When asked, many people will say they don’t know their risk for common diseases, such as diabetes or colon cancer. Previous studies have shown that people who don’t know their risk are less likely to engage in behaviors that will protect them against it.
With funding from the National Cancer Institute of the National Institutes of Health, scientists from the University at Buffalo and Memorial Sloan Kettering Cancer Center are leading an effort to address the problem. Dr. Heather Orom, associate professor of community health and health behavior in University at Buffalo School of Public Health and Health Profession, is one of the two principal investigators on the four-year, $1.3 million grant.
“It’s quite common for people to say that they don’t know their risk for disease,” Dr. Orom explains. In a recent survey, Dr. Orom and her colleagues conducted using a sample representative of the U.S. population, depending on how the question was asked, 21 percent and 30 percent of respondents said they did not know their risk for diabetes. Meanwhile, 31 percent and 47 percent of people said that they did not know their risk for colon cancer.
“This is surprising given the attention public health has paid to communicating about risk factors for these diseases, especially diabetes,” Dr. Orom said.
With the NIH funding, researchers will attempt to identify why people might be saying that they don’t know their risk for common diseases. In addition, Dr. Orom and colleagues will develop health communication strategies that help these individuals appraise their risk. “We started out with the hypothesis that people who say they don’t know their risk are more likely to have low health literacy or avoid information about a disease because they find it threatening,” Dr. Orom says. “This hypothesis runs counter to a popular explanation that people use ‘don’t know’ options on surveys because they aren’t motivated to spend the energy needed to answer the survey question in a thorough manner; what has been called survey satisficing.”
Health messages about diabetes and colon cancer risk factors may not be successfully reaching people with low health literacy, Dr. Orom explains, adding, “We need to redouble our efforts to reach this vulnerable population.” Moreover, she says, there are also people who may not want to know more about their risk for a disease; they, too, probably aren’t being reached by current messaging campaigns.
Dr. Orom and her team will also be helping researchers who are designing surveys decide whether to include “don’t know” options in their survey, as well as to understand what a “don’t know” response means.
“Based on the findings from our first study, we argue that ‘don’t know’ responses to perceived risk questions are really assessing uncertainty about personal risk and researchers should not be ignoring this group by either not offering a ‘don’t know’ option or discarding this group when they are analyzing their data. Both are common,” Dr. Orom said.