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Law JH, Sultan N, Finer S, Fudge N. Advancing the communication of genetic risk for cardiometabolic diseases: a critical interpretive synthesis. BMC Med 2023; 21:432. [PMID: 37953248 PMCID: PMC10641935 DOI: 10.1186/s12916-023-03150-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Genetics play an important role in risk for cardiometabolic diseases-including type 2 diabetes, cardiovascular disease and obesity. Existing research has explored the clinical utility of genetic risk tools such as polygenic risk scores-and whether interventions communicating genetic risk information using these tools can impact on individuals' cognitive appraisals of disease risk and/or preventative health behaviours. Previous systematic reviews suggest mixed results. To expand current understanding and address knowledge gaps, we undertook an interpretive, reflexive method of evidence synthesis-questioning the theoretical basis behind current interventions that communicate genetic risk information and exploring how the effects of genetic risk tools can be fully harnessed for cardiometabolic diseases. METHODS We obtained 189 records from a combination of database, website and grey literature searches-supplemented with reference chaining and expert subject knowledge within the review team. Using pre-defined critical interpretive synthesis methods, quantitative and qualitative evidence was synthesised and critiqued alongside theoretical understanding from surrounding fields of behavioural and social sciences. FINDINGS Existing interventions communicating genetic risk information focus predominantly on the "self", targeting individual-level cognitive appraisals, such as perceived risk and perceived behavioural control. This approach risks neglecting the role of contextual factors and upstream determinants that can reinforce individuals' interpretations of risk. It also assumes target populations to embody an "ascetic subject of compliance"-the idea of a patient who strives to comply diligently with professional medical advice, logically and rationally adopting any recommended lifestyle changes. We developed a synthesising argument-"beyond the ascetic subject of compliance"-grounded in three major limitations of this perspective: (1) difficulty applying existing theories/models to diverse populations, (2) the role of familial variables and (3) the need for a life course perspective. CONCLUSIONS Interventions communicating genetic risk information should account for wider influences that can affect individuals' responses to risk at different levels-including through interactions with their family systems, socio-cultural environments and wider health provision. PROTOCOL REGISTRATION PROSPERO CRD42021289269.
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Affiliation(s)
- Jing Hui Law
- Centre for Primary Care, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Najia Sultan
- Centre for Primary Care, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sarah Finer
- Centre for Primary Care, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | - Nina Fudge
- Centre for Primary Care, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Haga SB, Orlando LA. Expanding Family Health History to Include Family Medication History. J Pers Med 2023; 13:jpm13030410. [PMID: 36983592 PMCID: PMC10053261 DOI: 10.3390/jpm13030410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/13/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023] Open
Abstract
The collection of family health history (FHH) is an essential component of clinical practice and an important piece of data for patient risk assessment. However, family history data have generally been limited to diseases and have not included medication history. Family history was a key component of early pharmacogenetic research, confirming the role of genes in drug response. With the substantial number of known pharmacogenes, many affecting response to commonly prescribed medications, and the availability of clinical pharmacogenetic (PGx) tests and guidelines for interpretation, the collection of family medication history can inform testing decisions. This paper explores the roots of family-based pharmacogenetic studies to confirm the role of genes in these complex phenotypes and the benefits and challenges of collecting family medication history as part of family health history intake.
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Adjaye-gbewonyo K, de-Graft Aikins A, Vaughan M. ‘If you sell your sickness, you will get its medicine’: Care and intrafamilial communication for chronic diseases in southern Ghana. Scientific African 2022; 18:e01400. [DOI: 10.1016/j.sciaf.2022.e01400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Li M, Zhao S, Young CM, Foster M, Huei-Yu Wang J, Tseng TS, Kwok OM, Chen LS. Family Health History-Based Interventions: A Systematic Review of the Literature. Am J Prev Med 2021; 61:445-454. [PMID: 34226092 DOI: 10.1016/j.amepre.2021.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 10/20/2022]
Abstract
CONTEXT National efforts have advocated for the need to deliver family health history-based interventions to the lay public for more than a decade. Yet, the numbers, characteristics, and outcomes of such interventions are unknown. This first-of-its-kind systematic literature review examines the characteristics and effectiveness of the existing family health history-based interventions. EVIDENCE ACQUISITION The research team systematically searched peer-reviewed articles published between January 2003 and July 2020 in MEDLINE, Embase, CINAHL, and Google Scholar. EVIDENCE SYNTHESIS A total of 35 articles met the inclusion criteria. These studies assessed various behaviors, including family health history collection/communication with family members, family health history communication with healthcare providers, healthy diet adoption, physical activity level, uptake of medical screenings and genetic tests, and being proactive in healthcare matters. The average methodologic quality score of the studies was 9.9 (SD=1.6) of a theoretical range from 2 to 16. CONCLUSIONS Many family health history-based interventions exist to examine a variety of behaviors. Yet, there is room for improvement in methodology because few studies used a randomized or quasi-experimental design. In addition, most included studies did not report objective or longer-term outcome data to examine the effectiveness of family health history-based interventions.
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Affiliation(s)
- Ming Li
- Department of Health Sciences, College of Health Professions, Towson University, Towson, Maryland
| | - Shixi Zhao
- Department College of Health Professions, Exercise & Sports Sciences, College of Education & Human Sciences, The University of New Mexico, Albuquerque, New Mexico
| | | | - Margaret Foster
- Medical Science Library, Texas A&M University, College Station, Texas
| | - Judy Huei-Yu Wang
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Tung-Sung Tseng
- Behavioral & Community Health Sciences Program, LSU School of Public Health, LSU Health New Orleans, New Orleans, Louisiana
| | - Oi-Man Kwok
- Department of Educational Psychology, College of Education & Human Development, Texas A&M University, College Station, Texas
| | - Lei-Shih Chen
- Department of Health & Kinesiology, Texas A&M University, College Station, Texas.
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de la Haye K, Whitted C, Koehly LM. Formative Evaluation of the Families SHARE Disease Risk Tool among Low-Income African Americans. Public Health Genomics 2021; 24:280-290. [PMID: 34233327 DOI: 10.1159/000517309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/18/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Family Health Histories (FHH) have been endorsed by the surgeon general as a powerful yet underutilized tool for identifying individuals at risk for complex chronic diseases such as diabetes, heart disease, and cancer. FHH tools provide a mechanism for increasing communication about disease history and motivating behavior change to reduce disease risk. A critical gap in translation efforts includes a lack of research that adapts and evaluates tools for low-income, minority populations who experience disparities in chronic disease. METHODS This study is a formative mixed-methods evaluation of an evidence-based FHH intervention called "Families SHARE" among African Americans residing in low-income neighborhoods. Participants (N = 51) completed assessments before and 6 weeks after receiving the intervention, including surveys and focus groups. We evaluated (a) their use, understanding, and perceived value of the tool; (b) if the intervention led to increased intentions to adopt disease risk-reducing behaviors among those with heightened disease risk, given their FHH; and (c) acceptability of and recommendations for the tool. RESULTS The quantitative and qualitative data indicated that this population valued and used the tool, and it prompted communication about FHH with family, friends, and others. Receipt of the intervention resulted in mixed accuracy of their perceived disease risk, and it did not shift intentions to change health behaviors. Qualitative data provide insights for future iterations of the Families SHARE tool. CONCLUSION Families SHARE is an engaging FHH tool that can be further tailored to optimize its value and benefits for low-income African Americans.
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Affiliation(s)
- Kayla de la Haye
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Calandra Whitted
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, Maryland, USA.,Behavioral Sciences and Health Education, Florida A&M University, Tallahassee, Florida, USA
| | - Laura M Koehly
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, Maryland, USA
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Koehly LM, Persky S, Shaw P, Bonham VL, Marcum CS, Sudre GP, Lea DE, Davis SK. Social and behavioral science at the forefront of genomics: Discovery, translation, and health equity. Soc Sci Med 2021; 271:112450. [PMID: 31558303 PMCID: PMC9745643 DOI: 10.1016/j.socscimed.2019.112450] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/25/2019] [Indexed: 12/15/2022]
Abstract
This special issue highlights the unique role that social and behavioral science has to play at the forefront of genomics. Through the introduction of papers comprising this special issue, we outline priority research areas at the nexus of genomics and the social and behavioral sciences. These include: Discovery science; clinical and community translation, and equity, including engagement and inclusion of diverse populations in genomic science. We advocate for genomic discovery that considers social context, neural, cognitive, and behavioral endophenotypes, and that is grounded in social and behavioral science research and theory. Further, the social and behavioral sciences should play a leadership role in identifying best practices for effective clinical and community translation of genomic discoveries. Finally, inclusive research that engages diverse populations is necessary for genomic discovery and translation to benefit all. We also highlight ways that genomics can be a fruitful testbed for the development and refinement of social and behavioral science theory. Indeed, an expanded ecological lens that runs from genomes to society will be required to fully understand human behavior.
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Affiliation(s)
- Laura M. Koehly
- Corresponding author. 31 Center Drive, Rm B1B54, Bethesda, MD, 20892-2073, USA. (L.M. Koehly)
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Abstract
We investigate how interpersonal ties influence communication about type 2 diabetes risk and encouragement to maintain or adopt a healthy lifestyle between family members of Mexican heritage, after a family history-based risk assessment intervention. Results suggest that individuals are more likely to initiate risk communication with another family member if they are close to, already seek advice from, or discuss health with him or her. Risk communication precedes encouragement, which is initiated by the older generation of the family. Understanding the role of interpersonal relationships in Mexican-heritage families can help identify who best to target in future health behavior interventions.
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Affiliation(s)
- Jielu Lin
- Department of Sociology, Northern Arizona University, Flagstaff, Arizona (Dr Lin); National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland (Drs Lin and Koehly); Cincinnati Children's Hospital Medical Center & Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio (Dr Myers); and Department of Epidemiology, Human Genetics and Environmental Science, University of Texas School of Public Health, Austin, Texas (Dr Wilkinson)
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Abstract
Academic stress is a common long-term stress among the student population and is known to impact working memory within the frontoparietal attention network. Perceived control is an individual variation that may play a buffering role between stress and overall adjustment. In this study, we addressed the moderating effects of perceived control between academic stress and working memory. Fifty-nine male college students participated in the study. Academic stress and perceived control were assessed before participants completed a working memory (n-back) task. Event-related potentials (ERPs) including P2 and P3 were analyzed to examine the attention and maintenance processes of working memory. A moderating effect of perceived control on the relationship between academic stress and working memory was found. For students with low levels of perceived control, academic stress was negatively associated with P2 amplitudes at the high workload (3-back) task, suggesting a negative impact on attention process of working memory. In contrast, academic stress did not affect students with high and moderate levels of perceived control. The results indicate that perceived control may serve as a buffer to protect the cognitive function from the disruption of academic stress.
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Affiliation(s)
- Li Lin
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Science, Beijing, China
| | - Jingyu Zhang
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Science, Beijing, China
| | - Peishan Wang
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Science, Beijing, China
| | - Xinwen Bai
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Science, Beijing, China
| | - Xianghong Sun
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Science, Beijing, China
| | - Liang Zhang
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Science, Beijing, China
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