Amanda J. Dillard

The Dark Side of Optimism: Unrealistic Optimism About Problems With Alcohol Predicts Subsequent Negative Event Experiences:

College students were identified who were unrealistically optimistic about the likelihood they would experience severe problems due to alcohol consumption. These individuals were then followed over a 2-year period to determine whether they were more likely to report experiencing a range of alcohol-related negative events. Unlike the majority of studies on unrealistic optimism, this study (a) assessed bias at the individual rather than group level and (b) used a prospective rather than cross-sectional design. Participants completed measures at four times, each separated by 4-6 months. Findings showed that unrealistic optimism at Time 1 was associated with a greater number of negative events at Times 2, 3, and 4. Similarly, unrealistic optimism at Time 2 was associated with more negative events at Times 3 and 4. In all cases, the relationships were significant when controlling for previous negative events, suggesting the effects of unrealistic optimism can mount over time.

Risk Perception Measures' Associations With Behavior Intentions, Affect, and Cognition Following Colon Cancer Screening Messages

OBJECTIVE Risk perception is important for motivating health behavior (e.g., Janz & Becker, 1984), but different measures of the construct may change how important that relationship appears. In two studies, we examined associations between four measures of risk perception, health behavior intentions and possible behavioral determinants. METHODS Participants in these studies, who were due for colorectal cancer screening, read an online message about the importance of screening to reduce the chance of cancer. We examined bivariate and multivariate associations between risk perception measures, including absolute, comparative, and feelings-of-risk, and behavioral intentions to screen, general worry, and knowledge and attitudes related to screening. RESULTS Results across the two studies were consistent, with all risk perception measures being correlated with intentions and attitudes. Multivariate analyses revealed that feelings-of-risk was most predictive of all variables, with the exception of general worry, for which comparative measures were the most predictive. CONCLUSIONS Researchers interested in risk perception should assess feelings-of-risk along with more traditional measures. Those interested in influencing health behavior specifically should attempt to increase feelings of vulnerability rather than numerical risk.

Narratives that address affective forecasting errors reduce perceived barriers to colorectal cancer screening

Narratives from similar others may be an effective way to increase important health behaviors. In this study, we used a narrative intervention to promote colorectal cancer screening. Researchers have suggested that people may overestimate barriers to colorectal cancer screening. We recruited participants from the US, ages 49-60 who had never previously been screened for colorectal cancer, to read an educational message about screening for the disease. One-half of participants were randomly assigned to also receive a narrative within the message (control participants did not receive a narrative). The narrative intervention was developed according to predictions of affective forecasting theory. Compared to participants who received only the educational message, participants who received the message along with a narrative reported that the barriers to screening would have less of an impact on a future screening experience. The narrative also increased risk perception for colorectal cancer and interest in screening in the next year.

Do personal stories make patient decision aids more effective? A critical review of theory and evidence.

BackgroundPatient decision aids support people to make informed decisions between healthcare options. Personal stories provide illustrative examples of others’ experiences and are seen as a useful way to communicate information about health and illness. Evidence indicates that providing information within personal stories affects the judgments and values people have, and the choices they make, differentially from facts presented in non-narrative prose. It is unclear if including narrative communications within patient decision aids enhances their effectiveness to support people to make informed decisions.MethodsA survey of primary empirical research employing a systematic review method investigated the effect of patient decision aids with or without a personal story on people’s healthcare judgements and decisions. Searches were carried out between 2005-2012 of electronic databases (Medline, PsycINFO), and reference lists of identified articles, review articles, and key authors. A narrative analysis described and synthesised findings.ResultsOf 734 citations identified, 11 were included describing 13 studies. All studies found participants’ judgments and/or decisions differed depending on whether or not their decision aid included a patient story. Knowledge was equally facilitated when the decision aids with and without stories had similar information content. Story-enhanced aids may help people recall information over time and/or their motivation to engage with health information. Personal stories affected both “system 1” (e.g., less counterfactual reasoning, more emotional reactions and perceptions) and “system 2” (e.g., more perceived deliberative decision making, more stable evaluations over time) decision-making strategies. Findings exploring associations with narrative communications, decision quality measures, and different levels of literacy and numeracy were mixed. The pattern of findings was similar for both experimental and real-world studies.ConclusionsThere is insufficient evidence that adding personal stories to decision aids increases their effectiveness to support people’s informed decision making. More rigorous research is required to elicit evidence about the type of personal story that a) encourages people to make more reasoned decisions, b) discourages people from making choices based on another’s values, and c) motivates people equally to engage with healthcare resources.

Giving to Others and the Association Between Stress and Mortality

OBJECTIVES We sought to test the hypothesis that providing help to others predicts a reduced association between stress and mortality. METHODS We examined data from participants (n = 846) in a study in the Detroit, Michigan, area. Participants completed baseline interviews that assessed past-year stressful events and whether the participant had provided tangible assistance to friends or family members. Participant mortality and time to death was monitored for 5 years by way of newspaper obituaries and monthly state death-record tapes. RESULTS When we adjusted for age, baseline health and functioning, and key psychosocial variables, Cox proportional hazard models for mortality revealed a significant interaction between helping behavior and stressful events (hazard ratio [HR] = 0.58; P < .05; 95% confidence interval [CI] = 0.35, 0.98). Specifically, stress did not predict mortality risk among individuals who provided help to others in the past year (HR = 0.96; 95% CI = 0.79, 1.18), but stress did predict mortality among those who did not provide help to others (HR = 1.30; P < .05; 95% CI = 1.05, 1.62). CONCLUSIONS Helping others predicted reduced mortality specifically by buffering the association between stress and mortality.

Perceived Risk of Cancer and Patient Reports of Participation in Decisions about Screening: The DECISIONS Study

Background Health behavior theories suggest that high perceived risk for cancer will be associated with screening, but few studies have examined how perceived risk relates to the screening decision process. Objective To examine relationships between perceived risk of cancer and behaviors during decision making for 3 screening tests. Design Cross-sectional survey conducted between November 2006 and May 2007. Setting Nationwide random-digit dial telephone survey. Participants A total of 1729 English-speaking US adults aged 40 y and older who reported making a cancer screening decision (about breast, colon, or prostate tests) in the previous 2 y. Measurements Participants completed measures of perceived risk, information seeking, and shared decision-making tendencies. Results As perceived risk for cancer increased, patients were more likely to seek information about screening on their own (e.g., 35% of participants who perceived a high risk of cancer searched the Internet compared with 18% for those who perceived a low risk, P < 0.001) and in interactions with their physicians. As perceived risk increased, patients were also more likely to consult with more than 1 provider. Gender moderated the shared decision-making preference such that men with high perceived risks were more likely than women with high perceived risks to report they would have preferred more involvement in the decision (35% v. 9%, P = 0.001). Limitations Cross-sectional data limit causal inferences. Conclusions Higher perceived risk was associated with greater patient participation, as shown by more information seeking and greater desire for decisional involvement (moderated by gender). The results suggest that perceived risk of cancer could influence patient behavior when deciding about screening.

Using a Health Message With a Testimonial to Motivate Colon Cancer Screening Associations With Perceived Identification and Vividness

Research suggests that testimonials, or first-person narratives, influence health behavior and health-related decision making, but few studies have examined conceptual factors that may be responsible for these effects. In the current study, older adults who were due for colorectal cancer screening read a message about screening that included a testimonial from a similar other who had previously made the screening decision. We assessed participants’ identification with the testimonial character and the degree to which they found the message to be vivid. We explored associations between these factors and participants’ knowledge following the message, mood, certainty about screening, and their behavioral intentions to look for more information about screening and to have a test in the next year. In bivariate analyses, identification and vividness were both significantly, positively associated with knowledge and behavioral intentions to have screening in the next year. However, multivariate analyses revealed that only vividness remained significantly associated with knowledge and intentions to be screened.

Health Numeracy: The Importance of Domain in Assessing Numeracy

Background and Objective. Existing research concludes that measures of general numeracy can be used to predict individuals’ ability to assess health risks. We posit that the domain in which questions are posed affects the ability to perform mathematical tasks, raising the possibility of a separate construct of “health numeracy” that is distinct from general numeracy. The objective was to determine whether older adults’ ability to perform simple math depends on domain. Methods. Community-based participants completed 4 math questions posed in 3 different domains: a health domain, a financial domain, and a pure math domain. Participants were 962 individuals aged 55 and older, representative of the community-dwelling US population over age 54. Results. We found that respondents performed significantly worse when questions were posed in the health domain (54% correct) than in either the pure math domain (66% correct) or the financial domain (63% correct). Our experimental measure of numeracy consisted of only 4 questions, and it is possible that the apparent effect of domain is specific to the mathematical tasks that these questions require. Conclusions. These results suggest that health numeracy is strongly related to general numeracy but that the 2 constructs may not be the same. Further research is needed into how different aspects of general numeracy and health numeracy translate into actual medical decisions.

Breast cancer anxiety's associations with responses to a chemoprevention decision aid

Few studies have examined how specific emotions may affect decision-making processes. Anxiety may be especially relevant in health decisions such as those related to cancer in which thoughts of illness or death may be abundant. We examined associations between womens anxiety about developing breast cancer and variables related to their decision to take a medication that could reduce their chances of the disease. Six-hundred and thirty-two American women, who had an increased risk of breast cancer, reviewed a web-based decision aid about tamoxifen. We examined associations between their baseline, self-reported anxiety about developing the disease and post decision aid measures including knowledge about tamoxifen, attitude toward the medication, and behavioral intentions to look for more information and take the medication. Results showed that anxiety was not associated with knowledge about tamoxifen, but it was associated with attitude toward the medication such that women who were more anxious about developing breast cancer were more likely to think the benefits were worth the risks. Greater anxiety was also associated with greater behavioral intentions to look for additional information and take the medication in the next few months. Secondary analyses showed that behavioral intentions were related to knowledge of tamoxifen and attitude toward the medication only for women who were reporting low levels of anxiety. Overall, the findings suggest that anxiety about breast cancer may motivate interest in tamoxifen and not necessarily through affecting knowledge or attitudes.

Projection, conformity and deviance regulation: a prospective study of alcohol use.

We examine how alcohol-related attitudes and behaviour are related to injunctive and descriptive norms over time, and how these perceptions are linked to the experience of alcohol-related problems. In a longitudinal study of alcohol use (n = 239, over three time points), we explored the presence of projection, conformity and deviance in college students – a group in the process of identity formation and redefining peer relationships. We found that the first year of college was characterised by both conformity and projection, and that positive attitudes towards alcohol, greater drinking, and higher descriptive norms were associated prospectively with more alcohol-related problems. However, in the second year, the pattern changed such that alcohol consumption behaviour was characterised by deviance such that those who believed others engaged in more drinking reported relatively lower consumption. The longitudinal findings support deviance regulation theory (Blanton, H., & Christie, C. (2003). Deviance regulation: A theory of action and identity. Review of General Psychology, 7, 115–149), which states that individuals form identities by deviating from peers in ways they perceive as desirable. In general, one must consider the role and stage of identity development when making predictions about how attitudes and perceived norms influence alcohol use and the experience of alcohol-related problems.