Knowledge and perceived risk of major diseases in middle-aged and older women

A Pre-Test-Post-Test Trial of a Breast Cancer Risk Report for Women in Their 40s

INTRODUCTION

Guidelines recommend individualized breast cancer screening and prevention interventions for women in their 40s. Yet, few primary care clinicians assess breast cancer risk.

STUDY DESIGN

Pretest-Posttest trial.

SETTING/PARTICIPANTS

Women aged 40-49 years were recruited from one large Boston-based academic primary care practice between July 2017 and April 2019.

INTERVENTION

Participants completed a pretest, received a personalized breast cancer risk report, saw their primary care clinician, and completed a posttest.

MAIN OUTCOME MEASURES

Using mixed effects models, changes in screening intentions (0-100 scale [0=will not screen to 100=will screen]), mammography knowledge, decisional conflict, and receipt of screening were examined. Analyses were conducted from June 2019 to February 2020.

RESULTS

Patient (n=337) mean age was 44.1 (SD=2.9) years, 61.4% were non-Hispanic white, and 76.6% were college graduates; 306 (90.5%) completed follow-up (203 with 5-year breast cancer risk <1.1%). Screening intentions declined from pre- to post-visit (79.3 to 68.0, p<0.0001), especially for women with 5-year risk <1.1% (77.2 to 63.3, p<0.0001), but still favored screening. In the 2 years prior, 37.6% had screening mammography compared with 41.8% over a mean 16 months follow-up (p=0.17). Mammography knowledge increased and decisional conflict declined. Eleven (3.3%) women met criteria for breast cancer prevention medications (ten discussed medications with their clinicians), 22 (6.5%) for MRI (19 discussed MRI with their clinician), and 67 (19.8%) for genetic counseling (47 discussed with the clinician).

CONCLUSIONS

Receipt of a personalized breast cancer report was associated with women in their 40s making more-informed and less-conflicted mammography screening decisions and with high-risk women discussing breast cancer prevention interventions with clinicians.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.govNCT03180086.

Knowledge about modifiable risk factors for non-communicable diseases adults living with HIV in Rwanda

BACKGROUND

Non-communicable diseases (NCD) are of international public health concern. Of more concern are people living with HIV (PLHIV), who have the increased risk of developing NCDs, such as hypertension, stroke and diabetes. Research has revealed that there is a relationship between knowledge of NCD risk factors and risk perceptions in the general population. Therefore, an assessment of PLHIV's NCD risk factors knowledge is quite critical, to design effective NCD prevention programmes.

OBJECTIVE

To assess the level of knowledge of modifiable risk factors for NCDs and its associated factors among adults living with HIV in Rwanda.

METHODS

A cross-sectional quantitative design was used to collect the data. The study targeted PLHIV who visited the out-patients' public health centres in three purposively selected provinces of Rwanda. The knowledge assessment questionnaire relating to risk factors for chronic diseases of lifestyle was used to collect the data. Data were analysed using SPSS version 23.

RESULTS

Of the 794 respondents, 64.6% were women, and the mean age was 37.9 (±10.8) years. The results revealed that the majority of the respondents (65.0%) had low levels of knowledge about NCD risk factors, while some (35.6%) were of the opinion that they had a low risk of contracting NCDs. Good knowledge was significantly associated with high educational status, a low CD4+ cell count (< 350 cells/mm3) and normotension.

CONCLUSION

The current study findings highlight the need for comprehensive health education, to raise awareness of non-communicable diseases' risk factors for adults living with HIV in Rwanda.

Heart disease versus cancer: understanding perceptions of population prevalence and personal risk

Although the gap is narrowing, Americans are more likely to be diagnosed with and die from heart disease than cancer, and yet many believe cancer is more common and their personal risk of cancer is higher than their heart disease risk. Using nationally representative 2013 Health Information National Trends Survey data, we assessed such beliefs and examined sociodemographic and psychological factors and health behaviors associated with these beliefs. 42.8% of participants rated cancer as more common and 78.5% rated their own cancer risk as equal to or exceeding their heart disease risk. These misperceptions were only modestly correlated. Beliefs about relative population risk were associated with various psychological factors, whereas beliefs about relative personal risk were not. Both beliefs were inconsistently associated with health behaviors. Accuracy in beliefs about cancer and heart disease relative risk and prevalence is low and future research should explore antecedents and consequences of these beliefs.

Health Risk Perceptions and Exercise in Older Adulthood

Protection Motivation Theory (PMT) was applied to explore the relationship between perceived risk of acute health crises and intent to exercise. Interviews of 351 community-living older adults assessed prior physical activity (PPA), all PMT components, and exercise intent. A multi-group structural equation model revealed gender differences in PMT predictors of exercise intent. PPA, age, self-efficacy, and response efficacy directly predicted men’s intent. Women’s PPA and age predicted PMT components of self-efficacy and response costs, which predicted intent. Findings have implications for devising interventions to enhance physical activity in later life by targeting different PMT components for older men and women.

Cardiovascular health knowledge and preventive practices in people living with HIV in Kenya

BACKGROUND

Traditional cardiovascular disease (CVD) risk factors contribute to increase risk of CVD in people living with HIV (PLWH). Of all world regions, sub-Saharan Africa has the highest prevalence of HIV yet little is known about PLWH's CVD knowledge and self- perceived risk for coronary heart disease (CHD). In this study, we assessed PLWH's knowledge, perception and attitude towards cardiovascular diseases and their prevention.

METHODS

We conducted a cross-sectional study in the largest HIV care program in western Kenya. Trained research assistants used validated questionnaires to assess CVD risk patterns. We used logistic regression analysis to identify associations between knowledge with demographic variables, HIV disease characteristics, and individuals CVD risk patterns.

RESULTS

There were 300 participants in the study; median age (IQR) was 40 (33-46) years and 64 % women. The prevalence of dyslipidemia, overweight and obesity were 70 %, 33 % and 8 %, respectively. Participant's knowledge of risk factors was low with a mean (SD) score of 1.3 (1.3) out of possible 10. Most (77.7 %) could not identify any warning signs for heart attack. Higher education was a strong predictor of CVD risk knowledge (6.72, 95 % CI 1.98-22.84, P < 0.0001). Self-risk perception towards CHD was low (31 %) and majority had inappropriate attitude towards CVD risk reduction.

CONCLUSION

Despite a high burden of cardiovascular risk factors, PLWH in Kenya lack CVD knowledge and do not perceived themselves at risk for CHD. These results emphasis the need for behavior changes interventions to address the stigma and promote positive health behaviors among the high risk HIV population in Kenya.

Women's knowledge about heart disease: Differences among ethnic and cultural groups in the Israeli Women's Health in Midlife Study

The current investigation aimed to assess levels of knowledge about risk factors for heart disease among midlife Israeli women, and to evaluate the relationship of knowledge to personal risk factors and vulnerability to heart disease. Face-to-face interviews with women aged 45-64 years were conducted during 2004-2006 within three population groups: long-term Jewish residents (LTR), immigrants from the former Soviet Union, and Arab women. The survey instrument included six knowledge statements relating to: the risk after menopause, family history, elevated cholesterol level, diabetes, obesity, and warning signs of a heart attack. The findings showed wide disparities in knowledge by educational level and between immigrants and LTR, after taking into account personal risk factors and education. Personal risk factors were not significantly related to the knowledge items, except for personal history of cardiovascular disease, which was associated with knowledge about "warning signs of a heart attack" and "family history." Women who perceived themselves as more vulnerable to heart disease were more likely to identify several risk factors correctly. These findings stress the need to increase knowledge about heart disease, especially among less educated and minority women, and to emphasize the risk of patients' personal status by health providers.

Moderating effects of media exposure on associations between socioeconomic position and cancer worry

Reducing fear of cancer is significant in developing cancer screening interventions, but the levels of fear may vary depending on the degrees of media exposure as well as individuals' socioeconomic positions (SEP). However, few studies have examined how the SEP influences the fear of cancer under the moderating process of general and specific forms of media exposure. We investigated the moderating effect of media exposure on the relationship between SEP and the level of fear of cancer by assuming that cancer knowledge is a covariate between those two. In particular, this study examined how exposure to both general and specific media changes the series of processes from SEP to fear of cancer. We conducted path analyses with three types of media--television, radio and the Internet--using data from a health communication survey of 613 adults in Massachusetts in the United States. We found that SEP influences cancer knowledge directly and fear of cancer indirectly, as moderated by the level of media exposure. Health-specific exposure, however, had a more consistent effect than general media exposure in lowering the fear of cancer by increasing knowledge about cancer. A higher level of health-specific exposure and greater amount of cancer knowledge lessened the fear of cancer. In addition, the more people were exposed to health information on television and the Internet, the lower the level of fear of cancer as a result. These findings indicate a relationship between SEP and fear of cancer, as moderated by the level and type of media exposure. Furthermore, the findings suggest that for early detection or cancer prevention strategies, health communication approaches through mass media need to be considered.

Development and evaluation of a decision aid on mammography screening for women 75 years and older

IMPORTANCE

Guidelines recommend that women 75 years and older should be informed of the benefits and risks of mammography before being screened. However, few are adequately informed.

OBJECTIVES

To develop and evaluate a mammography screening decision aid (DA) for women 75 years and older.

DESIGN

We designed the DA using international standards. Between July 14, 2010, and April 10, 2012, participants completed a pretest survey and read the DA before an appointment with their primary care physician. They completed a posttest survey after their appointment. Medical records were reviewed for follow-up information.

SETTING AND PARTICIPANTS

Boston, Massachusetts, academic primary care practice. Eligible women were aged 75 to 89 years, English speaking, had not had a mammogram in 9 months but had been screened within the past 3 years, and did not have a history of dementia or invasive or noninvasive breast cancer. Of 84 women approached, 27 declined to participate, 12 were unable to complete the study for logistical reasons, and 45 participated.

INTERVENTIONS

The DA includes information on breast cancer risk, life expectancy, competing mortality risks, possible outcomes of screening, and a values clarification exercise.

MAIN OUTCOMES AND MEASURES

Knowledge of the benefits and risks of screening, decisional conflict, and screening intentions; documentation in the medical record of a discussion of the risks and benefits of mammography with a primary care physician within 6 months; and the receipt of screening within 15 months. We used the Wilcoxon signed rank test and McNemar test to compare pretest-posttest information.

RESULTS

The median age of participants was 79 years, 69% (31 of 45) were of non-Hispanic white race/ethnicity, and 60% (27 of 45) had attended at least some college. Comparison of posttest results with pretest results demonstrated 2 findings. First, knowledge of the benefits and risks of screening improved (P < .001). Second, fewer participants intended to be screened (56% [25 of 45] afterward compared with 82% [37 of 45] before, P = .03). Decisional conflict declined but not significantly (P = .10). In the following 6 months, 53% (24 of 45) of participants had a primary care physician note that documented the discussion of the risks and benefits of screening compared with 11% (5 of 45) in the previous 5 years (P < .001). While 84% (36 of 43) had been screened within 2 years of participating, 60% (26 of 43) were screened within 15 months after participating (≥ 2 years since their last mammogram) (P = .01). Overall, 93% (42 of 45) found the DA helpful.

CONCLUSIONS AND RELEVANCE

A DA may improve older women's decision making about mammography screening.

Associations between health communication behaviors, neighborhood social capital, vaccine knowledge, and parents' H1N1 vaccination of their children

During the H1N1 pandemic in 2009-10, the vaccination behavior of parents played a critical role in preventing and containing the spread of the disease and the subsequent health outcomes among children. Several studies have examined the relationship between parents' health communication behaviors and vaccinations for children in general. Little is known, however, about the link between parents' health communication behaviors and the vaccination of their children against the H1N1 virus, and their level of vaccine-related knowledge. We drew on a national survey among parents with at least one child less than 18 years of age (n=639) to investigate Parents' H1N1-related health communication behaviors including sources of information, media exposure, information-seeking behaviors, H1N1-related knowledge, and neighborhood social capital, as well as the H1N1 vaccination rates of their children. Findings showed that there is a significant association between the degree at which parents obtained H1N1 vaccination for their children and health communication variables: watching the national television news and actively seeking H1N1 information. And this association was moderated by the extent of the parents' H1N1-related knowledge. In addition, the parents' degree of neighborhood social capital mediated the association between H1N1 knowledge of the parents and H1N1 vaccination acceptance for their children. We found, compared to those with a low-level of neighborhood social capital, parents who have a high-level of neighborhood social capital are more likely to vaccinate their children. These findings suggest that it is necessary to design a strategic health communication campaign segmented by parent health communication behaviors.

Perceptions of coronary heart disease: the development and psychometric testing of a measurement scale

Individuals' perceptions of coronary heart disease (CHD) have implications for the ways in which they respond to the disease, process risks, make decisions, and take action to reduce CHD risks. This study aimed to develop and evaluate the psychometric properties of the perceptions of coronary heart disease scale (PCS) among a Hong Kong Chinese population. A cross-sectional study was conducted using a convenient sample (n = 232) of participants recruited from a variety of catchments including public domains, a cardiac unit, and a cardiac rehabilitation and prevention center. Exploratory factor analysis identified a nine-item, two-factor model that accounted for 52.5% of the total explained variance. The two factors were the perceived risk (five items) and perceived seriousness (four items) of CHD. The PCS demonstrated good content validity; acceptable total, and subscale internal consistency (.73, .61 - .81); and significant contrast-group differences with higher levels of CHD perceptions among males (p = .002), younger participants (p < .001), and those with higher educational levels (p < .001), suggesting excellent construct validity. The newly developed PCS demonstrates acceptable psychometric properties as a short measurement scale, which supports its use in future research. Future validation of this scale is warranted.

Development of a Comprehensive Heart Disease Knowledge Questionnaire

BACKGROUND: Heart disease is the number one killer of both men and women in the United States, yet a comprehensive and evidence-based heart disease knowledge assessment is currently not available. PURPOSE: This paper describes the 2 phase development of a novel heart disease knowledge questionnaire. METHODS: After review and critique of the existing literature, a questionnaire addressing 5 central domains of heart disease knowledge was constructed. In Phase I, 606 undergraduates completed a 82-item questionnaire. In Phase II, 248 undergraduates completed a revised 74-item questionnaire. In both phases, item clarity and difficulty were evaluated, along with the overall factor structure of the scale. RESULTS: Exploratory and confirmatory factor analyses were used to reduce the scale to 30 items with fit statistics, CFI = .82, TLI = .88, and RMSEA = .03. Scores were correlated moderately positively with an existing scale and weakly positively with a measure of health literacy, thereby establishing both convergent and divergent validity. DISCUSSION: The finalized 30-item questionnaire is a concise, yet discriminating instrument that reliably measures participants' heart disease knowledge levels. TRANSLATION TO HEALTH EDUCATION PRACTICE: Health professionals can use this scale to assess their patients' heart disease knowledge so that they can create a tailored program to help their patients reduce their heart disease risk.

Applying the Health Belief Model to college students' health behavior

The purpose of this research was to investigate how university students' nutrition beliefs influence their health behavioral intention. This study used an online survey engine (Qulatrics.com) to collect data from college students. Out of 253 questionnaires collected, 251 questionnaires (99.2%) were used for the statistical analysis. Confirmatory Factor Analysis (CFA) revealed that six dimensions, "Nutrition Confidence," "Susceptibility," "Severity," "Barrier," "Benefit," "Behavioral Intention to Eat Healthy Food," and "Behavioral Intention to do Physical Activity," had construct validity; Cronbach's alpha coefficient and composite reliabilities were tested for item reliability. The results validate that objective nutrition knowledge was a good predictor of college students' nutrition confidence. The results also clearly showed that two direct measures were significant predictors of behavioral intentions as hypothesized. Perceived benefit of eating healthy food and perceived barrier for eat healthy food to had significant effects on Behavioral Intentions and was a valid measurement to use to determine Behavioral Intentions. These findings can enhance the extant literature on the universal applicability of the model and serve as useful references for further investigations of the validity of the model within other health care or foodservice settings and for other health behavioral categories.

Differences in perceptions of coronary disease among Hong Kong Chinese: implications for the societal readiness in disease prevention

Perceptions of coronary heart disease (CHD) influence individual health behavior, which is central to preventing the disease. Not enough is known about the demographic differences in perceptions of CHD among Chinese communities. This study examined these differences in the perceived seriousness and risk of CHD among Hong Kong Chinese. A self-developed questionnaire was administered to a convenient sample (n = 236). Significant differences were identified in the perceived seriousness and risk of CHD between younger and older age groups (p < 0.001) and groups with lower and higher education levels (p < 0.001), but not between genders (p > 0.05). Over 50% of participants expressed greater concern about infectious disease than about CHD, while two-thirds to over half of female, older, and less educated participants were more concerned about stroke. This study highlighted populations with lower levels of CHD perception that need increased public education. The findings have implications for the societal readiness to establishing ongoing public healthcare strategies to increase awareness of CHD.

Passing years, changing fears? Conceptualizing and measuring risk perceptions for chronic disease in younger and middle-aged women

As is true for many behavioral theory constructs, no consensus exists on how best to measure perceived risk; therefore, it is unclear whether different measures of disease risk perception are conceptually equivalent and whether such measures are equally appropriate for people with different objective disease risk. To investigate these issues, we used four commonly utilized risk perception items (measuring beliefs about personal risk, others' risk, disease prevalence, and mortality) to assess susceptibility to cardiovascular disease, breast cancer, and lung cancer among 454 younger (ages 18-25) and 169 middle-aged (40-64) women. We examined age- and ethnicity-related differences in participants' responses to the items. We also used structural equation modeling to test whether these items reflect a multidimensional, disease-specific latent construct of risk perception; and to test whether consistency exists in participants' disease-specific risk perceptions. Despite differences in responses to individual items, hypothesized models of perceived risk fit both age groups, suggesting that risk perception can be conceptualized in younger and middle-aged women as a multidimensional construct that is specific to disease yet reflective of global risk-related beliefs.

Theoretical considerations in reducing risk for cardiovascular disease: implications for nursing practice

AIMS AND OBJECTIVES

This article describes the theoretical foundation of risk perception as a key component of changing deleterious health behaviours associated with cardiovascular disease (CVD). Furthermore, perception in increasing cardiovascular risk-reducing behaviours in a socio-cultural framework is discussed, and an empirical development conceptual model presented.

BACKGROUND

Perception of risk is strongly linked with health-seeking behaviours. Understanding how to reduce risk and maximise cardiovascular health is an increasing focus of clinicians, researchers and policy makers. Increasing cultural diversity in contemporary society means that nurses need to develop and evaluate interventions in this context.

DESIGN

An integrative literature review.

METHOD

An integrative literature review method was used to assess conceptual models relating to risk perception of developing CVD. On the basis of the findings, a model was developed to inform future intervention studies, considering individual, social and cultural factors.

DISCUSSION

Studies examining CVD and health behaviours report that there is limited concordance between actual and perceived risk in people with CVD. This mismatch risk likely impedes the adoption of risk-reducing behaviours.

CONCLUSION

There is a critical need to develop interventions for enhancing an accurate perception of CVD risk considering not only individual but social factors.

RELEVANCE TO CLINICAL PRACTICE

There is limited correlation between knowledge and behaviours, and health behaviours are influenced by individual, social and cultural factors. Appraising the congruence between actual and perceived risk is an important step in developing effective care plans to reduce cardiovascular risk.

A Survey of Coronary Heart Disease Knowledge in a Sample of Hong Kong Chinese

Using a self-developed questionnaire, this study examined the knowledge of coronary heart disease (CHD) in 467 Hong Kong Chinese, comprising participants with a low risk (LR) of CHD and high risk (HR) of CHD, and those who had had a myocardial infarction (MI). The results showed that the LR and HR respondents were less likely to respond correctly to items regarding knowledge of typical symptoms and certain risk factors for CHD. The MI group had the highest level of CHD knowledge. Significant differences were found across the 3 target populations in most of the domains of CHD knowledge. Women and older respondents of the LR population were found to have better CHD knowledge than their counterparts. The study highlighted that CHD prevention in Hong Kong should not focus on secondary prevention at the expense of primary prevention. Promotion of knowledge should be targeted to primary education, in particular among the male population and younger Chinese.

Do older people perceive cancer prevention and early detection to be worthwhile? Implications for prevention

Despite evidence that suggests modifying risk factors at any age can reduce the risk of cancer, many older people fail to take relevant preventive actions. The objectives of the project were to assess whether older people perceived taking actions to prevent cancers as worthwhile after the age of 60 years. Fifty men (19) and women (31) 60 years and older (mean age 68 years) participated in seven focus groups to assess their perceptions of preventive health actions and barriers and motivators in relation to cancer prevention. Most participants reported not adhering to preventive actions for cancer. Many did not perceive the benefits if the actions are initiated after the age of 60 years, and some risk factors were not perceived to be related to cancer. There was strong agreement that screening for cancer was worthwhile after the age of 60 years. It appears that awareness programs specifically tailored to seniors may be desirable to promote cancer prevention within a context of chronic disease prevention in general.

Physician recommendations for mammography in women aged 70 and older

OBJECTIVES

To estimate the percentage of U.S. women aged 70 and older who reported a recent mammography recommendation and to identify whether factors suggesting limited life expectancy, such as comorbidities, are associated with a lower probability of a reported recommendation.

DESIGN

A national, population-based, cross-sectional survey.

SETTING

United States.

PARTICIPANTS

There were 1,782 screen-eligible women 70 and older who responded to the National Health Interview Survey in 2005 and met eligibility criteria, including reporting at least one doctor visit in the previous 12 months. Weighted, these women represented almost 9.3 million women nationally.

MEASUREMENTS

Multiple logistic regression was used to examine the relationship between demographic, comorbidity, and health services utilization variables on self-reported physician recommendation for a mammogram.

RESULTS

More than half (58.9%) of the sample reported a recent mammography recommendation (63.0% of those aged 70 to 79 and 51.5% of those aged 80 and older). The strongest multivariable association suggested that women who reported a recent clinical breast examination (CBE) had 5.9 times greater odds of reporting a mammography recommendation than women who reported never having a CBE.

CONCLUSION

This study failed to find negative associations between factors suggesting limited life expectancy and a recent mammography recommendation. Instead, findings revealed a strong positive association between a recent CBE and mammography recommendation. Findings may suggest that recent clinical interactions weigh more heavily on a decision to recommend mammography to older, screen-eligible women than considerations for the woman's overall long-term health or may reflect a greater perceived or actual recall of physician recommendations from women with a recent CBE.

The impact of different time frames of risk communication on Type 2 diabetes patients' understanding and memory for risk of coronary heart disease and stroke

AIMS

We examined the impact of communicating risk of coronary heart disease (CHD) and stroke, using three time frames (1, 5 or 10 years), on Type 2 diabetic (T2D) patients' understanding of risk of CHD/stroke and their memory for these risks.

METHODS

Patients (N = 95) estimated their risk of developing CHD/having a stroke as a result of diabetes, in one of three time frames. Using the United Kingdom Prospective Diabetes Study Risk Engine and the same time frame, patients were then given individualized, objective risk estimates of developing CHD/stroke. Following explanation of these risks, patients' risk understanding was examined by asking them to report again their risk of developing CHD/stroke. Six weeks later we assessed patient memory for these risks by asking them to recall their actual risk estimates for CHD/stroke.

RESULTS

In all time frames, we successfully reduced participants' originally inflated risk perceptions of CHD (F(1,92) = 73.01, P < 0.001) and stroke (F(1,91) = 119.05, P < 0.001), although the 10-year risk group was the most resistant to correction for both CHD (F(1,90) = 9.32, P < 0.001) and stroke (F(2,88) = 3.97, P < 0.02). Participants' recall of their stroke risk at 6 weeks regressed towards original, inflated risk perceptions for the 10-year group only (F(4,176) = 4.73, P < 0.001).

CONCLUSION

Patients' inflated perceptions of CHD/stroke risk can be easily corrected using shorter (1- or 5-year) risk communication time frames.

Perceptions of coronary heart disease risk in Korean immigrants with type 2 diabetes

PURPOSE

The purpose of this study was to examine coronary heart disease (CHD) risk perception, risk factor status, and factors associated with CHD risk perception in Korean immigrants with type 2 diabetes mellitus.

METHODS

A community sample of 143 Korean adults with type 2 diabetes, aged 30 to 80 years old, completed questionnaires and biological measures. A multiple regression analysis was conducted to evaluate the relationships between CHD knowledge, general health, smoking, medications for CHD risk factors, demographic variables (independent variables), and the perception of CHD risk (dependent variable).

RESULTS

Participants had low perception of CHD risk, with most (76.9%) indicating their risk to be the same or lower than people of the same age and sex in the general population. Overall, CHD risk factor control was suboptimal according to American Diabetes Association guidelines. Only 41.3% of participants met the HbA1c goal of less than 7%. More than half (55%) had uncontrolled blood pressure, and a similar proportion (53.6%) had higher low-density lipoprotein cholesterol than the target goal. CHD knowledge and self-reported general health influenced the perception of CHD risk. More CHD knowledge and poor general health were associated with higher perception of CHD risk.

CONCLUSIONS

To increase the perception of CHD risk in Korean immigrants with type 2 diabetes, diabetes educators and clinicians should educate such patients about CHD risk factors and discuss their risk status at every visit. Those who report their health to be good deserve particular attention.

Unrealistic pessimism about risk of coronary heart disease and stroke in patients with type 2 diabetes

OBJECTIVE

We examined the accuracy of type 2 diabetes (T2D) patients' risk estimates of developing coronary heart disease (CHD)/having a stroke as a consequence of diabetes and their mood about these risks.

METHODS

Patients reported their perceived risks of developing CHD/having a stroke and rated their mood about these risks using a self-report measure. Using an objective risk calculator, they were then told their actual risk of CHD and stroke and their mood was re-assessed.

RESULTS

Patients' estimates of their risk of CHD/stroke were grossly inflated. A negative relationship between disease risk and mood was also seen where higher risk of actual and perceived CHD/stroke was related to worse mood. A positive relationship between mood and extent of perceptual error was further observed; the more inaccurate patients' perceptions of CHD/stroke risk were, the better their mood. Mood improved after patients were given accurate risk information.

CONCLUSION

T2D patients are unrealistically pessimistic about their risk of developing CHD/stroke. These risks and the extent of perceptual risk error are associated with mood, which improves upon providing patients with accurate risk information about CHD/stroke.

PRACTICE IMPLICATIONS

These results have implications for the routine communication of risk to T2D patients.

Healthy Women with a Family History of Breast Cancer: Impact of a Tailored Genetic Counseling Intervention on Risk Perception, Knowledge, and Menopausal Therapy Decision Making

BACKGROUND

Women with a family history of breast cancer have several menopausal therapy options, including tamoxifen, hormone therapy (HT), alternative medications, or no treatment. This complex decision should be based on each woman's risk to develop breast cancer, menopausal symptoms, preferences, and risks for other conditions. The authors determined the effects of a personalized risk assessment and genetic counseling intervention on knowledge, risk perception, and decision making in a group of healthy women who had a first-degree relative with breast cancer.

METHODS

Forty-eight cancer-free menopausal women age > or =40 years who had at least one first-degree relative with breast cancer were randomized to a genetic counseling intervention or control. Intervention participants were given a personalized risk assessment for breast cancer, heart disease, osteoporosis, and uterine cancer based on family history and personal health data. Knowledge, risk perception, and medication usage were measured at baseline, 1 month, and 6 months.

RESULTS

Knowledge was higher in the intervention group at both follow-up time points postintervention. Perceived risk for developing breast cancer was significantly lower and more accurate in the intervention group at 1 and 6 months postintervention than at baseline, as was perceived risk of developing heart disease. Although the counseling intervention did affect both knowledge and risk perception, overall, both groups were reluctant to take any form of menopausal therapy.

CONCLUSIONS

A personalized risk assessment and genetic counseling intervention improves patient knowledge and risk perception; however, it is unclear that the intervention influenced menopausal treatment decisions.

Changes in Prognostic Awareness among Seriously Ill Older Persons and Their Caregivers

PURPOSE

To examine changes in patients' and caregivers' understanding of prognosis with progression of the patient's illness.

SUBJECTS AND METHODS

Community-dwelling persons 60 years of age and older who were seriously ill with cancer, congestive heart failure, or chronic obstructive pulmonary disease and their caregivers were interviewed every 4 months and more frequently with a decline in the patient's status for up to one year. We examined responses to, "If you had to take a guess, how long do you think that (you/the patient) might have to live?" at baseline and at the interview closest to death.

RESULTS

Among 218 patients, 87 died within 1 year. At their initial interview 46% were uncertain about their life expectancy (LE) and 9% believed LE was 1 year or less; at their final interview, 55% were uncertain and 17% believed LE was 1 year or less. At the caregiver's initial interview, 29% were uncertain about the patient's LE and 20% believed LE was 1 or less; at their final interview, 30% were uncertain and 34% believed LE was 1 year or less. Among those interviewed within 30 days of the patient's death, 31% of patients and 52% of caregivers believed LE was 1 year or less. Patients' estimates of the LE did not differ according to their diagnosis.

CONCLUSIONS

There was little change in prognostic awareness over time. Even close to death, a large proportion of patients and caregivers were uncertain about prognosis, and few believed the patient had a limited life expectancy. Whether or not patients should know their prognosis is the subject of active debate; the persistence of prognostic misperception suggests that prognostic awareness may be difficult to change.

Predictors of perceived risk for colon cancer in a national probability sample in the United States

This study examines potential predictors of perceived risk for colon cancer in a U.S. sample of 2,949 individuals aged 45 and older with no colon cancer history. We examined perceived comparative risk for colon cancer as the outcome in ordinal regression analyses, and perceived absolute risk for colon cancer in linear regression analyses. Potential predictors included demographics, current risk behaviors, self-reported health, family and personal cancer history, emotion variables (colon cancer worry, general anxiety, and fear of positive screening findings), general cancer beliefs (causes, lack of preventability, information overload), and cancer information seeking. Those who had poorer self-reported health, a family cancer history, and increased colon cancer worry had higher perceived comparative and absolute colon cancer risk (all ps < .05). Those who were younger, interviewed in Spanish, had increased anxiety, and information overload had higher comparative risk; those with a personal history of cancer and fear that colon cancer screening would result in positive findings had higher absolute risk (all ps < .05). We determined that older individuals, those with risk factors, and those with good subjective health may not realize their colon cancer risk. Those distressed about colon cancer and who report cancer prevention information overload may require different messages.

Risks and benefits of population-based genetic testing for Mendelian subsets of common diseases were examined using the example of colorectal cancer risk

OBJECTIVE

Genetic testing for adult-onset, common diseases is becoming more commonplace in clinical medicine. We modeled the proportions of hypothetic populations that would potentially benefit or suffer harm from widespread predisposition testing.

METHODS

Using the traditional two-by-two table from the discipline of epidemiology, we modeled three hypothetic populations using the example of genetic testing for hereditary colorectal cancer in three groups: the general population, a genetically increased-risk population, and a population at increased risk due to nongenetic factors.

RESULTS

We demonstrate that the potential benefits are increased and risks are reduced when testing is limited to those at increased genetic risk when compared with testing in the general population. Where disease incidence is increased due to nongenetic factors, genetic testing has the potential to detract from the detection and reduction of other potentially important risk factors.

CONCLUSION

While targeted testing can benefit those truly at increased risk, broadly applied genetic testing can do more harm than good.

Knowledge of aging and life satisfaction among older adults

Four hundred young-, middle-, and old-old adults responded to a battery of quizzes dealing with life satisfaction and objective aging knowledge in the physical, psychological, and social domains. Analyses incorporated domains of aging knowledge, life satisfaction, age, gender, and demographic variables. Both means difference and regression analyses were computed. Significant age group, gender, and life satisfaction differences were found for the three aging knowledge domains. For successive age groups, knowledge of aging decreased, with females knowing less than males. The greater knowledge of aging, the higher the life satisfaction. The demographic variables education, financial status, health, living arrangement, and volunteerism were significant covariates for knowledge of aging. Results from this study indicate that knowledge of aging in specific domains varies among older adult age groups and is associated with life satisfaction.

Beyond Medical Risk: Investigating the Psychological Factors Underlying Women's Perceptions of Susceptibility to Breast Cancer, Heart Disease, and Osteoporosis

The relationships of epidemiological (objective) risk indices, perceived disease characteristics, and cognitive heuristics to women's perceived susceptibility to breast cancer, heart disease, and osteoporosis in a community sample of 312 women ages 40-86 were examined. Epidemiological indices accounted for a small to moderate proportion of the variance in perceived susceptibility. Psychological factors (perceived similarity to women who contract the target disease and perceived disease prevalence) predicted perceived susceptibility above and beyond medical risk factors. Opposite to actual risk, age correlated negatively with perceived susceptibility to all 3 diseases. Exploratory analyses suggested that perceived similarity, perceived prevalence, and absent/exempt beliefs might mediate this relationship. Confirmatory factor analyses verified that measures of absolute and direct comparative risk assess the same underlying construct of perceived susceptibility.

Understanding Older Women's Health Care Concerns: A Qualitative Study

BACKGROUND

Older women often have different physical and psychological health priorities compared to men, and health systems must strive to extend and improve health care delivery to meet older women's specific health care needs. The goal of this study was to obtain information from older women on how to improve health care services to best support their efforts to age successfully and receive optimal quality health care in later life.

METHODS

Focus groups were conducted among women aged 65 or older recruited from the community in the Montreal, Quebec, area. A total of 36 women participated. The focus group sessions were audiotaped, and the transcripts of each session were analyzed for issues and themes emerging from the text. Content analysis using the framework approach was used to explore and understand the experience of the focus group participants. The data from the text were then coded according to the relevant and emergent ideas and concepts.

RESULTS

Participants felt that their physical health care needs were being met, but that a number of issues relating to psychological health were inadequately addressed by health care professionals. The importance of feeling validated as active participants in a health care relationship, recognition of fears and anxieties associated with aging, and the need for information-sharing and education were all viewed as important health care priorities for older women. Time and accessibility were identified as the most significant barriers towards receiving optimal health care in later life.

INTERPRETATION

The current health care system does not meet the global health care needs of older women. Health care leaders must recognize that success in program development and delivery for older women will require designing clinical programs that address both the physiological and psychosocial requirements of women. Only when women feel that they are being cared for in a comprehensive manner, one that includes attention to physical, psychological and emotional health, are we likely to be delivering health care that optimally promotes successful aging.

Physician adherence to preventive cardiology guidelines for women

Despite the publication of the American Heart Association/American College of Cardiology (AHA/ACC) "Guide to Preventive Cardiology for Women" primary care screening and treatment of women at risk for coronary heart disease risk is not optimal. The purpose of this article is to apply a framework of physician behavior to describe specific challenges in implementing clinical practice guidelines for women's cardiovascular health in the primary care setting. Specifically, we illustrate 1) underlying barriers to adherence, 2) attempts and interventions to overcome these barriers, and 3) future areas of research to improve physician adherence to guidelines for the prevention and treatment of heart disease in women.

Understanding older women's health care concerns: a qualitative study

BACKGROUND

Older women often have different physical and psychological health priorities compared to men, and health systems must strive to extend and improve health care delivery to meet older women's specific health care needs. The goal of this study was to obtain information from older women on how to improve health care services to best support their efforts to age successfully and receive optimal quality health care in later life.

METHODS

Focus groups were conducted among women aged 65 or older recruited from the community in the Montreal, Quebec area. A total of 36 women participated. The focus group sessions were audiotaped, and the transcripts of each session were analyzed for issues and themes emerging from the text. Content analysis using the framework approach was used to explore and understand the experience of the focus group participants. The data from the text were then coded according to the relevant and emergent ideas and concepts.

RESULTS

Participants felt that their physical health care needs were being met, but that a number of issues relating to psychological health were inadequately addressed by health care professionals. The importance of feeling validated as active participants in a health care relationship, recognition of fears and anxieties associated with aging, and the need for information-sharing and education were all viewed as important health care priorities for older women. Time and accessibility were identified as the most significant barriers towards receiving optimal health care in later life.

INTERPRETATION

The current health care system does not meet the global health care needs of older women. Health care leaders must recognize that success in program development and delivery for older women will require designing clinical programs that address both the physiological and psychosocial requirements of women. Only when women feel that they are being cared for in a comprehensive manner, one that includes attention to physical, psychological and emotional health, are we likely to be delivering health care that optimally promotes successful aging.

Worry regarding major diseases among older African-American, Native-American, and Caucasian women

This study examined worry regarding seven major diseases and their correlates in a sample of African-American (n = 57), Native-American (n = 50), and Caucasian (n = 53) women ages 36 to 91 years. African-American and Native-American women were most worried about developing cancer (44% and 50%, respectively) while Caucasian women were most worried about osteoporosis (37%) and cancer (33%). Women from each ethnic group were more worried about developing cancer than cardiovascular diseases and conditions. African-American and Native-American women were more worried than Caucasian women about developing diabetes and high cholesterol. Body mass index (BMI) was a consistent correlate of worry: heavier women were more worried about developing diseases than were leaner women. Other risk factors (e.g., physical activity, blood pressure), however, were generally not associated with disease worry. In fact, age was inversely associated with worry regarding diabetes, cancer, and osteoporosis. Although women who were more worried about developing cancer were more likely to perform monthly breast self-exams, worry regarding other diseases was not associated with preventive actions. These results are generally consistent with other studies that indicate women are more concerned about cancer than cardiovascular diseases.

Risk perception of participants in a family-based genetic screening program on familial hypercholesterolemia

The aim of this article is threefold. First, we describe the accuracy of people's risk perception who have been screened on familial hypercholesterolemia (FH) in a family-based screening program. Second, we identify factors that modify risk perception. Finally, we show the influence of risk perception on subsequent preventive behavior. The risk perception of 556 screenees (677 participants, overall response = 82%) was measured by postal questionnaires on three occasions: at screening and 3 days and 7 months after the test result was reported to the patient. Presentation of the risk was precategorized and given both as numerical (1 in x) and as verbal probability. In addition, medication use and attitudes toward gene therapy were determined 7 months after screening. On average, the screenees underestimated their numeric risk of having FH and getting a myocardial infarction (MI). Furthermore, FH-positive screenees perceived that they were at greater risk of MI than FH negatives, and screenees with the highest actual risk used medication more, perceived a greater risk, and opted more often for future gene therapy. Risk perception of having FH was influenced by cholesterol level, while MI risk perception was affected by age, education, cholesterol level, and cardiovascular disease (CVD) in the family. We conclude that FH-positive screenees correctly perceive a higher risk of getting a heart attack than do FH-negative screenees. Screenees did not believe that MI was inevitable, and risk perception was associated with both medication use and the intention to opt for gene therapy, but not with other preventive measures. Thus, genetic risk notification seems to be acceptable and does not lead to aversion to preventive behavior.

Counseling middle-aged women about physical activity using the stages of change

PURPOSE

To discuss application of the Stages of Change theoretical framework and provide clinical tips on exercise adherence among midlife women. Included is a checklist to assist the nurse practitioner (NP) in effectively delivering the message.

DATA SOURCES

Review of the current scientific literature on exercise adherence and the Stages of Change model.

CONCLUSIONS

Middle-aged women comprise a unique population. Determining the woman's readiness for change using the Stages of Change model, NPs can routinely include appropriate exercise recommendations in their practices.

IMPLICATIONS FOR PRACTICE

Nurse practitioners are in a unique position to promote healthy behaviors by counseling women in midlife about adopting an active lifestyle. Exercise counseling is an essential component of healthcare, especially among middle-aged women who are experiencing physical, emotional, and social changes.

Perception of risk for coronary heart disease in women undergoing coronary angiography

BACKGROUND

Even though coronary heart disease (CHD) is the leading cause of death among women in the United States, most women underestimate their risk of developing CHD.

DESIGN

Survey to examine the relationship between women's recollection of being told they were at risk for CHD and the presence of risk factors.

SETTING/PARTICIPANTS

A convenience sample of 450 women undergoing coronary angiography at 1 university hospital.

MAIN OUTCOME MEASURES

Self-recollection of being told one was at risk for CHD and presence of CHD risk factors.

RESULTS

Most women (83.6%) had 3 or more risk factors, 12.2% had 1 or 2 risk factors, and 0.9% had no risk factors. Only 35% of women recalled being told that they were at risk for CHD. Few relationships were found between being told one was at risk for CHD and the presence of individual risk factors. No difference was found in the mean number of risk factors among women who did and did not recall being told they were at risk. In logistic regression analysis, only 5% of the variance in recollection of being told one was at risk was predicted, with only age, education, and having a high cholesterol level significantly contributing to the equation.

CONCLUSIONS

Even though women may not remember conversations with their health care provider about CHD risk, the possibility that risk factors were not adequately assessed cannot be discounted. Patient-provider conversations about CHD risk factors should be encouraged as the first step toward successful risk reduction.

Are women worrying about heart disease?

Women at risk for coronary artery disease (CAD) may not be worried about the disease. In this study, demographic, CAD-risk, and CAD-worry data collected from Durham Veterans' Affairs Medical Center women veterans were examined using bivariate and multivariate analysis with worry as the outcome. Excluding CAD patients (N = 64) and incomplete data (N = 17) of 328 women, 42% worried about CAD. Younger age, single marital status, obesity, family history, and hyperlipidemia were associated with worry. Of women with up to three risk factors, fewer than half worried about CAD. Higher-risk women were unconcerned about CAD. This could undermine prevention efforts.

Risk and reluctance: understanding impediments to colorectal cancer screening

PURPOSE

Screening to detect and prevent colorectal cancer (CRC) is well below optimal, contributing to needless CRC-related morbidity and mortality. Little detailed information exists explaining why screening technologies are underutilized and why screening adherence rates are low. Prior to the design of an intervention study, we assessed knowledge about CRC among adult women and men with access to health care. We also investigated patterns of perceived risk for CRC, barriers and facilitators to screening, and experience and intentions with regard to both fecal occult blood testing and flexible sigmoidoscopy.

METHODS

We analyzed data from semistructured focus group interviews with a small, nonrepresentative sample (n = 39) of community-dwelling adult men and women ages 50 to 64 and 65 plus.

RESULTS

CRC-related knowledge is low, and misperceptions are common. Provider practices reinforce low levels of perceived risk. Multiple barriers to screening exist, of which many are remediable.

CONCLUSIONS

We are at an early stage in the diffusion of information about CRC. Screening utilization may be improved through development of appropriate public health awareness campaigns and by addressing service factors. Recommendations are provided.

Factors that influence personal perceptions of the risk of an acute myocardial infarction

Personal risk perceptions of acute myocardial infarction (AMI) affect people's preventive health behaviors as well as their beliefs during a heart attack episode. The authors investigated factors that are associated with personal risk perceptions of having an AMI. A random-digit-dial survey was conducted among 1294 respondents, aged 18 years or older, in 20 communities across the nation as part of the Rapid Early Action for Coronary Treatment (REACT) trial. Results of two mixed-model linear regression analyses suggested that worse perceived general health, more risk factors, and greater knowledge were associated with greater perception of AMI risk. The results also showed that women who answered, incorrectly, that heart disease is not the most common cause of death for women in the United States reported significantly lower risk perceptions than women who answered this question correctly. The findings in this study suggest that interventions need to target specific misconceptions regarding AMI risk.

It won't happen to me: lower perception of heart disease risk among women with family histories of breast cancer

BACKGROUND

The threat that breast cancer poses to American women, particularly to women with family histories of the disease, has received widespread attention in both medical and popular literatures. While this emphasis may have laudable consequences on breast cancer screening, it may also have a negative consequence, obscuring women's recognition of their risks for other health threats, such as heart disease. This study examined the possibility that women with family histories of breast cancer may be particularly susceptible to overestimating their risks of breast cancer while minimizing their risks of cardiovascular disease.

METHODS

Healthy women with (n = 73) and without n = 104) family histories of breast cancer (64% African American, 26% Caucasian, 10% other ethnicities, mean age 41.7 years) were recruited from medical centers in New York City, and completed questionnaires concerning their family histories and perceptions of risk.

RESULTS

Consistent with the study hypothesis, women with family histories of breast cancer had significantly higher perceived lifetime risk of breast cancer (P<0.0002) but lower perceived lifetime risk of heart disease (P<0.002) than women without family histories. Additionally, women with family histories of breast cancer had lower perceived colon cancer risk (P<0.02), suggesting that women with family histories of breast cancer may be underestimating their risks for a variety of diseases.

CONCLUSION

The emphasis on breast cancer risk, especially for women with family histories of the disease, may need to be balanced by educational efforts concerning women's risk of other diseases, particularly cardiovascular disease.

Prevention of heart disease in women: recommendations for management of risk factors

Coronary heart disease is the leading cause of death and disability in women in the U.S. Unfortunately, efforts for primary and secondary prevention of coronary heart disease are less than optimal. The need to emphasize prevention of coronary heart disease in women in important because first events are often fatal in women. Factors that are unique in terms of their influence on risk for coronary heart disease in women include age, reproductive and hormonal status, high density lipoprotein cholesterol and triglyceride levels, and the presence of diabetes. A consistent plan to address risk factor management of each woman is the key to long term risk reduction. Nurses and nurse practitioners, working in any setting, can use the recommendations presented in this paper to help women reduce their risk for coronary heart disease.

Engaging women's interest in colorectal cancer screening: a public health strategy

Screening rates for colorectal cancer are unacceptably low. New guidelines, public education campaigns, and expanded coverage of screening costs by healthcare insurance are expected to increase screening rates, but interventions targeting women may accelerate this change. Most American women already participate in regular cancer screening, in the form of Papanicolaou (Pap) tests and mammography, so they may be receptive to tailored messages about the need to add regular colorectal cancer screening to their preventive health regimen. In addition, their role in promoting the health of family members may position women to influence screening behavior in family and friends. Women may be particularly valuable change agents in populations where screening rates are traditionally low, such as medically underserved populations, the elderly or low socioeconomic status groups with competing health priorities, and populations with cultural values or practices inconsistent with the adoption of a new screening behavior. To serve as agents of change in their family and social networks, women must understand that colorectal cancer is not solely a man's disease and that the benefits of colorectal screening are similar to those of Pap testing and mammography. Colorectal cancer screening should also be promoted within a framework of a lifelong strategy for health maintenance for both men and women. The message to women should emphasize the value of colorectal cancer screening rather than the disagreement among experts over preferred screening strategies and should emphasize the value of shared decision making between the patient and her healthcare provider.