University at Buffalo, Buffalo, NY (HO, MTK, CB, XC).
Memorial Sloan Kettering Cancer Center, New York, NY (ES, YL, JLH).
Med Decis Making. 2018 Nov;38(8):1006-1017. doi: 10.1177/0272989X18799999.
People who say they don't know (DK) their disease risk are less likely to engage in protective behavior.
This study examined possible mechanisms underlying not knowing one's risk for common diseases.
Participants were a nationally representative sample of 1005 members of a standing probability-based survey panel who answered questions about their comparative and absolute perceived risk for diabetes and colon cancer, health literacy, risk factor knowledge and health information avoidance, and beliefs about illness unpredictability. Survey satisficing was a composite assessment of not following survey instructions, nondifferentiation of responses, haphazard responding, and speeding. The primary outcomes were whether a person selected DK when asked absolute and comparative risk perception questions about diabetes or colon cancer. Base structural equation modeling path models with pathways from information avoidance and health literacy/knowledge to DK responding for each DK outcome were compared to models that also included pathways from satisficing or unpredictability beliefs.
Base models contained significant indirect effects of health literacy (odds ratios [ORs] = 0.94 to 0.97, all P < 0.02) and avoidance (ORs = 1.05 to 1.15, all P < 0.01) on DK responding through risk factor knowledge and a direct effect of avoidance (ORs = 1.21 to 1.28, all P < 0.02). Adding the direct effect for satisficing to models resulted in poor fit (for all outcomes, residual mean square error estimates >0.17, all weighted root mean square residuals >3.2, all Comparative Fit Index <0.47, all Tucker-Lewis Index <0.49), indicating that satisficing was not associated with DK responding. Unpredictability was associated with not knowing one's diabetes risk (OR = 1.01, P < 0.01).
The data were cross-sectional; therefore, directionality of the pathways cannot be assumed.
DK responders may need more health information, but it needs to be delivered differently. Interventions might include targeting messages for lower health literacy audiences and disrupting defensive avoidance of threatening health information.
表示不知道（DK）自己患病风险的人不太可能采取保护行为。
本研究旨在探讨不了解常见疾病风险的潜在机制。
参与者为一项基于常设概率调查小组的全国代表性样本，共 1005 名成员，他们回答了有关糖尿病和结肠癌的相对和绝对感知风险、健康素养、风险因素知识和健康信息回避以及对疾病不可预测性的信念的问题。调查满意是对不遵守调查指令、反应无差异、随意反应和快速反应的综合评估。主要结果是当被问及关于糖尿病或结肠癌的绝对和相对风险感知问题时，一个人是否选择 DK。针对每种 DK 结果，将包含从信息回避和健康素养/知识到 DK 反应的途径的基础结构方程模型路径模型与还包含从满意或不可预测性信念到 DK 反应的途径的模型进行比较。
基础模型包含健康素养（比值比 [ORs] = 0.94 至 0.97，均 P < 0.02）和回避（ORs = 1.05 至 1.15，均 P < 0.01）对 DK 反应的显著间接影响，通过风险因素知识和回避的直接影响（ORs = 1.21 至 1.28，均 P < 0.02）。将满意的直接效应添加到模型中会导致拟合不良（对于所有结果，残差均方误差估计值 >0.17，所有加权根均方残差 >3.2，所有比较拟合指数 <0.47，所有 Tucker-Lewis 指数 <0.49），表明满意与 DK 反应无关。不可预测性与不知道自己的糖尿病风险有关（OR = 1.01，P < 0.01）。
数据是横断面的；因此，不能假设途径的方向性。
DK 响应者可能需要更多的健康信息，但需要以不同的方式提供。干预措施可能包括针对健康素养较低的受众的信息，并打破对威胁性健康信息的防御性回避。
