"Don't Know" Responses to Risk Perception Questions: Identifying Mechanisms and Solutions

 描述（由申请人提供）：改变风险认知的策略是健康决策的模型。两者都基于一个可能并不总是正确的假设--即个人知道自己患某种疾病的风险。我们和其他实验室的初步工作表明，相当一部分人口不确定他们患常见疾病的风险。此外，我们已经表明，对一个人的疾病风险的不确定性是特别有可能的， 在美国人口中，谁遭受健康差距的负担。然而，风险不确定性的潜在机制仍然未知，这限制了我们制定有效干预策略以改变行为的能力，特别是对于那些尽管广泛传播基于风险的健康信息但仍然不确定其风险的人。R 01研究项目的目标是阐明导致个体在回答风险感知问题时回答“不知道”的机制。在一项包括观察和实验工作的研究计划中，我们将研究与知识和健康素养相关的因素以及与防御性信息回避影响相关的因素如何不知道响应。这一目标将通过解决两个具体目标来实现：1）探索两个不同的，理论上知情的解释不知道响应，和2）以测试是否实验操纵的机制假设导致不知道响应，减少不知道响应。目标1将通过一项全国性调查来实现，调查健康素养低和防御性风险信息回避是否与不知道对结直肠癌和2型糖尿病风险感知项目的反应有关。实现目标2将通过实验测试来实现：1）向不认识的应答者提供针对低健康素养受众定制的低健康素养健康信息是否会增加风险知识并减少不知道的应答，以及2）向倾向于避免健康信息的不认识的应答者提供在接收健康信息之前进行自我肯定的机会是否会增加对健康信息的关注，和理解这些消息，并减少不知道响应。这项研究是重要的，因为它检查了一个关键的，但未充分研究的现象有关的中央决策和行为改变的结构，对疾病的感知风险的不确定性。成功完成拟议的研究将产生测试策略，为那些不确定自己患常见疾病风险的人制定更有效的行为改变信息。鉴于疾病风险的不确定性在经历健康差异的人群中更为常见，我们的工作有可能解决导致这些持续健康差异的行为改变因素。

 DESCRIPTION (provided by applicant): Strategies to change risk perceptions are a models of health decision making. Both are based on an assumption that may not always be true - that individuals know their risk for a given illness. Preliminary work from our and other laboratories has shown that a non-trivial portion of the population is uncertain about their risk for common illnesses. Moreover, we have shown that uncertainty about one's illness risk is particularly likely among U.S. populations who suffer the burden of health disparities. However, the mechanisms underlying risk uncertainty remain unknown, which limits our ability to develop effective intervention strategies to change behavior, especially in those who remain uncertain about their risk despite the wide-spread dissemination of risk-based health messaging. The objective for this R01 program of research is to explicate the mechanisms leading individuals to answer "do not know" in response to risk perception questions. In a program of research encompassing both observational and experimental work, we will examine how factors relating to knowledge and health literacy as well as factors related to defensive information avoidance influence do not know responding. This objective will be achieved by addressing two specific aims: 1) To explore two distinct, theoretically-informed explanations for do not know responding, and 2) To test whether experimentally manipulating the mechanisms hypothesized to cause do not know responding, reduces do not know responding. Aim 1 will be achieved with a national survey examining if low health literacy and defensive risk information avoidance are related to do not know responding to colorectal cancer and type 2 diabetes risk perception items. Achieving Aim 2 will be accomplished by experimentally testing 1) whether giving do not know responders with low health literacy health messages tailored to a low health literacy audience increases risk knowledge and reduces do not know responding and 2) whether giving do not know responders who tend to avoid health information the opportunity to self-affirm prior to receiving health messages increases attending to, and comprehension of these messages and reduces do not know responding. This research is significant in that it examines a key, but understudied phenomenon related to a central decision making and behavior change construct, uncertainty about perceived risk for illness. Successful completion of the proposed research will generate tested strategies for developing more effective behavior change messages for individuals who are uncertain about their risk for common illnesses. Given the degree to which uncertainty about illness risk is more common in groups experiencing health disparities populations, our work has the potential to address behavior change factors that contribute to these ongoing health disparities.