Like most public health issues, beliefs about perceptions of risk have changed over time (Rowsell et al., 2000). The precise definition of risk is contested, with risk being equated at one extreme with danger and hazard, and therefore, being seen as something that should be avoided, while at the other end, it is linked to personal development as a positive liberating experience (Alaszewski & Alaszewski, 2002).
Epidemiological studies have identified risk factors that are characteristics or behaviours that are thought to signal the likelihood of higher risk for particular conditions in populations. When making judgments about personal risks, people draw on scientific information and discourse, as well as propaganda touted by the media and popular opinion (Rowsell et al., 2000). ‘Objective’ definitions of risk are based on statistical inferences, especially of present and future morbidity, and the aim of risk communication is often seen as that of conveying appropriate statistical information in an intelligible form (Alaszewski & Alaszewski, 2002). Not surprisingly, judgements about risk are viewed as crucial factors in individuals’ perceptions of their own risk as well as decisions concerning health-damaging and health-promoting behaviours. As such, they are included in most theoretical models of health behaviour and play a fundamental role in many intervention programs and health education campaigns. The ability to judge risk is generally considered to be an essential element of decision-making competence (Millstein & Halpern-Felsher, 2002). Eliciting meaningful risk judgements requires an adequate description of the conditions under which the risks are being assessed. In the case of behaviour-related risks, this means making explicit linkages between the outcomes and the behaviour (Millstein &
Halpern-Felsher, 2002). However, research on people’s ‘subjective’ perceptions of risk implies that statistical information is generally poorly understood and may be neglected in favour of informal decision rules or ‘heuristics’ (Eiser et al., 1993; Kreuter & Victor, 1995). Kunreuther and Slovic (1996) suggest that in investigating public reactions to risk, social science research has indicated features of risk that technical assessment and scientific investigation does not capture well. These include the uncertainties involved with risk, the inequities in the distribution of risk exposure, and the tendency for exposure to risk to be less ‘acceptable’ if it is involuntary, uncontrollable or dreaded. Previous literature suggests that taking a voluntary risk is related to a sense of controllability and is therefore perceived as more acceptable (Rowsell et al., 2000).
Nezlek and Zebrowski (2001) purported that perceived risk was more accurately characterised as a set of specific risk factors (s factors) rather than as a generalised perception of risk (g factor). This assumption allowed for two possible types of models: one in which specific factors represented totally independent constructs, and another in which specific factors represented constructs that were meaningfully distinct but had common variance in the form of a second-order general factor (Nezlek & Zebrowski, 2001). To the degree that risk judgements are viewed as multidimensional and as having cognitive and affective components, both of these interpretations may have some validity (Millstein & Halpern-Felsher, 2002).
Alternatively, cultural theory has emphasised that individual risk perceptions are a product of the relational activities of social groups to which those people belong, and that risk should be looked at with an awareness of how risk functions for particular
groups or cultures (Rowsell et al., 2000). One implication of this is that there is a greater focus on individual responsibility for health and less on possible social/structural causes of disease (Rowsell et al., 2000). For example, in attempting to understand why individuals make what might be perceived as risky health choices, it is important to bear in mind that there are sometimes social risks associated with not taking health risks (Rowsell et al., 2000). The ability to define those who are ‘at risk’ implies that people can attempt to reduce their personal perceived risk by not qualifying for membership of the ‘dangerous’ group (Rowsell et al., 2000). According to Rowsell and colleagues (2000) by identifying features that increased risk, women could take measures that they felt reduced their personal risk. They were able to create a boundary between those who had problems and themselves, providing a sense of control by identifying risk-reducing strategies that the individual could take. These strategies provided a sense of control, distanced the risk personally and classed those people with problems as different (Rowsell et al., 2000).
Perceptions of risk have been shown to be higher among those who engage in risky behaviour (Millstein & Halpern-Felsher, 2002). Van der Velde and colleagues (1992) suggested that perceptions of risk or vulnerability were related directly to preventative health behaviour. While Rothemund, Paepke, and Flor (2001) supported their argument that higher perception of personal risk led to more early detection behaviour, Ratliff and associates (1999) stated that perceptions of personal risk appeared to be more of an assessment of actual behaviours rather than a predictor of self-preserving behaviours (Ratliff et al., 1999). Therefore they argued that recognition of risk alone was not likely to change behaviour.
Rothemund and colleagues (2001) further examined this phenomenon in relation to breast cancer and found that understanding perception of risk in the general population involved consideration of the following factors; their personal risk estimate; risk estimates for women with a family history of breast cancer; the relation between age and breast cancer; and other behavioural and demographic variables (Rothemund et al., 2001). Rothemund and colleagues (2001) reported that 48% of the women in their study overestimated their own lifetime risk of breast cancer, supporting the notion that perception of risk need not be accurate. Indeed accuracy was neither the only, nor the paramount need, facing individuals when generating estimates of personal risk (Rothemund et al., 2001; Rothman, Klein & Weinstein, 1996). They also stated that breast self-examination did not differ significantly with different risk estimates and that knowledge expansion in the form of genetic counselling did not seem to alter the participants’ understanding of probabilities. Finally they found that lifetime risk estimate was not significantly related to adherence to any of the early detection behaviours (Rothemund et al., 2001). Kreuter and Victor (1995) concurred stating that individual risk feedback did not alter patient's perceptions of their heart attack risk.
Moore and Rosenthal (1996) in their Australian study of university students argued that individuals judge their likelihood of experiencing health problems to be significantly lower than that of the average person. In a 1992 study they reported that their sample of 17-20 year olds viewed their risk of AIDS and STD’s as lower than that of an ‘average’ individual of their own age and sex, and that, although perception of risk related somewhat to actual risky behaviour, the relationship was moderate (Moore & Rosenthal, 1992). In their 1994 study of 477 university and college
students they found that perceptions of risk were closely related to the stigma associated with sexually transmitted diseases (Rosenthal & Moore, 1994). Moore and Rosenthal (1996) further examined perception of risk and argued that attitude toward an illness and knowledge about it has the potential to affect perception of illness risk. They went on to suggest that the belief that one is knowledgeable about an illness should increase the accuracy of assessment of one’s own perception of risk. They hypothesised that while it was likely that attitudes toward any illness would be negative, extremely negative attitudes were likely to distort individuals’ ability to conceptualise a particular illness in a realistic way. Further they suggested that the very thought of an illness may be so unpleasant that precautionary, health promoting behaviours are difficult to plan and sustain (Moore & Rosenthal, 1996).
Moore and Rosenthal (1996) provided validation that knowledge, attitudes and beliefs influence perception of risk. The notion that these factors do indeed influence perception of risk is a key component of this thesis. In addition to the influence of knowledge, attitudes and beliefs, factors such as knowledge of a sufferer (De Noouer et al., 2001; Millstein & Halpern-Felsher, 2002), perceived seriousness of the illness (Moore & Rosenthal, 1996; Raviv et al., 2000), stereotypical representations of sufferers (Goldstein & Rosselli, 2003; Moore & Rosenthal, 1996; Rosenthal & Moore, 1994; Rothman et al., 1996), and perceived control over the illness (Lyn, 1999; Moore & Rosenthal, 1996; Riechard & Peterson, 1998) also have the potential to influence perception of risk.