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.     

Examining the help-seeking intentions of Chinese individuals in the United States

The underutilization of mental health services by Chinese individuals in the United States is concerning. In this study, we examined Chinese individuals’ help-seeking intentions utilizing the theory of planned behavior. Two hundred fifty-one participants were recruited for this study. The results revealed that help-seeking attitudes (β = 0.28, p < 0.001), perceived behavioral control (β = 0.21, p < 0.001), and subjective norms (β = 0.13, p < 0.001) were found to be significant predictors of help-seeking intentions. The implications of the results are discussed.     

Temporal stability of behavioural intention as a moderator of intention–health behaviour relationships

Seven prospective studies of health behaviours containing eight prospective datasets testing the moderating role of intention stability on intention–behaviour and past behaviour–behaviour relationships were examined within the context of the Theory of Planned Behaviour. The measure of intention stability was based on lack of change in intentions between the two measurement time points. Across different behaviours, samples and time frames more stable intentions were associated with intentions at time 1 that were stronger predictors of behaviour at time 2. Intention stability did not consistently moderate the past behaviour–behaviour relationship. Across studies the frequency-weighted mean correlation between intentions and behaviour was substantially greater for stable (r ₊?=?0.60) compared to unstable (r ₊?=?0.27) intentions (Z _difference?=?6.65, p?<?0.001). The past behaviour–behaviour correlation was also stronger for stable (r ₊?=?0.50, p?<?0.001) compared to unstable (r₊ ?=?0.34, p?<?0.001) intentions (Z _difference?=?3.12, p?<?0.01). Perceived behavioural control was the variable most strongly related to stable intentions. Implications for understanding the role of health cognitions in the performance of health behaviour are discussed.     

Habit as both a direct cause of intention to use a condom and as a moderator of the attitude-intention and subjective norm-intention relations

Abstract

Undergraduates at an American university were asked questions about their attitudes, subjective norms, habits, and intentions towards using a condom during sexual intercourse. Consistent with previous research (Chan and Fishbein, 1993; Trafimow, 1994), intentions were well predicted by attitudes and subjective norms (r = 0.88 and r = 0.73, p < 0.01 in both cases). Intentions were also well predicted by habits (r = 0.77, p < 0.01). More interestingly, however, for participants who were in the habit of using condoms, attitudes and subjective norms were not significant predictors of intentions to use condoms in the future (r = 0.18 and r = 0.10, p<0.1 in both cases). In contrast, attitudes and subjective norms were strong predictors for participants who were not in the habit of using condoms (r = 0.81 and r = 0.61, p < 0.01 in both cases). These findings were replicated in a second study.     

Physical activity: the relative associations with cognitive and affective risk beliefs

Abstract

Objective: The role of affectively oriented risk beliefs in explaining health behaviors has not been examined in the context of physical activity or in diverse study populations. We evaluated whether affective risk beliefs account for unique variance in physical activity intentions and behavior above and beyond that accounted for by cognitive risk beliefs.

Design: A cross-sectional survey of socio-demographically diverse US residents (N?=?835; 46.4% no college training; 46.7% minority racial/ethnic ancestry; 42.6% men).

Main outcome measures: Physical activity intentions and behavior.

Results: Hierarchical linear regressions showed that affective risk beliefs accounted for variance in physical activity intentions beyond that predicted by socio-demographics and cognitive risk beliefs (F-change ps<.001). Specifically, intentions were higher among people with higher anticipated regret (ps<.001) and with higher absolute feelings of risk (ps<.05) or worry (ps<.05). There was an indirect relationship between perceived absolute likelihood and intentions through anticipated regret and feelings of risk. Neither cognitive nor affective risk beliefs accounted for variance in physical activity behavior (F-change ps>.05), but unsurprisingly, behavior was positively associated with physical activity intentions (p<.001).

Conclusion: Future interventions could target affective risk beliefs—particularly anticipated regret—to increase intentions, and then add other intervention components to bridge the intention–behavior gap.     

A Structural Model for Adjustment to Aging among Older Women in Breast Cancer Remission

This study aims to build a structural model to explore the predictors of adjustment to aging (AtA) reported by older women in breast cancer remission. A community-dwelling sample of 771 older women in breast cancer remission aged between 75 and 98 years answered a questionnaire to determine socio-demographic (age, income, marital status, education, household, and living setting), and health-related characteristics (self-reported functional limitations and disabilities, time since remission, other type of cancer, breast reconstruction, perceived health, recent disease and medication). Several measures were employed to assess AtA, sense of coherence and subjective well-being. Structural equation modeling was used to explore a structural model of the self-reported AtA, encompassing all variables. Significant predictors of AtA are self-reported disability (β = .404; p < .001), time since remission (β = .371; p < .001), perceived health (β = .257; p < .001), other type of cancer (β = .231; p < .001), breast reconstruction (β = .153; p = .008), marital status (β = .141; p < .001), sense of coherence (β = .140; p < .001), and living setting (β = .139; p = .006). These variables accounted for 84.3% of the variability of AtA. Self-reported disability and time since remission were the strongest predictors of AtA. Our findings suggest that health care interventions with older women in breast cancer remission still living in the community may benefit from clearly including these predictors of AtA, as they are relevant for promoting older women’ s aging well.

     

Predicting changes in planning behaviour and physical activity among adults

Though the effect of action planning upon behavioural enactment is becoming well-established, adherence to planning interventions are modest. Motivations specific to action planning may predict planning behaviour. The primary purpose of the present study was to determine if theory of planned behaviour constructs operationalized for planning could predict change in planning behaviour. The secondary purpose was to determine if planning behaviour predicted changes in physical activity. Participants (n = 337, M_age = 31 ± 5) were adults with intentions to be more active who completed measures of affective and instrumental attitudes towards planning, subjective norms towards planning, perceived behavioural control over planning, intentions to plan, self-reported planning behaviour, intentions to be active and self-reported physical activity at baseline (T1) and after four weeks (T2). Affective attitudes towards planning (β = 0.10, p < .05), instrumental attitudes towards planning (β = 0.22; p < .01) subjective norms over planning (β = 0.12, p < .01) and perceived behavioural control over planning (β = 0.53, p < .01) predicted intentions to plan (adj. R² = 0.66). Intentions to plan (β = 0.16, p < .05) and intentions to be active (β = −0.25, p < .05) predicted change in planning behaviour (R²_change = 0.03). Planning behaviour (β = 0.27, p < .05) predicted change in physical activity (R²_change = 0.07). Planning behaviour appears to have its own motivations distinct from those of physical activity. Future interventions should target planning behaviour along with its motivations and control beliefs to increase rates of planning. The theoretical underpinnings of the TPB are of value for understanding both planning behaviour and physical activity.     

Living at Risk: The Sibling’s Perspective of Early-Onset Alzheimer’s Disease

Early-onset Alzheimer’s disease (EOAD) is an increasingly diagnosed condition and is associated with genetic risk factors. This is one of the first studies exploring the lived experience of siblings of individuals with EOAD. We used structured questionnaires and semi-structured interviews to assess a broad range of siblings’ experiences with and beliefs about EOAD, including knowledge, perceptions of personal risk, level of worry, and effects on life decisions. Participants (n = 24) were predominantly female (62.5%) and middle-aged (mean = 56.8 years; range 37–83). When asked about risk factors, genetics was cited most frequently (62.5%). Several potential means of reducing AD risk were endorsed, with 54% reporting engagement in behaviors for this purpose (e.g., keeping mentally active). Participants ranged widely in their perceived personal risk of AD (range: 0–100; mean = 35.6%), with higher perceived risk associated with worry about AD (p < 0.01). Understanding siblings’ experiences with EOAD can inform how genetic counselors and healthcare professionals work with this population to facilitate risk communication and decision-making about testing and healthcare.     

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.     

Organ donation intentions and behaviors: application and extension of the theory of planned behavior

Organ donation intentions and behaviors were investigated using a traditional and extended theory of planned behavior (TPB). In study 1, attitudes, subjective norms, and perceived behavioral control were associated with intentions to engage in donation behaviors in a student sample (all p ≤ .02), and intentions significantly predicted behavior 2 months later (p < .001). Study 2 utilized a community sample of Catholic, Jewish, and Muslim individuals. Measures of affect and religious attitudes were added to the traditional TPB, increasing the variance in intentions accounted for by the model, F(7, 181) = 6.94, p < .001. The studies support the use of an extended TPB in predicting donation‐related intentions and behaviors and suggest potential targets of interventions to promote donation.     

Factors associated with school nurses’ HPV vaccine attitudes for school-aged youth

School nurses are at the intersection of the healthcare and school communities, thus, they can be considered opinion leaders in providing health advice – including information about the human papillomavirus (HPV) vaccine – to parents and students. This study examined school nurses’ attitudes toward the HPV vaccine based on age, years as a school nurse, geographic location, urban vs. rural work setting, HPV and vaccine knowledge, perception of role as opinion leaders, and school district support in providing health education. Participants (n = 413) were systematically sampled from the National Association of School Nurses’ membership and completed a web-based survey. Multiple regression was used to predict positive HPV vaccine attitudes. The model was statistically significant accounting for 50.8% of the variance (F [9, 400] = 45.96, p < .001). Positive attitudes regarding the HPV vaccine were predicted by higher HPV and vaccine knowledge (β = .096, p < .001) and stronger perceptions of role as opinion leaders for the vaccine (β = .665, p < .001). No other variables were found to be statistically significant. These results suggest knowledge is essential in predicting positive attitudes, but not the strongest predictor as perceptions of role as opinion leaders was more crucial in terms of predicting school nurses’ positive attitudes towards HPV vaccine. Despite school nurses being seen as champions for adolescent vaccines, they need additional professional development to increase their HPV vaccine knowledge and attitudes to encourage parents and adolescents to consider the uptake of HPV vaccination. To engage school nurses’ in promoting HPV vaccine uptake, interventions need to focus on increasing school nurses’ perception of their role as opinion leaders for HPV vaccine and knowledge to increase positive attitudes towards HPV vaccination for youth.     

A little shot of humility: Intellectual humility predicts vaccination attitudes and intention to vaccinate against COVID-19

Vaccinations remain a critical, albeit surprisingly controversial, health behavior, especially with the promise of widely available COVID-19 vaccine. Intellectual humility, a virtue characterized by nonjudgmental recognition of one's own intellectual fallibility, may counter rigidity associated with anti-vaccination attitudes and help promote vaccine-related behaviors. This study investigated whether intellectual humility is related to anti-vaccination attitudes and intentions to vaccinate against COVID-19, and whether intellectual humility can predict unique variance in these outcomes beyond participant demographic and personal factors. Participants (N = 351, 57.23% male, mean age = 37.41 years, SD = 11.51) completed a multidimensional measure for intellectual humility, the anti-vaccination attitudes (VAX) scale, and a two-item COVID-19 vaccination intention scale. Bivariate correlations demonstrated that intellectual humility was negatively related with anti-vaccination attitudes overall, r(349) = −.46, p < .001, and positively related to intentions to vaccinate against COVID-19, r(349) = .20, p < .001. Hierarchical multiple regression revealed that intellectual humility predicted all four types anti-vaccination attitudes, overall anti-vaccination attitudes, and COVID-19 vaccination intentions above and beyond demographic and personal factors (i.e., sex, race/ethnicity, age, education, socioeconomic status, and political orientation), ΔR² between .08 and .18, ps < .001. These results bolster intellectual humility as a malleable psychological factor to consider in efforts to combat anti-vaccination attitudes and promote COVID-19 vaccination uptake.     

The Stigmatising Implications of Presenting Schizophrenia as a Genetic Disease

This study aimed to investigate the hypothesis that belief in a genetic aetiology of schizophrenia will increase the stigma associated with the disorder. Levels of five potentially stigmatising attitudes were compared in two groups of participants who had read a vignette describing an individual who has schizophrenia. In one group the disorder was explained as being caused by ‘genetic’ factors, and in the other by ‘environmental’ factors. This study found that three of the five potentially stigmatising attitudes measured were increased when participants read a vignette with a genetic causation rather than an environmental causation. Firstly, genetic attributions increased levels of associative stigma towards close relatives (p < 0.001). Secondly, participants viewed recovery as less likely when genetic factors were implicated as causative (p < 0.001). Finally, there was also an increased perception of the character’s “dangerousness” when the condition was explained by genetic factors (p < 0.05). Contrary to previous research was the finding that perceived aetiology had no effect on participant’s desire for social distance from an affected individual. Neither did perceived aetiology influence beliefs about moral accountability. The implications of these findings suggest that genetic counsellors and other health professionals, who are providing genetic information to those affected by schizophrenia should be aware of the possibility that a genetic explanation of schizophrenia could increase potentially stigmatising attitudes towards their clients and their clients’ families. It is also possible that individuals with a diagnosis of schizophrenia may themselves form deterministic interpretations of the genetic information they receive and subsequently be less likely to adopt behavioural advice or adhere to treatment. Counsellors and health professionals should strive to present information in a balanced manner, ensuring recipients understand the multi-factorial causes of the disease.     

Attitudes and uptake of a screening test: The moderating role of ambivalence

This study examined the extent to which ambivalence moderates the relationship between attitudes and screening behaviour in a clinical setting using an objective measure of behaviour. For this study 979 pregnant women eligible for prenatal Down syndrome screening completed questionnaire measures of attitudes, ambivalence and intentions towards undergoing the test. Screening behaviour, assessed by test uptake, was determined from medical records. Attitudes predicted intentions to undergo the test and screening behaviour. The correlations between attitudes and intentions and between attitudes and behaviour were greater in women with lower levels of ambivalence (r?=?0.85 and r?=?0.58, respectively) than in those with higher levels of ambivalence (r?=?0.50 and r?=?0.27, respectively). Regression analyses revealed that ambivalence moderated the relationships between attitudes and intention and between attitude and behaviour. In addition, a three-way interaction was found between ambivalence, attitudes and intention when predicting behaviour. Given that behaving consistently with attitudes is central to making an informed choice, ambivalence appears to undermine the making of such choices.     

Family Processes and Mental Health among Children and Caregivers in a Family Strengthening Program

Oppositional defiant disorder (ODD) is a common mental health concern and is particularly prevalent among children living in poverty-impacted communities. A family strengthening/parent management training (PMT)-based multiple family group (MFG) program entitled, the 4 Rs and 2 Ss for Strengthening Families, focuses on the following family process variables: rules, responsibilities, relationships, respectful communication, social support, and stress. While evidence supports effectiveness of this treatment program, less is known about the specific relationship between the family process variables and mental health outcomes of children and caregivers. The current study examined these relationships among a sample of 287 caregiver/child dyads who participated in a NIMH-funded Type II hybrid effectiveness-implementation study in New York City. Data were analyzed using SPSS 27 and Mplus 8. Results indicated that two of the six family process variables related to one or more child and caregiver mental health outcome. Caregiver stress significantly related to child inattention (b?=?0.034, SE?=?0.01, p?<?0.001), child ODD (b?=?0.053, SE?=?0.02, p?<?0.01), and caregiver depression (b?=?0.049, SE?=?0.02, p?<?0.01). Family rules significantly related to caregiver depression (b?=?0.228, SE?=?0.11, p?<?0.05) over time. Findings point towards the substantial role of caregiver stress in child and caregiver mental health, in addition to the impact of inconsistent discipline with difficulty establishing rules on caregiver depression. Examinations of treatment components in relation to improvements in child and caregiver mental health can guide practitioners towards utilizing models that result in positive therapeutic outcomes and/or making adaptations with added content that has been shown to be effective.

     

Cognitive predictors of posttraumatic stress symptoms six months following acute coronary syndrome

This study examined patients’ illness representations assessed shortly after an acute coronary syndrome (ACS) as predictors of posttraumatic stress symptoms six months later. Illness representations were assessed in ACS patients using standard measures at a home visit three weeks after discharge from hospital. Posttraumatic stress symptoms were assessed at the same time, and again six months later. Patients were aged 61 years on average, the majority being men (89.8%) of white European decent (89%). Greater posttraumatic symptoms at six months were associated with beliefs that the illness would last a long time (timeline), that it had an unpredictable time course (timeline – cyclical), greater consequences, less personal and treatment control, poorer illness coherence and stronger negative emotional representations (emotional upset relating to the illness; p?<?0.05). In multiple regression analyses, controlling for demographic, clinical and psychological factors (age, gender, ethnicity, social deprivation, ACS severity, negative affectivity and cardiac symptom recurrence), more intense emotional representations (β?=?0.146, p?=?0.041) and reduced illness coherence (β?=??0.133, p?=?0.029), emerged as independent predictors of posttraumatic symptom severity at six months. There was a near significant effect for personal control (β?=??0.113, p?=?0.058). These results demonstrate the importance of illness representations of ACS in predicting longer-term posttraumatic stress symptoms.     

Living Well in Later Life: The Influence of Sense of Coherence,and Socio-Demographic,Lifestyle and Health-Related Factors on Older Adults’ Satisfaction with Life

This study aims at exploring a structural model of satisfaction with life’s (SWL) predictors in a cross-national sample of older adults. A quantitative approach was followed with a cross-sectional study design. A community-dwelling sample of 1,234 older adults from four different nationalities residing in Portugal, was assessed regarding SWL, sense of coherence (SOC) and socio-demographic, lifestyle and health-related characteristics. Sampling was performed in lifelong learning centres’ message boards and local community centres’ list-serves in the Lisbon metropolitan area and in the Algarve region. Structural equation modeling was used to investigate a structural model of the self-reported SWL, comprising SOC, socio-demographic characteristics (age, sex, education, marital and professional status, household, adult children, income, living setting and religion), as well as lifestyle and health-related characteristics (physical activity, recent disease and medication). Significant predictors are SOC (β?=?0.733; p?<?0.001), religion (β?=?0.725; p?<?0.001), income (β?=?0.551; p?<?0.001), adult children (β?=?0.546; p?<?0.001), education (β?=??0.403; p?<?0.001), living setting (β?=??0.292; p?<?0.001) and medication (β?=??. 197; p?<?0.001). The variables accounted for 24.8 % of the variability of SWL. Moreover, differences between the four nationality groups (F _{(3, 671)}?=?3.671, p?=?0.066) were not found concerning SWL. Sense of coherence is the strongest predictor of self-reported SWL. Other predictors are religion, income, adult children, education, living setting and medication. The four nationalities did not present significant differences, concerning SWL. This study points out the potential factors that influence older adults’ SWL, in particular SOC, religion and income, as promoters of aging well, within a salutogenic model of health for older populations.     

Socio-ecological influences of attitudes toward disability among Kenyan undergraduate students

This study examined personal and contextual variables as predictors of attitudes toward disability at a Kenyan higher education setting. Participants were a convenience sample of 309 undergraduate students at a Kenyan university enrolled in Sociology, Social Work, Psychology, Political Science, and Public Administration majors. Data on attitudes were collected using the Attitudes Towards Disabled Persons scale (ATDP: Antonac & Livneh, 1988). A cross-sectional survey design was employed for data collection, and a multiple regression analysis was used for data analysis. Results revealed that the model was significant: F (9, 250)?=?2.784, p?=?0.004. However, only age (β?=?0.173, p?=?0.044) significantly predicted attitudes towards disability, indicating older students held more positive attitudes than their younger counterparts. Older students had a more favourable attitude towards people with disabilities than younger students. Seniority, by age, is highly valued in Africa than perhaps anywhere in the world. Kenyan older adults may be key to enhancing favourable attitudes toward individuals with disabilities in Kenya as well as interventions aimed at changing negative attitudes towards people with disabilities.     

Cognitive Heuristics and AIDS Risk Assessment Among Physicians1

Physicians (N= 331) reported perceived risk of HIV exposure, worry about on-the-job HIV exposure, and experience with patients who test seropositive for the HIV. In addition, the use of the availability heuristic was examined by responses to questions about talking and reading about AIDS, and the use of the simulation heuristic was examined by responses to questions about imagining oneself being exposed to HIV on the job. Simulation of the HIV-exposure experience related significantly to perceived risk (p < .001), even after variance attributable to actual experience and use of the availability heuristic was taken into account. Availability of AIDS information related marginally to perceived risk after variance attributable to actual experience and use of the simulation heuristic was taken into account. Simulation related strongly with worry about on-the-job exposure (p < .001), and availability was not significantly related to worry after variance associated with simulation and experience with AIDS was removed. Implications of these results for physician training are discussed.