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Peleg S, Nudelman G, Shiloh S. COVID-19 state anxiety of older adults: effects of defensive information processes. ANXIETY, STRESS, AND COPING 2022; 35:111-123. [PMID: 34314271 DOI: 10.1080/10615806.2021.1956479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES To explore coping processes used by adults aged 60 and above (defined as high age-related risk group) in reaction to the COVID-19 threat, and the associations between these processes and state anxiety. DESIGN AND METHODS A cross-sectional study with 498 respondents of an online survey, 72 (15%) in the high age-related risk group. Questionnaires measured: background variables, state anxiety, and COVID-19 related perceptions. RESULTS The high age-related risk group perceived the coronavirus as more severe, their belongingness to a risk group as higher, and the behavioral recommendations as more effective compared to the low age-related risk group. The part of perceived vulnerability that is not explained by belonging to an age-related risk group (defined as residual perceived vulnerability) was lower in the high age-related risk group. Mediation analysis indicated that the high (compared to the low) age-related risk group had lower anxiety levels, and that this effect was mediated by lower residual perceived vulnerability and higher perceived disease severity levels. CONCLUSIONS The higher age-related risk group maintains a relatively moderate level of anxiety without denying their belonging to a high risk group. This can be explained by defensive processing of COVID-19 related information and by developmental processes.
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Affiliation(s)
- Shira Peleg
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Nudelman
- Department of Psychology, The Academic College of Tel Aviv-Yaffo, Israel
| | - Shoshana Shiloh
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
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2
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Kwon S, Park A. Understanding user responses to the COVID-19 pandemic on Twitter from a terror management theory perspective: Cultural differences among the US, UK and India. COMPUTERS IN HUMAN BEHAVIOR 2021; 128:107087. [PMID: 34744298 PMCID: PMC8558263 DOI: 10.1016/j.chb.2021.107087] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/23/2021] [Accepted: 10/30/2021] [Indexed: 12/04/2022]
Abstract
This study uses a new approach to understand people's varied responses to the COVID-19 pandemic. Heightened media coverage and surging death tolls undoubtedly increase individuals' death-related thoughts. Thus, this study draws on terror management theory to analyze the general public's reactions during which mortality is salient. Twitter data were collected from three countries—the US, the UK, and India. Topic modeling analysis using Latent Dirichlet Allocation identified a total of seven themes reflecting two types of defenses: proximal defenses and distal defenses. Proximal defenses included calls for behavioral changes in response to COVID-19. Distal defenses included searching for meaning, political polarization and government incompetence, racial division, and sharing up-to-date information. During a prolonged crisis, anxiety-buffering systems can be undermined and lead to either maladaptive defenses (i.e., psychological distress) or new forms of defenses (i.e., adjusting to the new normal). The analysis highlights cultural differences in defenses across the three countries. Theoretical and practical implications for public health practitioners and social media platform managers are then discussed.
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Affiliation(s)
- Soyeon Kwon
- Division of Digital Business, College of Global Business, Korea University, 2511 Sejong-ro., Sejong, 30019, South Korea
| | - Albert Park
- Department of Software and Information Systems, College of Computing and Informatics, UNC Charlotte, Woodward 310H, 9201 University City Blvd, Charlotte, NC, 28223, USA
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3
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Persky S, Goldring MR, El-Toukhy S, Ferrer RA, Hollister B. Parental Defensiveness about Multifactorial Genomic and Environmental Causes of Children's Obesity Risk. Child Obes 2019; 15:289-297. [PMID: 30946599 PMCID: PMC6590722 DOI: 10.1089/chi.2018.0315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Future integration of genomics into weight management may target children with overweight given prospects for prevention. Meanwhile, parents learn about weight-related genomics primarily through the media, and little is known about parental reactions to complex genomic and environmental causes underlying children's obesity risk. Methods: Three hundred twenty-four parents with overweight who have a child 3-13 years of age were recruited through Amazon Mechanical Turk. Parents were randomized to read an article highlighting one of three causes of obesity risk: genetics only, family environment only, gene-family environment interactions (G × FE), or read a control article. Results: Parents who perceived their child to be overweight exhibited increased risk perception and guilt over parents of lean children overall, but exhibited decreased worry in response to the G × FE message. Furthermore, parents of children with overweight who received the G × FE message did not exhibit heightened risk perception or guilt, reported that the message was less relevant, and that they paid less attention to it. Conclusions: Multifactorial causal information about children's obesity risk elicits unintended consequences among parents whose children are most at-risk for obesity in adulthood. As these messages are most accurate, it is crucial to investigate effective ways to communicate the holistic nature of obesity risk to parents.
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Affiliation(s)
- Susan Persky
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD.,Address correspondence to: Susan Persky, PhD, Social and Behavioral Research Branch, National Human Genome Research Institute, 31 Center Drive B1B36, Bethesda, MD 20892
| | | | - Sherine El-Toukhy
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD
| | - Rebecca A. Ferrer
- Behavioral Research Program, National Cancer Institute, Bethesda, MD
| | - Brittany Hollister
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD
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4
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Does Smokers’ Self-Construal Moderate the Effect of (Self-)persuasion on Smoking? HEALTH PSYCHOLOGY BULLETIN 2019. [DOI: 10.5334/hpb.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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5
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Gamp M, Schupp HT, Renner B. Risk Perceptions After Receiving Multiple Risk Feedback. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2018; 44:1350-1363. [PMID: 29716423 DOI: 10.1177/0146167218767877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
How do people respond to multiple risk feedback in a real-life context? Based on theoretical assumptions, three different predictions for risk perceptions were tested: (a) relative accuracy in risk perceptions, (b) self-defensive responses according to self-affirmation theory, and (c) compensatory responses according to the compensatory health belief model. Participants of a community health screening ( N = 725) received multiple risk indicator feedback for actual blood pressure, blood glucose, and blood lipid levels. Consistent multiple risk feedback profiles encompassed three consistent readings (three normal or three elevated readings). Mixed risk profiles included one elevated and two normal readings. Results indicate relative accuracy in responses: an elevated reading triggered higher risk perception of the respective risk factor. Importantly, the effect was not modulated by the presence of normal readings as assumed by the self-defensive or compensatory response perspective, indicating that people accurately integrate multiple risk indicator feedback as it is often provided in real life.
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Fowler SL, Klein WMP, Ball L, McGuire J, Colditz GA, Waters EA. Using an Internet-Based Breast Cancer Risk Assessment Tool to Improve Social-Cognitive Precursors of Physical Activity. Med Decis Making 2017; 37:657-669. [PMID: 28363033 DOI: 10.1177/0272989x17699835] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Internet-based cancer risk assessment tools might serve as a strategy for translating epidemiological risk prediction research into public health practice. Understanding how such tools affect key social-cognitive precursors of behavior change is crucial for leveraging their potential into effective interventions. PURPOSE To test the effects of a publicly available, Internet-based, breast cancer risk assessment tool on social-cognitive precursors of physical activity. METHODS Women (N = 132) aged 40-78 with no personal cancer history indicated their perceived risk of breast cancer and were randomly assigned to receive personalized ( www.yourdiseaserisk.wustl.edu ) or nonpersonalized breast cancer risk information. Immediately thereafter, breast cancer risk perceptions and physical activity-related behavioral intentions, self-efficacy, and response efficacy were assessed. RESULTS Personalized information elicited higher intentions, self-efficacy, and response efficacy than nonpersonalized information, P values < 0.05. Self-efficacy and response efficacy mediated the effect of personalizing information on intentions. Women who received personalized information corrected their inaccurate risk perceptions to some extent, P values < 0.05, but few fully accepted the information. CONCLUSION Internet-based risk assessment tools can produce beneficial effects on important social-cognitive precursors of behavior change, but lingering skepticism, possibly due to defensive processing, needs to be addressed before the effects can be maximized.
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Affiliation(s)
| | | | - Linda Ball
- Washington University in St. Louis, St. Louis, MO (LB, JM, GAC, EAW)
| | - Jaclyn McGuire
- Washington University in St. Louis, St. Louis, MO (LB, JM, GAC, EAW)
| | - Graham A Colditz
- Washington University in St. Louis, St. Louis, MO (LB, JM, GAC, EAW)
| | - Erika A Waters
- Washington University in St. Louis, St. Louis, MO (LB, JM, GAC, EAW)
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Brown JD, Dutton KA. Truth and Consequences: The Costs and Benefits of Accurate Self-Knowledge. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2016. [DOI: 10.1177/01461672952112006] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Accurate self-knowledge is widely assumed to be necessary, sought after, and characteristic of most people. In this article, the authors examine the logical and evidentiary basis of these assumptions and reach the opposite conclusions.
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8
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Senior V, Smith JA, Michie S, Marteau TM. Making Sense of Risk: An Interpretative Phenomenological Analysis of Vulnerability to Heart Disease. J Health Psychol 2016; 7:157-68. [DOI: 10.1177/1359105302007002455] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study investigates perceptions of familial hypercholesterolaemia (FH) and its genetic basis in patients diagnosed with, and receiving treatment for, FH. Semi-structured interviews were conducted with seven patients. Transcripts were analysed using interpretative phenomenological analysis (IPA). Participants reported engaging in an active process of seeking causes for their FH. FH was invariably attributed to genes. In some cases diet and stress were also considered as causes of FH. Causal attributions appear to be both a determinant and a result of behavioural strategies to reduce risk. On the whole, FH was perceived as unproblematic, a perception that appeared to reflect downward social comparison processes. Nonetheless, participants reported acting in ways consonant with the perception of an increased risk of heart attack, in particular, being vigilant to symptoms of a possible heart attack.
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9
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Blumenthal-Barby JS. Biases and Heuristics in Decision Making and Their Impact on Autonomy. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2016; 16:5-15. [PMID: 27111357 DOI: 10.1080/15265161.2016.1159750] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cognitive scientists have identified a wide range of biases and heuristics in human decision making over the past few decades. Only recently have bioethicists begun to think seriously about the implications of these findings for topics such as agency, autonomy, and consent. This article aims to provide an overview of biases and heuristics that have been identified and a framework in which to think comprehensively about the impact of them on the exercise of autonomous decision making. I analyze the impact that these biases and heuristics have on the following dimensions of autonomy: understanding, intentionality, absence of alienating or controlling influence, and match between formally autonomous preferences or decisions and actual choices or actions.
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10
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Gamp M, Renner B. Experience-based health risk feedback and lack of reassurance. Health Psychol Behav Med 2015. [DOI: 10.1080/21642850.2015.1108197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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11
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Hay JL, Orom H, Kiviniemi MT, Waters EA. "I don't know" my cancer risk: exploring deficits in cancer knowledge and information-seeking skills to explain an often-overlooked participant response. Med Decis Making 2015; 35:436-45. [PMID: 25810268 DOI: 10.1177/0272989x15572827] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 01/19/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Perceived risk is a central theoretical construct in health behavior research. Participants' "don't know" responses to perceived-risk items (DKPR) are usually excluded from analyses. Yet those who provide such responses may have unique cancer information needs. OBJECTIVE The hypotheses that DKPR responding may be due to cancer knowledge deficits or behavioral, skill, and attitudinal antecedents to knowledge deficits (information seeking, numeracy, and self-efficacy, respectively) were explored. METHODS Data from the 2005 Health Information National Trends Survey (HINTS; N = 1789), a US population-based survey, and an urban, minority, primary care clinic survey (N = 590) were analyzed. Multivariable logistic regressions were conducted to examine knowledge deficit explanations for responding DKPR to colon cancer risk perception questions (adjusting for demographics and family colorectal cancer history). MEASURES Comparative (HINTS) and absolute verbal perceived risk of colon cancer (HINTS, clinic survey), knowledge of colon cancer risks and screening, cancer/health information-seeking behavior and self-efficacy (HINTS), and numeracy (clinic survey). RESULTS Greater knowledge of colon cancer prevention and screening, cancer and health information seeking, and numeracy were each associated with lower odds of providing a DKPR response. LIMITATIONS The study was cross-sectional, which limits the ability to infer causal direction. The use of existing data sets limited our variable choices. Other plausible hypotheses may also explain DKPR responding. CONCLUSIONS People who report that they don't know their colon cancer risk may have low cancer knowledge and reduced knowledge acquisition behaviors and skills. Health behavior research could benefit from including data concerning DKPR responses to risk perception questions, because individuals who respond in this way may require interventions to address potential cancer risk knowledge deficits.
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Affiliation(s)
- Jennifer L Hay
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA (JLH)
| | - Heather Orom
- Department of Community Health & Health Behavior, School of Public Health and Health Professions, University at Buffalo, SUNY, New York, NY, USA (HO, MTK)
| | - Marc T Kiviniemi
- Department of Community Health & Health Behavior, School of Public Health and Health Professions, University at Buffalo, SUNY, New York, NY, USA (HO, MTK)
| | - Erika A Waters
- Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis, St. Louis, MO, USA (EAW)
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12
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Myers RE, Ruth K, Manne SL, Cocroft J, Sifri R, Ziring B, Burgh D, Ross E, Weinberg DS. Effects of genetic and environmental risk assessment feedback on colorectal cancer screening adherence. J Behav Med 2015; 38:777-86. [PMID: 25783675 DOI: 10.1007/s10865-015-9626-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 02/23/2015] [Indexed: 01/22/2023]
Abstract
Little is known about the impact of genetic and environmental risk assessment (GERA) feedback on colorectal cancer (CRC) screening. In a recently completed randomized trial, primary care patients received GERA feedback based on a blood test for genetic polymorphisms and serum folate level (GERA Group) versus usual care (Control Group). Subsequently, participants were offered CRC screening. Among participants who received GERA feedback, being at elevated risk was negatively associated with prospective CRC screening adherence. Secondary analyses of data from this study were performed to identify independent predictors of adherence among participants who received GERA feedback. We obtained baseline survey, follow-up survey, and endpoint medical records data on sociodemographic background, knowledge, psychosocial characteristics, risk status, and adherence for 285 GERA Group participants. Univariate and multivariable analyses were performed to identify predictors of CRC screening adherence. Following a 6-month outcomes observation period, we also conducted two focus groups with GERA Group participants to assess their perceptions of GERA risk feedback and screening. Content analyses of focus group data were evaluated to gain insights into participant response to risk feedback. Overall, half of GERA Group participants adhered to screening within 6 months after randomization. Multivariable analyses showed a statistically significant interaction between race and GERA feedback status relative to screening adherence (p = 0.043). Among participants who received average risk feedback, adherence was comparable among whites (49.7 %) and nonwhites (54.1 %); however, among those at elevated risk, adherence was substantially higher among whites (66.7 %) compared to nonwhites (33.3 %). Focus group findings suggest that whites were more likely than nonwhites to view elevated risk feedback as a prompt to screen. In response to receiving elevated risk feedback, nonwhites were more likely than whites to report feeling anxiety about the likelihood of being diagnosed with CRC. Further research is needed to explore race-related CRC screening differences in response to GERA feedback.
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Affiliation(s)
| | - Karen Ruth
- Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | | | - Randa Sifri
- Thomas Jefferson University, Philadelphia, PA, USA
| | - Barry Ziring
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Eric Ross
- Fox Chase Cancer Center, Philadelphia, PA, USA
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Napper LE, Harris PR, Klein WMP. Combining self-affirmation with the extended parallel process model: the consequences for motivation to eat more fruit and vegetables. HEALTH COMMUNICATION 2013; 29:610-618. [PMID: 24138335 DOI: 10.1080/10410236.2013.791962] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
There is potential for fruitful integration of research using the Extended Parallel Process Model (EPPM) with research using Self-affirmation Theory. However, to date no studies have attempted to do this. This article reports an experiment that tests whether (a) the effects of a self-affirmation manipulation add to those of EPPM variables in predicting intentions to improve a health behavior and (b) self-affirmation moderates the relationship between EPPM variables and intentions. Participants (N = 80) were randomized to either a self-affirmation or control condition prior to receiving personally relevant health information about the risks of not eating at least five portions of fruit and vegetables per day. A hierarchical regression model revealed that efficacy, threat × efficacy, self-affirmation, and self-affirmation × efficacy all uniquely contributed to the prediction of intentions to eat at least five portions per day. Self-affirmed participants and those with higher efficacy reported greater motivation to change. Threat predicted intentions at low levels of efficacy, but not at high levels. Efficacy had a stronger relationship with intentions in the nonaffirmed condition than in the self-affirmed condition. The findings indicate that self-affirmation processes can moderate the impact of variables in the EPPM and also add to the variance explained. We argue that there is potential for integration of the two traditions of research, to the benefit of both.
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Affiliation(s)
- Lucy E Napper
- a Department of Psychology , University of Sheffield
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14
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Baldwin AS, Bruce CM, Tiro JA. Understanding how mothers of adolescent girls obtain information about the human papillomavirus vaccine: associations between mothers' health beliefs, information seeking, and vaccination intentions in an ethnically diverse sample. J Health Psychol 2013; 18:926-38. [PMID: 22992585 PMCID: PMC4005804 DOI: 10.1177/1359105312445078] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We examined factors associated with information seeking about the human papillomavirus vaccine among mothers of adolescent girls by testing whether information seeking and vaccination intentions for their daughters are associated with perceived vulnerability, severity, and vaccine benefits in an ethnically diverse sample. Mothers (N = 256) of unvaccinated girls living in Dallas, Texas, were surveyed (49% Black, 29% Hispanic, and 18% White). Perceived vulnerability to human papillomavirus was associated with talking with others (odds ratio = 1.71, 95% confidence interval = 1.09, 2.66) and talking with a doctor about the vaccine (odds ratio = 1.42, 95% confidence interval = 1.01, 1.99), and perceived vaccine benefits were associated with vaccination intentions (odds ratio = 2.96, 95% confidence interval = 1.98, 4.42), but the perceived severity was not associated with any dependent measure. Beliefs about human papillomavirus risk are associated with seeking information from a doctor and interpersonal sources, but ethnic minorities are less likely to talk with others about the vaccine.
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Affiliation(s)
- Austin S Baldwin
- Department of Psychology, Southern Methodist University, Dallas, TX 75275- 0442, USA.
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15
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van ‘t Riet J, Ruiter RA. Defensive reactions to health-promoting information: an overview and implications for future research. Health Psychol Rev 2013. [DOI: 10.1080/17437199.2011.606782] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Hollands GJ, Marteau TM. The impact of using visual images of the body within a personalized health risk assessment: An experimental study. Br J Health Psychol 2012; 18:263-78. [DOI: 10.1111/bjhp.12016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 11/15/2012] [Indexed: 12/15/2022]
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ten Hoor GA, Peters GJY, Kalagi J, de Groot L, Grootjans K, Huschens A, Köhninger C, Kölgen L, Pelssers I, Schütt T, Thomas S, Ruiter RAC, Kok G. Reactions to threatening health messages. BMC Public Health 2012; 12:1011. [PMID: 23171445 PMCID: PMC3575362 DOI: 10.1186/1471-2458-12-1011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 11/13/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Threatening health messages that focus on severity are popular, but frequently have no effect or even a counterproductive effect on behavior change. This paradox (i.e. wide application despite low effectiveness) may be partly explained by the intuitive appeal of threatening communication: it may be hard to predict the defensive reactions occurring in response to fear appeals. We examine this hypothesis by using two studies by Brown and colleagues, which provide evidence that threatening health messages in the form of distressing imagery in anti-smoking and anti-alcohol campaigns cause defensive reactions. METHODS We simulated both Brown et al. experiments, asking participants to estimate the reactions of the original study subjects to the threatening health information (n = 93). Afterwards, we presented the actual original study outcomes. One week later, we assessed whether this knowledge of the actual study outcomes helped participants to more successfully estimate the effectiveness of the threatening health information (n = 72). RESULTS Results showed that participants were initially convinced of the effectiveness of threatening health messages and were unable to anticipate the defensive reactions that in fact occurred. Furthermore, these estimates did not improve after participants had been explained the dynamics of threatening communication as well as what the effects of the threatening communication had been in reality. CONCLUSIONS These findings are consistent with the hypothesis that the effectiveness of threatening health messages is intuitively appealing. What is more, providing empirical evidence against the use of threatening health messages has very little effect on this intuitive appeal.
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Affiliation(s)
- Gill A ten Hoor
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Gjalt-Jorn Y Peters
- Dept. of Research Methods & Statistics, Faculty of Psychology, Open University, P.O. Box 2960, 6401, DL, Heerlen, The Netherlands
| | - Janice Kalagi
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Lianne de Groot
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Karlijne Grootjans
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Alexander Huschens
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Constanze Köhninger
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Lizan Kölgen
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Isabelle Pelssers
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Toby Schütt
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Sophia Thomas
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Robert AC Ruiter
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Gerjo Kok
- Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
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Cameron LD, Reeve J. Risk perceptions, worry, and attitudes about genetic testing for breast cancer susceptibility. Psychol Health 2012; 21:211-30. [PMID: 21985118 DOI: 10.1080/14768320500230318] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study assessed the unique associations of risk perceptions and worry with attitudes about genetic testing for breast cancer susceptibility. Women (general practitioner clinic attenders, university students, and first-degree relatives of breast cancer survivors; N = 303) read information about genetic testing and completed measures assessing perceived cancer risk, cancer worry, and genetic testing attitudes and beliefs. Worry was associated with greater interest in genetic testing, stronger beliefs that testing has detrimental emotional consequences, and positive beliefs about benefits of testing and risk-reducing surgeries. Perceived risk was unrelated to interest and associated with more skeptical beliefs about emotional consequences and benefits of testing and risk-reducing surgeries. At low worry levels, testing interest increased with more positive beliefs about testing benefits; at high worry levels, interest was high regardless of benefits beliefs. The findings support Leventhal's Common-Sense Model of self-regulation delineating interactive influences of risk-related cognitions and emotions on information processing and behavior.
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Wright AJ, Sutton SR, Hankins M, Whitwell SCL, Macfarlane A, Marteau TM. Why does genetic causal information alter perceived treatment effectiveness? An analogue study. Br J Health Psychol 2011; 17:294-313. [PMID: 22107338 DOI: 10.1111/j.2044-8287.2011.02038.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES When a health problem is perceived as having a genetic cause, this appears to increase the perceived effectiveness of pharmacological treatments and reduce perceived effectiveness of non-pharmacological treatments. Potential mediators of this effect include causal attributions, perceived severity, and perceived control over the health problem. This study aimed to use experimental methods to establish which beliefs mediate the effect of genetic causal information on perceived effectiveness of treatments. DESIGN A 4(cause: environmental, family history, genetic test, family history & genetic test)×2(severity: higher or low) between-subjects design using vignettes about heart disease risk, obesity or depression. METHODS A total of 647 adults, randomly assigned to read one of the experimental vignettes, were interviewed. Key outcomes were perceived effectiveness of medication and of non-pharmacological treatments. Potential mediators of perceived severity, perceived controllability, and causal attributions were also assessed. RESULTS For heart disease risk, genetic causes reduced perceived effectiveness of non-pharmacological treatments (an effect mediated by causal attributions and perceived control) but did not influence perceived medication effectiveness. For obesity, neither severity nor cause influenced the perceived effectiveness of either treatment. For depression, genetic causes only increased perceived effectiveness of medication for more severe depression, an effect mediated by perceived control. CONCLUSIONS The impact of genetic causal information on perceived effectiveness of treatments varies with type of health problem. When genetic causal information influences perceived treatment effectiveness, it does so by altering causal attributions and perceived controllability. However, these effects are small and unlikely to translate into clinically meaningful differences in health-enhancing behaviours.
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Affiliation(s)
- Alison J Wright
- Department of Primary Care & Public Health Sciences, King's College London, UK.
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Klein WM, Harris PR, Ferrer RA, Zajac LE. Feelings of vulnerability in response to threatening messages: Effects of self-affirmation. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2011. [DOI: 10.1016/j.jesp.2011.05.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Van ’t Riet J, Ruiter R, De Vries H. Preaching to the choir? The influence of personal relevance on the effects of gain- and loss-framed health-promoting messages. J Health Psychol 2011; 17:712-23. [DOI: 10.1177/1359105311421047] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This article examines the moderating influence of personal relevance on the persuasive effects of gain- and loss-framed messages. We assessed current behaviour as a proxy for personal relevance, provided 169 participants with gain- and loss-framed messages advocating skin self-examination (SSE) and assessed intention to engage in SSE as the outcome measure. The results showed that loss-framed information was more persuasive than gain-framed information, but only for low-relevance participants. This suggests that loss-framed information might be mainly effective for recipients who need little persuading and, in fact, runs the risk of ‘preaching to the choir’.
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Klein WMP, Lipkus IM, Scholl SM, McQueen A, Cerully JL, Harris PR. Self-affirmation moderates effects of unrealistic optimism and pessimism on reactions to tailored risk feedback. Psychol Health 2011; 25:1195-208. [PMID: 20204982 DOI: 10.1080/08870440903261970] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We examined whether self-affirmation would facilitate intentions to engage in colorectal cancer (CRC) screening among individuals who were off-schedule for CRC screening and who were categorised as unrealistically optimistic, realistic or unrealistically pessimistic about their CRC risk. All participants received tailored risk feedback; in addition, one group received threatening social comparison information regarding their risk factors, a second received this information after a self-affirmation exercise and a third was a no-treatment control. When participants were unrealistically optimistic about their CRC risk (determined by comparing their perceived comparative risk to calculations from a risk algorithm), they expressed greater interest in screening if they were self-affirmed (relative to controls). Non-affirmed unrealistic optimists expressed lower interest relative to controls, suggesting that they were responding defensively. Realistic participants and unrealistically pessimistic participants who were self-affirmed expressed relatively less interest in CRC screening, suggesting that self-affirmation can be helpful or hurtful depending on the accuracy of one's risk perceptions.
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Affiliation(s)
- William M P Klein
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA.
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Sweeny K, Cavanaugh AG. Waiting is the hardest part: a model of uncertainty navigation in the context of health news. Health Psychol Rev 2010. [DOI: 10.1080/17437199.2010.520112] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kate Sweeny
- a Department of Psychology , University of California , Riverside, 900 University Ave., Riverside , CA , 90064 , USA
| | - Arezou Ghane Cavanaugh
- a Department of Psychology , University of California , Riverside, 900 University Ave., Riverside , CA , 90064 , USA
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Harris PR, Sillence E, Briggs P. The effect of credibility-related design cues on responses to a web-based message about the breast cancer risks from alcohol: randomized controlled trial. J Med Internet Res 2009; 11:e37. [PMID: 19709989 PMCID: PMC2762857 DOI: 10.2196/jmir.1097] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 03/04/2009] [Accepted: 06/17/2009] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Internet sites typically contain visual design elements that are unrelated to the quality of the health information presented but that could influence credibility judgments and responses to health advice. To assess the effects of such design elements, or credibility cues, experimentally, we exposed women with different levels of weekly alcohol consumption to a website containing high quality but unpalatable information about a related health risk (breast cancer). The information was presented alongside either positive or negative credibility cues unrelated to information content. OBJECTIVES We explored four research questions: (1) Did the cues influence how the women engaged with the site? (2) Did they influence how the women responded cognitively and emotionally? (3) Did they influence whether the women subsequently acted on the advice? (4) Did the impact of the cues vary with how much alcohol the women reported drinking? METHOD A total of 85 women were randomly assigned to view one of two versions of a website containing the same high-quality content but different cues. One version had positive credibility cues (trustmarks), the other had negative ones (adverts, pharmaceutical sponsorship, and a donation button). Objective measures included visual attention (using eye-tracking equipment), time studying the material, and recall. Subjective measures included cognitive and affective responses and intention to change. Measures of subsequent behavior were taken 1 week later. RESULTS First, the cues did not affect how long the women spent on the site or how long they spent reading the text. However, women in the negative cues condition spent more time looking at a donation button than those in the positive cues condition spent looking at a TRUSTe seal (beta = -.43, P < .001) but less time looking at a logo (beta = .43, P < .001) or at certain other features of the site. Those in the negative cues condition also recalled more site content (beta = -.22, P = .048). Second, there were no effects of the cues on any of the measures of cognition, affect, vulnerability, or intentions. However, third, at follow-up, the positive cues had promoted greater alcohol reduction than the negative cues among those women who had previously reported drinking more heavily (beta = -.22, P = .02). So, fourth, the responses to the cues did vary with how much alcohol the women typically drank. CONCLUSIONS Content-irrelevant images and logos can influence the behavioral response to quality health-risk information. These effects may be subtle, changing with time.
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Affiliation(s)
- Peter R Harris
- Psychology Department, University of Sheffield, Western Bank, UK.
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25
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Cole M. Exploring the hand hygiene competence of student nurses: a case of flawed self assessment. NURSE EDUCATION TODAY 2009; 29:380-388. [PMID: 19062139 DOI: 10.1016/j.nedt.2008.10.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Revised: 09/25/2008] [Accepted: 10/18/2008] [Indexed: 05/27/2023]
Abstract
Hand hygiene remains the single most effective measure to prevent hospital acquired infection and yet poor compliance is reported repeatedly. Nurses represent the largest labour group and perform the greatest amount of direct patient care in the contemporary National Health Service. They receive their initial hand hygiene training in the pre-registration curriculum within a competence framework based on knowledge, skills and attitudes. The pre-eminent training method is one that delivers behavioural competence, making the tacit assumption that compliance will follow. In this study a mixed methods approach demonstrated that students overestimated their knowledge and skills, found it difficult to give an objective account of their performance, and reported an improbable level of compliance. The reasons why people can be self serving in their judgements may be due to information processing errors, exacerbated by the model of education and training. Flawed self assessments may present major barriers to improved performance if students view their compliance as better than it actually is. Conceptualising hand hygiene as a taxonomy of learning and introducing the cognitive strategies of reflection and self assessment would better enable students to problem solve, seek out new information, draw on past experience and gain greater and deeper understanding of the complex topic of hand hygiene behaviour.
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Affiliation(s)
- Mark Cole
- School of Nursing, University of Nottingham, Grantham and District Hospital, Grantham, Lincolnshire NG31 8DG, United Kingdom.
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26
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Spontaneous reactions to health risk feedback: a network perspective. J Behav Med 2009; 32:317-27. [DOI: 10.1007/s10865-009-9206-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Accepted: 01/29/2009] [Indexed: 10/21/2022]
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Detweiler-Bedell JB, Friedman MA, Leventhal H, Miller IW, Leventhal EA. Integrating co-morbid depression and chronic physical disease management: identifying and resolving failures in self-regulation. Clin Psychol Rev 2008; 28:1426-46. [PMID: 18848740 PMCID: PMC2669084 DOI: 10.1016/j.cpr.2008.09.002] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 08/15/2008] [Accepted: 09/02/2008] [Indexed: 11/22/2022]
Abstract
Research suggests that treatments for depression among individuals with chronic physical disease do not improve disease outcomes significantly, and chronic disease management programs do not necessarily improve mood. For individuals experiencing co-morbid depression and chronic physical disease, demands on the self-regulation system are compounded, leading to a rapid depletion of self-regulatory resources. Because disease and depression management are not integrated, patients lack the understanding needed to prioritize self-regulatory goals in a way that makes disease and depression management synergistic. A framework in which the management of co-morbidity is considered alongside the management of either condition alone offers benefits to researchers and practitioners and may help improve clinical outcomes.
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Psychological responses to cardiac diagnosis: changes in illness representations immediately following coronary angiography. J Psychosom Res 2008; 65:553-6. [PMID: 19027444 DOI: 10.1016/j.jpsychores.2008.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Revised: 06/03/2008] [Accepted: 07/07/2008] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Coronary angiography is a commonly used diagnostic test for ischemic heart disease. Little is known, however, about how undergoing the procedure impacts on the ways in which individuals perceive their illness. We sought to explore patients' reactions to an angiogram in terms of changes in symptom appraisal, perceived consequences of their condition, and patients' illness concern and emotional response to their condition after the receiving diagnostic results. METHODS The Brief IPQ was administered to patients undergoing a diagnostic coronary angiogram (N=57) before and immediately following the procedure. Changes in illness representations were then compared between patients diagnosed with diseased arteries and patients with normal arteries. RESULTS We found that the number of symptoms patients associated with their condition, illness consequences, and illness emotion decreased for patients receiving normal results but remained unchanged for patients receiving results showing diseased arteries. Illness concern decreased significantly for both patient groups. CONCLUSIONS The results demonstrate that diagnostic results can have clear and immediate effects on how patients' view and emotionally respond to their symptoms. The results also suggest that patients cognitively prepare themselves to receive an unfavorable diagnosis and the pattern suggests those receiving normal results modify their perceptions in a positive direction rather than those receiving an unfavorable diagnosis.
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Kiviniemi MT, Rothman AJ. What do people think about changes in health behaviors? Differential perceptions of consequences of increases and decreases in health behaviors. Psychol Health 2008; 23:867-885. [PMID: 19802395 PMCID: PMC2753289 DOI: 10.1080/14768320701360500] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Most health decision-making models posit that cost-benefit analyses underlie decisions to make changes in health-related behavioral practices. In a series of studies, participants imagined either increasing or decreasing the frequency of a variety of health behaviors and estimated the consequences of those changes. In Studies 1 and 2, individuals consistently estimated that increasing a health behavior produced greater consequences than did decreasing the behavior by an equivalent amount. The results of Study 3 demonstrated that this effect is due to differences in how individuals judge the impact of health behavior changes which involve not engaging in the behavior at all versus other types of changes. Taken together, these findings suggest that perceptions of the outcomes afforded by health behavior changes depend on both the behavioral frequency and direction of changes in behavior an individual is considering. This asymmetry has the potential to help explain patterns of behavior in a range of important health domains and may impact the effectiveness of behavior change interventions.
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Affiliation(s)
- Marc T Kiviniemi
- Department of Psychology, University of Nebraska - Lincoln, NE, USA
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30
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Panzer M, Renner B. To be or not to be at risk: Spontaneous reactions to risk information. Psychol Health 2008; 23:617-27. [DOI: 10.1080/08870440701606889] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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31
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Wright AJ, Takeichi C, Whitwell SCL, Hankins M, Marteau TM. The impact of genetic testing for Crohn's disease, risk magnitude and graphical format on motivation to stop smoking: an experimental analogue study. Clin Genet 2008; 73:306-14. [PMID: 18261131 PMCID: PMC2440307 DOI: 10.1111/j.1399-0004.2008.00964.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Genetic tests may motivate risk-reducing behaviour more than other types of tests because they generate higher risk magnitudes and because their results have high personal relevance. To date, trial designs have not allowed the disentangling of the effects of these two factors. This analogue study examines the independent impacts of risk magnitude and provenance, and of risk display type, on motivation to quit smoking. A total of 180 smokers were randomly allocated to one of the 18 Crohn's disease risk vignettes in a 3 (risk provenance: family history. genetic test mutation positive. genetic test mutation negative) x 3 (risk magnitude: 3%, 6%, 50%) x 2 (display: grouped or dispersed icons) design. The 50% group had significantly higher intentions to quit than the 3% group. A significant risk provenance x magnitude interaction showed that participants in 50% or 6% groups were equally motivated, regardless of risk provenance, while participants in the 3% group had higher intentions associated with a mutation negative result than with a result based on family history alone. Grouped icon displays were more motivating than the dispersed icons. Using genetic tests to estimate risks of common complex conditions may not motivate behaviour change beyond the impact of the numerical risk estimates derived from such tests.
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Affiliation(s)
- A J Wright
- Health Psychology, Department of Psychology, King's College London, London, UK.
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Klein WMP, Cerully JL. Health-Related Risk Perception and Decision-Making: Lessons from the Study of Motives in Social Psychology. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2007. [DOI: 10.1111/j.1751-9004.2007.00023.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Good A, Abraham C. Measuring defensive responses to threatening messages: a meta-analysis of measures. Health Psychol Rev 2007. [DOI: 10.1080/17437190802280889] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Haney EM, Huffman LH, Bougatsos C, Freeman M, Steiner RD, Nelson HD. Screening and treatment for lipid disorders in children and adolescents: systematic evidence review for the US Preventive Services Task Force. Pediatrics 2007; 120:e189-214. [PMID: 17606543 DOI: 10.1542/peds.2006-1801] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE This was a systematic evidence review for the US Preventive Services Task Force, intended to synthesize the published evidence regarding the effectiveness of selecting, testing, and managing children and adolescents with dyslipidemia in the course of routine primary care. METHODS Literature searches were performed to identify published articles that addressed 10 key questions. The review focused on screening relevant to primary care of children without previously identified dyslipidemias, but included treatment trials of children with dyslipidemia because some drugs have only been tested in that population. RESULTS Normal values for lipids for children and adolescents are defined according to population levels (percentiles). Age, gender, and racial differences and temporal trends may alter these statistical cut points. Approximately 40% to 55% of children with elevated total cholesterol and low-density lipoprotein levels will continue to have elevated lipid levels on follow-up. Current screening recommendations based on family history will fail to detect substantial numbers (30%-60%) of children with elevated lipid levels. Drug treatment for dyslipidemia in children has been studied and shown to be effective only for suspected or proven familial monogenic dyslipidemias. Intensive dietary counseling and follow-up can result in improvements in lipid levels, but these results have not been sustained after the cessation of the intervention. The few trials of exercise are of fair-to-poor quality and show little or no improvements in lipid levels for children without monogenic dyslipidemias. Although reported adverse effects were not serious, studies were generally small and not of sufficient duration to determine long-term effects of either short or extended use. CONCLUSIONS Several key issues about screening and treatment of dyslipidemia in children and adolescents could not be addressed because of lack of studies, including effectiveness of screening on adult coronary heart disease or lipid outcomes, optimal ages and intervals for screening children, or effects of treatment of childhood lipid levels on adult coronary heart disease outcomes.
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Affiliation(s)
- Elizabeth M Haney
- Oregon Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Portland, OR, USA.
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Eckert SL, Katzen H, Roberts JS, Barber M, Ravdin LD, Relkin NR, Whitehouse PJ, Green RC. Recall of disclosed apolipoprotein E genotype and lifetime risk estimate for Alzheimer's disease: the REVEAL Study. Genet Med 2007; 8:746-51. [PMID: 17172937 DOI: 10.1097/01.gim.0000250197.44245.a3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To determine whether individuals recall their apolipoprotein E genotype and numeric lifetime risk estimates after undergoing a risk assessment for Alzheimer's disease. METHODS One-hundred and four participants underwent Alzheimer's disease risk assessment that included disclosure of apolipoprotein E genotype and a numeric lifetime risk estimate. RESULTS At six weeks and one year post-disclosure, 59% and 48% of participants, respectively, recalled their lifetime risk estimate, and 69% and 63% recalled their apolipoprotein E genotype. Participants were more likely to remember their genotype than numeric lifetime risk estimate at one year (P < 0.05). Apolipoprotein E epsilon4-positive participants had better recall of their genotype at both time points (P < 0.05). Participants were more likely to recall whether they carried the "risk-enhancing form of apolipoprotein E" than their specific genotype (P < 0.05). CONCLUSIONS These data suggest that apolipoprotein E genotype, especially the presence of an epsilon4 allele, is more memorable than a numeric risk estimate for Alzheimer's disease. Participants recalled genotype information in a more simplified, binary form. Health professionals testing for complex disorders such as Alzheimer's disease must find an appropriate balance between communicating risk in an understandable format and addressing the probabilistic nature of the information.
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Affiliation(s)
- Susan LaRusse Eckert
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York, USA
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Kiviniemi MT, Rothman AJ. Selective memory biases in individuals’ memory for health-related information and behavior recommendations. Psychol Health 2006; 21:247-72. [DOI: 10.1080/14768320500098715] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Cerully JL, Klein WMP, McCaul KD. Lack of acknowledgment of fruit and vegetable recommendations among nonadherent individuals: associations with information processing and cancer cognitions. JOURNAL OF HEALTH COMMUNICATION 2006; 11 Suppl 1:103-15. [PMID: 16641077 DOI: 10.1080/10810730600637491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Inadequate consumption of fruits and vegetables is regarded as an important behavioral risk factor for multiple types of cancer. Nevertheless, adherence with the National Cancer Institute (NCI) guidelines to eat between five and nine servings of fruits and vegetables per day is remarkably low. The current study explored the extent to which nonadherent respondents in a national survey (N = 5,625) listed fruit and vegetable consumption as a method by which to decrease their own or others' cancer risk. We sought to determine whether respondents who listed fruit and vegetable consumption as a method by which to decrease their own or others' cancer risk (hereafter referred to as "listers") differed from respondents who did not list fruit and vegetable consumption as a method by which to decrease their own or others' cancer risk (hereafter referred to as) "nonlisters" on measures of information processing and cancer cognitions. Nonlisters were more likely than listers to seek out cancer information but less likely to trust the information. The two groups did not differ in the amount of attention they paid to such information. Listers had lower absolute risk perceptions than nonlisters, but listers and nonlisters did not differ on measures of relative breast and colon cancer risk perceptions and worry for cancer in general. Female listers did perceive themselves to be at less relative risk for breast cancer than nonlisters. Respondents were more likely to list fruit and vegetable consumption as a cancer-risk reduction strategy for others than for themselves, suggesting a "double standard" in their beliefs. These findings suggest that communications designed to promote fruit and vegetable consumption need to account for biases in how nonadherent individuals respond to these communications.
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Croyle RT, Loftus EF, Barger SD, Sun YC, Hart M, Gettig J. How well do people recall risk factor test results? Accuracy and bias among cholesterol screening participants. Health Psychol 2006; 25:425-32. [PMID: 16719615 DOI: 10.1037/0278-6133.25.3.425] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors conducted a community-based cholesterol screening study to examine accuracy of recall for self-relevant health information in long-term autobiographical memory. Adult community residents (N = 496) were recruited to participate in a laboratory-based cholesterol screening and were also provided cholesterol counseling in accordance with national guidelines. Participants were subsequently interviewed 1, 3, or 6 months later to assess their memory for their test results. Participants recalled their exact cholesterol levels inaccurately (38.0% correct) but their cardiovascular risk category comparatively well (88.7% correct). Recall errors showed a systematic bias: Individuals who received the most undesirable test results were most likely to remember their cholesterol scores and cardiovascular risk categories as lower (i.e., healthier) than those actually received. Recall bias was unrelated to age, education, knowledge, self-rated health status, and self-reported efforts to reduce cholesterol. The findings provide evidence that recall of self-relevant health information is susceptible to self-enhancement bias.
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Affiliation(s)
- Robert T Croyle
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
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Han PKJ, Moser RP, Klein WMP. Perceived ambiguity about cancer prevention recommendations: relationship to perceptions of cancer preventability, risk, and worry. JOURNAL OF HEALTH COMMUNICATION 2006; 11 Suppl 1:51-69. [PMID: 16641074 PMCID: PMC4194067 DOI: 10.1080/10810730600637541] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
In this study, we apply the concept of "ambiguity," as developed in the decision theory literature, to an analysis of potential psychological consequences of uncertainty about cancer prevention recommendations. We used Health Information National Trends Survey (HINTS) 2003 data to examine how perceived ambiguity about cancer prevention recommendations relates to three other cognitive variables known to influence cancer-protective behavior: perceived cancer preventability, perceived cancer risk, and cancer-related worry. Using logistic regression analyses, we tested several predictions derived from a review of literature on the effects of ambiguity perceptions on decision making, cognitions, and emotions. We found perceived ambiguity to have a strong negative relationship with perceived cancer preventability, consistent with "ambiguity aversion"-a pessimistic bias in the interpretation of ambiguity. Cancer worry moderated this relationship; ambiguity aversion increased with higher levels of worry. At the same time, perceived ambiguity was positively related to both perceived cancer risk and cancer worry. Furthermore, perceived risk partially mediated the relationship between perceived ambiguity and worry. These findings suggest that perceived ambiguity about cancer prevention recommendations may have broad and important effects on other health cognitions. We discuss ethical implications of these findings for health communication efforts, and propose a tentative causal model to guide future research.
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Affiliation(s)
- Paul K J Han
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland 20892-7363, USA.
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Marteau TM, Roberts S, LaRusse S, Green RC. Predictive genetic testing for Alzheimer's disease: impact upon risk perception. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2005; 25:397-404. [PMID: 15876213 DOI: 10.1111/j.1539-6924.2005.00598.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
UNLABELLED The aim of this study was to determine the impact on risk perceptions of disclosing genetic test results used to estimate the risk of Alzheimer's disease (AD). Adult children (n = 149) of people with AD were randomized to one of two groups--Intervention group: lifetime risk estimates of AD based on age, gender, family history, and Apolipoprotein E (APOE) genotype; CONTROL GROUP lifetime risk estimates of AD based on the same risk factors excluding APOE genotype. Perceptions of personal risk (PPR) for AD were assessed six weeks after risk assessments. PPR were correlated with actual lifetime risk estimates (r = 0.501; p < 0.0001). After controlling for lifetime risks communicated to participants, age, and number of affected relatives, PPR scores among those with an epsilon4-positive test result (the test result associated with increased AD susceptibility) (adjusted mean: 3.4 (SD: 0.7)) were not different from the PPR scores in the CONTROL GROUP (adjusted mean: 3.4 (SD: 0.7) (F1,91= 1.98; p = 0.162). Again, controlling for lifetime risk estimates, age, and number of affected relatives, the PPR score of those receiving an epsilon4-negative test result was significantly lower (adjusted mean: 3.1 (SD: 0.8)) than those in the CONTROL GROUP (adjusted mean: 3.4 (SD: 0.7) (F1,95 = 6.23; p = 0.014). Perceptions of risk of developing AD are influenced by genetic test disclosure in those receiving epsilon4-negative, but not those receiving epsilon4-positive test results. Despite the reduced perceptions of risk in the former group, there was no evidence of false reassurance (i.e., perceiving risks as equal to or lower than population risks of AD), although this possibility should be assessed in other testing contexts.
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Affiliation(s)
- Theresa M Marteau
- Psychology and Genetics Research Group, Institute of Psychiatry, King's College London, London, UK.
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Renner B. Biased reasoning: adaptive responses to health risk feedback. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2004; 30:384-96. [PMID: 15030627 DOI: 10.1177/0146167203261296] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The present study examined reactions toward repeated self-relevant feedback. Participants in a community health screening received feedback about their cholesterol level on two separate occasions. Reactions to the first feedback were examined with regard to feedback valence and expectedness. The findings showed that negative feedback was devalued, but only when it was unexpected. Feedback consistency was incorporated into analyses of the second feedback. Again, results showed that negative feedback was not always devalued-only when it was inconsistent with the first feedback. Furthermore, positive feedback was not unconditionally accepted. When receiving unexpected positive feedback of low consistency, recipients were doubtful about its accuracy. Conversely, expected positive feedback was accepted regardless of its consistency. These results suggest that negative or unexpected positive feedbacks evoke greater sensitivity to feedback consistency, indicating elaborate cognitive processing. Theoretical accounts of these findings are discussed.
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Affiliation(s)
- Britta Renner
- Psychology, University of Greifswald, Greifswald, Germany.
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Renner B. Hindsight bias after receiving self-relevant health risk information: A motivational perspective. Memory 2003; 11:455-72. [PMID: 14562874 DOI: 10.1080/09658210244000531] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The phenomenon of hindsight bias was explored in the context of self-relevant health risk information. Participants in a community screening estimated their cholesterol level (foresight measure) before receiving positive or negative feedback based on their actual cholesterol level. Hindsight estimations were then assessed twice: once immediately after the feedback, and again several weeks later. While the unexpected positive feedback group showed no systematic recall bias, hindsight estimations of individuals receiving unexpectedly negative feedback showed a dynamic change over time. Immediately after the feedback, participants' recollection of their expected cholesterol level were shifted towards their actual cholesterol level (hindsight bias). In contrast, several weeks later, foresight estimations were recalled as less accurate than they had been (reversed hindsight bias). These data might reflect a change of the motivational focus from "hot affect" and fear control, which occur immediately after receiving negative feedback, to danger control, which occurs some time after the feedback, as proposed by the dual process model.
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Affiliation(s)
- Britta Renner
- Psychologie, Ernst-Moritz-Arndt-Universität Greifswald, Germany.
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Decruyenaere M, Evers-Kiebooms G, Cloostermans T, Boogaerts A, Demyttenaere K, Dom R, Fryns JP. Psychological distress in the 5-year period after predictive testing for Huntington's disease. Eur J Hum Genet 2003; 11:30-8. [PMID: 12529703 DOI: 10.1038/sj.ejhg.5200913] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2002] [Revised: 09/12/2002] [Accepted: 10/02/2002] [Indexed: 11/08/2022] Open
Abstract
The paper reports on a 5-year longitudinal study on psychological distress after predictive testing for Huntington's disease (HD) and on correlates of post-test distress. Psychometric tests and questionnaires were used. The tested persons were invited to participate in the follow-up study; the uptake rate was 75% (24 carriers, 33 non-carriers). Three time points were included: baseline, 1 year and 5 years post-test. Five years after the test, mean distress scores of both carriers and non-carriers were within the normal range. Carriers did not differ from non-carriers with regard to mean general distress. Compared to non-carriers, however, carriers had significantly less positive feelings (P<0.001) and were more consciously avoiding HD-related situations and thoughts (P<0.01). These findings reflect the carriers' conscious and unconscious attempt to escape from pessimism and to minimise negative consequences of the test result. Psychological distress 5 years post-test was significantly associated with ego-strength (P<0.05 to P<0.001). Except for intrusion and avoidance, distress was also associated with test motivation (P<0.05 to P<0.01). Compared with baseline level, mean depression, general and specific anxiety had significantly decreased 1 year and 5 years post-test (P<0.05 to 0.01). This evolution was independent of the test result. However, based on test motivation, a subgroup of tested persons having long lasting psychological distress could be identified, also irrespective of test result. Persons who asked the test to get rid of the uncertainty, without being able to specify implications for substantial life areas, had more psychological distress before and after the test than those who wanted the test for specific reasons (P<0.001 to P<0.0001). Moreover, the pattern of post-test anxiety differed over time, depending on the test motivation (P<0.05). The findings suggest that pre- and post-test counselling should pay special attention to persons with lower ego-strength and with an unspecified test motivation, because they are at higher risk for long-term psychological distress, independently of the test result.
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Rimes KA, Salkovskis PM. Prediction of psychological reactions to bone density screening for osteoporosis using a cognitive-behavioral model of health anxiety. Behav Res Ther 2002; 40:359-81. [PMID: 12002895 DOI: 10.1016/s0005-7967(01)00015-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pre-screening measures derived from a cognitive-behavioral theory of health anxiety were significant predictors of individual differences in post-screening reactions to a health screening procedure, bone densitometry. Predictors included specific illness beliefs (vulnerability, severity/consequences, coping and treatment) and general health anxiety measures. Three months after a low bone mineral density (BMD) result, women with high levels of pre-existing general health anxiety gave higher ratings of anxiety about osteoporosis and perceived likelihood of developing osteoporosis than women with low levels of preexisting health anxiety, even though the two groups' initial ratings had not differed significantly. Women with a low BMD result generally showed "minimization" of the seriousness of low BMD but women with very high levels of pre-existing health anxiety did not. After a high BMD result, highly health anxious women were only temporarily reassured. The results were consistent with the cognitive-behavioral analysis of health anxiety.
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Affiliation(s)
- Katharine A Rimes
- Department of Psychology, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, UK.
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Abstract
Mediators and moderators of anxiety following predictive genetic testing were investigated in a cross-sectional study of 208 individuals at risk for familial adenomatous polyposis (FAP). Receiving a positive test result was associated with increased anxiety. The relationship between test result and anxiety was mediated by how threatened individuals felt by their test results. The impact of a positive test result was greater for those who felt distressed about FAP in their families, perceived FAP to be more serious, and perceived the genetic test to be more accurate. The results suggest that assessing, and possibly modifying, people's appraisals of the condition and of its impact on the family and of the threat of the genetic test may help to reduce subsequent anxiety. This has implications for the practice of genetic counseling.
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Michie S, Bobrow M, Marteau TM. Predictive genetic testing in children and adults: a study of emotional impact. J Med Genet 2001; 38:519-26. [PMID: 11483640 PMCID: PMC1734924 DOI: 10.1136/jmg.38.8.519] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To determine whether, following predictive genetic testing for familial adenomatous polyposis (FAP), children or adults receiving positive results experience clinically significant levels of anxiety or depression, and whether children receiving positive results experience higher levels of anxiety or depression than adults receiving positive results. DESIGN Two studies, one cross sectional and one prospective. SAMPLE 208 unaffected subjects (148 adults and 60 children) at risk for FAP who have undergone genetic testing since 1990. MAIN MEASURES DEPENDENT VARIABLES anxiety, depression; independent variables: test results, demographic measures, psychological resources (optimism, self-esteem). RESULTS Study 1. In children receiving positive results, mean scores for anxiety and depression were within the normal range. There was a trend for children receiving positive results to be more anxious and depressed than those receiving negative results. In adults, mean scores for anxiety were within the normal range for those receiving negative results, but were in the clinical range for those receiving positive results, with 43% (95% CI 23-65) of the latter having scores in this range. Regardless of test result, adults were more likely to be clinically anxious if they were low in optimism or self-esteem. Children receiving positive or negative results did not experience greater anxiety or depression than adults. Study 2. For children receiving a positive test result, mean scores for anxiety, depression, and self-esteem were unchanged over the year following the result, while mean anxiety scores decreased and self-esteem increased after receipt of a negative test result over the same period of time. CONCLUSION Children, as a group, did not show clinically significant distress over the first year following predictive genetic testing. Adults were more likely to be clinically anxious if they received a positive result or were low in optimism or self-esteem, with interacting effects. The association between anxiety, self-esteem, and optimism suggests that counselling should be targeted, not only at those with positive test results, but also at those low in psychological resources.
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Affiliation(s)
- S Michie
- Psychology and Genetics Research Group, Guy's, King's, and St Thomas's Medical School, King's College London, Guy's Campus, London SE1 9RT, UK.
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Decruyenaere M, Evers-Kiebooms G, Welkenhuysen M, Denayer L, Claes E. Cognitive representations of breast cancer, emotional distress and preventive health behaviour: a theoretical perspective. Psychooncology 2000; 9:528-36. [PMID: 11180588 DOI: 10.1002/1099-1611(200011/12)9:6<528::aid-pon486>3.0.co;2-#] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Individuals at high risk for developing breast and/or ovarian cancer are faced with difficult decisions regarding genetic testing, cancer prevention and/or intensive surveillance. Large interindividual differences exist in the uptake of these health-related services. This paper is aimed at understanding and predicting how people emotionally and behaviourally react to information concerning genetic predisposition to breast/ovarian cancer. For this purpose, the self-regulation model of illness representations is elaborated. This model suggests that health-related behaviour is influenced by a person's cognitive and emotional representation of the health threat. These representations generate coping behaviour aimed at resolving the objective health problems (problem-focussed coping) and at reducing the emotional distress induced by the health threat (emotion-focussed coping). Based on theoretical considerations and empirical studies, four interrelated attributes of the cognitive illness representation of hereditary breast/ovarian cancer are described: causal beliefs concerning the disease, perceived severity, perceived susceptibility to the disease and perceived controllability. The paper also addresses the complex interactions between these cognitive attributes, emotional distress and preventive health behaviour.
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Affiliation(s)
- M Decruyenaere
- Psychosocial Genetics Unit, University of Leuven, Belgium
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Rothman AJ, Kiviniemi MT. Treating people with information: an analysis and review of approaches to communicating health risk information. J Natl Cancer Inst Monogr 2000:44-51. [PMID: 10854457 DOI: 10.1093/oxfordjournals.jncimonographs.a024207] [Citation(s) in RCA: 148] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The communication of risk information is a fundamental aspect of nearly all health promotion interventions. However, no consensus exists regarding the most effective way to provide people with risk information. We will review and evaluate the relative merits of two approaches to risk communication. One approach relies on the presentation of numerical information regarding the probability of a health problem occurring, whereas the other relies on the presentation of information about the antecedents and consequences of a health problem. Because people have considerable difficulty understanding and using quantitative information, the effectiveness of interventions that rely solely on numerical probability information has been limited. Interventions that provide people with a broader informational context in which to think about a health problem have had greater success systematically influencing perceptions of personal risk but have several important limitations. However, before any final conclusions can be drawn regarding the relative merits of different communication strategies, investigators must agree on the specific criteria that should be used to identify an effective intervention.
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Affiliation(s)
- A J Rothman
- Department of Psychology, University of Minnesota, Minneapolis, USA.
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50
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Figueiras M, Price H, Marteau TM. Effects of Textual and Pictorial Information Upon Perceptions of Down Syndrome: An Analogue Study. Psychol Health 1999. [DOI: 10.1080/08870449908410763] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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