Browsing by Subject "Risk perceptions"

Abstract

Problem: African Americans face a disparate risk for renal disease development secondary to type 2 diabetes (T2D), and African-American women have shown to be at the highest risk. Despite this, there is minimal research on African American's awareness of renal disease and existing renal disease risk perceptions, and none focused specifically on African-American women with T2D. Although the literature has shown that a portion of this disparate risk is due to modifiable social and cultural factors, there is still a significant amount of unexplained risk. Since past research has shown that risk perceptions can influence preventative behaviors, it is important to gain an in-depth understanding of renal disease beliefs and existing risk perceptions among high-risk African-American women with T2D. Once risk perceptions are better understood in this population, interventions can be developed to correct inaccurate beliefs and risk perceptions and aim to decrease renal disease risk.

Methods: Three different methods of analyses were employed in this dissertation, including: 1) a systematic review of the literature, 2) an exploratory, descriptive, qualitative study, and 3) a quantitative secondary analysis, including descriptive statistics, a cluster analysis and mixed modeling. The Common Sense Model guided all three studies and these three methods of evaluation helped us to gain a more complete understanding of renal disease risk perceptions in African Americans, particularly African-American women with T2D, and provided guidance for future intervention research in this population.

Conclusions: The findings of this dissertation illustrated there is a significant gap in the literature on African American's renal disease awareness and risk perceptions, yet the available research was used to guide the in-depth interviews with African-American women with T2D. Overall, African Americans underestimate their renal disease risk and lack an understanding of the disease, even in the presence of risk factors. African-American women, in particular, related renal disease directly to the end-stages of the disease, perceived a greater risk for other complications of diabetes, and exhibited significant fear related to their perceived consequences of the disease. This fear frequently initiated maladaptive coping mechanisms, which influenced risk perceptions negatively and hindered preventative behaviors. This study also found that health care providers rarely discussed the disease and often exhibited provider control. Therefore, these findings suggest an urgent need for clinical practice suggestions and intervention research aimed at correcting inaccurate risk perceptions. The secondary analysis findings showed that a culturally relevant intervention with coping skills training resulted in significant improvements in renal disease risk factors among high-risk African-American women with T2D; however, we cannot be sure which facets of the intervention or control care for equal attention may have influenced these outcomes, and renal disease beliefs and risk perceptions were not assessed in the parent study. Therefore, the knowledge gained from this dissertation can be used to guide intervention research that evaluates change over time in renal disease risk representations, risk perceptions, coping procedures and outcomes among participants at high-risk for renal disease.

Background: Swine Influenza (SI) not only increases the burden of disease in pigs worldwide, but also presents a serious challenge for public health, especially for China and the United States. Although swine influenza viruses (SIVs) are not generally transmitted from pigs to humans, sporadic human infection cases do occur and this phenomenon appears to be increasing in recent years. Additionally, there is mounting evidence that swine workers and residents who live near areas with a high density of pig farms are at more risk for being infected with SIVs than is the general public. Thus, to help them prevent future SIV infection in humans, there is a need to understand their current risk perception and their responses to precautionary methods. This study measures the risk perception among at-risk populations in rural areas in Hubei (China) and North Carolina (the U.S.A.) and examines the association between those risk perceptions and their responses to precautionary methods.

Methods: A cross-sectional, quantitative method study was conducted in four rural counties of Hubei province and one rural county of North Carolina. Four rural counties in Hubei were selected because many of residents are pig farmers with backyard-sized pig farms. One rural county in North Carolina was selected because it is a residential area with a high density of industrial hog operations (IHOs). A total of 67 face-to-face questionnaire interviews in Chinese were conducted among participants in Hubei counties, while 33 face-to-face questionnaire interviews in English or Spanish were conducted among participants in North Carolina. All participants completed the same questionnaire that assessed their risk perception of swine influenza virus infection and responses to precautionary behavior. The measure of risk perception in this study is focused upon perceived likelihood and susceptibility of SIVs infections.

Results: In terms of perceived likelihood of SIVs infection, only 23.9% of respondents in the Hubei study part thought SIVs infection among swine workers was likely or strongly likely to occur in China and 20.9% of them thought this was likely or strongly likely to occur in Hubei. Additionally, overall 27.3% of respondents in North Carolina study part thought SIVs infection among swine workers was likely or strongly likely to occur in the United States and 39.4% of them thought this was likely or strongly likely to occur in North Carolina. In terms of perceived personal susceptibility of SIVs infections, the majority of respondents (80.6%) in the Hubei study thought they were at low risk, but most respondents in North Carolina (66.7%) perceived themselves to be at moderate risk. Furthermore, results showed that 16.4% of respondents in Hubei and more than half (60.6%) of respondents in North Carolina took no precautionary methods after touching pigs. In addition, considering the larger sample size in the Hubei part of the study, we further conducted single and multiple regression analysis to see the determinants of risk perceptions as well as the association between risk perceptions and intensity of precautionary methods. Results showed that female respondents and younger respondents were more likely to have higher risk perceptions. In addition, people who had high levels of risk perceptions were also more likely to take more precautionary measures.

Conclusions: This study provided evidence for the following conclusions: 1) Most pig farmers in the rural Hubei study, despite had relatively low-risk perceptions, were still willing to use at least one precautionary method; and 2) Although participants in rural North Carolina had relatively high-risk perceptions, more than half of them still thought it was not necessary to take precautionary measures. In addition, further multiple regression analysis of data in the Hubei study also indicated that risk perceptions are significantly associated with gender and age, and the intensity of precautionary methods may be influenced by risk perceptions. These results carry important policy implications about the need to better educate at-risk populations about their risk of SIV infection and to promote appropriate precautionary methods for future disease prevention.