Comparison of risk perceptions and beliefs across common chronic diseases

Abstract

Objectives

Few studies have compared perceptions of risk, worry, severity and control across multiple diseases. This paper examines how these perceptions vary for heart disease, diabetes, stroke, and colon, breast, and ovarian cancers.

Methods

The data for this study came from the Family Healthware™ Impact Trial (FHITr), conducted in the United States from 2005 to 2007. Healthy adults (N  = 2362) from primary care practices recorded their perceptions at baseline for each disease. Analyses were conducted controlling for study site and personal risk factors.

Results

Perceived risk was significantly higher for cancers than for other diseases. Men worried most about getting heart disease; women worried most about getting breast cancer, followed by heart disease. Diabetes was perceived to be the least severe condition. Heart disease was perceived to be the most controllable compared to cancers, which were perceived to be the least controllable. Women had higher perceived risk and worry ratings compared to men for several diseases.

Conclusions

These data highlight how individuals comparatively view chronic diseases. Addressing prior disease perceptions when communicating multiple disease risks may facilitate an accurate understanding of risk for diseases, and help individuals to effectively identify and engage in relevant behaviors to reduce their risk.

Introduction

Altogether, coronary heart disease, cancer, stroke, and diabetes account for approximately 60% of total deaths each year in the United States (Minino et al., 2007). Overall, these diseases represent a large portion of chronic disease morbidity and mortality suffered by adult men and women in the US. Efforts to educate the public on health behaviors to prevent chronic disease necessitate a better understanding of the attitudes and beliefs individuals hold about these conditions.

Perceptions of risk, worry, severity and control have been the foundation of health behavior theories for decades and are integral to many theories including the Health Belief Model (Becker, 1974, Janz and Becker, 1984), Theory of Planned Behavior (Ajzen, 1991), Common-Sense Model (Leventhal et al., 2003), and Extended Parallel Process Model (Witte, 1992). Although the importance of these constructs for predicting health behaviors has been well studied in many disease contexts (Bowen et al., 2004, Dassow, 2005, Moser et al., 2007), less is known on how these perceptions vary across common diseases and correspond to actual comparative disease risks and availability of preventive measures. The perceptions that individuals have about one disease, however, not only have implications for how they view other diseases, but also the health protective actions they may (or may not) take to reduce their risks for these diseases (DiLorenzo et al., 2006, Erblich et al., 2000). Existing perceptions for one disease might also influence how individuals respond to and process new health information related to this or other diseases. As such, the knowledge of how perceptions vary across diseases will become increasingly important, especially as family health history tools and multiplex genetic tests are utilized to identify an individual's risk for multiple diseases simultaneously (Khoury et al., 2004, Yang et al., 2003, Yoon, 2005, Yoon and Scheuner, 2004).

Prior research comparing perceptions across diseases has focused primarily on perceived risk, particularly among women. Findings suggest that women often have misconceptions about the diseases for which they are at greatest risk. For example, women have heightened concerns about their risk for breast cancer even though other diseases such as lung cancer and heart disease have higher mortality rates (Covello and Peters, 2002). The majority of studies in this area have reported a heightened risk perception for breast cancer or cancer in general compared to heart disease (Mosca et al., 2000, Mosca et al., 2004, Wilcox et al., 2002), although there have been exceptions (DiLorenzo et al., 2006). Little information is available comparing individual's perceptions of risk across diseases among men. One study (DiLorenzo et al., 2006) found that men perceived their risks for heart disease the greatest, followed by prostate cancer, diabetes and colorectal cancer.

The variability of other important perceptions including worry, severity, and controllability across diseases has not been well studied, with few studies providing comparative reports. In one study, women reported the highest worry for breast cancer, followed by heart disease, diabetes and colorectal cancer, whereas worry among men was highest for heart disease, followed by prostate cancer, diabetes and colorectal cancer (DiLorenzo et al., 2006). Others have also noted that women report the greatest worry for cancer in general compared to cardiovascular diseases (Mosca et al., 2000, Wilcox et al., 2002). Perceived severity has not been shown to differ between various diseases including breast cancer and heart disease (Gerend et al., 2004) or breast and colorectal cancer (Dassow, 2005). In contrast, perceived control has been shown to be significantly higher for heart disease compared to breast cancer among women Gerend et al. (2004).

This study examines individuals' perceptions of risk, worry, severity and control for 6 common chronic conditions: heart disease, diabetes, stroke, and breast, ovarian, and colon cancer. The analyses aim to identify whether individuals perceive certain diseases to be more threatening, provoke more worry, or under greater personal control.