Center for Nursing Science and Clinical Inquiry, US Army Nurse Corps, USA.
J Adv Nurs. 2013 Mar;69(3):726-37. doi: 10.1111/j.1365-2648.2012.06096.x. Epub 2012 Jul 20.
This article presents a discussion of development of a mid-range theory of risk perception.
Unhealthy behaviours contribute to the development of health inequalities worldwide. The link between perceived risk and successful health behaviour change is inconclusive, particularly in vulnerable populations. This may be attributed to inattention to culture.
The synthesis strategy of theory building guided the process using three methods: (1) a systematic review of literature published between 2000-2011 targeting perceived risk in vulnerable populations; (2) qualitative and (3) quantitative data from a study of Samoan Pacific Islanders at high risk of cardiovascular disease and diabetes.
Main concepts of this theory include risk attention, appraisal processes, cognition, and affect. Overarching these concepts is health-world view: cultural ways of knowing, beliefs, values, images, and ideas. This theory proposes the following: (1) risk attention varies based on knowledge of the health risk in the context of health-world views; (2) risk appraisals are influenced by affect, health-world views, cultural customs, and protocols that intersect with the health risk; (3) strength of cultural beliefs, values, and images (cultural identity) mediate risk attention and risk appraisal influencing the likelihood that persons will engage in health-promoting behaviours that may contradict cultural customs/protocols.
Interventions guided by a culturally sensitive mid-range theory may improve behaviour-related health inequalities in vulnerable populations.
The synthesis strategy is an intensive process for developing a culturally sensitive mid-range theory. Testing of the theory will ascertain its usefulness for reducing health inequalities in vulnerable groups.
本文旨在探讨风险感知中程理论的发展。
不健康行为是导致全球健康不平等的原因之一。感知风险与成功改变健康行为之间的联系尚无定论,尤其是在弱势群体中。这可能归因于对文化的忽视。
理论构建的综合策略指导了这一过程,使用了三种方法:(1)对 2000 年至 2011 年间针对弱势群体感知风险的文献进行系统回顾;(2)来自对处于心血管疾病和糖尿病高风险的萨摩亚太平洋岛民的研究中的定性和定量数据。
该理论的主要概念包括风险关注、评估过程、认知和情感。这些概念的核心是健康世界观:了解健康的文化方式、信仰、价值观、形象和观念。该理论提出以下观点:(1)风险关注基于健康世界观中对健康风险的了解而有所不同;(2)风险评估受到情感、健康世界观、文化习俗和与健康风险相交的协议的影响;(3)文化信仰、价值观和形象(文化身份)的强度调节风险关注和风险评估,影响人们是否会采取可能与文化习俗/协议相矛盾的促进健康行为的可能性。
受文化敏感中程理论指导的干预措施可能会改善弱势群体中与行为相关的健康不平等现象。
综合策略是开发文化敏感中程理论的一个密集过程。对该理论的测试将确定其在减少弱势群体健康不平等方面的有用性。