Modelling decisions to undergo genetic testing for susceptibility to common health conditions: an ancillary study of the Multiplex Initiative

New genetic tests reveal risks for multiple conditions simultaneously, although little is understood about the psychological factors that affect testing uptake. We assessed a conceptual model called the multiplex genetic testing model (MGTM) using structural equation modelling. The MGTM delineates worry, perceived severity, perceived risk, response efficacy and attitudes towards testing as predictors of intentions and behaviour. Participants were 270 healthy insured adults aged 25-40 from the Multiplex Initiative conducted within a health care system in Detroit, MI, USA. Participants were offered a genetic test that assessed risk for eight common health conditions. Confirmatory factor analysis revealed that worry, perceived risk and severity clustered into two disease domains: cancer or metabolic conditions. Only perceived severity of metabolic conditions was correlated with general response efficacy (β?=?0.13, p<0.05), which predicted general attitudes towards testing (β?=?0.24, p<0.01). Consistent with our hypothesised model, attitudes towards testing were the strongest predictors of intentions to undergo testing (β?=?0.49, p<0.01), which in turn predicted testing uptake (OR 17.7, β?=?0.97, p<0.01). The MGTM explained a striking 48% of the variance in intentions and 94% of the variation in uptake. These findings support use of the MGTM to explain psychological predictors of testing for multiple health conditions.     

Modelling decisions to undergo genetic testing for susceptibility to common health conditions: An ancillary study of the Multiplex Initiative

New genetic tests reveal risks for multiple conditions simultaneously, although little is understood about the psychological factors that affect testing uptake. We assessed a conceptual model called the multiplex genetic testing model (MGTM) using structural equation modelling. The MGTM delineates worry, perceived severity, perceived risk, response efficacy and attitudes towards testing as predictors of intentions and behaviour. Participants were 270 healthy insured adults aged 25–40 from the Multiplex Initiative conducted within a health care system in Detroit, MI, USA. Participants were offered a genetic test that assessed risk for eight common health conditions. Confirmatory factor analysis revealed that worry, perceived risk and severity clustered into two disease domains: cancer or metabolic conditions. Only perceived severity of metabolic conditions was correlated with general response efficacy (β?=?0.13, p<0.05), which predicted general attitudes towards testing (β?=?0.24, p<0.01). Consistent with our hypothesised model, attitudes towards testing were the strongest predictors of intentions to undergo testing (β?=?0.49, p<0.01), which in turn predicted testing uptake (OR 17.7, β?=?0.97, p<0.01). The MGTM explained a striking 48% of the variance in intentions and 94% of the variation in uptake. These findings support use of the MGTM to explain psychological predictors of testing for multiple health conditions.     

Differences Between African American and White Research Volunteers in Their Attitudes,Beliefs and Knowledge Regarding Genetic Testing for Alzheimer’s Disease

Genetic susceptibility testing for common diseases is expanding, but little is known about race group differences in test perceptions. The purpose of this study was to examine differences between African Americans and Whites in knowledge, attitudes, and motivations regarding genetic susceptibility testing for Alzheimer’s disease (AD). Before enrolling in an AD genetic testing research trial, 313 first-degree relatives of AD patients (20% African American; 71% female; mean age = 58 years) were surveyed regarding: (1) knowledge about genetics and AD risk; (2) concerns about developing AD; and (3) reasons for seeking testing. In comparison to Whites, African Americans were less knowledgeable about genetics and AD risk (p < .01) and less concerned about developing AD (p < .05), with lower levels of perceived disease risk (p = .04). The results suggest that African Americans and Whites differ notably in their knowledge, beliefs, and attitudes regarding genetic testing for AD. Additional research with more representative samples is needed to better understand these differences.     

A Rapid Systematic Review of Outcomes Studies in Genetic Counseling

As healthcare reimbursement is increasingly tied to value-of-service, it is critical for the genetic counselor (GC) profession to demonstrate the value added by GCs through outcomes research. We conducted a rapid systematic literature review to identify outcomes of genetic counseling. Web of Science (including PubMed) and CINAHL databases were systematically searched to identify articles meeting the following criteria: 1) measures were assessed before and after genetic counseling (pre-post design) or comparisons were made between a GC group vs. a non-GC group (comparative cohort design); 2) genetic counseling outcomes could be assessed independently of genetic testing outcomes, and 3) genetic counseling was conducted by masters-level genetic counselors, or non-physician providers. Twenty-three papers met the inclusion criteria. The majority of studies were in the cancer genetic setting and the most commonly measured outcomes included knowledge, anxiety or distress, satisfaction, perceived risk, genetic testing (intentions or receipt), health behaviors, and decisional conflict. Results suggest that genetic counseling can lead to increased knowledge, perceived personal control, positive health behaviors, and improved risk perception accuracy as well as decreases in anxiety, cancer-related worry, and decisional conflict. However, further studies are needed to evaluate a wider array of outcomes in more diverse genetic counseling settings.     

The Concept of Multiculturalism: A Study Among Dutch Majority Members

The current study examined the concept of multiculturalism as seen by 1,285 Dutch majority members, and tested its expected relation with acculturation and intergroup relations aspects. The concepts of multiculturalism and acculturation were unidimensional. Dutch majority members were slightly positive (almost neutral) toward multiculturalism, and saw both its advantages and disadvantages. They preferred immigrants to adapt as much as possible, and they perceived a norm that they should approve the immigrant's way of living. A path model showed that acculturation orientations and intergroup relations aspects (perceived social norms/social distance) predicted multicultural attitudes. Furthermore, multicultural attitudes predicted contact with and knowledge about immigrants. Finally, level of education and perceived opportunities in society were positively associated with multicultural attitudes.     

The Impact of Test Outcome Certainty on Interest in Genetic Testing Among College Women

Osteoporosis and hemochromatosis are both late-onset preventable diseases, but future genetic tests for these conditions are likely to differ in their predictive abilities. To determine whether interest in a specific genetic test for hemochromatosis would be higher than interest in a theoretical test for osteoporosis susceptibility, undergraduate women at the University of Cincinnati (N = 181) were surveyed regarding their interest in genetic testing for these conditions. The clinical features of the diseases and the limits of a genetic test for each were described. Sixty-three percent of the total population was interested in genetic testing with a trend toward higher interest in the osteoporosis group. Disease familiarity, perceived disease severity, and perceived risk for disease appear to be more important predictors of genetic test acceptance than diagnostic specificity. Suggested implications for the development of population genetic screening tests are discussed.     

Nature, decay, and spiraling of the effects of fear-inducing arguments and HIV counseling and testing: a meta-analysis of the short- and long-term outcomes of HIV-prevention interventions.

OBJECTIVE: To examine the long-term efficacy of both fear-inducing arguments and HIV counseling and testing at encouraging and maintaining knowledge about HIV transmission and prevention, as well as condom use. DESIGN: Analyses were conducted with a sample of 150 treatment groups and 34 controls and included measures of change at an immediate follow-up and a delayed follow-up. MAIN OUTCOME MEASURES: The main outcome measures were perceived risk of HIV infection, knowledge about HIV, and condom use. RESULTS: Results indicated that receiving fear-inducing arguments increased perceptions of risk at the immediate follow-up but decreased knowledge and condom use, whereas resolving fear via HIV counseling and testing decreased perceptions of risk and increased knowledge and condom use at both the immediate and delayed follow-ups. The effects on perceived risk [corrected] decreased over time, but the effects on knowledge [corrected] condom use became more pronounced. CONCLUSION: Inducing fear is not an effective way to promote HIV-relevant learning or condom use either immediately following the intervention or later on. However, HIV counseling and testing can provide an outlet for HIV-related anxiety and, subsequently, gains in both knowledge and behavior change immediately and longitudinally.     

The use of health technology and information: e-learning technological approach.

The Internet is becoming the preferred place for finding information. Millions of people go online in search of health and medical information. Likewise, health care professionals must be able to retrieve and manage information in an efficient, effective manner. The development of health technology and informatics (HTI) has been rapid, yet little is known about the knowledge and attitudes of nursing students with regard to using HTI. Therefore, the objective of the present study was to explore nursing students' knowledge of and attitudes toward using HTI and to use an e-learning workshop to enhance the effective use of HTI. In Phase I, 115 first-year full-time nursing students were invited to complete a 13-item questionnaire regarding knowledge of and attitudes toward computer and Internet use, knowledge of HTI, and attitudes toward the future development of HTI. Participants perceived themselves to be knowledgeable in computer and Internet use, while knowledge of HTI was perceived to be low and attitudes toward the future development of HTI were generally positive. Phase II was an e-learning HTI workshop; topics included an introduction to HTI, examples of HTI in use, and the application and implementation of various HTI projects. There were 30 participants in the E-learning workshop, and their feedback was positive. Nurses and all health care professionals must be prepared to participate in the development of health technology and informatics. Teaching and learning activities should be geared toward mastery of HTI in the nursing education curriculum in order to enhance health care quality and safety.     

Risk perceptions,worry, and attitudes about genetic testing for breast cancer susceptibility

This study assessed the unique associations of risk perceptions and worry with attitudes about genetic testing for breast cancer susceptibility. Women (general practitioner clinic attenders, university students, and first-degree relatives of breast cancer survivors; N?=?303) read information about genetic testing and completed measures assessing perceived cancer risk, cancer worry, and genetic testing attitudes and beliefs. Worry was associated with greater interest in genetic testing, stronger beliefs that testing has detrimental emotional consequences, and positive beliefs about benefits of testing and risk-reducing surgeries. Perceived risk was unrelated to interest and associated with more skeptical beliefs about emotional consequences and benefits of testing and risk-reducing surgeries. At low worry levels, testing interest increased with more positive beliefs about testing benefits; at high worry levels, interest was high regardless of benefits beliefs. The findings support Leventhal's Common-Sense Model of self-regulation delineating interactive influences of risk-related cognitions and emotions on information processing and behavior.     

Risk perceptions, worry, and attitudes about genetic testing for breast cancer susceptibility

This study assessed the unique associations of risk perceptions and worry with attitudes about genetic testing for breast cancer susceptibility. Women (general practitioner clinic attenders, university students, and first-degree relatives of breast cancer survivors; N?=?303) read information about genetic testing and completed measures assessing perceived cancer risk, cancer worry, and genetic testing attitudes and beliefs. Worry was associated with greater interest in genetic testing, stronger beliefs that testing has detrimental emotional consequences, and positive beliefs about benefits of testing and risk-reducing surgeries. Perceived risk was unrelated to interest and associated with more skeptical beliefs about emotional consequences and benefits of testing and risk-reducing surgeries. At low worry levels, testing interest increased with more positive beliefs about testing benefits; at high worry levels, interest was high regardless of benefits beliefs. The findings support Leventhal's Common-Sense Model of self-regulation delineating interactive influences of risk-related cognitions and emotions on information processing and behavior.     

Acculturation and Familiarity With, Attitudes Towards and Beliefs about Genetic Testing for Cancer Risk Within Latinas in East Harlem, New York City

Recent research underscores the need for increasing use of genetic testing for cancer risk in Latinos. This study examined the influence of acculturation on attitudes, beliefs about and familiarity with genetic testing for cancer risk in a community-based sample of Latinas in East Harlem, New York City (N = 103). Multivariate linear regression models analyzed the relationship of acculturation to: (1) familiarity (2) perceived benefits (3) perceived barriers and (4) concerns about abuses of genetic testing for cancer risk. Controlling for sociodemographic factors, results revealed that with increasing acculturation Latinas were more familiar with genetic testing (β = 1.62, SE = 0.72, p = 0.03), more likely to cite perceived benefits (β = 1.67, SE = 0.79, p = 0.04), and less likely to report perceived barriers related to genetic testing (β = −2.76, SE = 1.64, p = 0.10). Study results may help inform the development of culturally-appropriate health education outreach materials and programs targeted to increase awareness, knowledge and understanding about genetic testing for cancer risk within Latinas.     

Knowledge and Attitudes Regarding Non-Invasive Prenatal Testing (NIPT) and Preferences for Risk Information among High School Students in Sweden

Non-invasive prenatal testing (NIPT) was recently introduced for prenatal testing of genetic disorders. Cell-free fetal DNA is present in maternal blood during pregnancy and enables detection of fetal chromosome aberrations in a maternal blood sample. The public perspective to this new, simple method has not been illuminated. The views of young people (i.e. future parents) are important to develop suitable counseling strategies regarding prenatal testing. The aim was to explore Swedish high school students’ attitudes, knowledge and preferences regarding NIPT. A questionnaire was completed by 305 students recruited from one high school in Stockholm, November and December 2014. Most students (80 %) considered prenatal testing as good. The majority (65 %) was positive or very positive towards NIPT and 62 % stated that they potentially would like to undergo the test if they or their partner was pregnant. The vast majority (94 %) requested further information about NIPT. Most students (61 %) preferred verbal information, whereas 20 % preferred information via the Internet. The majority of the high school students was positive towards prenatal testing and most was positive towards NIPT. Further, information was requested by the vast majority before making a decision about NIPT. Most of the students preferred verbal information and to a lesser extent information via the Internet. The attitudes, knowledge and preferences for risk information concerning NIPT in young adults are important, in order to increase knowledge on how to educate and inform future parents.     

Exploring risk and protective mechanisms associated with HIV infection among adolescents in South Africa

This study explored South African adolescents’ perceived risk and protection for HIV infection. Adolescents (N=28) with a mean age of 14.6 years receiving mental health care participated in Focus Group Discussions (FGDs) to engage in an in-depth exploration of their perceived risk and protective mechanisms for HIV prevention. The data were analysed using thematic content analysis. Themes that emerged from the FGDs associated with risk for HIV infection were: Alcohol and illicit drug use; Non-condom use; Prostitution and risky sexual activity with multiple partners; and Non-disclosure of HIV status. Themes that emerged as protective mechanisms included: HIV knowledge and appropriate HIV risk reducing behaviour; and Proactive parental attitudes and behaviour. These findings highlight the importance of ascertaining the perceptions of adolescents about risk and protection from HIV infection in order to inform future programs for HIV prevention among adolescents.     

Knowledge, Attitudes and Behavioral Intentions of Agricultural Professionals Toward Genetically Modified (GM) Foods: A Case Study in Southwest Iran

While there has been a number of consumers’ studies looking at factors that influence individuals’ attitudes and behavior toward GM foods, few studies have considered agricultural professionals’ intentions in this regard. This study illuminates agricultural professionals’ insights toward GM foods in Southwest Iran. A random sample of 262 respondents was studied. The results indicated that the majority of the respondents had little knowledge about GM foods. They perceived few benefits or risks of GM foods. Their perceived benefits and trust in individuals and institutions had positive impacts on the behavioral intentions of the agricultural professionals. The results also revealed that the low knowledge level of the respondents had a negative impact on the behavioral intentions toward GM foods. This state of affairs is problematic, either GM foods have serious problems or the knowledge conveyed to the Iranian agricultural experts is inappropriate. We recommend a well defined communication strategy to provide information in such a way that allows individuals to feel adequately informed about GM foods. Furthermore, the development of trust and knowledge regarding GM foods can be greater when risk analysis frameworks are transparent, risk assessment methodologies are objective, all stakeholders are engaged in the risk management process, and risk communication focuses on consumers.     

Effects of and attention to graphic warning labels on cigarette packages

Objective: The present study investigates the effects of graphic cigarette warnings compared to text-only cigarette warnings on smokers’ explicit (i.e. ratings of the packages, cognitions about smoking, perceived health risk, quit intentions) and implicit attitudes. In addition, participants’ visual attention towards the graphic warnings was recorded using eye-tracking methodology.Design and methods: Sixty-three smokers participated in the present study and either viewed graphic cigarette warnings with aversive and non-aversive images or text-only warnings. Data were analysed using analysis of variance and correlation analysis.Results: Especially, graphic cigarette warnings with aversive content drew attention and elicited high threat. However, whereas attention directed to the textual information of the graphic warnings predicted smokers’ risk perceptions, attention directed to the images of the graphic warnings did not. Moreover, smokers’ in the graphic warning condition reported more positive cognitions about smoking, thus revealing cognitive dissonance.Conclusion: Smokers employ defensive psychological mechanisms when confronted with threatening warnings. Although aversive images attract attention, they do not promote health knowledge. Implications for graphic health warnings and the importance of taking their content (i.e. aversive vs. non-aversive images) into account are discussed.     

Attitudes Toward Cystic Fibrosis Carrier and Prenatal Testing and Utilization of Carrier Testing Among Relatives of Individuals with Cystic Fibrosis

A questionnaire and an offer of free carrier testing was mailed to 173 relatives of individuals with CF. The questionnaire addressed their knowledge of clinical and genetic aspects of CF, as well as their attitudes toward carrier testing, prenatal diagnosis, and pregnancy termination for CF. Eighty-one individuals returned the questionnaire (47%) and 50 elected carrier testing (29%). Most respondents underestimated their carrier risk (60%), but overestimated their risk to have a child with CF (63%). Most (93%) indicated they would utilize carrier testing, and 70% would use prenatal testing; however, only 7% would consider terminating a pregnancy for CF. The intention to use prenatal testing was correlated with the perceived health of the proband and whether the respondent was planning to have (more) children. The acceptability of abortion was correlated with the respondent's perceived impact or burden of CF.     

Communicating to Farmers About Skin Cancer The Behavior Adaptation Model

Although health campaigns promote avoidance of behaviors that put an individual's health at risk, often these behaviors cannot be avoided, and campaign messages designed to encourage behavior adaptation afford greater likelihood of success. With that in mind, a model of health risk behavior adaptation was proposed and tested using four different behaviors in a communication campaign aimed at reducing farmers' risk for skin cancer, farmers and farm wives answered a series of questions about their skin cancer prevention and detection behaviors and attitudes. Interpersonal expectancies, social resources, and actual procedural knowledge predicted perceived procedural knowledge and public commitment, which, in turn, predicted behavior adaptation.     

Attitudes of Health Care Trainees About Genetics and Disability: Issues of Access, Health Care Communication, and Decision Making

Prior studies suggest that knowledge and attitudes of health care professionals influence patient communication and medical decision making. To study this dynamic in the context of genetic disability, we developed a survey on health professionals' attitudes regarding disability and genetic screening and pilot-tested it on a sample of medical students, residents, and genetic counseling students (N = 85). Despite minimal experience with disability or genetics, most respondents reported feeling comfortable dealing with genetics (59%) and disability (75%). The majority felt that disability caused significant suffering for both the person (51%) and family (64%), and that research should be directed toward preventing genetic disability (62%). Similar to prior literature, perceived Quality of Life was most often based on degrees of physical and cognitive functioning, pain, and social support. However, differences were found between genetic counseling trainees and other medical trainees in their relative emphasis of social versus medical issues in questions of disability and genetic testing, and these response patterns were associated with differences in the groups' priorities for offering information about social resources. Respondents agreed that access to genetic testing and information is personal and that testing should be available upon request for oneself (68%) and to a lesser degree for one's fetus (55%) or child (41%). However, the same individuals frequently stated that society should regulate access to such technologies. Although most felt that the patient and professional should jointly make such decisions on a case-by-case basis, it was also seen as appropriate for the health care professional to occasionally decline genetic testing. It seems apparent that training and experience influence knowledge and attitudes. Therefore, it is critical to document knowledge and attitudes of various health care providers and trainees, including differences between various specialties, to improve educational interventions geared to this area.     

Enhanced counselling for women undergoing BRCA1/2 testing: Impact on knowledge and psychological distress–results from a randomised clinical trial

This randomised controlled trial evaluated the impact of an enhanced counselling (EC) intervention on knowledge about the heritability of breast and ovarian cancer and distress, as a function of BRCA test result, among high-risk women. Before deciding about whether or not to undergo genetic testing, participants were randomly assigned to the EC intervention (N = 69), designed to promote cognitive and affective processing of cancer risk information (following the standard individualised counselling session), or to the control condition (N = 65), which involved standard individualised counselling followed by a general health information session to control for time and attention. Women in the EC group exhibited greater knowledge than women in the control group, 1 week after the intervention. Further, at the affective level, the intervention was found to be the most beneficial for women testing positive: specifically 1 week after test result disclosure, women in the intervention group who tested positive experienced lower levels of distress than women in the control group who tested positive. The findings suggest that the design of counselling aids should include a component that explicitly activates the individual's cognitive–affective processing system.