The Relationship of Perceived Risk and Biases in Perceived Risk to Fracture Prevention Behavior in Older Women
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ORIGINAL ARTICLE
The Relationship of Perceived Risk and Biases in Perceived Risk to Fracture Prevention Behavior in Older Women Salene M. W. Jones, PhD 1 & Nancy M. Gell, PhD 1 & Joshua A. Roth, PhD 1 & Delia Scholes, PhD 1 & Andrea Z. LaCroix, PhD 1,2
# The Society of Behavioral Medicine 2015
Abstract Background A bias in perceived risk for health outcomes, including fracture, exists. Purpose We compared perceived risk and biases in perceived risk for fracture to fracture preventive behavior. Methods Women over age 55 (n=2874) completed a survey five times over 5 years, and data was pulled from the medical record. Perceived risk was measured by asking women to rate their risk of fracture compared to similar women. Actual risk was measured using FRAX score. Bias was measured using an interaction between perceived and actual risk. Results Higher perceived risk was related to lower quality of life and self-reported health, more medication and calcium use, increased bone density scan use, and less walking. Bias was only associated with less medication use. Neither perceived risk nor bias predicted medication adherence. Conclusions Perceived risk, but not bias, may predict different fracture prevention behaviors. Clinicians may need to base interventions on risk perceptions.
Keywords Optimism bias . Unrealistic optimism . Risk perception . Osteoporosis
Electronic supplementary material The online version of this article (doi:10.1007/s12160-015-9702-7) contains supplementary material, which is available to authorized users. * Salene M. W. Jones, PhD [email protected] 1
Group Health Research Institute, 1730 Minor Ave #1600, Seattle, WA 98101, USA
2
University of California, San Diego, 9500 Gilman Drive #0725, La Jolla, CA 92093-0725, USA
Osteoporosis is characterized by low bone mineral density resulting in increased risk for fracture [1]. Osteoporosis is a major cause of morbidity and mortality in postmenopausal women and poses a potential threat to women’s quality of life, independence, and mental well-being [2]. While bone formation occurs primarily during childhood, preventive behaviors during adulthood such as weight-bearing exercise, calcium supplementation, and medication adherence are known to help mitigate bone density loss [3, 4]. Identifying which women are less or more likely to engage in these behaviors and how perceived fracture risk relates to these behaviors can help clinicians target specific interventions to the women who might benefit most. The role of perceived risk, or a person’s belief in the likelihood of an event, to health behaviors has been well studied, although few studies have examined fracture prevention. Perceived risk can be either absolute (what is the actual chance of an event) or comparative/relative (what is the risk compared to similar others; [5]) and is inherently subjective, being an attitudinal construct. Perceived risk is key in many theories of health behavior change. One theory, the behavior motivation hypothesis, posits that increased perceived risk motivates people to c
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