Framing recommendations to promote prevention behaviors among people at high risk: A simulation study of responses to me
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ORIGINAL RESEARCH
Framing recommendations to promote prevention behaviors among people at high risk: A simulation study of responses to melanoma genetic test reporting Jennifer M. Taber & Lisa G. Aspinwall
Received: 27 February 2014 / Accepted: 12 December 2014 # National Society of Genetic Counselors, Inc. 2015
Abstract A CDKN2A/p16 mutation confers 76 % lifetime risk of developing melanoma to US residents, and high-risk individuals are counseled to use sunscreen. Generally, for patients at population risk, gain framing more effectively promotes prevention behaviors; however, it is unknown whether loss frames might more effectively promote behavioral intentions and perceived control over disease risk among high-risk patients. Undergraduates (N=146) underwent a simulated genetic counseling and test reporting session for hereditary melanoma. Participants watched a video of a genetic counselor providing information in which genetic risk of melanoma (Low: 15 %; High: 76 %) and framed recommendations to use sunscreen (Loss: Risk may increase by 15 % if don’t use sunscreen; Gain: Risk may decrease by 15 % if use sunscreen) were manipulated. Controlling for baseline sunscreen use, high-risk participants given loss frames reported greater beliefs that sunscreen would reduce risk than high-risk participants given gain frames. Further, high-risk participants with fair skin tended to report greater intentions to use sunscreen when given loss frames versus gain frames. Perceived control over risk mediated the effect of message frame and disease risk on intentions to use sunscreen. When counseling patients with elevated cancer risk, genetic counselors may consider framing prevention behavioral recommendations in terms of potential losses.
Keywords Reflection effect . Message framing . Disease risk . Perceived control . Melanoma . Genetic testing . Prevention behavior . Sunscreen . Intentions . Response efficacy J. M. Taber : L. G. Aspinwall (*) Department of Psychology, University of Utah, 380 S. 1530 E., Room 502, Salt Lake City, UT 84112, US e-mail: [email protected]
Introduction Genetic testing for hereditary melanoma American adults who test positive for the CDKN2A/p16 (or simply, p16) mutation have a 76 % lifetime chance of developing melanoma, a deadly form of skin cancer. Additionally, geographic variation in penetrance indicates that p16 mutation carriers who live in sunny regions such as Australia have a 91– 92 % lifetime risk of melanoma, whereas those who live in less sunny regions such as the UK have a 58 % lifetime risk (Bishop et al. 2002). Although there are likely additional phenotypic, behavioral, and other environmental differences determining penetrance, these data suggest that ultraviolet radiation exposure influences lifetime penetrance. Therefore, practicing or failing to practice sun-protection behavior could potentially decrease or increase high-risk patients’ risk, respectively. Accordingly, individuals who undergo p16 testing are recommended to reduce their sun exposure and to engage in pre
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