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PubMed1999

Attitudes toward colon cancer gene testing: factors predicting test uptake.

OBJECTIVES: Genetic discoveries in hereditary nonpolyposis colorectal cancer (HNPCC) have made possible genetic testing to determine susceptibility to this form of colorectal cancer (CRC). This study measured the uptake of genetic testing for HNPCC among first-degree relatives of CRC patients and conducted a preliminary analysis of the predictors of test uptake. MATERIALS AND METHODS: We compared 77 test acceptors and 181 decliners on demographic, medical history, and psychological characteristics, controlling for distance from the testing center. The psychological factors studied were risk perception for CRC, frequency of cancer thoughts, and perceived ability to cope with unfavorable genetic information. RESULTS: In the final regression model, after accounting for all variables, the significant predictors of test uptake were increased risk perception, greater perceived confidence in ability to cope with unfavorable genetic information, more frequent cancer thoughts, and having had at least one colonoscopy. The association between risk perception and uptake was dependent on frequency of cancer thoughts. Among those who thought about getting CRC more often, the probability of testing increased as perceived risk increased to approximately 50% likelihood of getting CRC and then leveled off. In contrast, among those who never or rarely thought about getting CRC, risk perception was unrelated to testing decision. CONCLUSIONS: Our findings are consistent with the associations reported between psychological factors and other cancer screening behaviors.

Adaptation, Psychological↗

PubMed2005

Perceptions of local HIV/AIDS prevalence and risks for HIV/AIDS and other sexually transmitted infections: preliminary study of intuitive epidemiology.

BACKGROUND: Risk perceptions are theoretically important in predicting health behavior but have only shown modest evidence in predicting sexual risk behavior. PURPOSE: Our purpose is to investigate whether perceptions of the local prevalence of disease serve as a predictor of health behavior, particularly behaviors associated with infectious diseases such as HIV/AIDS. METHODS: Four hundred eighty-seven men and 236 women receiving diagnostic and treatment services at a sexually transmitted infections (STI) clinic in a moderate-size U.S. city completed anonymous surveys of perceived prevalence of HIV/AIDS and other STI and sexual risk and protective behaviors. RESULTS: Participants who estimated a lower AIDS burden in their city relative to other U.S. cities demonstrated greater numbers of sex partners, higher rates of sexual risk practices, and higher rates of STI. They were also less likely to have been tested for HIV. CONCLUSIONS: This initial study of intuitive epidemiology suggests that STI clinic patients may have a sense for the relative burden of AIDS in their city and estimates of local disease prevalence may predict sexual risk behaviors.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Psychosocial aspects of risk communication and mutation testing in familial breast-ovarian cancer.

PURPOSE OF REVIEW: As cancer genetics services develop, psychosocial research evaluating risk communication and mutation testing for familial breast-ovarian cancer has expanded rapidly. It is timely to review findings in key areas. These will inform risk counselling practice and help prepare women making risk management decisions. RECENT FINDINGS: The psychological effect of risk communication and genetic counselling has been elucidated and women's risk perceptions explored. Knowledge of optimal risk communication strategies is lacking, but recent research shows both consistency in information giving and deficiencies in specific communication skills; the need for personally tailored risk information, which addresses counsellees' concerns, is highlighted. Outcome assessments of risk communication, such as risk perception and psychological distress, are useful but insufficient to evaluate the complex communication process, and decision making in this context is underresearched. Subsequent diffusion of risk information and interfamily communication pose difficulties for high-risk individuals. The short-term psychological consequences of predictive mutation testing are an important focus of research and are largely reassuring, but long-term outcomes are sparse. SUMMARY: Our understanding of the psychological benefits and limitations of risk counselling and mutation testing can now inform clinical practice, but insufficient knowledge exists of long-term outcomes. Most women are unlikely to be distressed following risk communication, but some may need psychosocial support in the short term following predictive testing for BRCA1/2. Different approaches to risk communication need to be developed and evaluated in parallel with communications skills training to ensure an adequate focus on the women's agenda.

Breast Neoplasms↗

PubMed2006

Formative research on adolescent and adult perceptions of risk factors for breast cancer.

This study uses the Health Belief Model (HBM) as a framework to guide formative research of the lay public's perceptions of risks associated with breast cancer. Data were collected from adolescent females and adult females across four counties in Michigan, US. Ten focus groups (N=91) were conducted and analyzed with a coding scheme based on the HBM. Participants' responses to focus group questions (N=5168 thought units) reveal beliefs about severity, susceptibility, and efficacy pertaining to breast cancer, nutrition, activity, environment, and the role of government and industry. Chi-squares examined the distribution of statements across categories between adult females and adolescent females. Results revealed that both adolescent and mother groups recognized gender and heredity as relevant risk factors related to susceptibility, and detection as a strategy to decrease severity of breast cancer through early treatment. Beliefs about environmental factors were characterized by uncertainty for both groups. Also, while adolescent girls communicated more about efficacy issues, mothers focused significantly more than adolescent girls on the role of government and industry in breast cancer prevention and treatment. Representative qualitative thought units are included based on their frequency, salience, and relevance to HBM message design guidelines. Formative research is the first phase in the development of health campaigns, informing the creation of health messages for target audiences.

Adolescent↗

PubMed1999

Attitudes toward colon cancer gene testing: survey of relatives of colon cancer patients.

OBJECTIVES: Various studies have identified psychosocial factors that may influence attitudes toward colon cancer gene testing. Whereas family history of colon cancer has been associated with interest in gene testing, this has not been examined extensively. We hypothesized that the strength of family history of colon cancer is associated with risk perception and willingness to undergo gene testing. MATERIALS AND METHODS: We evaluated attitudes toward colon cancer gene testing among persons who had at least one first-degree relative with colon cancer. A total of 2680 at-risk relatives in 863 kindreds were identified and mailed an extensive survey regarding sociodemographic variables, family history, health behaviors and knowledge, and willingness to take a colon cancer gene test. A total of 56.6% of persons completed and returned surveys. We conducted a brief telephone survey of a random sample of 200 persons who did not respond to the mail survey. RESULTS: The combined study sample of 1373 people was 42% male, had a mean age of 55 +/- 15 years, was 96% white, and had moderate-to-high SES. A total of 77.4% were very likely to take the gene test, and 92.4% were somewhat or very likely to take the gene test. A total of 78% of the sample perceived a higher colon cancer risk, although patterns of risk perception and worry differed significantly between mail survey and telephone survey respondents. More of the telephone survey respondents were also somewhat unlikely or very unlikely to take the gene test compared to the mail survey respondents (13.7% versus 6.9%). In the combined sample, concern about developing colon cancer and risk perception increased with number of relatives with colon cancer (P < 0.0001). Eight percent expressed no concern about developing colon cancer; 4.8% felt their chance of developing colon cancer was lower than others of the same age, sex, and race; and 3.3% felt that they were very unlikely to develop colon cancer in their lifetime. However, there was strong interest in gene testing regardless of the number of affected relatives, and persons with more affected relatives were generally willing to pay more for the gene test (up to $1000). CONCLUSIONS: The strength of family history of colon cancer is associated with risk perception but not with willingness to undergo gene testing.

Aged↗

PubMed2002

Priorities in information desire about unknown risks.

Research on risk perception aims to explain how people perceive risks in order to better communicate about them. Most of this research has tended to view people as passive risk perceivers. However, if confronted with an unknown risk, people can also actively seek information. The main purpose of this study was to investigate what kind of risk information people desire when confronted with an unknown risk and how this desire for information relates to the main dimensions underlying risk perception. Nine focus-group interviews were conducted. The main results of the focus groups were backed up by a paper-and-pencil questionnaire that was distributed among a random sample of 500 households in the Netherlands. Overall, people desire information with which they can determine the personal relevance of the risk confronting them. This pattern is similar to appraisal steps described by health behavior models. The focus-group results provide a dynamic picture of the way risk aspects might interact to create a final risk judgment.

Adult↗

PubMedDate not supplied

The effectiveness of video-based interventions in promoting condom acquisition among STD clinic patients.

GOAL OF THIS STUDY: This study examined the effectiveness of video-based patient education interventions on promoting condom use among men and women seeking services at a large public STD clinic in New York City. METHODS: Culturally sensitive video-based interventions designed to promote safer sex behaviors were evaluated in a randomized study of black and Hispanic male and female STD clinic patients. Subjects (n = 1,653) were randomly assigned to one of three groups: 1) control, 2) video viewing, and 3) video viewing followed by participation in an interactive group session led by a trained facilitator. The authors examined 1) the effectiveness of interventions in increasing STD and condom-related knowledge, positive attitudes about condoms, human immunodeficiency virus/STD risk perceptions, and self-efficacy and 2) the relationships among these variables, level of intervention, and condom acquisition, a behavioral measure of condom use. RESULTS: Compared with a control group, subjects assigned to video viewing demonstrated greater knowledge about condoms and STDs, more positive attitudes about condom use, increased human immunodeficiency virus/STD risk perceptions, greater self-efficacy, and higher rates of condom acquisition. Subjects assigned to video viewing followed by interactive sessions demonstrated still further increases in risk perceptions, self-efficacy, and condom acquisition, but not in knowledge or condom attitudes. A significant proportion of the association between the behavioral outcome of condom acquisition and level of intervention is attributable to the impact of interventions on risk perception and self-efficacy. CONCLUSIONS: Based on extensive formative research that identified barriers to safer sex behaviors, video-based interventions were developed to promote condom use among black and Hispanic men and women attending STD clinics. Designed to be integrated into clinic services, these interventions help improve knowledge, promote positive attitudes about condoms, and increase condom acquisition among individuals at high risk of acquiring and transmitting human immunodeficiency virus infection and other STDs.

Black or African American↗

PubMed2006

Psychological determinants of reactions to food risk messages.

In recent years, European countries have witnessed a number of food crises such as dioxin-contaminated chicken, foot-and-mouth disease, and BSE. In such cases, food might be contaminated by microorganisms or chemicals that could pose a risk to the consumer. These cases attract media attention and might instigate the consumer to reduce the consumption of the allegedly contaminated products. Although a decline in consumption of (potentially) contaminated products has been observed, it is not yet clear what determines the individual's reaction to food risk messages. To study the psychological determinants of the reaction to food risk messages, a survey was conducted in the Netherlands (n= 280). Subjects had to imagine two situations involving chicken contamination and report how they would react behaviorally if this situation occurred. Risk perception, affective response, perceived susceptibility to foodborne disease, self-efficacy, outcome expectation, trust, experience with foodborne disease, and need for information were also assessed. It was found that 60% of the subjects would allegedly avoid the risks by not consuming chicken for a while and approximately 60% would seek additional information. Risk avoidance was significantly related to information seeking and the psychological determinants, especially risk perception, affective response, need for information, perceived susceptibility to foodborne disease, and trust. Seeking information was also significantly related to risk perception, affective response, need for information, susceptibility to foodborne disease, and trust, but to a lesser degree. A model describing the relationships between the variables was tested using AMOS. Results are presented and implications are discussed.

Adult↗

PubMed2004

Perception of risk associated with asthma research procedures among adolescents, parents, and pediatricians.

BACKGROUND: Little empirical data exist about how adolescents with asthma, their parents, and pediatricians view the risks and benefits associated with asthma clinical research. OBJECTIVE: Two studies examined similarities and differences in the perception of risks and benefits associated with asthma research. METHODS: In study I questionnaires were completed by adolescents with asthma and parents at the end of an audio and written presentation of a hypothetical research vignette. In study II adolescents with asthma, their parents, and pediatricians rated the risks and benefits associated with discreet asthma research procedures. RESULTS: In study I adolescents and parents made distinctions in riskiness among the asthma research procedures ( P < .001 and P < .001, respectively). With the exception of venipuncture, rank orders of risk ratings among procedures were similar for both groups. In study II significant differences in risk and benefit ratings for individual procedures were found among respondent groups, including experimental medication, placebo, and venipuncture. Overall, asthma research procedures were viewed as more beneficial than risky ( P < .001). CONCLUSION: Participants generally viewed asthma research procedures as more beneficial than risky. Overall, the relative risk rankings among all respondents were similar. However, there were between-group difference in ratings of risk associated with venipuncture and experimental medication. Parents and adolescents rated the benefit of placebo significantly higher than did pediatricians.

Adolescent↗

PubMed2002

An evaluation of the effectiveness of a peer sexual health intervention among secondary-school students in Zambia.

This study investigated whether there were any changes in knowledge and normative beliefs regarding abstinence and condoms and personal risk perception of acquiring HIV among Zambian secondary-school students who were exposed to a peer sexual health intervention. Schools were randomly assigned to intervention and control groups. A baseline assessment that measured knowledge, normative beliefs about abstinence and condoms and personal risk perception was conducted in all schools. Students in the intervention group were exposed for a 1-hour-and-45-minute-long in-class peer sexual health intervention. Students in the control schools were exposed to a 1-hour-long in-class peer water purification intervention. A follow-up assessment of students was conducted after the intervention. Logistic regression analyses were conducted to determine whether significant differences between intervention and control groups emerged at follow-up. Relative to students in the control group, knowledge was higher and normative beliefs about abstinence and condoms were significantly more positive among students in the intervention schools. Students in the intervention schools also had a higher personal risk perception of acquiring HIV than students in control schools. These findings show that a school-based peer sexual health intervention implemented in Zambia was effective in increasing knowledge, positive normative beliefs about abstinence and condoms, and personal risk perception.

Adolescent↗

PubMed2003

Effecting behavior change: awareness of family history.

This article explores the use of family history of disease as a public health tool for risk stratification and improved disease prevention by drawing from previous research on women at moderate risk of developing breast cancer because of a positive family history. About one quarter to one third of women do not appear to be aware of the added risk a family history of breast cancer poses, and many women with a family history overestimate their risk. It is unclear whether risk perceptions are causally related to breast cancer screening in women with a family history. Exaggerated risk perceptions may not hinder breast cancer screening, unless accompanied by distress. Studies suggest that counseling women with a family history of breast cancer about their risk has a small and short-term effect on risk comprehension, a small effect on breast cancer screening, psychological benefits for some women, and unintended negative effects on screening for other women. Future research needs to consider the psychological, individual difference, and cultural variables that moderate counseling effects, recruitment biases, the prospective relationship between perceived risk and breast cancer screening, and whether risk perceptions and comprehension need to match objective risk to be an effective tool to promote screening.

Breast Neoplasms↗

PubMed2005

Use of antidepressants by pregnant women: evaluation of perception of risk, efficacy of evidence based counseling and determinants of decision making.

BACKGROUND: The World Health Organization predicts that by 2012, depression will be the number one disease in the world. Thus, many women who become pregnant will require treatment with antidepressants. We are aware that women and their health care providers remain hesitant to prescribe and take these drugs during pregnancy, despite evidence of the relative safety. OBJECTIVES: 1) To determine perception of risk of antidepressant drugs by pregnant women with depression, 2) to determine the efficacy of evidence-based counseling, and 3) to identify determinants that influence women in their decision making regarding the continuation/discontinuation of antidepressants during pregnancy. METHODS: Women who called The Motherisk Program requesting information about the safety of an antidepressant during pregnancy were compared with two other groups: 1) Women who called about antibiotic use (i.e., non-teratogenic drugs used short-term) and 2) women who called about gastric medications (i.e., non-teratogenic drugs used long-term). Their perception of risk was measured before and after evidenced-based information was given and determinants of decision making was also evaluated. RESULTS: We recruited 100 women taking antidepressants during pregnancy and 100 in each comparison group. Despite receiving evidence-based reassuring information, 15% of antidepressant users, compared to 4% using gastric drugs and 1% using antibiotics, chose to discontinue their medication. The main determinants of decision making were based on: information received prior to calling Motherisk, family and friends advice, the internet, sequence of advice given and if a women was undecided at the time of call. CONCLUSIONS: Women continue to fear taking antidepressants during pregnancy, more so than non psychiatric drugs, however, evidence based counseling can lower this fear, although not totally. Deciding whether to continue to take a medication or not during pregnancy, is a complex decision for women and their healthcare providers to make.

Adult↗

PubMed1997

Cardiologists' perception of risk of coronary revascularization procedures.

We sought to determine if differences exist between interventional and noninterventional cardiologists in the perception of risk of revascularization procedures and to compare the physicians' estimates with a computer-based predictor formula from a large regional database. We found that interventional cardiologists perceived greater risk of percutaneous transluminal coronary angioplasty-related morbidity and mortality than noninterventionalists and that these differences were accentuated in female patients, the elderly, and the most seriously ill patients.

Adult↗

PubMedDate not supplied

Perception of risk factors for infusion phlebitis among Swedish nurses: a questionnaire study.

This questionnaire study was set up to assess the perceptions of risk factors for infusion phlebitis among Swedish nurses, as their concepts of these factors may influence the incidence. A majority of the nurses believed that insertion of a peripheral venous catheter in the forearm and catheter rotation within 48 hours was protective. These measures are not supported in recent studies and guidelines. Surveillance of the educational level of staff, who insert peripheral venous catheters, is an important tool for reducing the incidence of infusion phlebitis.

Adult↗

PubMed2005

Initial cancer genetic counseling consultation: change in counselees' cognitions and anxiety, and association with addressing their needs and preferences.

The fulfillment of counselees' expectations in cancer genetic counseling and how this affects the outcome of counseling have received little attention so far. This study investigates how the initial consultation influences counselees' cognitions and anxiety, whether counselors address counselees' prior needs and preferences during the visit, and whether addressing needs is associated with a more positive outcome of the visit. One hundred twenty-eight affected and unaffected counselees from families with no known mutation, who were seen by one of fourteen counselors, participated. Pre- and post-visit questionnaires assessed correct knowledge about hereditary breast or colon cancer, perceived personal control (PPC), anxiety (STAI), risk perceptions, and (fulfillment of) needs (QUOTE-gene(ca)). Results demonstrated a pre- to post-visit significant increase in correct knowledge and PPC, and a significant decrease in STAI and risk perceptions. However, marked overestimation of risks persisted. Decrease in STAI and risk perceptions was significantly less pronounced in affected versus unaffected counselees. The majority of counselees were (very) satisfied about the extent to which their needs were addressed, albeit about one-fifth were not regarding emotional matters and explanations about their own cancer risk. Finally, the better counselees perceived their needs to be fulfilled, the significantly higher their PPC and the significantly lower their STAi scores were. Findings suggest that both unaffected and affected counselees should be counseled carefully. Also, a more effective service may be attained if counselors pay more attention to counselees' emotional needs and detail more inheritance and penetrance of mutated genes in relation to counselees' family history.

Adolescent↗

PubMed2006

Pesticides in the homes of farmworkers: Latino mothers' perceptions of risk to their children's health.

Pesticide exposure has been linked with immediate and delayed health effects. Anyone who lives in a farmworker household may be exposed to pesticides. Studies with farmworkers have found generally low levels of awareness of pesticide exposure and prevention. Less is known about the perceptions of nonfarmworkers living with farmworkers. This article presents the results of 41 in-depth interviews conducted with Latino women in farmworker households regarding their knowledge of pesticides and perceptions of risk to their children's health. Their perceptions and behavior differ from scientific understanding and policy recommendations for exposure management, resulting in behaviors that may increase children's risk of exposure and subsequent health problems. Because the level at which exposure becomes harmful remains a subject of scientific debate, the wisest course of action is to minimize exposure (the precautionary principle). Families living in farmworker households would benefit from health education programs that target their specific needs.

Adolescent↗

PubMed1999

Pilot study of an information aid for women with a family history of breast cancer.

OBJECTIVE: To develop and pilot study an information aid for women with a family history of breast cancer. DESIGN, SETTING AND PARTICIPANTS: The information aid, consisting of a booklet and audiotape, was developed by a multi-disciplinary team of health care professionals, breast cancer survivors and their relatives. Women with no personal history of breast cancer, on the waiting list for a familial breast cancer clinic at either of two centres, who could read English, were eligible for the pilot study which consisted of three sets of mailed questionnaires. MAIN OUTCOME MEASURES: The baseline questionnaires included: demographic information: the Breast Cancer and Heredity Knowledge Scale (BCHK); psychological measures (the State-Trait Anxiety Inventory [STAI], Centre for Epidemiologic Studies Depression Scale [CES-D] and an item about breast cancer worry), and an item about breast cancer risk perception. Immediately after reviewing the information aid, participants completed a satisfaction survey, the risk perception and cancer worry items and a checklist about their personal family history. The third set of questionnaires, completed 2-4 weeks after reviewing the aid, was identical to the first. Patients then attended their scheduled clinic visit and an objective hereditary breast cancer risk assessment was made by the genetic counselling team. RESULTS AND CONCLUSIONS: Of 97 eligible women who were contacted, 67 completed all three sets of questionnaires. Overall, women were very satisfied with the aid and 96% would recommend it to other women. There was a highly significant improvement in their knowledge scores after they reviewed the aid. Anxiety and depression did not change and there was a decline in breast cancer worry. Risk perception did not change significantly. Ninety per cent of women completed their personal family history checklist accurately. Several important improvements have been made in the information aid and it will now be evaluated in the community.

Journal Article↗

PubMed2003

Thrombosis, prevalence and new evidence on current perceptions of risk.

Venous thromboembolism is a significant but unquantified clinical problem in patients with cancer. The FRONTLINE survey was designed to evaluate clinicians' perceptions of thrombosis risk for cancer patients and to examine current clinical practice with regard to thromboprophylaxis and treatment of venous thromboembolism. Over 3800 responses from surgeons, haematologists and other clinicians were received. Their perception of thrombosis risk for patients varied according to the site of primary tumour. Most surgeons thought that patients with brain tumours were at high risk of thrombosis. Most clinicians treating medical (non-surgical) cancer patients perceived pancreatic tumours to carry a high thrombosis risk in the absence of thromboprophylaxis.

Attitude of Health Personnel↗