Effects of racial and ethnic group and health literacy on responses to genomic risk information in a medically underserved population.

Abstract

Objective Few studies have examined how individuals respond to genomic risk information for common, chronic diseases. This randomized study examined differences in responses by type of genomic information [genetic test/family history] and disease condition [diabetes/heart disease] and by race/ethnicity in a medically underserved population. Methods 1057 English-speaking adults completed a survey containing one of four vignettes (two-by-two randomized design). Differences in dependent variables (i.e., interest in receiving genomic assessment, discussing with doctor or family, changing health habits) by experimental condition and race/ethnicity were examined using chi-squared tests and multivariable regression analysis. Results No significant differences were found in dependent variables by type of genomic information or disease condition. In multivariable models, Hispanics were more interested in receiving a genomic assessment than Whites (OR=1.93; p<0.0001); respondents with marginal (OR=1.54; p=0.005) or limited (OR=1.85; p=0.009) health literacy had greater interest than those with adequate health literacy. Blacks (OR=1.78; p=0.001) and Hispanics (OR=1.85; p=0.001) had greater interest in discussing information with family than Whites. Non-Hispanic Blacks (OR=1.45; p=0.04) had greater interest in discussing genomic information with a doctor than Whites. Blacks (β= −0.41; p<0.001) and Hispanics (β= −0.25; p=0.033) intended to change fewer health habits than Whites; health literacy was negatively associated with number of health habits participants intended to change. Conclusions Findings suggest that race/ethnicity may affect responses to genomic risk information. Additional research could examine how cognitive representations of this information differ across racial/ethnic groups. Health literacy is also critical to consider in developing approaches to communicating genomic information.

Relationships Between Health Literacy and Genomics-Related Knowledge, Self-Efficacy, Perceived Importance, and Communication in a Medically Underserved Population

“…Although further research is needed to investigate these effects and other types of provider-patient communication about genomics, the findings do suggest that the domains of knowledge and oral literacy are important aspects of genomics-related health literacy. We also found that individuals with limited health literacy placed greater value on genetic information than FHH information, despite the current greater usefulness of the latter for most individuals (Kaphingst et al, 2015; Valdez et al, 2010). This result highlights the need to investigate the underlying mechanisms further and develop messages regarding the importance of FHH for individuals with limited health literacy.…”

“…This finding suggests that messages about the importance and usefulness of FHH may not be reaching individuals with limited health literacy, or that they may not understand these messages, and that we need to develop new ways of communicating this information to reach a broader population (Kaphingst et al, 2011). Our prior work has indicated that individuals with limited health literacy may be more interested in receiving an assessment of genomic risk based on genetic testing than those with higher health literacy (Kaphingst et al, 2015), and other researchers have found that genetics-related literacy may impact how patients evaluate the utility of genetic testing (Hooker et al, 2014). Assessing knowledge of the benefits of genetic technologies separately from knowledge of the limitations may be important to understand the association between health literacy and knowledge (Kaphingst, Facio, et al, 2012).…”

The Role of Knowledge on Genetic Counseling and Testing in Black Cancer Survivors at Increased Risk of Carrying a BRCA1/2 Mutation

“…Understanding genetic risk information is complex and it is associated with health literacy and numeracy skills (Kaphingst et al, 2015). Research on how literacy and numeracy impact genomic information is lacking, especially in ethnic minorities (Lea, Kaphingst, Bowen, Lipkus, & Hadley, 2011).…”

Transcultural Diabetes Care in The United States – A Position Statement by the American Association of Clinical Endocrinologists

“…A common-ality among cardio-metabolic risks is inflammation, and Kocarnik et al (102) found 16 SNP-C-reactive protein (CRP) associations spanning multiple ancestral groups (European American, African American, and Hispanic, but not Asian/Pacific Islander or Native American), with many exhibiting pleiotropic effects. From a practical standpoint, Kaphingst et al (103) found that health literacy and communication skills were critical for patients to understand genomic information and how it affects their disease risk. Moreover, Ostergren et al (104) reported ethno-racial differences in the comprehension of personal genomic testing results.…”