Dispositional optimism and perceived risk interact to predict intentions to learn genome sequencing results.

Dispositional optimism and risk perceptions (single-event optimism) both assess a type of optimism, but are conceptually distinct and not highly correlated (e.g., Radcliffe & Klein, 2002). Risk perceptions may interact with dispositional optimism to influence health-related intentions, behaviors, and information seeking, although little research has examined interactions among multiple types of optimism (Klein & Zajac, 2009). We examined the interaction of dispositional optimism and risk perceptions in the context of deciding to receive genome sequencing feedback. Dispositional optimism is a personality trait indicating the degree to which individuals have positive expectations about their future (Carver & Scheier, 2002). Greater dispositional optimism is typically associated with beneficial health outcomes (Carver & Scheier, 2014; Nes & Segerstrom, 2006; Rasmussen, Scheier, & Greenhouse, 2009). These beneficial outcomes may occur because optimists exert more effort and are more persistent when striving toward goals and use more active than avoidant coping strategies (Aspinwall & Taylor, 1992; Carver & Scheier, 2014; Nes & Segerstrom, 2006; Taylor et al., 1992). Optimists also may be more receptive to threatening information (Aspinwall & Brunhart, 1996) and responsive to the utility and personal relevance of health information (Aspinwall, Richter, & Hoffman, 2001), suggesting that they may be more likely to seek out information to make informed decisions. People also can be optimistic, or have positive expectations, about a single event. In the context of health, these expectations can be measured by assessing perceived risk (Klein & Zajac, 2009). People can be said to display optimistic risk perceptions when they rate their risk of disease as being relatively low, regardless of how accurate their perceptions are. Perceived risk is a component of many health behavior theories (Rosenstock, 1990; Witte, 1992), and perceiving greater disease risk is posited to motivate behaviors intended to mitigate risk. However, in practice, risk perceptions are often only weakly or moderately associated with intentions and behavior (Brewer et al., 2007; McCaul, Branstetter, Schroeder, & Glasgow, 1996), although moderating factors may strengthen the association (Sheeran, Harris, & Epton, 2014). An important health behavior is opting to learn potentially threatening, health-relevant information such as genome sequencing results indicating disease risk. Genome sequencing is a rapidly emerging technology for early risk identification (Bick & Dimmock, 2011). Research is needed to determine how people make decisions about and respond to genome information (Berg, Khoury, & Evans, 2011; Collins, Green, Guttmacher, & Guyer, 2003). Just as greater perceived risk tends to promote greater health behaviors to reduce risk (albeit weakly); it also tends to promote health information seeking. This occurs because risk information is more likely to be health relevant and important when disease risk is high (Sweeny, Melnyk, Miller, & Shepperd, 2010; Wiebe & Black, 1997). However, because risk information conferring elevated risk is more likely to obligate unwanted action or to result in negative emotion, greater perceived risk can also be associated with avoiding health information (Persoskie, Ferrer, & Klein, 2014; Sweeny et al., 2010). That greater perceived risk promotes both information seeking and avoidance is consistent with evidence that perceived risk inconsistently predicts genetic testing uptake (Sweeny, Ghane, Legg, Huynh, & Andrews, 2014). We tested the interactive effects of dispositional optimism and perceived risk among adults who reported intentions to learn their actual genome sequencing results and to change their lifestyle and health behaviors in response. For participants with high perceived risk of learning negative information from their sequencing results, optimism may be necessary to promote willingness to learn information and to take action to mitigate risks. This effect may occur for two reasons: (1) Dispositional optimism prompts attention to the utility of information, such as when disease risk is high (Aspinwall et al., 2001); and (2) personal psychological resources can reduce information avoidance (Howell, Crosier, & Shepperd, 2014; Taber, Klein, Ferrer, Lewis, et al., 2014). Two studies have tested interactive effects of dispositional optimism and risk perceptions on health-related outcomes. Among dispositionally optimistic undergraduates, those with higher perceived comparative risk increased exercise more and retained relatively more information about coronary heart disease than those with lower perceived risk (Davidson & Prkachin, 1997), and when given false feedback indicating high risk for dental health problems, participants reported greater perceived credibility and importance of the feedback and dental hygiene information, respectively (Geers, Wellman, & Fowler, 2013). In both studies, perceived comparative risk was unassociated with outcomes for those low in dispositional optimism. Neither study examined the interaction of dispositional optimism with other types of risk perceptions. In the present study, we assessed three distinct types of risk perceptions. Absolute perceived risk is the subjective likelihood of developing disease, independent of context. Comparative perceived risk is the likelihood of developing disease compared to the likelihood of people with similar characteristics, such as gender and age. Experiential perceived risk (also known as “feelings of risk”) is the extent to which individuals feel at risk for disease (e.g., “I feel that I am vulnerable to cancer”) and is thought to be based on intuitive assessments and the experience of risk (Slovic, Peters, Finucane, & MacGregor, 2005; Weinstein et al., 2007). These different risk perception measures likely capture different constructs, as they are reported to be only moderately correlated (Dillard, Ferrer, Ubel, & Fagerlin, 2012; Lipkus, Klein, Skinner, & Rimer, 2005; Zajac, Klein, & McCaul, 2006). Comparative (Portnoy, Kaufman, Klein, Doyle, & de Groot, 2014) and experiential risk perceptions (Dillard et al., 2012; Janssen, Waters, van Osch, Lechner, & de Vries, 2014; Weinstein et al., 2007) are often more predictive of behavior than absolute risk. Because individuals attend greatly to comparative information (Suls & Wheeler, 2012), comparative risk perceptions may better reflect how individuals evaluate risk (Klein, 2003; Radcliffe & Klein, 2002). Experiential risk perceptions also may reflect how individuals evaluate risk because such perceptions encompass affect, which is a major influence on decision making (Loewenstein, Weber, Hsee, & Welch, 2001). Further, absolute risk perceptions may have lower predictive validity due to general difficulty interpreting numerical information (Nelson, Reyna, Fagerlin, Lipkus, & Peters, 2008). We tested several hypotheses. First, we predicted that greater perceived experiential risk would be more associated with intentions to learn genome information than absolute or comparative risk. Second, we predicted that greater dispositional optimism would be associated with greater intentions to learn genome information and to use this information to change lifestyle/health behaviors given optimists’ greater attention to threatening health information and employment of active coping strategies (Aspinwall & Brunhart, 1996; Aspinwall et al., 2001). Third, we expected that optimism and risk perceptions would interact to predict intentions to learn sequencing results—particularly for medically actionable disease—such that higher risk perceptions would be linked to greater intentions to receive results only for individuals high in dispositional optimism. We had no a priori predictions as to whether the three types of risk perceptions would interact differently with optimism to influence outcomes.