Using an Internet-Based Breast Cancer Risk Assessment Tool to Improve Social-Cognitive Precursors of Physical Activity

Abstract

Background Internet-based cancer risk assessment tools might be one strategy for translating epidemiological risk prediction research into public health practice. Understanding how such tools might affect key social-cognitive precursors of behavior change is crucial for leveraging their potential into effective interventions. Purpose To test the effects of a publicly-available Internet-based breast cancer risk assessment tool on social-cognitive precursors of physical activity. Methods Women (N=132) aged 40–78 with no personal cancer history indicated their perceived risk of breast cancer and were randomly assigned to receive personalized (www.yourdiseaserisk.wustl.edu) or non-personalized breast cancer risk information. Immediately thereafter, breast cancer risk perceptions and physical activity-related behavioral intentions, self-efficacy, and response-efficacy were assessed. Results Personalized information elicited higher intentions, self-efficacy, and response efficacy than non-personalized information, ps<.05. Self-efficacy and response efficacy mediated the effect of personalizing information on intentions. Women who received personalized information corrected their inaccurate risk perceptions to some extent, ps<.05, but few fully accepted the information. Conclusion Internet-based risk assessment tools can produce beneficial effects on important social-cognitive precursors of behavior change, but lingering skepticism, possibly due to defensive processing, needs to be addressed before the effects can be maximized.

Testing Explanations for Skepticism of Personalized Risk Information

“…We report 3 key findings from our exploration of possible explanations for skepticism of personalized diabetes risk information. First, consistent with other research related to communicating personalized health risk information, 4,7–14,47 risk skepticism was common; approximately 58% of participants expressed skepticism of the personalized diabetes risk information they were provided. Second, risk skepticism could happen in both “directions.” Few studies have separated people who are skeptical of personalized risk information because they believe it is too high versus too low (but see Weinstein et al, 7 Han et al, 13 and Aspinwall et al 48 ); instead, they combine both groups of people into a single “risk skepticism” category.…”

Commentary: 20 years online with “Your Disease Risk”

“…The first complete version of the online tool contained most of the elements still seen in today’s version, including estimates of disease risk, an accounting of the modifiable and non-modifiable factors that drive a user’s risk result, and the ability to see dynamically how adopting healthy behaviors could lower that risk in the future. This latter “risk manipulation” option remains a cornerstone of the tool’s functionality and has been linked to possible improvement in risk perception accuracy [ 12 ] as well as improved response efficacy [ 13 ]. The potential disease risk reduction users view when choosing a healthy lifestyle change is based on the magnitude of association assigned during the consensus process to each factor.…”

“…To date, no research has assessed the impact of the tool on, for example, population risk reduction. However, evidence from a small study suggests the tool’s approach may help improve social-cognitive precursors to healthy behavior change, including intentions, response efficacy, and self-efficacy [ 13 ].…”

Participatory Design of a Personalized Genetic Risk Tool to Promote Behavioral Health

“…In contrast, the Your Disease Risk tool (www.yourdiseaserisk.org), as an example, was designed to target constructs most likely to motivate behavior change. When compared to a static list of risk factors, this tool elicited more health-promoting cognitions such as self-efficacy, response efficacy, and behavioral intentions (30).…”