who received average-risk results and lower believability in those who received higher-risk results.

Examining strategies for addressing high levels of 'I don't know' responding to risk perception questions for colorectal cancer and diabetes: an experimental investigation

OBJECTIVE

Many people say they 'don't know' their risk for common diseases (DK responders). Inadequate health literacy and higher disease information avoidance may suppress risk knowledge and thereby increase DK responding. Study goals were to examine two plausible interventions to address the health education needs of DK responders. Design: Participants were identified in a pre-screener as DK responders for either diabetes or colorectal cancer (CRC) risk perception questions (N = 1276; 35% non-white; 49% inadequate health literacy). They were randomly assigned to read either standard or low literacy risk information about diabetes or CRC, and to undergo a self-affirmation intervention or not. Main outcome measure: DK responding following reading the risk information. Results: Neither intervention reduced DK responding. Multivariable analyses showed that health literacy, information avoidance and believing the disease is unpredictable - but not risk factor knowledge and need for cognition - best predicted participants' conversion from a DK response to a non-DK scale point response. Conclusion: Results confirm that both inadequate health literacy and higher information avoidance are associated with DK responding. DK responders are also disproportionately underserved and less adherent to health behaviors. Because galvanising risk perceptions are central to public health, addressing their information needs is a priority.

What people believe about detecting infectious disease using the senses

Do you believe you can tell if people are sick with infectious diseases by looking at, listening to, or smelling them? Research on pathogen detection and avoidance suggests that perceivers respond with caution both to true signs of infection and to cues only heuristically associated with infection threat. But what do perceivers actually believe about the effectiveness and use of specific sensory modalities for infection detection? In several studies, U.S. participants reported perceptions of effectiveness and likelihood of using each of the major senses to identify infection threat in two types of targets: people and food. Results revealed prioritization of sight and sound with person targets and prioritization of sight and smell with food targets. These patterns appear consistent with the use of "safe senses" (avoidance of cues involving high perceived transmission risk). Beliefs about sensory use also varied depending on the specific feature being examined, with different patterns of sensory beliefs associated with evaluation of pathogenic danger than with evaluation of desirability and fit with normative standards. We discuss these lay beliefs in the context of recent calls for descriptive research in psychology as well as their implications for current and future work on the behavioral immune system.