University at Buffalo, SUNY, New York, USA.
Washington University in Saint Louis, Missouri, USA.
Br J Health Psychol. 2018 May;23(2):420-435. doi: 10.1111/bjhp.12297. Epub 2018 Jan 31.
Risk perception is a key determinant of preventive health behaviour, but when asked, some individuals indicate they do not know their health risk. Low education is associated with both lack of knowledge about health risk and with the persistence and exacerbation of gaps in knowledge about health issues. This study uses the context of an emerging infectious disease threat to explore the hypothesis that the education-don't know risk relation results from differences in knowledge about the health issue of interest. Specifically, we examine whether patterns of change over time follow theoretical predictions that disparities in risk knowledge would increase over time in less educated sectors of the population (knowledge gap hypothesis).
Secondary analysis of population-representative behavioural surveillance survey.
We analysed data from the 1993 to 2000 Behavior Risk Factor Surveillance System surveys, which measured education and perceived HIV/AIDS risk in a population sample collected separately in each survey year; don't know responses were coded.
In each year, individuals with higher education were less likely to respond don't know. The absolute prevalence of don't know responding dropped over time; nonetheless, there was an increase over time in the magnitude of the pattern of lower education being associated with greater don't know responding.
We found support for the knowledge gap hypothesis. Over time, populations with greater education gained more knowledge about their HIV risk than populations with lower education. Results highlight the need to carefully consider health communication strategies to reach and address those individuals with low education and health knowledge. Statement of contribution What is already known on this subject? A meaningful potion of the population answers 'don't know' when asked to report their risk for health problems, indicating a lack of risk perception in the domain. Previous studies have shown that level of education is associated with don't know responding - those with lower educational attainment are more likely to respond don't know. The education-don't know responding relation suggests that lack of health information and health domain knowledge might be a factor in lacking risk perception, but this mechanism has not been previously tested. What does this study add? Patterns of changes in don't know responding over time as population-level knowledge of a health risk increase are consistent with the health information/health knowledge hypothesis outlined above. As population knowledge of HIV/AIDS risk in the United States increased over time (indicated by declining overall rates of don't know responses), the relation of education level to don't know responding actually became stronger. The pattern of change over time is the classic 'knowledge gap hypothesis' pattern, which has not been previously demonstrated for knowledge of personal health risk. The knowledge gap response pattern supports the health information/health knowledge hypothesis.
风险认知是预防性健康行为的关键决定因素,但有些人在被问及风险时表示不知道自己的健康风险。低教育水平与对健康风险的了解不足以及对健康问题的了解差距的持续存在和加剧有关。本研究利用新发传染病威胁的背景,探讨了这样一种假设,即教育与不知道风险之间的关系源于对相关健康问题的知识差异。具体来说,我们检验了随着时间的推移,风险知识差异是否会按照理论预测增加,即人口中受教育程度较低的人群的风险知识差距会随着时间的推移而增加(知识差距假说)。
对具有代表性的行为危险因素监测调查进行的二次分析。
我们分析了 1993 年至 2000 年行为危险因素监测系统调查的数据,该调查分别在每个调查年份收集的人群样本中测量了教育程度和感知的艾滋病毒/艾滋病风险;对“不知道”的回答进行了编码。
在每年中,教育程度较高的个体更不可能回答“不知道”。随着时间的推移,绝对不知道的比例下降;尽管如此,随着时间的推移,受教育程度较低的人群与更大的不知道比例之间的关联模式有所增加。
我们支持知识差距假说。随着时间的推移,教育程度较高的人群对自己的艾滋病毒风险有了更多的了解,而教育程度较低的人群则了解较少。结果强调需要仔细考虑健康传播策略,以接触和解决那些教育程度低、健康知识少的人。 主题贡献 关于这个主题已经知道了什么?当被要求报告他们的健康问题风险时,相当一部分人口回答“不知道”,这表明他们在该领域缺乏风险感知。先前的研究表明,教育水平与不知道的反应有关——教育程度较低的人更有可能回答“不知道”。教育与不知道反应之间的关系表明,缺乏健康信息和健康领域知识可能是缺乏风险感知的一个因素,但这一机制尚未得到先前的检验。 本研究有何新发现?随着人群对健康风险的了解程度的提高,随着时间的推移,不知道反应的变化模式与上述健康信息/健康知识假说一致。随着美国艾滋病毒/艾滋病风险的整体知晓率随着时间的推移而下降(这表明不知道的总体比例下降),教育水平与不知道反应的关系实际上变得更强。随着时间的推移,变化的模式是典型的“知识差距假说”模式,这在以前没有针对个人健康风险的知识表现出来。知识差距反应模式支持健康信息/健康知识假说。