A single risk factor can increase the risk of developing multiple diseases, but most risk communication research has been conducted in the context of a single disease. We explored which combination of three recommended risk communication strategies is most effective in simultaneously conveying risk estimates of four diseases associated with physical inactivity: colon cancer, stroke, diabetes, and heart disease. Participants (N = 1161, 50% no college experience, 50% racial/ethnic minority) were shown hypothetical risk estimates for each of the four diseases. All four diseases were placed at varying heights on 1 of 12 vertical bar charts (i.e., “risk ladders”) to indicate their respective probabilities. The risk ladders varied in a 2 (risk reduction information: present/absent) × 2 (numerical format: words/words and numbers) × 3 (social comparison information: none/somewhat higher than average/much higher than average) full factorial design. Participants were randomly assigned to view one of the risk ladders and then completed a questionnaire assessing message comprehension, message acceptance, physical activity-related risk and efficacy beliefs, and physical activity intentions. Higher message acceptance was found among (1) people who received risk reduction information versus those who did not (p = .01), and (2) people who did not receive social comparison information versus those told that they were at higher than average risk (p = .03). Further, absolute cognitive perceived risk of developing “any of the diseases shown in the picture” was higher among people who did not receive social comparison information (p = .03). No other main effects and only very few interactions with demographic variables were found. Combining recommended risk communication strategies did not improve or impair key cognitive or affective precursors of health behavior change. It might not be necessary to provide people with extensive information when communicating risk estimates of multiple diseases.
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The original intent was to show participants either no social comparison information, information that they were at lower than average risk, or information that they were at higher than average risk. However, an error resulted in participants who should have been assigned to the lower than average condition instead being shown information that they were at somewhat higher than average risk. We collapsed the two higher than average conditions into 1 “higher than average” category, resulting in 2 social comparison conditions (i.e. absent/higher than average).
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We would like to thank Susan Gillham Design for excellent work creating the visual displays and the following individuals for their valuable input regarding study design and interpretation of the results: Dr. Graham A. Colditz, Dr. Deborah J. Bowen, Mr. Hank Dart, and Dr. Sarah Gehlert.
The results presented in this paper were presented at the Annual Meeting of the Society of Medical Decision Making in 2016. This research was supported by funding awarded to Erika Waters from the U.S. National Cancer Institute (R01CA190391). The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. The content is solely the responsibility of the authors and does not necessarily represent the official view of the National Cancer Institute.
Conflict of interest
Eva Janssen, Robert A. C. Ruiter, and Erika A. Waters declare that they have no conflicts of interest.
Human and animal rights and Informed consent
All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.
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Janssen, E., Ruiter, R.A.C. & Waters, E.A. Combining risk communication strategies to simultaneously convey the risks of four diseases associated with physical inactivity to socio-demographically diverse populations. J Behav Med 41, 318–332 (2018). https://doi.org/10.1007/s10865-017-9894-3
- Risk communication
- Decision making
- Physical activity
- Health disparities