THE COMPLEXITY AND MULTIDIMENSIONALITY OF HEALTH RISK PERCEPTION: DISTORTIONS AND DETERMINANTS OF RISK PERCEPTION FOR VASCULAR AND ONCOLOGICAL HEALTH RISKS AND RISK FACTORS IN GERMANY

Purpose: High rates of mortality due to vascular and oncological diseases and concurrent increasing prevalence of modifiable risk factors (smoking, hypertension, diabetes mellitus type 2, hypercholesterolemia, overweight / obesity, physical inactivity, eating habits, alcohol consumption) call for better comprehension of health risk perception. The purpose of this study was to explore distortions between objective and subjective risk and to identify the underlying determinants.

Method: An online questionnaire was designed, measuring personal and general risk perception (1. intuitive risk perception: participants had to report the most important cause of death and risk factor, 2. risk ranking of various causes of death and risk factors), socio-demographic characteristics, health status, knowledge, lifestyle and personality. The objective general and personal mortality risk and population attributable risk rates were eruated from data of the German Federal Office of Statistics and calculated with individual data based on Framingham general CVD algorithm. Respondents were categorized into age and (low, moderate, high) risk groups. Thus, deviations between actual and perceived risk of major death causes and risk factors were compared age- and risk-specifically, providing a multifaceted analysis of health risk perception and its determinants.

Result: Overall, as to intuitional perception, mortality risk of traffic accidents was overestimated as were genetic predisposition and familial history, whereas vascular incidents were underestimated, but correctly ranked in the second part. The reasons given were uncontrollability, dreadfulness, exposure, experience, and probability. A significant deviation between objective and subjective risk was present in the age group from 40 upwards regarding cerebro- and cardiovascular causes of death. Though hypertension was correctly ranked, knowledge and ranking of modifiable lifestyle-related risk factors were deficitary. The phenomenon of optimistic bias was observed in all age groups. Best performance was present among people with either experience, exposure to severe diseases or risk factors, longtime healthy lifestyle, or elevated health knowledge.

Conclusion: A synopsis indicates that risk perception is a very complex and multidimensional construct which is influenced by various determinants to be addressed in everyday practice of general practitioners and internists dealing with target age groups. We suggest the importance of integrating individual-specific risk concepts and personalized approaches into primary prevention in order to increase accuracy of risk perception and contribute to effective health promotion, and further research on modifying and improving health perception.