Perceived Risk of Heart Attack and Type 2 Diabetes in Hispanic Adults With Overweight and Obesity

The role of acculturation in the accuracy of type 2 diabetes risk perception: National Health and Nutrition Examination Survey 2011-2016

OBJECTIVE

High rates of undiagnosed Type 2 diabetes mellitus (T2DM) necessitate additional efforts to increase risk awareness, particularly among marginalized and immigrant populations. We examined the association of acculturation with the likelihood of accurate perception of T2DM risk in a large nationally representative sample of adults at risk for T2DM.

METHOD

Participants were 5,034 adults, M (SD) age: 53 (23) years, 48% female. Acculturation was operationalized as length of time in the United States, and whether participants predominantly spoke English or their native language at home. Adults were considered to have accurate risk perception if they (a) met American Diabetes Criteria for prediabetes, and (b) self-reported their risk.

RESULTS

Less than half of the sample (33%) accurately perceived their T2DM risk. Logistic regression models adjusting for age, race, sex, education, insurance status, smoking, alcohol use, waist circumference, and family history of T2DM revealed that adults living in the United States up to 15 years were 1.35-2.33 times (ps < .04) as likely to inaccurately perceive their risk for T2DM compared to adults living in the United States > 15 years and United States-born adults. Adults with lower versus higher English proficiency had a 41% (p = .03) increased likelihood of misperceiving their T2DM risk.

CONCLUSIONS

Findings suggest that acculturation plays an important role in shaping T2DM risk perceptions among both nonimmigrant and immigrant populations. Increased cognizance of acculturation status (e.g., by healthcare providers) may be warranted to promote early T2DM risk detection and prevention at the population level. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Measurement of Perceived Risk of Developing Diabetes Mellitus: A Systematic Literature Review

BACKGROUND

This systematic review describes approaches to measuring perceived risk of developing type 2 diabetes among individuals without diagnoses and describes the use of theories, models, and frameworks in studies assessing perceived risk. While a systematic review has synthesized perceived risk of complications among individuals with diabetes, no reviews have systematically assessed how perceived risk is measured among those without a diagnosis.

METHODS

Medline, PubMed, PsycINFO, and CINAHAL databases were searched for studies conducted through October 2022 with measures of perceived risk among adults ≥ 18 years without a diabetes diagnosis. Extracted data included study characteristics, measures, and health behavior theories, models, or frameworks used.

RESULTS

Eighty-six studies met inclusion criteria. Six examined perceived risk scales' psychometric properties. Eighty measured perceived risk using (1) a single item; (2) a composite score from multiple items or subconstructs; and (3) multiple subconstructs but no composite score. Studies used items measuring "comparative risk," "absolute or lifetime risk," and "perceived risk" without defining how each differed. Sixty-four studies used cross-sectional designs. Twenty-eight studies mentioned use of health behavior theories in study design or selection of measures.

DISCUSSION

There was heterogeneity in how studies operationalized perceived risk; only one third of studies referenced a theory, model, or framework as guiding design or scale and item selection. Use of perceived lifetime risk, absolute risk, or comparative risk limits comparisons across studies. Consideration of context, target population, and how data are utilized is important when selecting measures; we present a series of questions to ask when selecting measures for use in research and clinical settings. This review is the first to categorize how perceived risk is measured in the diabetes prevention domain; most literature focuses on perceived risk among those with diabetes diagnoses. Limitations include exclusion of non-English and gray literature and single reviewer screening and data extraction.

Perceived Heart Attack Likelihood in Adults with a High Diabetes Risk

BACKGROUND

Heart disease is the leading cause of death for women and men in the United States. Yet, little is known about the motivation for care-seeking behavior for heart attack and the perception of self-risk of a heart attack in individuals, especially those at high risk for developing type 2 diabetes.

OBJECTIVES

This study aimed to describe knowledge and awareness of heart attacks and perceived risk for future heart attacks and evaluate factors associated with a low perceived risk of a heart attack in adults with a high risk for type 2 diabetes.

METHODS

In this secondary data, cross-sectional study, the screening/baseline data of 80 adults participating in the mobile phone-based diabetes prevention program trial were analyzed. Validated measures assessed knowledge, self-efficacy, and heart attack risk perception were used. Logistic regressions were performed.

RESULTS

The mean (standard deviation) age of participants was 55.4 (9.0) years. 32.5% of the sample failed to identify any heart attack symptoms. Half of the sample did not perceive their risk of having a heart attack in their lifetime. Older age, lower body mass index, not having a family history of heart attack, and current smokers were significantly associated with a lower perceived risk of heart attack (P < .05).

CONCLUSIONS

Healthcare providers need to assess the discrepancies between the individual's risk perception and the presence of actual risk factors of a heart attack in adults with a high risk for type 2 diabetes.