The influence of risk labeling on risk perception and willingness to seek help in an experimental simulation of preventive medical examinations

Highlights

• Our vignette study tested various presentation formats of test results.

• Scenarios of results of a preventive medical examination of workers were used.

• The risks of fatigue or being overweight were emphasized or presented neutrally.

• Risk perception and willingness to seek help were higher after emphasizing the risk.

Abstract

Objective

To study the influence of the presentation of results of a preventive medical examination on risk perception and willingness to seek help for work-related fatigue or being overweight.

Methods

A factorial design experiment was conducted, presenting workers (n = 82) with vignettes including eight scenarios of test results with and without an emphasis on the risk of a current or future health condition or a probe to seek help. Participants rated perceived risk and willingness to seek help (0–100 Visual Analogue Scale) as if these were their own results. Differences were tested with paired-sample t-tests.

Results

In scenarios emphasizing the risk of a current or future disorder, participants perceived higher risk and were more willing to seek help (p-values < .00). Slightly higher willingness to seek help scores was observed in all scenarios that included probes (p < .00).

Conclusion

Risk perception and willingness to seek help of workers participating in a preventive medical examination were higher when they were told that the test results indicate a risk of a current or future disorder and after being advised to seek help.

Practice implications

Healthcare providers should take the potential effects on risk perception and help-seeking into account in preventive settings.

Introduction

Over recent decades, shared decision-making (SDM) has received much attention in academic debates on medical decision-making. SDM has been described as “an approach where clinicians and patients make decisions together using the best available evidence [….] and where patients are supported to consider options so that they can communicate their preferences and help select the best course of action for them” [1]. SDM involves information exchange between physicians and patients, exploring patient preferences and joint decision-making.

SDM approach can be applied to preventive settings and is also referred to as Informed Decision Making in that context [2]. First, SDM can be applied to the decision to participate in the preventive program, often entailing a screening procedure [3]. Second, it can help patients make decisions about health promotion recommendations related to their individual risk profile and context (e.g. family history, personal health history, and values) [4]. Risk communication plays a role in both types of decisions. Research on risk communication has shown that how the test results are presented clearly influences risk perception and screening uptake [5].

In contrast to situations with an established disease, in preventive risk communication, context is particularly important to aid decision-making about screening participation or treatment [6]. A preventive intervention has the benefit of reducing the risk of an adverse outcome (e.g., mortality risk or risk of a disease), rather than alleviating an existing health condition. In a preventive setting, it is important to know what the chance of that adverse outcome is for people who do not have that risk factor. Risk communication is thus a crucial aspect of shared decision making in preventive settings.

Different formats can be used to communicate the quantitative aspect of risks [7]. Issues around the presentation of risks include numerical aspects of risk communication, such as whether to present risk percentages (e.g. 15% chance) or discrete frequencies (e.g. 15 in 100) [8]. It also involves the verbal labeling of the numerical information. A study using hypothetical prenatal screening showed that participants reported higher perceived risk when the test result was accompanied by a label which interpreted the results as “abnormal” or “positive” compared to the presentation of test results without interpretation [9]. Moreover, participants in an experiment involving a hypothetical breast cancer risk were influenced by comparative risk information. This meant that they felt more compelled to undergo a treatment if their risk was “above average,” even when the expected risk reduction of undergoing the treatment was the same for risk groups below and above average [10]. A typical feature of a preventive setting is that the current risk may be lower than the risk of developing a health problem if the risk factor is not addressed. In this study we are interested in how emphasizing either current or future risk in risk communication influences risk perception.

It can be debated whether risk perception and seeking treatment should be promoted in a preventive setting. In cancer screening, the current prevailing paradigm of encouraging screening participation is debated by those who claim that informed decisions, rather than high participation should be aimed for [[11], [12]]. But at the very least the effects of the presentation of the risks on these parameters should be known in order to design preventive consultations that support the decision-making process.

These issues around risk communication are also relevant in preventive occupational health, where a Workers’ Health Surveillance program involves a preventive medical examination [13]. This is seen as a means to implement preventive action by identifying and treating health complaints relevant to work, and thereby protect workers from health problems relevant to their work performance now or in the future [[14], [15]]. Generic health promotion; for example, aimed at lowering cardiovascular health risks, may also be part of a Workers’ Health Surveillance program [16]. In such a preventive program, a worker is presented with their test results by an occupational physician. One job-specific preventive program focusing on mental health in nurses found that screening and feedback enhanced help-seeking behavior in workers [17]. Help-seeking behavior such as visiting a health provider may be enhanced by giving advice to seek help after the presentation of the test results. However, as far as we know the effects of such ‘probing’ to seek help have not yet been evaluated. In general, little is known about how the presentation of test results influences the risk perception and subsequent help-seeking.

Therefore, the research question of this experimental study is whether the presentation of the results of a worker’s health surveillance examination influences risk perception and willingness to seek help to improve or prevent future health problems. Two different formats for labeling the health risk are tested, as well as the influence of introducing a probe to seek help. The results for men and women and for participants with lower and higher social status will be compared to explore whether these subgroups respond differently to the information presented.