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Communication strategies for enhancing understanding of the behavioral implications of genetic and biomarker tests for disease risk: The role of coherence

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Abstract

Individuals frequently have difficulty understanding how behavior can reduce genetically-conferred risk for diseases such as colon cancer. With increasing opportunities to purchase genetic tests, communication strategies are needed for presenting information in ways that optimize comprehension and adaptive behavior. Using the Common-Sense Model, we tested the efficacy of a strategy for providing information about the relationships (links) among the physiological processes underlying disease risk and protective action on understanding, protective action motivations, and willingness to purchase tests. We tested the generalizability of the strategy’s effects across varying risk levels, for genetic tests versus tests of a non-genetic biomarker, and when using graphic and numeric risk formats. In an internet-based experiment, 749 adults from four countries responded to messages about a hypothetical test for colon cancer risk. Messages varied by Risk-Action Link Information (provision or no provision of information describing how a low-fat diet reduces risk given positive results, indicating presence of a gene fault), Risk Increment (20%, 50%, or 80% risk given positive results), Risk Format (numeric or graphic presentation of risk increments), and Test Type (genetic or enzyme). Providing risk-action link information enhanced beliefs of coherence (understanding how a low-fat diet reduces risk) and response efficacy (low-fat diets effectively reduce risk) and lowered appraisals of anticipated risk of colon cancer given positive results. These effects held across risk increments, risk formats, and test types. For genetic tests, provision of risk-action link information reduced the amount individuals were willing to pay for testing. Brief messages explaining how action can reduce genetic and biomarker-detected risks can promote beliefs motivating protective action. By enhancing understanding of behavioral control, they may reduce the perceived value of genetic risk information.

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References

  • 23andme. (2011). Downloaded on May 28 2011 from the 23andme website: http://www.23andme.com/

  • Beery, T. A., & Williams, J. K. (2007). Risk reduction and health promotion behaviors following genetic testing for adult-onset disorders. Genetic Testing, 11, 111–123.

    Article  PubMed  Google Scholar 

  • Bishop, A. J., Marteau, T. M., Hall, S., Kitchener, H., & Hayek, P. (2005). Increasing women’s intentions to stop smoking following an abnormal cervical smear test result. Preventive Medicine, 41, 179–185.

    Article  PubMed  Google Scholar 

  • Brownlee, S., Leventhal, H., & Leventhal, E. A. (2000). Regulation, self-regulation and regulation of the self in maintaining physical health. In M. Boekartz, P. R. Pintrick, & M. Zeidner (Eds.), Handbook of self regulation (pp. 369–416). San Diego, CA: Academic Press.

    Google Scholar 

  • Bruine de Bruin, W., Fischhoff, B., Millstein, S. G., & Halpern-Felsher, B. L. (2000). Verbal and numerical expressions of probability: “It’s a fifty–fifty chance”. Organizational Behavior and Human Decision Processes, 81, 115–131.

    Google Scholar 

  • Cameron, L. D. (2008). Illness risk representations and motivations to engage in protective behavior: The case of skin cancer risk. Psychology and Health, 23, 91–112.

    Article  Google Scholar 

  • Cameron, L. D., & Muller, C. (2009). Psychosocial aspects of genetic testing. Current Opinion in Psychiatry, 22, 218–223.

    Article  PubMed  Google Scholar 

  • Cameron, L. D., & Reeve, J. (2006). Risk perceptions, worry, and attitudes about genetic testing for breast cancer susceptibility. Psychology and Health, 21, 211–230.

    Article  PubMed  Google Scholar 

  • Cameron, L. D., Sherman, K. A., Marteau, T. M., & Brown, P. M. (2009). Impact of genetic risk information and type of disease on perceived risk, anticipated affect, and expected consequences of genetic tests. Health Psychology, 28, 307–316.

    Article  PubMed  Google Scholar 

  • French, D. P., & Marteau, T. M. (2007). Communicating risk. In S. Ayers, A. Baum, C. McManus, S. Newman, K. Wallston, & J. Weinman (Eds.), Cambridge handbook of psychology, health, and medicine (2nd ed., pp. 431–434). Cambridge, UK: Cambridge University Press.

    Google Scholar 

  • Frosch, D. L., Mello, P., & Lerman, C. (2005). Behavioral consequences of testing for obesity risk. Cancer Epidemiology, Biomarkers and Prevention, 14, 1485–1489.

    Article  PubMed  Google Scholar 

  • Grosse, S., Wordsworth, S., & Payne, K. (2008). Economic methods for valuing the outcomes of genetic testing: Beyond cost-effectiveness analysis. Genetics in Medicine, 10, 648–654.

    Article  PubMed  Google Scholar 

  • Hall, J., Fiebig, D. G., King, M. T., Hossain, I., & Louviere, J. J. (2006). What influences participation in genetic carrier testing? Results from a discrete choice experiment. Journal of Health Economics, 25, 520–537.

    Article  PubMed  Google Scholar 

  • Hall, S., Weinman, J., & Marteau, T. M. (2004). The motivational impact of informing women smokers of a link between smoking and cervical cancer: The role of coherence. Health Psychology, 23, 419–424.

    Article  PubMed  Google Scholar 

  • Ito, H., Matsuo, K., Wakai, K., et al. (2006). An intervention study of smoking cessation with feedback on genetic cancer susceptibility in Japan. Preventive Medicine, 4, 102–108.

    Article  Google Scholar 

  • Karamanidou, D., Weinman, J., & Horne, R. (2008). Improving haemodialysis patients’ understanding of phosphate-binding medication: A pilot study of a psycho-educational intervention designed to change patients’ perceptions of the problem and treatment. British Journal of Health Psychology, 13, 205–214.

    Article  PubMed  Google Scholar 

  • Klein, W. (1997). Objective standards are not enough: Affective, self-evaluative, and behavioral responses to social comparison information. Journal of Personality and Social Psychology, 72, 763–774.

    Article  PubMed  CAS  Google Scholar 

  • Lerman, C., Croyle, R. T., Tercyak, K. P., & Hamann, H. (2002). Genetic testing: Psychological aspects and implications. Journal of Consulting and Clinical Psychology, 70, 784–797.

    Article  PubMed  Google Scholar 

  • Leventhal, H., Brissette, I., & Leventhal, E. A. (2003). The common-sense model of self-regulation of health and illness. In L. D. Cameron & H. Leventhal (Eds.), The self-regulation of health and illness behaviour (pp. 42–65). London: Routledge.

    Google Scholar 

  • Lipkus, I. M., Biradavolu, M., Fenn, K., Keller, P., & Rimer, B. (2001). Informing women about their breast cancer risks: Truth and consequences. Health Communication, 13, 205–226.

    Article  PubMed  CAS  Google Scholar 

  • Marteau, T. M., & Lerman, C. (2001). Genetic risk and behavioural change. British Medical Journal, 322, 1056–1059.

    Article  PubMed  CAS  Google Scholar 

  • Marteau, T. M., Senior, V., Humphries, S. E., Bobrow, M., Cranston, T., Crook, M. A., et al. (2004). Psychological impact of genetic testing for familial hypercholesterolaemia in a previously aware population: A randomized controlled trial. American Journal of Medical Genetics, 128A, 285–293.

    Article  PubMed  Google Scholar 

  • Marteau, T. M., & Weinman, J. (2006). Self-regulation and the behavioural response to DNA risk information: A theoretical analysis and framework for future research. Social Science and Medicine, 62, 1360–1368.

    Article  PubMed  Google Scholar 

  • McBride, C. M., Bepher, G., Lipkus, I. M., Lyna, P., Samsa, G., Albright, J., et al. (2002). Incorporating genetic susceptibility feedback into a smoking cessation program for African American smokers with low income. Cancer Epidemiology, Biomarkers and Prevention, 11, 521–528.

    PubMed  Google Scholar 

  • McBride, C. N., Bowen, D., Brody, L. C., Condit, C. M., Croyle, R. T., Gwinn, M., et al. (2010a). Future health applications of genomics: Priorities for communication, behavioral, and social sciences research. American Journal of Preventive Medicine, 38, 555–561.

    Article  Google Scholar 

  • McBride, C. M., Koehly, L. M., Sanderson, S. C., & Kaphingst, K. (2010b). The behavioral response to personalized genetic information: Will genetic risk profiles motivate individuals and families to choose more healthful behaviors? Annual Review of Public Health, 31, 89–103.

    Article  PubMed  Google Scholar 

  • Navigenics. (2011). Downloaded on May 28, 2011 from the Navigenics Website: http://www.navigenics.com/

  • NCCN. (2011). Colorectal cancer screening. NCCN clinical practice guidelines in oncology. Downloaded on May 28, 2011 from the National Comprehensive Cancer Network Website: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp

  • Olsen, J., Donaldson, C., & Pereira, J. (2004). The insensitivity of ‘willingness-to-pay’ to the size of the good: New evidence for health care. Journal of Economic Psychology, 25, 445–460.

    Article  Google Scholar 

  • Olson, J., & Smith, R. (2001). Theory versus practice: A review of willingness-to-pay in health and health care. Health Economics, 10, 39–52.

    Article  Google Scholar 

  • President and Fellows of Harvard College. (2007). Your disease risk. Downloaded from Harvard University, School of Public Health Website: http://www.diseaseriskindex.harvard.edu

  • Sanderson, S. C., & Michie, S. (2007). Genetic testing for heart disease susceptibility: Potential impact on motivaiton to quit smoking. Clinical Genetics, 71, 501–510.

    Article  PubMed  CAS  Google Scholar 

  • Witte, K., & Allen, M. (2000). A meta-analysis of fear appeals: Implications for effective public health campaigns. Health Education and Behavior, 27, 608–632.

    Article  Google Scholar 

  • Wright, A. J., Weinman, J., & Marteau, T. M. (2003). The impact of learning of a genetic predisposition to nicotine dependence: An analogue study. Tobacco Control, 12, 227–230.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Linda D. Cameron.

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Cameron, L.D., Marteau, T.M., Brown, P.M. et al. Communication strategies for enhancing understanding of the behavioral implications of genetic and biomarker tests for disease risk: The role of coherence. J Behav Med 35, 286–298 (2012). https://doi.org/10.1007/s10865-011-9361-5

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  • DOI: https://doi.org/10.1007/s10865-011-9361-5

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