Lay and expert conceptions of health risks of diabetes, CVD and kidney disease

Transcription

1 Lay and expert conceptions of health risks of diabetes, CVD and kidney disease Olga Damman Willemijn Pas Allard van der Beek Danielle Timmermans Department of Public and Occupational Health Quality of Care EMGO Institute for Health and Care Research

2 This presentation A short introduction about health checks and risk communication Our research project The results of part 1 of the project: lay and expert conceptions of diabetes, CVD and kidney disease Discussion

3 Communication about health risks Medische Informatie test jezelf (overzichtslijst) Bereken je risico op een hart- en vaatziekte

4 Your Disease Risk

5 Communication about health risks Difficulty to understand the message in health checks Health checks not very powerful in changing health behavior Explanations: - (Quantitative) estimation of the risk too difficult or vague - Too complex language - Inappropriate content in education materials Remember: people s time is limited and they get easily overwhelmed by information

6 Communication about health risk The mental models approach Communicate things that people need to know but do not know already Suit with existing lay conceptions and beliefs and correct these if necessary Morgan MG, Fischhoff B, Bostrom A, Atman CJ. Risk communication: A mental models approach. Ambridge University Press, 2002.

7 Communication about health risks Risk communication is not only about the quantitative estimation, but about the whole image. Mental model: Causes and risk factors Consequences Timeline Risk reduction strategies Relationship between these factors

8 Mental model Risk factors High blood pressure, too much food Diabetes Consequences Amputations, dialysis.. Size of the risk Vascular disease Timeline Very long time until vascular disease becomes noticeable Risk reducing activities Decreasing salts in my diet Heart disease Kidney disease

9 The research project Three parts (1) Assessing people s mental models of health risks of diabetes, CVD, and kidney disease (and the basic content of a health check) (2) Assessing the effect of presentation formats of the size of the risk (3) Investigating people s opinions and attitudes towards health checks in the occupational setting

10 The research project part 1 Descriptive qualitative approach Expert model: literature and interviews with 8 experts Mental model: in-depth interviews with: - construction workers (N=15) - people from the general public (N=25)

11 The research project part 1 Comparing the mental models to the expert model - Which elements from the expert model not (sufficiently) apparent in the mental models? - Which elements from the mental models not (sufficiently) apparent in expert model? - Which facts do lay people have sufficient knowledge of? - How is lay people s knowledge represented?

12 Findings expertmodel Achterliggende oorzaken / blootstelling aan schade Core Causes Sociale / omgevingsfactoren Veroudering Erfelijke aanleg Leefstijl Roken Lichamelijke inactiviteit Ongezonde voeding Alcoholgebruik (pos) Psychosociale factoren / stress Slaap/waakritme Grootte van het risico Fysiologische processen? Werking van vetzuren en hormonen Verstoorde stofwisseling Lipotoxiciteit Ontstekingsactiviteit Glycosilering eiwitten Endotheeldisfunctie Vasoconstrictie Atherosclerose Slagaderlaesies Verminderde nierfunctie Physiological processes Verhoogde waarden van biologische risicofactoren Hyperglycemie Glucoseintolerantie Hypertensie Dyslipidemie Overgewicht Abdominaal overgewicht Proteinurie Risicoreductie Stoppen met roken Leefstijl Medicatie Risk reduction Glucoseregulatie Gezonde voeding Afvallen Bloeddrukverlagers Bewegen Cholesterolverlagers De aandoeningen Diabetes HVZ Nierfalen Diseases

13 Findings lay mental models Superficial knowledge Indiscriminate beliefs: health and illness in general Performing enough physical activities is good because you have to be active in the current society in which everyone uses the car for everything Alcohol use has a negative effect in any case. Too much alcohol affects the liver, that s something I know for sure

14 Findings lay mental models No coherent but rather differentiated knowledge My mother-in law had a high blood pressure, so she was taking pills for that. And for about 10 years ago, it seemed to disappear. And then she suddenly got diabetes. So if these two things are related to each other, I don t know. Well I know they can treat diabetes.. But it can happen that you re amputated or that you die. I m not sure about the treatment for CVD. Well perhaps angioplasty or new veins.. And the kidneys.. You can miss one kidney, that s what they say. But if I would be happy with that, I don t know.

15 Findings lay mental models Heredity and lifestyle important but not represented as multifactorial Socio-economic context as risk factor Lifestyle: 1. unhealthy nutrition; 2. stress; 3. smoking Let s see, people getting a heart attack.. I think those are people that eat unhealthy. No I don t know how people develop a high blood pressure. Perhaps partly because of stress?

16 Findings lay mental models Physiological processes: some ideas but not very detailed If you eat healthy and you perform a little bit of physical activity, then the blood becomes warm and circulates well. That s healthy.

17 Findings lay mental models No clear link between the 3 diseases R: I think there is a relation between the 3 diseases. I: Why do you think that? R: Well, 1+1 = 2! But I m not sure if that s really true. I see them as separate diseases. How they could have a relation, I don t know. I question whether they are actually linked to each other..

18 The research project Formulating conclusions based on differences between expert model and lay mental models Final analyses: comparing subgroups of individuals Questionnaire mental models: quantitative data Questionnaire opinion and attitude towards health checks Experiment presentation formats of risk information Guidelines for risk communication in health checks

19 Discussion Sweet food Heredity Diabetes Stress High risk Amputation Kidney disease Dialysis Alcohol Liver Sociale / omgevingsfactoren Veroudering E rfelijke aan leg Werking van vetzur en en hormonen Verstoorde stofwisseling Lipotoxiciteit Ontstekingsact ivite it Roken Gezonde di Bewegen Afvallen Glucosereg ulatie Bloeddrukverlag ers Cholesterolverlage rs Leefs ti jl Biologische ri sico fac toren HVZ Diabetes Roken Lich am e lijke inactiviteit Ongezond e voeding Hyperglycemie Glucoseintoleran ti e Nierfalen Grootte van het risico

20 Discussion We should focus on the elements from the expert model that are not in the mental models (e.g. ageing as a core cause, multifactorial roots of the diseases, physiological processes, the relation between the 3 diseases, kidney disease) We should focus on the elements from the mental models that are not in the expert model (e.g. socioeconomic context, stress and alcohol as risk factors, health and illness in general)