Perceptions of risk in adults with a low or high risk profile of developing type 2 diabetes; a cross-sectional population-based study

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Abstract

Objective

To compare the perceived seriousness and risk of type 2 diabetes among low risk with high risk profile non-diabetic subjects and examine the relationship of perceived risk with multiple self-reported risk indicators.

Methods

A cross-sectional population-based study among 4435 low risk profile and 2607 high risk profile non-diabetic residents of the Hoorn region, participating in a stepwise type 2 diabetes screening study. Main outcome measures were perceived seriousness and risk of diabetes in subjects categorized (low vs. high risk profile) using the Symptom Risk Questionnaire.

Results

85.0% of the low risk and 81.2% of the high risk profile subjects perceived diabetes as a moderate to very serious disease. About half (43.0%) of all 7042 subjects reported that they do not know their risk of having diabetes. The mean perceived risk of having diabetes was slightly lower for the low risk compared with the high risk profile subjects (difference = 2.8%; 95% confidence interval [CI] = 1.8% to 3.8%; P < 0.001). This difference was mostly explained by having a parent or sibling with diabetes, frequent thirst and claudication (difference = 0.6%; 95% CI = −0.7% to 1.9%). Interestingly, perceived risk decreased with increasing age within both groups (P for trend < 0.001).

Conclusions

Both low risk and high risk profile subjects perceive diabetes as a serious disease. Even among those at high risk profile for type 2 diabetes, almost half appeared not to know their risk. Perceived risk of having diabetes was slightly lower for the low risk compared with the high risk profile subjects. Furthermore, perceived risk decreases with increasing age.

Practice implications

This study points to a greater need to effectively address people's (mis)perceptions, and how to raise the awareness and understanding of type 2 diabetes and its risk factors in the general population in order to influence early detection and healthy lifestyle changes.

Introduction

Type 2 diabetes is a common and serious disease with chronic complications, which constitutes a substantial burden for both the patient and the health care system [1]. Type 2 diabetes is characterised by an asymptomatic phase between the actual onset of diabetic hyperglycaemia and clinical diagnosis [2]. Many patients seem to be unaware of the health risk associated with type 2 diabetes. The risk of developing type 2 diabetes is associated with older age, obesity and physical inactivity [3]. In order to reduce diabetes-related morbidity and mortality, screening in a clinical setting of individuals at high risk has been promoted [4].

Diabetes prevention programmes have demonstrated that in persons at high risk, the incidence of type 2 diabetes can be reduced significantly by means of lifestyle changes [5], [6]. However, the reach of diabetes prevention programmes is limited by a lack of awareness among those at risk for type 2 diabetes [7], [8]. If people at risk of type 2 diabetes are to be encouraged to change their lifestyle, they need to acknowledge their susceptibility to the health risks and the severity of the disease [9].

Risk is generally conceived as consisting of two components: the probability and the severity of a disease or negative outcome. The concept of perceived risk and seriousness figures prominently into most general behavioural theories applied to health behaviour change, such as the theory of reasoned action [10], the theory of planned behaviour [11], and the health action process approach [12]. Similarly, the self-regulation model includes several constructs important to risk perception [13]. A meta-analysis showed consistent relationships between risk perceptions and behaviour, suggesting that that risk perceptions are rightly placed as core concepts in these health behaviour theories [14].

These health behaviour theories agree that a high perceived risk of harm should encourage people to take action to reduce their risk [15]. Although this implied positive relation between perceived risk and subsequent behaviour is observed in many empirical studies, it is often weaker than expected [16]. In addition, there is no agreement on how perceived risk should be assessed [14]. We also know that laypeople have difficulty in making risk estimates [17]. The scarce data available on risk perception regarding type 2 diabetes in the general population seem to suggest that people underestimate their risk [18], [19].

We previously reported that among screening-detected type 2 diabetes patients the seriousness of the disease was generally acknowledged, while the perceived risk of having type 2 diabetes was low, despite the presence of risk factors [20]. Yet, little is known about the perceived risk of diabetes in the presence of multiple diabetes risk factors. In this paper we focus on the risk perceptions and their relationship with multiple diabetes risk factors in a large sample of low and high risk profile non-diabetic subjects of a stepwise type 2 diabetes screening study. This is particularly relevant for the latter group, as at least 30% of that high risk group will develop type 2 diabetes within 6.4 years [21]. Therefore, the aims of the present study are to compare the perceived seriousness and risk of type 2 diabetes among low risk with high risk profile non-diabetic subjects and examine the relationship of perceived risk with multiple self-reported risk indicators.

Section snippets

Subjects and setting

Data were collected in subjects of a stepwise screening programme for type 2 diabetes conducted from November 1998 to May 2000 in a general Dutch population (aged 50–75 years) of the West-Friesland region. Details of the screening project and design were previously described by Spijkerman et al. [22]. Briefly, 11,679 people were approached for the screening project, and a total of 9169 (78%) responded. Of these 9169 subjects, 741 did not participate, 417 were excluded because they were

The study population

The total population was over 99% Caucasian (data not shown). By definition, high risk profile subjects were older, had a higher body mass index, included a higher proportion having a parent or sibling with diabetes, use of anti-hypertensive drugs, frequent thirst, pain during walking with need to slow down, shortness of breath and included a lower proportion using a bicycle for transportation compared with low risk subjects (Table 1).

Perceived seriousness

85.0% of the low risk and 81.2% of the high risk profile

Discussion

This is the first population-based study comparing the personal perceptions of risk for type 2 diabetes among persons with a low and high risk profile. Both groups acknowledge the seriousness of type 2 diabetes, while almost half of all subjects have no idea of their risk of having type 2 diabetes. In the present study we found that perceived risk of having diabetes was slightly lower for the low risk compared with the high risk profile subjects. Based on their risk profile we expected the

Acknowledgements

We thank the subjects for participating in the study. We also thank the staff and members of the Diabetes Research Centre Hoorn that collaborated in the study. The Health and Research and Development Council of The Netherlands financially supported this study; project number 22000009.

Duality of interest: The authors declare that there is no duality of interest.

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