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Hardie EA. Australian community responses to the use of genetic testing for personalised health promotion. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/j.1742-9536.2011.00017.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Elizabeth A. Hardie
- Psychological Science and Statistics, Faculty of Life & Social Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Preventing Tire Blowout Accidents: A Perspective on Factors Affecting Drivers’ Intention to Adopt Tire Pressure Monitoring System. SAFETY 2018. [DOI: 10.3390/safety4020016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
OBJECTIVES To identify factors that may increase intentions to seek help for an early dementia diagnosis. Early dementia diagnosis in Ireland is low, reducing the opportunity for intervention, which can delay progression, reduce psychological distress and increase social supports. METHOD Using the theory of planned behaviour (TPB), and a mixed methods approach, three focus groups were conducted (N = 22) to illicit attitudes and beliefs about help seeking for an early dementia diagnosis. The findings informed the development of the Help Seeking Intentions for Early Dementia Diagnosis (HSIEDD) questionnaire which was piloted and then administered to a sample of community dwelling adults from Dublin and Kildare (N = 95). RESULTS Content analysis revealed participants held knowledge of the symptoms of dementia but not about available interventions. Facilitators of help seeking were family, friends and peers alongside well informed health professionals. Barriers to seeking help were a lack of knowledge, fear, loss, stigma and inaccessible services. The quantitative findings suggest the TPB constructs account for almost 28% of the variance in intentions to seek help for an early diagnosis of dementia, after controlling for sociodemographic variables and knowledge of dementia. In the final step of the regression analysis, the main predictors of help seeking were knowledge of dementia and subjective norm, accounting for 6% and 8% of the variance, respectively. CONCLUSION Future interventions should aim to increase awareness of the support available to those experiencing early memory problems, and should highlight the supportive role that family, friends, peers and health professionals could provide.
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Affiliation(s)
- Susan Devoy
- a School of Psychology , Ulster University , Northern Ireland , UK
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VonDras DD, Madey SF. The Attainment of Important Health Goals Throughout Adulthood: An Integration of the Theory of Planned Behavior and Aspects of Social Support. Int J Aging Hum Dev 2016; 59:205-34. [PMID: 15566011 DOI: 10.2190/78uq-5nmw-7yld-tfwv] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This research integrates the Theory of Planned Behavior (TPB) with aspects of social support and explores the utility of variables within each model in predicting the attainment of important health goals. Incorporating an idiographic methodology, 290 respondents ranging in age from 27 to 87 years were administered a postal survey and completed a brief follow-up telephone survey months later. The postal survey included measures of respondent's most important health goals, attitudes, motivation to comply with subjective norms, control beliefs, behavioral intention, and plan-of-action for attaining the health goal, as well as aspects of social support. The follow-up telephone survey inquired into respondents' successful goal attainment and health. Results indicate association, between TPB components and aspects of social support. Further, the emotional and instrumental support provided by a family member or friend and size of social support network were found to be unique predictors of health goal attainment after controlling for TPB components. The importance of personalized goals and social support in designing health interventions for older adults is discussed.
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Affiliation(s)
- Dean D VonDras
- College of Human Development and Psychology, University of Wisconsin-Green Bay, 54311-7001, USA.
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Kim SC, Cappella JN, Price V. Online discussion effects on intention to participate in genetic research: A longitudinal experimental study. Psychol Health 2016; 31:1025-46. [PMID: 26979570 DOI: 10.1080/08870446.2016.1165221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The National Human Genome Research Institute has emphasised community engagement and public dialogue in the U.S. on issues related to genetics. This study examines how online discussions among the U.S. public directly or indirectly influence psychosocial constructs of the Theory of Planned Behavior, including intention to take part in genetic research. DESIGN After completing the baseline questionnaire, participants (n = 3754) were randomly assigned to one of the following three groups: the discussion group, the pre-/post-only group and the End-of-Project group. The discussion group (n = 1824) was invited and participated in up to three online discussions, which were held from November 2008 to May 2009. MAIN OUTCOME MEASURES Behavioural intention, beliefs, attitudes, subjective norm and perceived behavioural control variables were assessed. RESULTS The most interesting finding was that those participating in online discussions had fewer negative beliefs about volunteering for genetic research, which in turn contributed to more positive attitudes, increased injunctive and descriptive norms and enhanced behavioural control. These relationships, then, were associated with higher intention to participate in genetic research. CONCLUSION These findings suggest that continuous public discussions seem to positively affect volunteer intention for genetic research through ameliorating fears of negative consequences.
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Affiliation(s)
- Sojung Claire Kim
- a Nido Qubein School of Communication , High Point University , High Point , NC , USA
| | - Joseph N Cappella
- b Annenberg School for Communication , University of Pennsylvania , Philadelphia , PA , USA
| | - Vincent Price
- b Annenberg School for Communication , University of Pennsylvania , Philadelphia , PA , USA
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Cooke R, French DP. How well do the theory of reasoned action and theory of planned behaviour predict intentions and attendance at screening programmes? A meta-analysis. Psychol Health 2014; 23:745-65. [PMID: 25160879 DOI: 10.1080/08870440701544437] [Citation(s) in RCA: 166] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Meta-analysis was used to quantify how well the Theories of Reasoned Action and Planned Behaviour have predicted intentions to attend screening programmes and actual attendance behaviour. Systematic literature searches identified 33 studies that were included in the review. Across the studies as a whole, attitudes had a large-sized relationship with intention, while subjective norms and perceived behavioural control (PBC) possessed medium-sized relationships with intention. Intention had a medium-sized relationship with attendance, whereas the PBC-attendance relationship was small sized. Due to heterogeneity in results between studies, moderator analyses were conducted. The moderator variables were (a) type of screening test, (b) location of recruitment, (c) screening cost and (d) invitation to screen. All moderators affected theory of planned behaviour relationships. Suggestions for future research emerging from these results include targeting attitudes to promote intention to screen, a greater use of implementation intentions in screening information and examining the credibility of different screening providers.
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Affiliation(s)
- Richard Cooke
- a School of Life & Health Sciences, Psychology , Aston University , Aston Triangle , Birmingham , B4 7ET
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Koch EJ. How Does Anticipated Regret Influence Health and Safety Decisions? A Literature Review. BASIC AND APPLIED SOCIAL PSYCHOLOGY 2014. [DOI: 10.1080/01973533.2014.935379] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sweeny K, Ghane A, Legg AM, Huynh HP, Andrews SE. Predictors of genetic testing decisions: a systematic review and critique of the literature. J Genet Couns 2014; 23:263-88. [PMID: 24719248 DOI: 10.1007/s10897-014-9712-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 03/11/2014] [Indexed: 12/28/2022]
Abstract
Genetic testing is increasingly available in medical settings and direct-to-consumer. However, the large and growing literature on genetic testing decisions is rife with conflicting findings, inconsistent methodology, and uneven attention across test types and across predictors of genetic testing decisions. Existing reviews of the literature draw broad conclusions but sacrifice nuanced analysis that with a closer look reveals far more inconsistency than homogeny across studies. The goals of this paper are to provide a systematic review of the empirical work on predictors of genetic testing decisions, highlight areas of consistency and inconsistency, and suggest productive directions for future research. We included all studies that provided quantitative analysis of subjective (e.g., perceived risk, perceived benefits of testing) and/or objective (e.g., family history, sociodemographic variables) predictors of genetic testing interest, intentions, or uptake, which produced a sample of 115 studies. From this review, we conclude that self-reported and test-related (as opposed to disorder-related or objective) predictors are relatively consistent across studies but that theoretically-driven efforts to examine testing interest across test types are sorely needed.
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Affiliation(s)
- Kate Sweeny
- Department of Psychology, University of California, 900 University Ave., Riverside, CA, 92521, USA,
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Sherman KA, Miller SM, Shaw LK, Cavanagh K, Sheinfeld Gorin S. Psychosocial approaches to participation in BRCA1/2 genetic risk assessment among African American women: a systematic review. J Community Genet 2013; 5:89-98. [PMID: 23934762 PMCID: PMC3955455 DOI: 10.1007/s12687-013-0164-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 07/18/2013] [Indexed: 01/07/2023] Open
Abstract
Breast cancer is a significant health concern for African American women. Nonetheless, uptake of genetic risk assessment (including both genetic counseling and testing) for breast cancer gene mutations among these populations remains low. This paper systematically reviews cognitive (i.e., beliefs) and affective (i.e., emotions) factors influencing BRCA1/2 genetic risk assessment among African American women as well as psychosocial interventions to facilitate informed decision making in this population. A systematic search of CINAHL, PubMed, and PsycINFO was undertaken, yielding 112 published studies. Of these, 18 met the eligibility criteria. African American woman are likely to participate in genetic risk assessment if they are knowledgeable about cancer genetics, perceive a high risk of developing breast cancer, have low expectancies of stigmatization from medical professionals, view themselves as independent from family, and have fatalistic beliefs and a future temporal orientation. Anticipated negative affective responses, such as an inability to “handle” the results of testing, are barriers to uptake. Specific perceptions, beliefs, and emotional factors are associated with genetic risk assessment among African American women. Understanding these factors is key in the development of interventions to facilitate informed decision making in this population.
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Affiliation(s)
- Kerry A Sherman
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, 2109, Australia,
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Overstreet RE, Cegielski C, Hall D. Predictors of the intent to adopt preventive innovations: a meta-analysis. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2013. [DOI: 10.1111/jasp.12058] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Casey Cegielski
- Department of Aviation and Supply Chain Management; Auburn University
| | - Dianne Hall
- Department of Aviation and Supply Chain Management; Auburn University
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Shiloh S, Wade CH, Roberts JS, Hensley Alford S, Biesecker BB. On averages and peaks: how do people integrate attitudes about multiple diseases to reach a decision about multiplex genetic testing? Med Decis Making 2013; 33:71-7. [PMID: 23128581 PMCID: PMC3799841 DOI: 10.1177/0272989x12464432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of the current study was to learn how people integrate attitudes about multiple health conditions to make a decision about genetic testing uptake. METHODS This study recruited 294 healthy young adults from a parent research project, the Multiplex Initiative, conducted in a large health care system in Detroit, Michigan. All participants were offered a multiplex genetic test that assessed risk for 8 common health conditions (e.g., type 2 diabetes). Data were collected from a baseline survey, a web-based survey, and at the time of testing. RESULTS Averaging attitudes across diseases predicted test uptake but did not contribute beyond peak attitudes, the highest attitude toward testing for a single disease in the set. Peak attitudes were found sufficient to predict test uptake. LIMITATIONS The effects of set size and mode of presentation could not be examined because these factors were constant in the multiplex test offered. CONCLUSIONS These findings support theories suggesting that people use representative evaluations in attitude formation. The implication of these findings for further developments in genetic testing is that the communication and impact of multiplex testing may need to be considered in the light of a bias toward peak attitudes.
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Affiliation(s)
- Shoshana Shiloh
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (SS)
| | - Christopher H Wade
- Department of Nursing, University of Washington Bothell, Bothell, WA, USA (CHW)
| | - J Scott Roberts
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA (JSB)
| | - Sharon Hensley Alford
- Department of Biostatistics and Research Epidemiology, Henry Ford Health System, Detroit, MI, USA (SHA)
| | - Barbara B Biesecker
- Social & Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA (BBB)
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Fisher A, Bonner C, Biankin AV, Juraskova I. Factors influencing intention to undergo whole genome screening in future healthcare: a single-blind parallel-group randomised trial. Prev Med 2012; 55:514-20. [PMID: 22935645 DOI: 10.1016/j.ypmed.2012.08.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 08/12/2012] [Accepted: 08/14/2012] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study investigated the effect of biased information on beliefs about, and intention to undergo, whole genome sequencing (WGS) screening; and predictors of intention. METHODS A single-blind parallel-group randomised trial was conducted in Australia, in 2011. Using Excel, 216 participants with English proficiency and no genetic testing experience were randomly allocated (1:1): a neutral information pamphlet or a biased version omitting screening limitations. Measures included: screening intention; Protection Motivation Theory (PMT) constructs; consideration of future consequences (CFC); uncertainty avoidance (UA); anticipated regret (AR). RESULTS Intention decreased from pre to post-manipulation (p<.001, η(2)=.07, 95% CIs [4.41, 4.86], [3.99, 4.44], respectively). Biased participants (n=106) had higher response efficacy beliefs than neutral participants (n=102) (p<.001, η(2)=.04, 95% CIs [4.80, 5.10], [4.49, 4.79] respectively), but equal intention. The model explained 36.2% of the variance in intention; response efficacy (p<.001), response costs (p<.001), self-efficacy (p=.024), and UA (p=.019) were predictors. CONCLUSION This is the first study investigating factors influencing anticipated WGS screening uptake. Omitting screening limitations may bias beliefs about screening efficacy and benefits. Uptake may be driven by perceived benefits and costs, self-efficacy beliefs, and uncertainty avoidance. PMT appears to be an appropriate psychosocial model for this setting.
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Affiliation(s)
- Alana Fisher
- Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Psychology, Brennan MacCallum (A18), University of Sydney, NSW, 2006, Australia.
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Rahman B, Meiser B, Sachdev P, Barlow-Stewart K, Otlowski M, Zilliacus E, Schofield P. To Know or Not to Know: An Update of the Literature on the Psychological and Behavioral Impact of Genetic Testing for Alzheimer Disease Risk. Genet Test Mol Biomarkers 2012; 16:935-42. [DOI: 10.1089/gtmb.2011.0300] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Belinda Rahman
- Psychosocial Research Group, Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Sydney, Australia
- Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
| | - Bettina Meiser
- Psychosocial Research Group, Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Sydney, Australia
- Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
| | - Perminder Sachdev
- Brain and Ageing Research Program, School of Psychiatry, University of New South Wales, Randwick, NSW, Sydney, Australia
- Neuropsychiatric Institute, Prince of Wale Hospital, Randwick, NSW, Sydney, Australia
| | - Kristine Barlow-Stewart
- Sydney Medical School, University of Sydney, Sydney, Australia
- Centre for Genetics Education, NSW Health, St. Leonards, NSW, Australia
| | - Margaret Otlowski
- Faculty of Law, Centre for Law and Genetics, University of Tasmania, Hobart, Australia
| | - Elvira Zilliacus
- Psychosocial Research Group, Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Sydney, Australia
- Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia
| | - Peter Schofield
- Neuroscience Research Australia, Sydney, Australia
- School of Medical Sciences, University of New South Wales, Sydney, Australia
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Prenatal genetic testing: an investigation of determining factors affecting the decision-making process. J Genet Couns 2012; 22:76-89. [PMID: 22477148 DOI: 10.1007/s10897-012-9498-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 03/07/2012] [Indexed: 10/28/2022]
Abstract
Despite the increase in popularity of prenatal genetic testing, relatively little is known about the role psychological factors play in the decision-making process. In this analogue study, a sample of Italian female university students was used to investigate determining factors that predict the intention of undergoing prenatal genetic testing. Structural Equation Modelling was used to describe the dynamic interplay between knowledge, beliefs, attitudes and health-related behaviour such as prenatal genetic testing. Following the Theory of Reasoned Action, three dimensions predicted the intention to undergo prenatal genetic testing: the need for more scientific information, a positive attitude towards genetic testing, and the inclination to terminate pregnancy after receiving a positive test result. Results showed that less religious women tended to be more in favour of prenatal tests and in undertaking such tests. This preliminary study provides genetic counsellors and policy makers with a clearer picture of their clients' motives and attitudes behind the decision-making process of prenatal genetic testing, contributing to improving both the communication process between counsellors and their clients and the organization of genetic services.
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Wolff K, Nordin K, Brun W, Berglund G, Kvale G. Affective and cognitive attitudes, uncertainty avoidance and intention to obtain genetic testing: An extension of the Theory of Planned Behaviour. Psychol Health 2011; 26:1143-55. [DOI: 10.1080/08870441003763253] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Widayanti CG, Ediati A, Tamam M, Faradz SMH, Sistermans EA, Plass AMC. Feasibility of preconception screening for thalassaemia in Indonesia: exploring the opinion of Javanese mothers. ETHNICITY & HEALTH 2011; 16:483-499. [PMID: 21797731 DOI: 10.1080/13557858.2011.564607] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Thalassaemia has become a major public health issue in Indonesia. It has been estimated that up to 10% of the population carries a gene associated with beta-thalassaemia. Currently, there is no formal recommendation for thalassaemia screening. This study aimed to explore awareness of thalassaemia, and to explore attitudes regarding carrier testing among Javanese mothers. METHODS A quantitative questionnaire, designed using constructs of the Theory of Planned Behaviour, was applied cross-sectionally. RESULTS Out of 191 mothers who were invited, 180 agreed to participate (RR = 94%), of whom 74 had a child affected with thalassaemia. Both attitudes towards receiving information about thalassaemia, and attitudes towards carrier testing were very positive. Awareness of thalassaemia was poor. Mothers, both those with and without an affected child, had barely heard of thalassaemia, nor of carrier testing. However, all mothers, including those with an affected child expressed high levels of interest in carrier testing. Respondents did not perceive that they had any control over carrier testing, and feared stigmatization and being discriminated against if their carrier status was identified. Attitudes towards carrier testing explained 23% of future reproductive intentions, in addition to perceived stigmatization, education level and 'mother's age' (R (2)=0.44; p=0.001). CONCLUSION Responding mothers expressed high levels of interest in receiving information on both thalassaemia and carrier testing. The less educated and the more deprived they were, the keener they were to receive this information. Overall, awareness of thalassaemia was low. Even mothers with affected children seemed unaware of the inheritance pattern and the recurrent risk of having an affected child in a subsequent pregnancy, showing the need for genetic counselling in Indonesia. It is therefore recommended not only to raise awareness about thalassaemia, but to improve the education of healthcare professionals as well.
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Affiliation(s)
- Costrie Ganes Widayanti
- Biomedical Postgraduate Program on Genetic Counseling, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
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Power TE, Swartzman LC, Robinson JW. Cognitive-emotional decision making (CEDM): a framework of patient medical decision making. PATIENT EDUCATION AND COUNSELING 2011; 83:163-169. [PMID: 20573468 DOI: 10.1016/j.pec.2010.05.021] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 04/21/2010] [Accepted: 05/25/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Assistance for patients faced with medical decisions has largely focussed on the clarification of information and personal values. Our aim is to draw on the decision research describing the role of emotion in combination with health behaviour models to provide a framework for conceptualizing patient decisions. METHODS A review of the psychological and medical decision making literature concerned with the role of emotion/affect in decision making and health behaviours. RESULTS Emotion plays an influential role in decision making. Both current and anticipated emotions play a motivational role in choice. Amalgamating these findings with that of Leventhal's (1970) SRM provide a framework for thinking about the influence of emotion on a patient medical decision. CONCLUSION Our framework suggests that a patient must cope with four sets of elements. The first two relate to the need to manage the cognitive and emotional aspects of the health threat. The second set relate to the management of the cognitive and emotional elements of the decision, itself. PRACTICE IMPLICATIONS The framework provides a way for practitioners and researchers to frame thinking about a patient medical decision in order to assist the patient in clarifying decisional priorities.
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Affiliation(s)
- Tara E Power
- Calgary Breast Health Program, Alberta Health Services, Calgary, Canada.
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Myers LB, Goodwin R. Determinants of adults' intention to vaccinate against pandemic swine flu. BMC Public Health 2011; 11:15. [PMID: 21211000 PMCID: PMC3024930 DOI: 10.1186/1471-2458-11-15] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 01/06/2011] [Indexed: 01/31/2023] Open
Abstract
Background Vaccination is one of the cornerstones of controlling an influenza pandemic. To optimise vaccination rates in the general population, ways of identifying determinants that influence decisions to have or not to have a vaccination need to be understood. Therefore, this study aimed to predict intention to have a swine influenza vaccination in an adult population in the UK. An extension of the Theory of Planned Behaviour provided the theoretical framework for the study. Methods Three hundred and sixty two adults from the UK, who were not in vaccination priority groups, completed either an online (n = 306) or pen and paper (n = 56) questionnaire. Data were collected from 30th October 2009, just after swine flu vaccination became available in the UK, and concluded on 31st December 2009. The main outcome of interest was future swine flu vaccination intentions. Results The extended Theory of Planned Behaviour predicted 60% of adults' intention to have a swine flu vaccination with attitude, subjective norm, perceived control, anticipating feelings of regret (the impact of missing a vaccination opportunity), intention to have a seasonal vaccine this year, one perceived barrier: "I cannot be bothered to get a swine flu vaccination" and two perceived benefits: "vaccination decreases my chance of getting swine flu or its complications" and "if I get vaccinated for swine flu, I will decrease the frequency of having to consult my doctor," being significant predictors of intention. Black British were less likely to intend to have a vaccination compared to Asian or White respondents. Conclusions Theoretical frameworks which identify determinants that influence decisions to have a pandemic influenza vaccination are useful. The implications of this research are discussed with a view to maximising any future pandemic influenza vaccination uptake using theoretically-driven applications.
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Affiliation(s)
- Lynn B Myers
- School of Social Sciences, Brunel University, Uxbridge, UK.
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Abstract
OBJECTIVES To develop a questionnaire that will capture patients' attitudes about dementia screening in primary care. METHODS Cross-sectional study of 315 patients aged 65 and older attending urban and rural primary care clinics in Indianapolis and North Carolina. The Perceptions Regarding Investigational Screening for Memory in Primary Care (PRISM-PC) questionnaire was administered via face-to-face or telephone interview. RESULTS The PRISM-PC questionnaire consists of two separate scales: the patient's acceptance of dementia screening scale and the patient's perceived harms and benefits of dementia screening scale. The face validity of the PRISM-PC questionnaire was based on a systematic literature review and the opinions of 16 clinician-investigators with experience in screening for dementia. Exploratory factor analyses for the acceptance scale revealed the presence of two dimensions: knowledge about dementia risk and testing for dementia. For the benefits and harms scale, exploratory factor analyses identified four dimensions: perceived benefits of screening, stigma of screening, suffering from screening, and impact of screening on patients' independence. The internal consistency of each of the above subscales was good with Cronbach's alpha ranging from 0.58-0.85. CONCLUSION The PRISM-PC questionnaire captures primary care patients' acceptance, perceived harms, and perceived benefits of dementia screening.
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Galvin JE, Fu Q, Nguyen JT, Glasheen C, Scharff DP. Psychosocial determinants of intention to screen for Alzheimer's disease. Alzheimers Dement 2007; 4:353-60. [PMID: 18790462 DOI: 10.1016/j.jalz.2007.09.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Revised: 07/05/2007] [Accepted: 09/10/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is little information about how receptive older adults are to discuss memory problems with healthcare providers. Here we test the psychosocial factors explaining older adults' intention to undergo screening for Alzheimer disease (AD). METHODS A population-based, random-digit dialing strategy surveyed 1,039 older adults. The Behavioral Model of Health Services Use was used as a conceptual framework for a questionnaire testing constructs from several behavioral theories. Structural equation modeling assessed the relationship of latent variables to each construct with goodness-of-fit indices. RESULTS The study had an 82% response rate and 72% completer rate. The respondents' mean age was 62.7 +/- 10.2 years (range, 50 to 97 years). The sample was 67% women, 86% were white, and less than 40% had personal experience with AD. Respondents were nondemented (Short Blessed scores, 1.7 +/- 2.2). Predictors of intention to screen included perceived benefits (gamma = .35), knowledge of dementia (gamma = .26), self-efficacy (gamma = .23), preventive health behaviors (gamma = .17), and perceived susceptibility (gamma = .14). Knowledge was positively correlated with perceived benefits (phi = .29) and susceptibility (phi = .20). Preventive behaviors (phi = .20) were positively correlated with perceived benefits. Self-efficacy correlated positively with preventive behaviors (phi = .24) and perceived benefits (phi = .37) and negatively with perceived susceptibility (phi = -.11). Goodness-of-fit indices suggested a good fit of this model (root mean square error of approximation, .037; comparative fit index, 0.98; relative fit index; .96). DISCUSSION Older adults who have knowledge of dementia and perceive benefit from diagnosis and treatment are more likely to exhibit willingness and confidence to be tested for cognitive problems. Individuals with high self-efficacy, perceived susceptibility, and positive preventive health behaviors are also more likely to exhibit intention. These constructs can now be used to develop interventions to evaluate cognitive health in the elderly.
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Affiliation(s)
- James E Galvin
- Department of Neurology, Washington University School of Medicine, St Louis, MO, USA.
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Sandberg T, Conner M. Anticipated regret as an additional predictor in the theory of planned behaviour: a meta-analysis. BRITISH JOURNAL OF SOCIAL PSYCHOLOGY 2007; 47:589-606. [PMID: 18039428 DOI: 10.1348/014466607x258704] [Citation(s) in RCA: 191] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper details the results of a meta-analysis incorporating all the appropriately augmented TPB studies in order to statistically determine the additive effects of anticipated regret (AR) both to the prediction of intentions after the TPB variables and to the direct impacts on behaviour. Over a number of studies there was a strong AR-intention relationship (r(+)=.47, k=25, N=11,254), and AR significantly and independently added to the prediction of intentions over and above the TPB variables; there was a moderate relationship between AR and behaviour (r(+)=.28, k=8, N=2,035) with AR having a direct and significant impact on prospective behaviour, and there was support for the unique contribution of AR even when accounting for attitude. Implications and issues for further research are discussed.
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Affiliation(s)
- Tracy Sandberg
- Institute of Psychological Sciences, University of Leeds, Leeds, UK.
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van den Berg M, Timmermans DRM, Kleinveld JH, van Eijk JTM, Knol DL, van der Wal G, van Vugt JMG. Are counsellors' attitudes influencing pregnant women's attitudes and decisions on prenatal screening? Prenat Diagn 2007; 27:518-24. [PMID: 17367105 DOI: 10.1002/pd.1720] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES It is generally recognised that choices concerning treatment or screening should be people's own, autonomous decisions. However, in the context of genetic counselling, many studies found that counsellors deviate from nondirectiveness, or that subjective norm influences behaviour. The present study aimed to investigate whether prenatal counsellors (midwives, gynaecologists) influence pregnant women's decisions and their attitudes regarding prenatal screening. It was hypothesised that uptake rates and attitudes would be associated with the counsellor's attitude toward prenatal screening. METHODS Pregnant women attending their midwifery or gynaecology practice were asked to fill out postal questionnaires before and after they were offered prenatal screening for Down syndrome. Their prenatal counsellors also filled in a questionnaire. These questionnaires assessed attitudes toward prenatal screening and background variables. The study sample consisted of 945 pregnant women, being guided by 97 prenatal counsellors. RESULTS Multilevel regression analyses revealed that neither uptake rates, nor attitude toward prenatal screening were significantly predicted by counsellors' attitudes toward prenatal screening. CONCLUSION It is suggested that the advice these pregnant women were reported to have received, should rather be interpreted as an indication of shared decision-making and social support than of social pressure and undesired influence.
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Affiliation(s)
- Matthijs van den Berg
- EMGO Institute, Department of Public and Occupational Health, VU University Medical Centre, Amsterdam, The Netherlands.
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Steadman J, Pawlby S, Mayers A, Bucks RS, Gregoire A, Miele‐Norton M, Hogan AM. An exploratory study of the relationship between mother–infant interaction and maternal cognitive function in mothers with mental illness. J Reprod Infant Psychol 2007. [DOI: 10.1080/02646830701691343] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sivell S, Elwyn G, Gaff CL, Clarke AJ, Iredale R, Shaw C, Dundon J, Thornton H, Edwards A. How risk is perceived, constructed and interpreted by clients in clinical genetics, and the effects on decision making: systematic review. J Genet Couns 2007; 17:30-63. [PMID: 17968638 DOI: 10.1007/s10897-007-9132-1] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Accepted: 09/28/2007] [Indexed: 12/18/2022]
Abstract
As an individual's understanding of their genetic risk may influence risk management decisions, it is important to understand the ways in which risk is constructed and interpreted. We systematically reviewed the literature, undertaking a narrative synthesis of 59 studies presenting data on the ways in which individuals perceive, construct and interpret their risk, and the subsequent effects. While most studies assessed perceived risk quantitatively, the combined evidence suggests individuals find risk difficult to accurately quantify, with a tendency to overestimate. Rather than being a stand-alone concept, risk is something lived and experienced and the process of constructing risk is complex and influenced by many factors. While evidence of the effects of perceived risk is limited and inconsistent, there is some evidence to suggest high risk estimations may adversely affect health and lead to inappropriate uptake of medical surveillance and preventative measures by some individuals. A more focused approach to research is needed with greater exploration of the ways in which risk is constructed, along with the development of stronger theoretical models, to facilitate effective and patient-centered counseling strategies.
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Affiliation(s)
- Stephanie Sivell
- Department of Primary Care and Public Health, School of Medicine, Cardiff University, 2nd Floor, Neuadd Meirionydd, Heath Park, Cardiff, CF14 4YS, UK.
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Binetti G, Benussi L, Roberts S, Villa A, Pasqualetti P, Sheu CF, Gigola L, Lussignoli G, Dal Forno G, Barbiero L, Corbellini G, Green RC, Rossini PM, Ghidoni R. Areas of intervention for genetic counselling of dementia: cross-cultural comparison between Italians and Americans. PATIENT EDUCATION AND COUNSELING 2006; 64:285-93. [PMID: 16860519 DOI: 10.1016/j.pec.2006.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Revised: 02/23/2006] [Accepted: 03/05/2006] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Purposes of this study are: (1) to evaluate attitudes, beliefs and experiences towards dementia among relatives of Italian familial cases; (2) to perform a cross-cultural comparison between Italian and American samples; (3) to identify predictors of intentions to undergo hypothetical genetic testing. METHODS Participants were 134 relatives of patients affected by familial forms of dementia. We administered tests measuring health psychological styles, social variables, illness perceptions, intentions regarding genetic testing, and perceptions of the pros and cons of genetic testing. RESULTS Respondents had a poor Alzheimer's disease knowledge and a low perceived dementia threat. When compared to Americans, Italians reported greater willingness to undergo genetic testing and perceived a different subset of benefits and risks. The strongest predictors of test intention were decisional balance, homemaker status and two beliefs concerning dementia causes. CONCLUSIONS Italians had a poor knowledge of the disease and a low awareness of personal risk of developing dementia. As compared to Americans, they expressed higher intentions to undergo genetic testing and they have a different perception of benefits and risks. PRACTICE IMPLICATIONS Understanding of cultural differences in knowledge, attitudes and perception of the disease is important to design optimal health services and education programs for dementia.
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Affiliation(s)
- Giuliano Binetti
- NeuroBioGen Lab-Memory Clinic IRCCS Centro San Giovanni di Dio-Fatebenefratelli, Brescia, Italy.
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Haga SB. Genomics-based labeling and attribution: a case for integrating social sciences into personalized medicine research. Per Med 2006; 3:317-323. [DOI: 10.2217/17410541.3.3.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
As the field of genomics uncovers the etiology and pathophysiological mechanisms of disease, we will gain a greater understanding of the causes of disease, leading to preventive interventions, early diagnoses and new and improved treatments. Although understanding the specific roles of environment and genetics in disease onset and development will most likely improve health outcomes, the impact of this information for the individual and public remains to be seen. Understanding what factors influence individual and public perceptions and behavioral consequences related to genome-based disease labels and attributions will be critical to a successful transition for personalized medicine. To better understand the impact of genomic-based disease labeling and attribution, social scientists need to be involved in clinical genomics studies to assess the consequences of the use of and response to new personalized diagnoses and treatments.
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Affiliation(s)
- Susanne B Haga
- Duke University, Institute for Genome Sciences & Policy, 101 Science Drive, Box 3382, Durham, NC 27708, USA
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Galvin JE, Scharff DP, Glasheen C, Fu Q. Development of a Population-based Questionnaire to Explore Psychosocial Determinants of Screening for Memory Loss and Alzheimer Disease. Alzheimer Dis Assoc Disord 2006; 20:182-91. [PMID: 16917189 DOI: 10.1097/00002093-200607000-00010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Alzheimer disease research has focused on detecting the earliest signs of cognitive decline and efforts are ongoing to develop biomarkers and cognitive measures that reliably distinguish between nondemented and demented individuals. However, little is known about factors that may directly or indirectly influence screening behavior of older community-dwelling adults. We describe an iterative process for the development and formative evaluation of a questionnaire about dementia knowledge and screening behaviors in older adults to understand the psychosocial factors underlying intention to obtain dementia screening to profile individuals manifesting intention to undergo dementia screening compared to those who will not. The Behavioral Model of Health Services Use was used as a conceptual framework for a questionnaire with constructs from the Health Belief Model, Theory of Reasoned Action and Self-Efficacy. After pretesting, we used a random dialing strategy to test our questionnaire on a final sample of 1024 older Missourians. Internal consistency and construct validity were examined. Pretesting identified several potential problems that were improved with rewording. Cronbach alpha was greater than 0.6 (range 0.62 to 0.92) in all but one construct testing dementia knowledge, suggesting good to excellent internal consistency. Convergent (construct) validity was assessed using confirmatory factor analysis. All constructs but 3 demonstrated good validity. Addressing these issues will allow researchers to identify unique characteristics based on age, race, sex, socioeconomic differences and geographic location, and characterize barriers to screening programs to more effectively develop targeted community-based interventions.
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Affiliation(s)
- James E Galvin
- Department of Neurology, Washington University School of Medicine, St Louis, MO, USA.
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Boustani M, Perkins AJ, Fox C, Unverzagt F, Austrom MG, Fultz B, Hui S, Callahan CM, Hendrie HC. Who refuses the diagnostic assessment for dementia in primary care? Int J Geriatr Psychiatry 2006; 21:556-63. [PMID: 16783796 DOI: 10.1002/gps.1524] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Early screening and detection of dementia in primary care remains controversial. At least half of the patients identified as cognitively impaired by screening instruments do not meet criteria for dementia and some patients refuse further evaluation following a positive screen. The aim of this study was to identify the characteristics of patients who refuse a clinical diagnostic assessment for dementia after screening. DESIGN Cross sectional study. SETTING Seven primary care practice centers in Indianapolis. PARTICIPANTS Four hundred and thirty-four individuals aged 65 and older who screened positive for dementia with a mean age of 74.6, 67% women, and 68% African-American. MAIN OUTCOME MEASURE Patients' acceptance of undergoing a dementia diagnostic assessment that included neuropsychological testing, caregiver interview, and medical chart review. RESULTS Among patients with positive screening results for dementia, approximately half (47.7%) refused further assessment to confirm their screening results. In a bivariate analysis, possible factors associated with a higher probability of refusing dementia assessment were older age and better screening score. In a multiple logistic regression model, performing well on the temporal orientation of the screening instrument was associated with a higher probability of refusing diagnostic assessment for dementia (OR = 1.37; p = 0.001). Also, African-American patients aged 80 and older were more likely to refuse the diagnostic assessment than African-Americans less than 80 years of age (OR = 3.1, p < 0.001), while there was no significant age association for white patients (OR = 0.9, p = 0.728). CONCLUSIONS Older primary care patients who perceived themselves as having no cognitive symptoms refused dementia diagnostic assessment despite their positive screening results. We must improve our understanding of the decision-making process driving patients' beliefs and behaviors about the benefits and risks of dementia screening and diagnosis before implementing any broad-based screening initiatives for dementia.
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Affiliation(s)
- Malaz Boustani
- Indiana University Center for Aging Research, Indianapolis, IN 46202-2872, USA.
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Gooding HC, Organista K, Burack J, Biesecker BB. Genetic susceptibility testing from a stress and coping perspective. Soc Sci Med 2006; 62:1880-90. [PMID: 16198036 DOI: 10.1016/j.socscimed.2005.08.041] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2004] [Indexed: 10/25/2022]
Abstract
Four theories of health behavior and of stress and coping are reviewed for their ability to illuminate interest in uptake and outcomes of genetic testing for adult-onset diseases. These theories are the Health Belief Model, the Theory of Planned Behavior (TPB), the Common Sense Model of Self-regulation (CSM), and the Transactional Model of Stress and Coping (TMSC). Basic concepts of each theory are discussed, followed by evidence from the literature supporting the relevance of these concepts to the understanding of genetic testing for four adult-onset diseases: Huntington's disease, Alzheimer's disease, hereditary breast/ovarian cancer, and hereditary colorectal cancer. Emphasis is placed on the finding that a decision to undergo genetic testing may be considered as a way to cope with both the cognitive and affective concerns that arise from living at increased risk of developing a disease in the future. The potential value of genetic testing for reducing uncertainty about and gaining a sense of control over one's risk of developing a chronic disease is highlighted. We argue that theories which focus on stress and coping provide a useful framework for future studies of genetic testing decisions for adult-onset disease risk.
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Affiliation(s)
- Holly C Gooding
- Division of Health and Medical Sciences, School of Public Health, University of California, 570 University Hall, Berkeley, CA 94720-1190, USA.
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Nordin K, Björk J, Berglund G. Factors influencing intention to obtain a genetic test for a hereditary disease in an affected group and in the general public. Prev Med 2004; 39:1107-14. [PMID: 15539044 DOI: 10.1016/j.ypmed.2004.04.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2003] [Revised: 03/24/2004] [Accepted: 04/26/2004] [Indexed: 11/25/2022]
Abstract
BACKGROUND To ensure successful implementations of genetic screening in the future, the attitudes of the public are an important factor to consider. The primary aim of this study is to investigate the intention to take a genetic test for an unidentified hereditary disease. A further objective is to assess the predictive values of attitudes, subjective norms, and perceived personal control on the intention to take a genetic test. These aims are investigated in two groups differing in their experience and knowledge of genetic testing. METHOD A questionnaire was developed according to the Theory of Planned Behavior (TPB) and mailed to a random sample of 1000 persons from the general public and to 330 persons in FAP families. The response rate was 60% and 74%, respectively. RESULTS The probability of taking a genetic test was high in both groups but significantly higher in the FAP group. The attitudes of the FAP group were significantly more positive when compared to the attitudes of the general public. For the persons in the FAP group, the most significant others in the decision to take a genetic test were their children, whereas spouses proved to be the most important significant others in the general public. The most important predictor of the intention to take a test in both groups was attitude, accounting for 64% of the variance. CONCLUSIONS The study indicated that most of the individuals in the FAP group and many in the general public intended to take a genetic test. Our findings suggest that living in an affected group and having some kind of experience of a hereditary disease may lead to an even more positive attitude to genetic testing. Using the TPB, attitudes were found to be the strongest predictor of intention to take a genetic test in both groups.
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Affiliation(s)
- Karin Nordin
- Department of Public Health and Caring Sciences, Uppsala University, SE-751 83 Uppsala, Sweden.
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Boustani M, Watson L, Fultz B, Perkins AJ, Druckenbrod R. Acceptance of dementia screening in continuous care retirement communities: a mailed survey. Int J Geriatr Psychiatry 2003; 18:780-6. [PMID: 12949845 DOI: 10.1002/gps.918] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In a recent systematic review of the evidence for dementia screening to support recommendations from the US Preventive Services Task Force, we found no evidence regarding the interest or willingness of older adults to be screened, and insufficient evidence to provide an estimate of the potential harms of dementia screening. OBJECTIVE In an attempt to address the acceptability of dementia screening, we asked older adults living in two Continuous Care Retirement Communities (CCRC) if they would agree to routine screening for memory problems. DESIGN Cross-sectional study using self-administered mailed survey questionnaires. SETTING Two CCRCs in Orange County, North Carolina. PARTICIPANTS 500 residents of the independent living section of CCRCs. RESULTS There was a 64% survey response rate. Of these, 49% of participants stated they would agree to routine screening for memory problems. In comparison to people who would not agree to routine memory screening, those who accepted memory screening were more likely to accept depression screening, be male, use drug-administration assisted devices, and take more medications. CONCLUSION Approximately half of the residents in this affluent residential community setting were not willing to be screened routinely for memory problems. This high refusal rate indicates that dementia screening may be associated with perceived harms. We must improve our understanding of the decision-making process driving individual's beliefs and behaviors about dementia screening before implementing any broad-based screening initiatives for dementia or cognitive impairment.
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Affiliation(s)
- Malaz Boustani
- Indiana University Center for Aging Research and Regenstrief Institute, Inc., Indiana 46202, USA.
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Werner P. Factors influencing intentions to seek a cognitive status examination: a study based on the Health Belief Model. Int J Geriatr Psychiatry 2003; 18:787-94. [PMID: 12949846 DOI: 10.1002/gps.921] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS The aim of the present study was to examine the factors influencing intention to seek a cognitive status evaluation in the presence of memory problems. METHODS A convenience sample of 186 community-dwelling adults (mean age=64) were interviewed face-to-face using measures derived from the Health Belief Model. RESULTS Participants' intentions to be examined were higher when presented with scenarios describing family history of Alzheimer's disease (AD). Perceived barriers and cues to action were significant predictors of intention, accounting for 24% of the variance. CONCLUSIONS These findings suggest the need to develop effective educational strategies to improve knowledge about AD and decision-making concerning cognitive status examinations.
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Affiliation(s)
- Perla Werner
- Department of Gerontology, University of Haifa, Israel.
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