Research ArticleOriginal Research

Inaccurate Risk Perceptions and Individualized Risk Estimates by Patients with Type 2 Diabetes

Barry G. Saver, Kathleen M. Mazor, J. Lee Hargraves and Marcela Hayes
The Journal of the American Board of Family Medicine July 2014, 27 (4) 510-519; DOI: https://doi.org/10.3122/jabfm.2014.04.140058

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Mean outcome rankings and probabilities. MI, myocardial infarction; UKPDS, UK Prospective Diabetes Study.

  • Figure 2.
    Figure 2.

    Change in ranking of mortality risk, sorted by initial ranking. *The initial ranking was categorized as 1 = most likely to 6 = least likely.

Tables

  • Table 1. Overview of Study Procedures
    Procedures for Initial Group (First 38 Participants)Procedures for Verification Group (Final 18 Participants)
    Demographic data collectedSame
    S-TOFHLA numeracy testSame
    Questions about current health-related activities and sources and sufficiency of informationSame
    Questions about risk perception: What are you most worried about in coming X years and why?Same
    Rank health risks using card sort (were not asked to rank mortality if estimated risk is high)Same
        (1) Reviewed personalized risk information, randomly presenting either bar chart or crowd charts; mortality risk censored if too high(1) Presented bar charts first; if did not clearly understand, presented crowd charts as well
        (2) Asked for reactions to risk projections: comprehension, personal relevance, preferred format(2) Asked to rank second set of risk cards as UKPDS model predicted them
        (3) Presented with and reviewed other set of risk representations (crowd or bar charts)(3) If could not properly rank risk cards, presented crowd charts if not already done, reviewed data, encouraged to try again
    Given second set of cards and asked to rank based on current feelings about risk with original ranking and risk charts in viewIf able to rank second set of cards correctly, given third set of cards to rank based on current feelings, with first 2 card sets and risk charts in view
    Asked about reasons for changing/not changing rankings, why they did or did not believe or match computer estimates, whether they are motivating for change, and suggestions for improvementSame

    • S-TOFHLA, Short Test of Functional Literacy in Adults; UKPDS, UK Prospective Diabetes Study.

  • Table 2. Participant Characteristics, Including Comorbid Cardiovascular Risk Prevalence and Risk Factor Levels
    CharacteristicsOverall (n = 56)Initial Group (n = 56)Verification Group (n = 56)
    Primarily Spanish-speaking (n)990
    Hypertension (%)736883
    Hyperlipidemia (%)797978
    Reporting smoking (%)201822
    Literacy (S-TOFHLA) scores (%)
        Adequate (score 23–36)828283
        Marginal (score 17–22)220
        Inadequate (score 0–16)161617
    Numeracy score*3.7 (2.7)4.0 (2.7)3.2 (2.7)
    Mean age, years (range)55 (26–80)54 (26–80)56 (38–74)
    Mean BMI, kg/m2 (range)36 (20–57)34 (20–57)41 (28–53)
    Systolic pressure, mmHg129 (13)128 (14)130 (11)
    Total cholesterol, mg/dL181 (51)178 (43)186 (66)
    Hemoglobin A1c, %8.2 (2.2)8.0 (1.9)8.5 (2.9)

    • Data are mean (standard deviation) unless otherwise indicated.

    • ↵* Number of questions answered correctly on Lipkus instrument; maximum score is 8.

    • BMI, body mass index; S-TOFHLA, Short Test of Functional Health Literacy in Adults.

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