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PubMed2001

The short-term impact of tailored mammography decision-making interventions.

BACKGROUND: We assessed the short-term impact of decision-making interventions on knowledge about mammography, accuracy of women's breast cancer risk perceptions, attitudes toward mammography, satisfaction with decisions, and mammography use since the intervention. METHODS: The study was conducted among women who were members of Blue Cross Blue Shield of North Carolina and were in their 40s or 50s at the time the study began in 1997. Women were randomly assigned to usual care (UC), tailored print booklets (TP) alone, or TP plus telephone counseling (TP+TC ). RESULTS: 12-month interviews were completed by 1127 women to assess short-term intervention effects. Generally, women who received TP+TC were significantly more knowledgeable about mammography and breast cancer risk and were more accurate in their breast cancer risk perceptions than women in the TP and UC groups. They also were more likely to have had a mammogram since the baseline interview. In multivariable analyses, we found significant benefits of the combination of TP+TC compared to TP and to UC for knowledge, accuracy of risk perceptions, and mammography use. DISCUSSION: For complex decision-making tasks, such as women's decisions about mammography in the face of controversy, the combination of TP and TC may be more effective than TP alone, and certainly more effective than UC. It is critical that investigators determine the topics for which TP is appropriate and the situations that require additional supportive interventions.

Adult↗
PubMed1995

Prospective effects of perceived risk of developing HIV/AIDS on risk behaviors among injection drug users in Puerto Rico.

The relationship between perceived risk of developing AIDS and subsequent behavioral risk status is estimated for 1740 Puerto Rican injection drug users (IDUs). Prospective behavioral effects were examined comparing data collected at two intervals approximately 6 months apart. We estimated the association between perceived risk at baseline and risky behaviors at follow-up with unadjusted odds ratios. We confirmed the results with adjusted odds ratios using logistic regressions which included baseline risk status as well as socio-demographic and health status covariates. The analyses showed that having a high HIV/AIDS risk perception was related to subsequent sharing of needles, injection of drugs in shooting galleries and sharing of cookers. None of the tests between risk perception and sex risk behaviors showed a significance association. Increasing IDUs' perceived vulnerability to HIV/AIDS might not be effective in helping reduce HIV risk behaviors. IDUs perceiving themselves to be at high risk of AIDS might believe there is little they can do to reverse the consequences of risky behavior.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Evaluation of a decision aid for patients considering autologous blood donation before open-heart surgery.

BACKGROUND: Patients undergoing open-heart surgery frequently require one or more blood transfusions. Because of the risks of receiving blood from volunteer donors, some patients choose to donate their own blood before surgery. This reduces their risk of exposure to volunteer-donated blood, but it increases their chance of receiving any transfusion, either of self-donated or volunteer-donated blood. Also, preoperative hemoglobin levels tend to be lower in patients who donate their own blood, and surgeons may be more likely to give transfusions to patients with self-donated blood. To help patients decide whether to donate their blood before surgery, we designed a decision aid comprising a booklet and audiotape and assessed its effectiveness. METHODS: The 59 study subjects were a sample of consecutive patients referred to the Ottawa Heart Institute between Oct. 1, 1998, and Jan. 5, 1999, for future coronary artery bypass grafting, valve surgery or combined surgery. All were eligible to donate blood. Initial questionnaires were administered in the clinic by a physician or study nurse, and follow-up questionnaires were completed at home and mailed in after use of the decision aid. Outcome measures included patients' knowledge, values (importance ratings), preferences for transfusion methods, decisional conflict (the amount of uncertainty about the course of action to take), risk perception and acceptability of the decision aid. RESULTS: Mean knowledge scores on a 15-item test increased from 67% correct responses before the decision aid to 85% correct responses after use of the aid (p < 0.001); the effect was similar when the patients were divided into subgroups according to education level. The number of patients favouring donating their own blood increased from 41 (69%) before to 45 (76%) after use of the aid. Nine (64%) of 14 initially uncertain patients preferred autologous donation after use of the aid. The overall mean score for decisional conflict was unchanged, at 1.7, which indicated a low level of uncertainty. Risk perception improved, from 0%-14% correct responses on an 8-item test before the aid to 18%-60% correct responses after use of the aid. The decision aid was acceptable to the majority of patients, and 95% indicated that they would recommend it to others. INTERPRETATION: The decision aid improved knowledge and risk perceptions of blood donation and transfusion, and it helped uncertain patients to make choices.

Adolescent↗
PubMed2005

Knowledge, attitudes, behaviors, and perceptions of risk related to HIV/AIDS among Chinese university students in Hunan, China.

The purpose of this paper is to describe HIV/AIDS knowledge, attitudes, and perceptions and identify personal risk behaviors among undergraduate students in China. A descriptive, cross-sectional survey of 1326 students between ages 17 through 28 was conducted in 2002. Results indicated that students held considerable misconceptions about HIV transmission by casual contact and needle sharing as well as stigmatizing attitudes about injection drug use, homosexuality and HIV-positive women who bear children. Results indicated that 14% of Chinese university students are sexually active and risk behaviors tended to increase with age. Additionally, 24% of the students considered themselves to be at moderate to very high risk of contracting HIV and 40% of sexually active students never used condoms. Therefore, it is important to design HIV prevention strategies that target university students in China.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Do perceptions of risk and quality of life affect use of hormone replacement therapy by postmenopausal women?

BACKGROUND: Although the understanding of the health impact of hormone replacement therapy (HRT) is incomplete, even less is known about the attitudes, perceptions, and motivations of women faced with the decision to use HRT. The purpose of this study was to evaluate the relation between HRT use and women's perceptions of the risk and benefits associated with HRT use. METHODS: A written questionnaire was administered to 387 women, aged 45 years and older, responding to a health plan invitation for free bone mineral density screening. Women were asked to estimate the lifetime probability of developing breast cancer, uterine cancer, osteoporosis, and myocardial infarction when taking HRT and when not taking HRT. Women rated their quality of life in their current state of health, with breast cancer, with uterine cancer, with osteoporosis, and after myocardial infarction. RESULTS: HRT users perceived a greater risk reduction using HRT compared with HRT nonusers for osteoporosis (-34.9% vs -17.8%, P <.001) and myocardial infarction (-20.7% vs -8.4%, P <.001). HRT nonusers perceived a greater risk increase using HRT compared with HRT nonusers for breast cancer (16.5% vs 3.3%, P <.001) and uterine cancer (9.2% vs 0.6%, P =.004). HRT users estimated a greater quality-of-life reduction compared with HRT nonusers for osteoporosis (-31.0 vs -24.5, P =.006). CONCLUSIONS: Regardless of whether they used HRT, women in this study overestimated their risk for all four diseases. HRT users perceived greater benefit and less risk using HRT than nonusers. The results of our study show that continuing efforts are needed to help women understand the risks and benefits of HRT.

Aged↗
PubMedDate not supplied

Beliefs about breast cancer risk and use of postmenopausal hormone replacement therapy.

BACKGROUND: Postmenopausal hormone replacement therapy (HRT) decreases the risks of coronary heart disease and osteoporosis, but increases the risk of breast cancer. Although only 20-30% of postmenopausal women in the United States take HRT, the relationship between breast cancer risk perception and use of HRT is not known. OBJECTIVE: To assess the impact of belief that HRT increases breast cancer risk and high perceived risk of breast cancer on the use of HRT. DESIGN: Cross-sectional mailed survey. PARTICIPANTS: 189 randomly selected postmenopausal women from a general internal medicine practice in the Philadelphia area. MAIN RESULTS: Of the 268 women (67%) who returned surveys, 189 were postmenopausal; 70 (37%) were currently using HRT and 21 (11 %) had previously used HRT. Respondents' mean age was 59.6 years; 64% were Caucasian, and 33% had completed college. Fifty-nine women (33%) thought HRT increased the risk of breast cancer, 22 (12%) thought it did not, and 100 (55%) were unsure. Mean perceived lifetime risk of breast cancer was 31% (range 0%-100%). After multivariate adjustment, current use of HRT was inversely associated with age (OR 0.96 for each one-year increase, 95% CI 0.940.98), and positively associated with Caucasian race (OR 2.73, 95% CI 1.40-5.32). Use of HRT was not associated with belief that HRT increases the risk of breast cancer, breast cancer risk perception, or perceived severity of breast cancer. CONCLUSIONS: Belief that HRT increases the risk of breast cancer and high perceptions of breast cancer risk may not be important barriers to use of HRT. Efforts to improve decision making about HRT should focus on previously established barriers, such as perceptions of menopause and lack of physician discussion, rather than misconceptions about breast cancer risk.

Attitude to Health↗
PubMed1996

Field-workers' sense of coherence and perception of risk when making home visits.

This study explored the relationship between the strength of the sense of coherence (SOC) and perceptions of different aspects of risks perceived by field-workers making home visits for Medicare-certified home care agencies. SOC is the disposition that individuals have toward stimuli. Field-workers with a strong SOC identified fewer risk encounters, attributed a lower level of risk to characteristics of home visits that have the potential for injury, and evaluated fewer situations as having the potential to be threatening than their weak SOC counterparts. Strong SOC field-workers were prepared to use behaviors similar to those of their weak SOC counterparts to protect themselves from harm should a situation become threatening. Knowledge of the strength of the SOC of field-workers can be helpful in the screening, selection, and orientation of potential field-workers as well as in designing programs to enhance the safety of home health care agency staff.

Adult↗
PubMed1999

Simultaneous analysis of individual and aggregate responses in psychometric data using multilevel modeling.

Psychometric data on risk perceptions are often collected using the method developed by Slovic, Fischhoff, and Lichtenstein, where an array of risk issues are evaluated with respect to a number of risk characteristics, such as how dreadful, catastrophic or involuntary exposure to each risk is. The analysis of these data has often been carried out at an aggregate level, where mean scores for all respondents are compared between risk issues. However, this approach may conceal important variation between individuals, and individual analyses have also been performed for single risk issues. This paper presents a new methodological approach using a technique called multilevel modelling for analysing individual and aggregated responses simultaneously, to produce unconditional and unbiased results at both individual and aggregate levels of the data. Two examples are given using previously published data sets on risk perceptions collected by the authors, and results between the traditional and new approaches compared. The discussion focuses on the implications of and possibilities provided by the new methodology.

Humans↗
PubMed2003

Determinants of women's perceptions of risk in battering relationships.

Two studies have recently identified battered women's perceptions as a substantial predictor of reassault by their batterers. Only a few exploratory studies examine how women make these useful perceptions. We attempted to identify determinants of battered women's perceptions of reassault and safety using the 15-month follow-up of a multisite evaluation of batterer intervention. The regression analyses indicate that the perceived likelihood of reassault increased with men who were divorced or separated, heavy drinkers, and severely abusive in the past. The strongest determinant for perceptions of safety was the perceived likelihood of reassault. Also, the women's professed reasons for their perceptions corresponded to the actual determinants. The women's perceptions appear, therefore, to be grounded in practical circumstances and correspond to establish predictors of reassault. Further research is needed to identify the additional cues, processes, or intuitions that make women's perceptions such a strong predictor of reassault.

Adolescent↗
PubMed2002

Perception of risk of developing diabetes in offspring of type 2 diabetic patients.

BACKGROUND: The risk of developing diabetes is high in the offspring of patients with type 2 diabetes. There have been no studies to assess the offspring's awareness of the risk of developing diabetes. The aim of this study was to investigate how the male offspring of type 2 diabetic patients assess their likelihood of developing diabetes. METHODS: One hundred and one non-diabetic men with one or both parents having type 2 diabetes, aged 19-28 years, were recruited. RESULTS: Thirty-nine subjects (38.6%) were concerned about diabetes and 85 (84.2%) considered diabetes a serious problem. However, only 10 (9.9%) thought they might develop diabetes and 9 (8.9%) had previously attended diabetes education programs with their parents. The educational level amongst the diabetic parents was the only independent predictor of perception of the increased risk. Age, body mass index, waist-to-hip ratio, educational level and the perception of diabetes as a serious problem were not associated with perception of the increased risk. CONCLUSION: Most offspring of diabetic parents lacked knowledge about the increased risk amongst family members. We suggest that physicians and diabetic educators should provide knowledge about the increased risk of developing diabetes in offspring and the benefit of lifestyle modification to delay or prevent the development of the disease.

Adult↗
PubMed2004

Risk and climate change: perceptions of key policy actors in Canada.

This article examines factors that predict perceptions of risk associated with global climate change. The research focuses on the perceptions of those associated with climate change policy making in the prairie region of Canada. The data are from an online survey (n=851) of those policy actors. The analysis integrates several dominant approaches to the study of risk perception: psychometric approaches that examine the effects of cognitive structure; demographic assessments that examine, for example, differences in perception based on gender or family status; and political approaches that suggest that one's position in the policy process may affect his or her perceived risk. Attitudes toward climate change are to a degree predicted by all of these factors, but only when indirect effects are observed. Sociodemographic characteristics have little direct effect on perceived risk, but do affect general beliefs that affect risk perceptions. Perceived risk is related more strongly to these general beliefs or world views than to more specific beliefs about the effects of climate change on weather patterns. Position within the policy process also contributes to our understanding of perceptions, with industry and governmental actors demonstrating similar attitudes, which contrast with environmental groups and university researchers.

Journal Article↗
PubMed2003

Family and friends with disease: their impact on perceived risk.

BACKGROUND: For many common diseases, having a family history is the strongest predictor of lifetime risk. Perceptions of personal risk, important for appropriate prevention efforts, have been found to be exaggerated in healthy individuals with family histories. These findings highlight the contribution of objective and experiential factors to perceived risk. This study examined, across a variety of diseases, whether (1) family history of the disease contributes to perceived risk, (2) history of disease in a friend or nonblood relative, which would not increase one's objective risk, nonetheless increases perceived risk, and (3) these effects are similar across genders. METHODS: Participants (N = 522; 38% male; 56% Caucasian; mean age = 40 years) completed a brief health survey. RESULTS: Analyses revealed an effect of having a family history of the disease on perceived risk for breast and colon cancers, heart disease, and diabetes (P < 0.001). Interestingly, having a friend diagnosed with the disease also contributed to perceived risk for breast and colon cancers, as well as heart disease and diabetes among women (P < 0.05), but not among men. CONCLUSIONS: Results suggest that interventions to alter perceived risk of cancer should account for gender, as women appear to be impacted by who they know.

Adult↗
PubMed1996

Lay perceptions of risk of HIV infection and the social construction of safer sex: some experiences from Kenya.

Safer sex in the context of HIV/AIDS control in Kenya has mainly been promoted through the encouragement of condom use. In this strategy, safer sex is treated as though it is synonymous with condom use. This paper, which is based on ethnographic data drawn from a sample of 29 heterosexual HIV-positive patients presenting in four specialized treatment clinics in Nairobi, questions this assumption by examining some particular ways in which risks of HIV/AIDS are socially constructed, and how these perceptions have informed lay experiences of safer sex in Nairobi. The paper further examines the juxtaposition of common-sense and biomedical knowledge in producing socially meaningful experiences of safer sex. The implications of these lay safer sex constructions and experiences for government-sponsored HIV/AIDS control programmes and policies are discussed.

Adult↗
PubMed1994

Disease and risk factor perception among patients with coronary artery disease in Kuala Terengganu.

One hundred consecutive patients with coronary heart disease attending the Physician Clinic, Kuala Terengganu General Hospital self-completed a questionnaire on their awareness of the coronary risk factors and their perception of their disease. Seventy-one subjects were males. Twenty-seven subjects had never had formal education and only 6 had completed tertiary education. Whilst 52% considered themselves as having less than 25% knowledge about their disease, many were aware of hypercholesterolaemia, emotional stress, inadequate exercise and smoking as risk factors for coronary heart disease. Diabetes and family history were less known as coronary risk factors. Despite their awareness of the risk factors, though, the subjects failed to control these. For example, smoking was prevalent and their awareness of the harmful effects of smoking did not seem to deter them from this habit. Further, formal education did not seem to influence positive health behaviour. In terms of disease perception, the subjects tended to believe that their illness could be cured. Eighty subjects expected a cure from their doctors. Sixty-three subjects wanted more explanation of their illness from their doctors. These findings suggest that efforts should be made to translate patients' awareness of their illness to appropriate health behaviour, and perhaps doctors could achieve this by spending more time explaining to the patients, and educating them.

Aged↗
PubMed1995

Infection control and human immunodeficiency virus: perceptions of risk among nurses and hospital domestic workers.

In December 1993 the first case of patient-to-patient transmission of human immunodeficiency virus (HIV), at a doctor's surgery in New South Wales, was documented. In an environment of heightened anxiety about HIV transmission and the adequacy of infection-control measures taken by health providers, it is important to explore perceptions of occupational risk of exposure to infection among hospital workers, reasons why hospital domestic workers sometimes depart from standard procedure in infection control, and how they regard the patients who have infectious diseases. In this study, at an infectious diseases hospital where there is an acute awareness of such issues, nurses had accurate knowledge about control of infection, including HIV, but had limited trust of that knowledge. They gave rationales for why they sometimes departed from infection-control procedures. They had low levels of fear of homosexuals and of acquired immune deficiency syndrome. The hospital domestic workers had lower levels of accurate knowledge about infection control, including HIV, and less trust of that knowledge and of protection by health provider from occupational exposure to infection. They had low levels of fear of homosexuals and HIV. Both groups sought regular, small-group, interactive education programs on infection control and HIV to allow them to discuss their concerns. Participatory education of workers should include eliciting concerns of participants, and should discuss concerns regarding administrators' and educators' interests in their safety and wellbeing.

Adult↗
PubMed1998

Initial emergency department diagnosis and return visits: risk versus perception.

STUDY OBJECTIVES: To identify diagnostic predictors of return emergency department visits, and to compare actual and perceived associations between initial ED diagnosis and revisits to help identify target diagnoses for prevention strategies. METHODS: This 2-part study involved a retrospective observational study and a health professional survey. The study population consisted of all patients with 2 or more visits to the University of Michigan ED within a 3-day period between July 1995 and June 1996 ("early-return visitors"). Billing records identified the initial diagnoses of subsequent return visitors. The prevalence of each initial diagnosis was determined in the general ED population (n=52,553), early-return population (n=1,422), and early-return population admitted to the hospital ("return-admit," n=313). Surveys were distributed to all ED health professionals to assess their perception of the diagnoses most likely to return within 3 days. Relative risk (RR) ratios and 95% confidence intervals (CIs) were calculated. RESULTS: Dehydration was the most common diagnosis in the general, early-return, and return-admit populations (prevalence: 7%, 15%, 25%, respectively). Dehydration was also the diagnosis with the highest risk for both early return and subsequent admission on early return (RR [95% CI]: 2.3 [2.0-2.6], 1.8 [1.5-2.3], respectively). Nearly two thirds of health professionals, however, did not identify dehydration as a diagnosis at high risk for return, and almost half did not consider dehydration a high risk for admission. CONCLUSION: Initial ED diagnosis may be a useful predictor of early ED return and admission. Patients with an initial diagnosis of dehydration are at particularly high risk for early return and admission, yet providers underestimate the risk in this very common group. Screening a return ED population for high-frequency diagnoses may reveal underrecognized target groups for specific prevention strategies.

Adolescent↗
PubMed1999

Underreporting of family history of colon cancer: correlates and implications.

Scientific advances in cancer genetics, risk counseling, and management of high-risk individuals require information about familial cancer history. Because some people may not report, or may be unaware of, cancer in their families, it is important to examine the extent of underreporting of family history. We mailed a survey to first-degree relatives of patients with histologically confirmed diagnoses of colorectal cancer (CRC) before age 60 (n = 426, 77% response rate). Analyses examined the extent of underreporting of family history and its predictors (demographics, cancer characteristics, knowledge, and communication) and correlates (cancer worry, perceived risk). Logistic regression analysis was performed using generalized estimating equations to account for family clusters. Despite confirmed diagnosis of CRC in a parent or sibling, 25.4% of respondents reported having no first-degree relative with colon cancer. In multivariate models, the most significant predictor of awareness of a relative's CRC was the stage-at-diagnosis; also, males and those with low knowledge about colon cancer were significantly less aware. Awareness of a relative's CRC was associated with higher cancer worry and risk perception, and being a college graduate contributed independently to increased risk perception. Sole dependence on mailed self-administered questionnaires may lead to substantial underreporting of familial colon cancers, especially those that are in situ or localized.

Adult↗