Online Health Communication about Human Genetics: Perceptions and Preferences of Internet Users

Extending the purview of risk perception attitude (RPA) framework to understand health insurance-related information seeking as a long-term self-protective behavior

Objective: The purpose of this study is to examine the roles of risk perceptions and efficacy beliefs play in predicting emerging adults' health insurance information seeking behavior based on the risk perception attitude (RPA) framework. In addition, the current study tests a role of worry to elucidate an underlying mechanism of their health insurance information seeking behavior. Participants: A total of 694 participants was recruited from a large public university in Southwest, USA. Methods: Participants completed an online survey questionnaire. Results: Efficacy beliefs influenced health insurance-related information seeking behavior. An intriguing finding is that there were significant differences in worry across the attitudinal groups posited in the RPA framework, which is consistent with findings in prior literature. Conclusions: Information about health insurance helps individuals make good decisions for their health in a long-term perspective, which is the primary interest of the RPA framework and the current study. The findings would provide resources for designing effective communication materials to help human beings improve their well-being and prepare for their well-ending. This communication effort would contribute to ensuring public health safety, reducing health disparities, and enhancing a society's well-being.

Risk perceptions and risk-averse attitude influenced older patients' first-diagnosis-seeking behaviour at tertiary hospitals

OBJECTIVE

This qualitative study aimed to investigate the associations of older patients' inappropriate healthcare-seeking behaviour at tertiary hospitals in China with their risk perceptions and attitude.

METHODS

The study was based on nine focus group interviews (involving 41 older patients, with three to six per group) and involved the grounded theory method. The participants were recruited at tertiary hospitals.

RESULTS

The results of this study showed that older patients' inappropriate first-diagnosis-seeking behaviour at tertiary hospitals was impacted by their risk perceptions and risk-averse attitude. Both external factors (family/friends and the Internet) and internal factors (preferences and habits) had played important roles in related processes.

CONCLUSION

Thus, to guide older patients' healthcare-seeking behaviour, changing the thoughts and behaviour of the older patients themselves, their spouses, adult children, other relatives, and friends are all important. More attention should be paid on guiding appropriate risk perceptions and attitude regarding lower-level medical institutions, increasing their preferences and habit formation regarding lower-level medical institutions, enhancing older patients' social support and improving and standardising online health information. These are important for the future development of the hierarchical medical system in China.

Media Exposure and Genetic Literacy Skills to Evaluate Angelina Jolie's Decision for Prophylactic Mastectomy

PURPOSE

To examine public preparedness to evaluate and respond to Angelina Jolie's well-publicized decision to have a prophylactic mastectomy.

METHODS

A consumer panel (n = 1,008) completed an online survey in November 2013, reporting exposure to Jolie's story, confidence applying genomic knowledge to evaluate her decision, and ability to interpret provided genetic risk information (genetic literacy skills). Linear and logistic regressions tested mediating/moderating models of these factors in association with opinions regarding mastectomies.

RESULTS

Confidence with genomics was associated with increased genetic literacy skills and increased media exposure, with a significant interaction between the two. Confidence was also associated with favoring mastectomies for women with BRCA mutations, mediating the relationship with media exposure. Respondents were more likely to form opinions about mastectomies if they had high genetic literacy skills.

CONCLUSION

These findings suggest that having higher genetic literacy skills may increase the public's ability to form opinions about clinical applications of genomic discovery. However, repeated media exposure to high-profile stories may artificially inflate confidence among those with low genetic literacy.

The Many Facets of Genetic Literacy: Assessing the Scalability of Multiple Measures for Broad Use in Survey Research

OBJECTIVES

To determine how three dimensions of genetic literacy (familiarity, skills, and factual knowledge) fit the hierarchy of knowledge outlined in E.M. Rogers' Diffusion of Innovations to better conceptualize lay understandings of genomics.

METHODS

A consumer panel representing the US adult population (N = 1016) completed an electronic survey in November 2013. Adjusting for education, we used correlations, principle components analysis, Mokken Scale tests, and linear regressions to assess how scores on the three genetic literacy sub-dimensions fit an ordered scale.

RESULTS

The three scores significantly loaded onto one factor, even when adjusting for education. Analyses revealed moderate strength in scaling (0.416, p<0.001) and a difficulty ordering that matched Rogers' hierarchy (knowledge more difficult than skills, followed by familiarity). Skills scores partially mediated the association between familiarity and knowledge with a significant indirect effect (0.241, p<0.001).

CONCLUSION

We established an ordering in genetic literacy sub-dimensions such that familiarity with terminology precedes skills using information, which in turn precedes factual knowledge. This ordering is important to contextualizing previous findings, guiding measurement in future research, and identifying gaps in the understanding of genomics relevant to the demands of differing applications.

Developing patient-friendly genetic and genomic test reports: formats to promote patient engagement and understanding

With the emergence of electronic medical records and patient portals, patients are increasingly able to access their health records, including laboratory reports. However, laboratory reports are usually written for clinicians rather than patients, who may not understand much of the information in the report. While several professional guidelines define the content of test reports, there are no guidelines to inform the development of a patient-friendly laboratory report. In this Opinion, we consider patient barriers to comprehension of lab results and suggest several options to reformat the lab report to promote understanding of test results and their significance to patient care, and to reduce patient anxiety and confusion. In particular, patients’ health literacy, genetic literacy, e-health literacy and risk perception may influence their overall understanding of lab results and affect patient care. We propose four options to reformat lab reports: 1) inclusion of an interpretive summary section, 2) a summary letter to accompany the lab report, 3) development of a patient user guide to be provided with the report, and 4) a completely revised patient-friendly report. The complexity of genetic and genomic test reports poses a major challenge to patient understanding that warrants the development of a report more appropriate for patients.

Impact of delivery models on understanding genomic risk for type 2 diabetes

BACKGROUND

Genetic information, typically communicated in-person by genetic counselors, can be challenging to comprehend; delivery of this information online--as is becoming more common--has the potential of increasing these challenges.

METHODS

To address the impact of the mode of delivery of genomic risk information, 300 individuals were recruited from the general public and randomized to receive genomic risk information for type 2 diabetes mellitus in-person from a board-certified genetic counselor or online through the testing company's website.

RESULTS

Participants were asked to indicate their genomic risk and overall lifetime risk as reported on their test report as well as to interpret their genomic risk (increased, decreased, or same as population). For each question, 59% of participants correctly indicated their risk. Participants who received their results in-person were more likely than those who reviewed their results on-line to correctly interpret their genomic risk (72 vs. 47%, p = 0.0002) and report their actual genomic risk (69 vs. 49%, p = 0.002).

CONCLUSIONS

The delivery of personal genomic risk through a trained health professional resulted in significantly higher comprehension. Therefore, if the online delivery of genomic test results is to become more widespread, further evaluation of this method of communication may be needed to ensure the effective presentation of results to promote comprehension.

Exploring dispositional tendencies to seek online information about direct-to-consumer genetic testing

Varying perspectives exist regarding the implications of genetic susceptibility testing for common disease, with some anticipating adverse effects and others expecting positive outcomes; however, little is known about the characteristics of people who are most likely to be interested in direct-to-consumer genetic testing. To that end, this study examines the association of individual dispositional differences with health risk perceptions and online information seeking related to a free genetic susceptibility test. Healthy adults enrolled in a large health maintenance organization were surveyed by telephone. Eligible participants (N = 1,959) were given access to a secure website that provided risk and benefit information about a genetic susceptibility test and given the option to be tested. Neuroticism was associated with increased perceptions of disease risk but not with logging on. Those scoring high in conscientiousness were more likely to log on. We found no evidence that neuroticism, a dispositional characteristic commonly linked to adverse emotional response, was predictive of online genetic information seeking in this sample of healthy adults.

Interaction of Comparative Cancer Risk and Cancer Efficacy Perceptions on Cancer-Related Information Seeking and Scanning Behaviors

This study examined the interaction between perceived cancer risk and self-efficacy related to cancer screening on cancer-related information seeking and scanning behaviors (SSB) among the general population. Individuals completed a cross-sectional survey, were classified into 1 of 4 clusters based on their relative risk and self-efficacy belief scores (i.e., high relative risk and high self-efficacy, high relative risk and low self-efficacy, low relative risk and high self-efficacy, and low relative risk and low self-efficacy), and asked about their information SSB related to the colonoscopy, prostate-specific antigen test, or mammogram. A national probability sample of 2,489 adults aged 40 to 70 took part in this study. Individuals who perceived themselves to be at high relative risk for cancer and had high self-efficacy beliefs in performing cancer-screening behaviors generally reported the highest amounts of SSB for cancer-screening information, compared to the others.

"I am pregnant and my husband has diabetes. Is there a risk for my child?" A qualitative study of questions asked by email about the role of genetic susceptibility to diabetes

Background

Diabetes Mellitus is a global health problem. Scientific knowledge on the genetics of diabetes is expanding and is more and more utilised in clinical practice and primary prevention strategies. Health consumers have become increasingly interested in genetic information. In the Netherlands, the National Genetic Research and Information Center provides online information about the genetics of diabetes and thereby offers website visitors the opportunity to ask a question per email. The current study aims at exploring people's need of (additional) information about the role of inheritance in diabetes. Results may help to tailor existing clinical and public (online) genetic information to the needs of an increasing population at risk for diabetes.

Methods

A data base with emailed questions about diabetes and inheritance (n = 172) is used in a secondary content analysis. Questions are posted in 2005-2009 via a website providing information about more than 600 inheritable disorders, including all diabetes subtypes. Queries submitted were classified by contents as well as persons' demographic profiles.

Results

Questions were received by diabetes patients (49%), relatives (30%), and partners (21%). Questioners were relatively young (54.8% ≤ 30 years) and predominantly female (83%). Most queries related to type 1 diabetes and concerned topics related to (future) pregnancy and family planning. Questioners mainly asked for risk estimation, but also clarifying information (about genetics of diabetes in general) and advice (mostly related to family planning) was requested. Preventive advice to reduce own diabetes risk was hardly sought.

Conclusions

Genetic information on diabetes provided by professionals or public health initiatives should address patients, as well as relatives and partners. In particular women are receptive to genetic information; they worry about the diabetes related health of (future) offspring. It seems important that information on the contribution of genetics to type 1 diabetes is more readily available. Considering the high prevalence of type 2 diabetes with strong evidence for a genetic predisposition, more effort seems needed to promote awareness around familial clustering and primary prevention.

Participation in genetic testing research varies by social group

BACKGROUND

Advances in technology have made individual access to personal genetic information foreseeable in the near future. Policy makers and the media forecast that the ready availability of personal genetic profiles would benefit both the individual and the health care system by improving outcomes and decreasing cost. However, there is a significant gap between having access to genetic data and either wanting or understanding the information it provides.

OBJECTIVE

Our primary aim was to evaluate, using a population-based sample of healthy adults, whether gender, race and education status influences interest and participation in a multiplex genetic susceptibility test.

METHODS

Healthy, insured individuals, 25-40 years of age, were approached via a large, integrated health system in which primary and specialty care is available. Study participants were offered personalized genetic risk information on 8 common chronic health conditions. Social groups historically known not to participate in genetic research (men, African Americans and those from lower education neighborhoods) were oversampled. We describe the recruitment outcomes and testing decisions of these social groups.

RESULTS

We found that even among those with access to health care, African Americans were less likely to participate in the multiplex genetic susceptibility test, while those from higher education neighborhoods were more likely to participate.

CONCLUSIONS

Our results suggest that large social groups will likely be underrepresented in research in personalized genomics even when robust population-based recruitment strategies are employed.

Characteristics of users of online personalized genomic risk assessments: implications for physician-patient interactions

PURPOSE

To evaluate what psychological and behavioral factors predict who is likely to seek SNP-based genetic tests for multiple common health conditions where feedback can be used to motivate primary prevention.

METHODS

Adults aged 25-40 years who were enrolled in a large managed care organization were surveyed. Those eligible could log on to a secure study Web site to review information about the risks and benefits of a SNP-based genetic test and request free testing. Two primary outcomes are addressed: accessing the Web (yes or no) and deciding to be tested (completed a blood draw at the clinic)

RESULTS

Those considering genetic susceptibility testing did not hold genetically deterministic beliefs (0.42 on scale of 0 [behavior] to 1 [genetic]) but believed genetic information to be valuable and were confident they could understand such information. Individuals who believed it important to learn about genetics (odds ratio = 1.28), were confident they could understand genetics (odds ratio = 1.26), and reported the most health habits to change (odds ratio = 1.39) were most likely to get tested.

CONCLUSIONS

Individuals who present to health care providers with online genetics information may be among the most motivated to take steps toward healthier lifestyles. These motives might be leveraged by health care providers to promote positive health outcomes.

The role of genetics in the provision of essential public health services

States include genetics services among their public health programs, but budget shortfalls raise the question, is genetics an essential part of public health? We used the Essential Services of Public Health consensus statement and data from state genetics plans to analyze states' public health genetics programs. Public health genetics programs fulfill public health obligations: birth defects surveillance and prevention programs protect against environmental hazards, newborn screening programs prevent injuries, and clinical genetics programs ensure the quality and accessibility of health services. These programs fulfill obligations by providing 4 essential public health services, and they could direct future efforts toward privacy policies, research on communications, and rigorous evaluations.

Personality traits as predictors of intentions to seek online information about STDs and HIV/AIDS among junior and senior college students in Taiwan

The purpose of this cross-sectional study is to examine how personality traits such as sensation- seeking and impulsive decision-making affect Taiwanese college students' intentions to seek online information about sexually transmitted diseases (STDs) and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). Five hundred thirty-five (n = 535) junior and senior college students in Taiwan were recruited and completed self-report questionnaires. This study found high sensation-seekers were more likely to seek information about STDs and HIV/AIDS on the Internet than low sensation-seekers. Impulsive decision-makers were less likely than rational decision-makers to seek information about STDs and HIV/AIDS on the Internet. These findings suggest that personality needs to be considered as an exploratory factor which potentially influences intentions to seek STD and HIV/AIDS information on the Internet among Taiwanese college students.