Passing years, changing fears? Conceptualizing and measuring risk perceptions for chronic disease in younger and middle-aged women

Abstract

As is true for many behavioral theory constructs, no consensus exists on how best to measure perceived risk; therefore, it is unclear whether different measures of disease risk perception are conceptually equivalent and whether such measures are equally appropriate for people with different objective disease risk. To investigate these issues, we used four commonly utilized risk perception items (measuring beliefs about personal risk, others' risk, disease prevalence, and mortality) to assess susceptibility to cardiovascular disease, breast cancer, and lung cancer among 454 younger (ages 18-25) and 169 middle-aged (40-64) women. We examined age- and ethnicity-related differences in participants' responses to the items. We also used structural equation modeling to test whether these items reflect a multidimensional, disease-specific latent construct of risk perception; and to test whether consistency exists in participants' disease-specific risk perceptions. Despite differences in responses to individual items, hypothesized models of perceived risk fit both age groups, suggesting that risk perception can be conceptualized in younger and middle-aged women as a multidimensional construct that is specific to disease yet reflective of global risk-related beliefs.

Psychosocial Factors Associated With Risk Perceptions for Chronic Diseases in Younger and Middle-Aged Women

“…As reported previously (Hamilton & Lobel, 2012), the measures of perceived risk were a good fit for a higher-order model in which a latent factor representing generalized core beliefs about risk contributed to each latent variable representing perceptions of risk for CVD, breast cancer, and lung cancer. This higher-order model was the outcome in all analyses.…”

“…Participants estimated how many women out of 100 would “develop [specific disease] during their lifetime.” Perceived mortality rate of disease. Participants estimated how many women out of 100 would “die from [specific disease] during their lifetime.” For each disease, items assessing these four dimensions of perceived risk demonstrated acceptable reliability (reliability rho ranging from 0.62-0.82; Hamilton & Lobel, 2012). …”

“…Participants indicated their informed consent by completing the study questionnaire. We reported study procedures in detail elsewhere (Hamilton & Lobel, 2012). Briefly, we recruited younger women between the ages of 18-25 years ( n =458) from an undergraduate pool comprised predominantly of students enrolled in an Introductory Psychology course, but also included students from some other courses.…”

“…Here we conceptualize perceptions of disease risk as multiply-indicated latent variables comprised of commonly used risk perception measures (see Hamilton & Lobel, 2012). Our past research demonstrated that such measures are reliable indicators of women’s disease-specific risk perceptions, and that women’s disease-specific risk perceptions are partially explained by underlying, generalized beliefs about disease risk (conceptualized as an underlying, higher-order latent factor).…”

Cancer Screening and Genetics: A Tale of Two Paradigms

“…Furthermore, whereas the traditional outcomes of morbidity and mortality are constant in their conceptualization and measurement across studies, such standardization is largely lacking for psychological and behavioral outcomes. These outcomes are reflected by numerous constructs (e.g., depression, anxiety, stigma, perceived risk), and there is little consensus regarding the best metrics for assessing these constructs (30, 31). An additional challenge is presented by the rapidly evolving genetic testing landscape – advances in gene sequencing technology (e.g., next-generation sequencing, whole genome and whole exome sequencing) have dramatically increased knowledge about associations between genetic variation and various diseases, and there has been an increase in the availability of genetic testing and the marketing of such tests directly to the public.…”