Responses to health risk information; Risk type, controllability and the role of the self

1. Responses to health risk information; Risk type, controllability and the role of the self L. Claassen1, L. Henneman1, H.C.W. de Vet1, T.M. Marteau2, D.R.M. Timmermans1 1 EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands2 Psychology & Genetics Research Group, King's College, London, United Kingdom.

2. Background Providing people with genetic risk information (based on family history and/or DNA testing) may induce preventive behaviour if a person beliefs that this behaviour can reduce the risk But: If a person assigns excessive causation to genes and considers personal attributes (including a genetic susceptibility) as fixed, he or she may be more likely to adopt a fatalistic attitude towards the risk

3. Malleability of personal attributes There are two fundamentally different perspectives on human nature (Dweck, 1999): • Entity theorists consider personal attributes as fixed over time and situations • Incremental theorists view personal attributes as malleable and understand themselves in needs, goals and states of mind Entity theorists may be more likely to regard a genetic susceptibility to a disease in a trait like fashion, as fixed and unchangeable

4. Aims of the study • Validation of a self-concept questionnaire, for the assessment of individual differences in the way people look at their personal attributes • To test if the amount of fatalism generated by (genetic) risk information varies with these individual differences and the type of information

5. Method I: Internal consistency, convergent and discriminant validity Participants: • University students (n=94) • Patients from a general practice and people visiting out-patients clinics (obstetrics and ophthalmology)(n=96) Measures: • 27-item self-concept questionnaire • Multi-dimensional Health Locus of Control - MHLC-(Wallston, 1976) • Self-esteem (Rosenberg, 1965) • Optimism (revised-LOT, Scheier & Carver,1994) • Neuroticism (NEO-FFI subscale, Costa & Mc Crae, 1992) • Depression (HADS-subscale, Zigmund & Snaith, 1983)

6. Self-concept questionnaire Malleability of personal attributes: • 10 items based on Kind of person Implicit Theories-self form (Dweck, 1999) Personal control beliefs: • 9 items selected from Locus of Control scale (Rotter, 1966) • 8 items selected from different generalized self-efficacy scales (Pearlin & Schooler, 1978, Sherer et al.,1982, Chen et al. 2001)

7. Results I Student sample (n=94) • After factor analyses, 3 factors (explaining 35.8% of total variance) emerged roughly corresponding with the original constructs (9 items were removed) • Malleablity of Self (MOS) - 7 items (α=0.83) • Self-Efficacy (SEff) - 8 items (α=0.81 • Locus Of Control (LOC) - 4 items (α=0.67) (1item in common with SEff) Patient sample (n=96) • The factor structure was confirmed • Reliability of the scales: MOS α=0.84, SEff α=0.78 and LOC α=0.58)

8. MHLC Depress. Self-Est. Neurot. Optim. Internal Physician Chance MOS -.188 -.085 .034 -.190* .027 -.150 .091 SEff .116 -.090 -.084 -.078 .458** -.369** .378** LOC .214* .106 .061 -.069 .362** -.061 .114 Results I: correlations • MOS is not correlated with SEff and LOC • SEff en LOC are moderately correlated (r=.551, p=000)) * correlation is significant at the 0.05 level (two tailed) ** correlation is significant at the 0.01 level (two tailed)

9. Method II II: Predictive validity Participants: University students (n=94) Materials: 3 Scenario’s depicting different types of (genetic) risk for cardiovascular heart disease (CVD) - in counter balanced order Measures: • MOS • Perceived control over cholesterol levels and CVD risk (an index of fatalistic responses) in each scenario –6 items (0.80 < α < 0.85)

10. Scenario Family History and DNA-information scenario: Try to imagine yourself in the following situation: A few years ago your uncle (a brother of your mother) died of a heart attack. A DNA-test revealed he had Familial Hypercholesterolemia (a genetic condition causing an increased risk for CVD). This FH-mutation was also detected in your mother. Consequently cholesterol levels in her blood were too high. Her physician prescribed cholesterol lowering drugs and advised her to change her lifestyle. A DNA-test showed you also carry the FH-mutation in addition your cholesterol levels are too high.

11. “Malleability of Self” Figure 1: “Malleability of Self”(mean item-score) 0 1 2 3 4 5 6 • Participants were divided in a group with a static self-concept; mean item-score < 3,25 (n=31) and a group with a dynamic self-concept; mean item-score >4 (n=32), the middle group was excluded in subsequent analyses.

12. Results II Figure 2: Type of information concerning CVD risk, “Malleablity of Self” and perceived control over cholesterol levels and CVD risk (n=63)

13. Conclusions • The “Malleability of self” scale is a valid instrument for the assessment of individual differences in the way people look at their personal attributes (static or dynamic) • Providing people at risk for a disease, especially those with a static self-concept, with (additional) genetic risk information may induce them to adopt a more fatalistic attitude towards the risk

14. Acknowledgements Prof. M.G.A.AM. Nijpels, MD, PhD Prof. G.H.M.B. van Rens, MD, PHD M.A.H. Engels, MD