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Jane Ling MY, Ahmad N, Aizuddin AN. Risk perception of non-communicable diseases: A systematic review on its assessment and associated factors. PLoS One 2023; 18:e0286518. [PMID: 37262079 PMCID: PMC10234567 DOI: 10.1371/journal.pone.0286518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 05/17/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The burden of non-communicable diseases (NCDs) is increasing. Risk perception of NCDs is an important factor towards the uptake of preventive health interventions. There are various questionnaires assessing risk perception of NCDs, but no internationally standardized questionnaire has been available. Identification of factors associated with risk perception of NCDs may facilitate the development of targeted interventions. This systematic review aims to identify available questionnaire assessing risk perception of NCDs and the factors associated with risk perception of NCDs. METHODS The reporting of this systematic review is in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We carried out a literature search through three databases (Scopus, PubMed, Web of Science) and targeted original article published in English between 2012 and 2021. Quality appraisal of the eligible articles was conducted using the Mixed Methods Appraisal Tool. Findings were synthesized using content analysis. RESULTS A total of 86 studies were included. We found a variety of questionnaires assessing risk perception of NCDs, with many differences in their development, domains, items and validity. We also identified several personal, sociopsychological and structural factors associated with risk perception of NCDs. LIMITATIONS Most of the included studies were of cross-sectional design, and therefore the quality of evidence was considered low and exhibit a high risk of bias. The role of publication bias within this systematic review should be acknowledged as we did not include grey literature. Additionally, language bias must be considered as we only included English-language publications. CONCLUSION Further development and testing of available questionnaire is warranted to ensure their robustness and validity in measuring risk perception of NCDs. All the identified factors deserve further exploration in longitudinal and experimental studies.
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Affiliation(s)
- Miaw Yn Jane Ling
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Norfazilah Ahmad
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Azimatun Noor Aizuddin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
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Mehta J, MacLaughlin KL, Millstine DM, Faubion SS, Wallace MR, Shah AA, Fields HE, Ruddy BE, Bryan MJ, Patel BK, Buras MR, Golafshar MA, Kling JM. A Comparison of Perceived Lifetime Breast Cancer Risk to Calculated Lifetime Risk Using the Gail Risk Assessment Tool. J Womens Health (Larchmt) 2022; 31:356-361. [PMID: 35041492 DOI: 10.1089/jwh.2019.8231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Understanding the accuracy of a woman's perceived breast cancer risk can enhance shared decision-making about breast cancer screening through provider and patient discussion. We aim to report and compare women's perceived lifetime breast cancer risk to calculated lifetime breast cancer risk. Methods: Women presenting to Mayo Clinic in Arizona and Minnesota in July 2016 completed a survey assessing their perceived breast cancer risk. Lifetime Gail risk scores were calculated from questions pertaining to health history and were then compared with perceived breast cancer risk. Results: A total of 550 predominantly white, married, and well-educated (≥college) women completed surveys. Using lifetime Gail risk scores, 5.6% were classified as high risk (>20% lifetime risk), 7.7% were classified as intermediate risk (15%-20%), and 86.6% were classified as average risk (<15%). Of the 27 women who were classified as high risk, 18 (66.7%) underestimated their risk and of the 37 women who were intermediate risk, 12 (32.4%) underestimated risk. Women more likely to underestimate their risk had a reported history of an abnormal mammogram and at least one or more relative with a history of breast cancer. Surveyed women tended to overestimate risk 4.3 (130/30) times as often as they underestimated risk. Conclusion: In a group of predominantly white, educated, and married cohort of women, there was a large portion of women in the elevated risk groups who underestimated risk. Specific aspects of medical history were associated with underestimation including a history of abnormal mammogram and family history of breast cancer. Overall, in our sample, more women overestimated than underestimated risk.
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Affiliation(s)
- Jaya Mehta
- Department of General Internal Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | | | - Denise M Millstine
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Stephanie S Faubion
- Mayo Clinic, Jacksonville, Florida, USA.,Division of General Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Mark R Wallace
- Department of Community Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Amit A Shah
- Department of Community Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Heather E Fields
- Department of Community Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Barbara E Ruddy
- Department of Community Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Michael J Bryan
- Department of Family Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Bhavika K Patel
- Department of Radiology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Matthew R Buras
- Division of Biostatistics and Bioinformatics, Department of Health Sciences Research, Scottsdale, Arizona, USA
| | - Michael A Golafshar
- Division of Biostatistics and Bioinformatics, Department of Health Sciences Research, Scottsdale, Arizona, USA
| | - Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA.,Mayo Clinic, Jacksonville, Florida, USA
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Martínez-Urquijo A, Postigo Á, Cuesta M, Fernández-Álvarez MDM, Martín-Payo R. Development and validation of the MARA scale in Spanish to assess knowledge and perceived risks and barriers relating to breast cancer prevention. Cancer Causes Control 2021; 32:1237-1245. [PMID: 34236574 PMCID: PMC8492559 DOI: 10.1007/s10552-021-01473-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/24/2021] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to develop a measurement instrument for assessing knowledge of breast cancer and perceived risk of developing the disease (MARA). Methods 641 women with a mean age of 36.19 years (SD = 7.49) participated in the study. Data collection took place during 2019 and included sociodemographic data, data on history of cancer and breast cancer, perceived risk, and feelings of concern about developing breast cancer. Internal consistency, test–retest reliability, convergent validity, and structural validity were tested. Results The questionnaire items comprise 4 subscales: risk factors (9 items), signs and symptoms (9 items), perceived risk (6 items), barriers (7 items). A factor analysis revealed that the first two subscales had two dimensions each, whereas the other two subscales had one dimension each. Each subscale was shown to have adequate reliability (α = 0.74–0.92) and temporal stability (r = 0.201–0.906), as well as strong evidence of validity in relation to a questionnaire on breast cancer knowledge (r = 0.131–0.434). In addition, the subscales were shown to have high discriminatory power in terms of the presence or absence of a history of cancer or breast cancer, perceived risk, and feelings of concern. Conclusion The MARA questionnaire represents a valid, reliable tool for assessing Spanish women’s knowledge, risks, perceptions, and barriers regarding breast cancer.
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Affiliation(s)
- Andrea Martínez-Urquijo
- Hospital Cruz Roja Gijón, Gijón, Spain.,Equipo de Investigación Precam, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Álvaro Postigo
- Facultad de Psicología, Universidad de Oviedo, Oviedo, Spain
| | | | - María Del Mar Fernández-Álvarez
- Facultad de Medicina y Ciencias de La Salud, Universidad de Oviedo, Oviedo, Spain. .,Equipo de Investigación Precam, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.
| | - Rubén Martín-Payo
- Facultad de Medicina y Ciencias de La Salud, Universidad de Oviedo, Oviedo, Spain.,Equipo de Investigación Precam, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
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Perceived Breast Cancer Risk among Female Undergraduate Students in Ghana: A Cross-Sectional Study. JOURNAL OF ONCOLOGY 2021; 2021:8811353. [PMID: 33953748 PMCID: PMC8064772 DOI: 10.1155/2021/8811353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 03/21/2021] [Accepted: 04/08/2021] [Indexed: 12/24/2022]
Abstract
Background While breast cancer accounts for the highest mortality among women across the globe, little is known about its perceived risks among them. We examined the perceived risk of breast cancer among undergraduate female university students in Ghana. Methods This was a cross-sectional survey of 358 undergraduate female students at the University of Health and Allied Sciences, Ghana. Descriptive and inferential statistics comprising frequencies, percentages, chi-square, and binary logistic regression analyses were used in analysing the data collected. All analyses were done using STATA Version 13.1. Results Seventy-three percent were aware of breast cancer and 45.2% out of this did not perceive themselves to be at risk of breast cancer. Academic year (p=0.02), school (p=0.01), knowledge of someone with breast cancer (p < 0.001), family history of breast cancer (p < 0.001), current use of oral pills/injectable contraception (p=0.03), history of breast cancer screening (p < 0.001), and intention to perform breast self-examination (p < 0.001) were the risk factors of breast cancer risk perception. Students without a family history of breast cancer were 90% less likely to perceive breast cancer risk (AOR = 0.10, 95% CI = 0.04-0.29) compared with those having a family history of breast cancer. Students who had never screened for breast cancer were also 62% less likely to perceive that they were at risk of breast cancer (AOR = 0.10, 95% CI = 0.04-0.29) compared with those who had ever screened for breast cancer. Conclusion This study showed that female university students tend to estimate their breast cancer risk based on their experience of breast cancer. Students who have ever screened for breast cancer and those with the intention to perform breast self-examination in the future are more likely to perceive themselves as being at risk and thus take action to avoid getting breast cancer.
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Hajian-Tilaki K, Nikpour M. Accuracy of self-perceived risk perception of breast cancer development in Iranian women. BMC WOMENS HEALTH 2021; 21:93. [PMID: 33663481 PMCID: PMC7934235 DOI: 10.1186/s12905-021-01238-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 02/22/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND The accuracy of subjective risk perception is a matter of concern in breast cancer development. The objective of this study was to evaluate the accuracy of self-perceived risk assessment of breast cancer development and compared to actual risk in Iranian women. METHODS The demographic, clinical, and reproductive characteristics of 800 women aged 35-85 years were collected with an in-person interview. The self-perceived risk and the actual risk were assessed using the visual analog scale (VAS) and he Gail model respectively. Gail's cutoff of 1.66% risk was used to categorize the estimated 5-year actual risk as low/average risk (< 1.66%) and high risk (≥ 1.66). In low/average risk, if the self-perceived risk > actual risk, then individuals were considered as overestimating. Similarly, in high-risk women, if the perceived risk < actual risk, then, the subjects were labeled as under-estimate; otherwise, it was labeled as accurate. The Kappa statistics were used to determine the agreement between self-perceived risk and actual risk. ROC analysis was applied to determine the accuracy of self-perceived risk in the prediction of actual risk. RESULTS The perceived risk was significantly higher than actual risk (p = 0.001, 0.01 for 5-year and lifetime risk respectively). Both in low and high-risk groups about half of the women over-estimate and underestimate the risk by subjective risk perception. For a 5-year risk assessment, there was no agreement between perceived risk and actual risk (Kappa = 0.00, p = 0.98) but a very low agreement between them in lifetime risk assessment (Kappa = 0.09, p = 0.005). The performance of accuracy of risk perception versus actual risk was very low (AUC = 0.53, 95% CI 0.44-0.61 and AUC = 0.58, 95% CI 0.54-0.62 for the 5-year risk and lifetime risk respectively). CONCLUSION The clinical performance of risk perception based on VAS is very poor. Thus, the efforts of the public health education program should focus on the correct perception of breast cancer risk among Iranian women.
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Affiliation(s)
- Karimollah Hajian-Tilaki
- Department of Biostatistics and Epidemiology, Babol University of Medical Sciences, Babol, Iran.,Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Maryam Nikpour
- Non-Communicable Disease Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
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Açucena Vieira Alves S, Weller M. Breast Cancer Risk Perception and Mammography Screening Behavior of Women in Northeast Brazil. WOMEN'S HEALTH REPORTS 2020; 1:150-158. [PMID: 33786479 PMCID: PMC7784808 DOI: 10.1089/whr.2019.0026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Previous studies suggest that education and income affect Brazilian women's breast cancer prevention behavior. The present study focused on the impact of perceived and estimated risk on mammography screening (MS) behavior. Materials and Methods: Information regarding socioeconomic variables and risk perception was obtained from 396 healthy women aged 40-79 years. Perceived comparative risk was measured on a seven-point Likert scale. A Breast Cancer Risk Assessment Tool of 5-year risk to develop breast cancer was used to determine objective risk. Estimated comparative risk was determined as categories of perceived risk relative to the objective risk. Regression analysis was applied to determine odds ratios (ORs) and confidence intervals (95% CIs) of variables. Results: Asked about the potential of MS to lower risk of death because of breast cancer, 215 (54.29%) responded that it does not lower risk. Women with low perceived comparative risk had a twofold (OR = 0.493; 95% CI: 0.24-1.00) decreased chance to participate in MS annually, compared with women with high-perceived comparative risk (p = 0.020). Women without family history had a 7.6-fold (OR = 0.132; 95% CI: 0.07-0.25) decreased chance of having a high-perceived comparative risk (p = 0.000). If compared with underestimation, the overestimation and accurate estimation of comparative risk tended to be associated with a decreased chance of MS attendance (p = 0.017). Regression modeling indicated that low educational level, no occupation, and no family history decreased the chance of women having MS (p = 0.040; p = 0.010; p = 0.022). Conclusions: Risk perception depended on family history. Present data did not indicate that overestimation, or accurate estimation of comparative risk, increased chance of MS attendance. Educational level, occupation status, and family history, instead, determined MS performance.
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Affiliation(s)
| | - Mathias Weller
- Post Graduate Program in Public Health, State University of Paraíba (UEPB), Campina Grande, Paraíba, Brazil
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Nikpour M, Hajian-Tilaki K, Bakhtiari A. Risk Assessment for Breast Cancer Development and Its Clinical Impact on Screening Performance in Iranian Women. Cancer Manag Res 2019; 11:10073-10082. [PMID: 31819640 PMCID: PMC6890170 DOI: 10.2147/cmar.s229585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/16/2019] [Indexed: 01/28/2023] Open
Abstract
Introduction The aim of this study is to estimate the objective and subjective risk and to examine their associations with three forms of breast cancer screening. Methods This cross-sectional study was conducted with a sample of 800 women aged 35–85 years from the community setting and outpatient clinic in Babol, the north of Iran. The demographic, socio-economic characteristics and the risk factor profiles were collected through in-person interview. The health belief model (HBM) and visual analog scales were used to assess the women’s perceived risk of breast cancer. The practice of women regarding breast self-examination (BSE), breast clinical examination (BCE), and mammography were measured. We used the Gail model in estimating 5-year and lifetime risk. The logistic regression model was applied to determine the relationship of calculated and perceived risk on screening behaviors. Results The mean of estimated 5-year and lifetime risk were 0.89 ±0.89 and 8.87 ±3.84 percent respectively while the perceived personal risk on visual scale perception was much greater than the calculated risk. The high 5-year calculated risk was a predictor of mammography practice but not BSE and BCE; however, after adjusting the subscales of HBM and socio-demographic characteristics, its effect remained significant (adjusted OR=1.97(95% CI: 1.02–3.08)). The perceived risk from HBM in particular self-efficacy (p=0.001) remained positively significant on all forms of screening practice. Conclusion While the perceived risk from HBM scale was meaningful in screening performance, the calculated risk from the Gail model had a clinical impact on mammography behaviors independent of HBM scales.
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Affiliation(s)
- Maryam Nikpour
- Student Research Committee, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Karimollah Hajian-Tilaki
- Department of Biostatistics and Epidemiology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Afsaneh Bakhtiari
- Department of Midwifery, School of Medicine, Babol University of Medical Sciences, Babol, Iran
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Paalosalo-Harris K, Skirton H. Mixed method systematic review: the relationship between breast cancer risk perception and health-protective behaviour in women with family history of breast cancer. J Adv Nurs 2016; 73:760-774. [DOI: 10.1111/jan.13158] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 12/18/2022]
Affiliation(s)
| | - Heather Skirton
- School of Nursing and Midwifery; Faculty of Health and Human Sciences; Plymouth University; Plymouth UK
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Eismann S, Vetter L, Keller M, Bruckner T, Golatta M, Hennings A, Domschke C, Dikow N, Sohn C, Heil J, Schott S. Long-term experiences with genetic consultation in people with hereditary breast and ovarian cancer. Arch Gynecol Obstet 2016; 294:1011-1018. [DOI: 10.1007/s00404-016-4133-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 06/02/2016] [Indexed: 12/30/2022]
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Kelly KM, Chopra I, Dolly B. Breastfeeding: An Unknown Factor to Reduce Heart Disease Risk Among Breastfeeding Women. Breastfeed Med 2015; 10:442-7. [PMID: 26436588 DOI: 10.1089/bfm.2015.0082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Breastfeeding confers many health benefits not only to babies but also to their lactating mothers. Breastfeeding is a notable protective factor in the Gail model for breast cancer and is protective for heart disease. Although individuals in the Appalachian region have lower risk of developing breast cancer, their risk of heart disease is elevated compared with the national value for the United States. SUBJECTS AND METHODS We surveyed 155 predominantly breastfeeding mothers of toddlers under 3 years old, recruited through parenting groups, daycares, and county extension in Appalachian West Virginia. Participants were asked their perceived comparative risks for breast cancer and heart disease and why they felt their risk was higher, same, or lower than that of the general population. RESULTS For breast cancer, 29.7% felt their risk was lower than the general population. For heart disease, 26.5% felt their risk was lower than the general population. Although these risks were highly correlated (p=0.006), there was considerable variability in responses (p<0.03). Qualitative responses for breast cancer risk frequently included breastfeeding (30.3%) and family history (30.3%). Qualitative responses for heart disease noted family history (36.1%) but did not include breastfeeding. A regression analysis found that greater family history, shorter duration of breastfeeding, and fewer pregnancies were associated with greater breast cancer risk perceptions. Family history, lower household income, and current smoking were associated with greater heart disease risk perceptions. CONCLUSIONS These well-educated, predominantly lactating women did not know the protective effects of breastfeeding for heart disease. Increased educational efforts about heart disease may be helpful to encourage more women to breastfeed.
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Affiliation(s)
- Kimberly M Kelly
- School of Pharmacy, West Virginia University , Morgantown, West Virginia
| | - Ishveen Chopra
- School of Pharmacy, West Virginia University , Morgantown, West Virginia
| | - Brandon Dolly
- School of Pharmacy, West Virginia University , Morgantown, West Virginia
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