1. Care and PreventionResearch Programme > Responses to health risk information; Risk type, controllability and the role of the self L. Claassen 1, L. Henneman 1, H.C.W. de Vet 1, T.M. Marteau 2, D.R.M. Timmermans 1 1 EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands 2 Psychology & Genetics Research Group, King's College, London, United Kingdom.

2. Background Providing people with genetic risk information (based on family history and/or DNA testing) may induce preventive behaviour if a person beliefs that this behaviour can reduce the risk But: If a person assigns excessive causation to genes and considers personal attributes (including a genetic susceptibility) as fixed, he or she may be more likely to adopt a fatalistic attitude towards the risk

3. Malleability of personal attributes There are two fundamentally different perspectives on human nature (Dweck, 1999): –Entity theorists consider personal attributes as fixed over time and situations –Incremental theorists view personal attributes as malleable and understand themselves in needs, goals and states of mind Entity theorists may be more likely to regard a genetic susceptibility to a disease in a trait like fashion, as fixed and unchangeable

4. Aims of the study 1.Validation of a self-concept questionnaire, for the assessment of individual differences in the way people look at their personal attributes 2.To test if the amount of fatalism generated by (genetic) risk information varies with these individual differences and the type of information

5. Method I: Internal consistency, convergent and discriminant validity Participants: University students (n=94) Patients from a general practice and people visiting out-patients clinics (obstetrics and ophthalmology)(n=96) Measures: 27-item self-concept questionnaire Multi-dimensional Health Locus of Control - MHLC-(Wallston, 1976) Self-esteem (Rosenberg, 1965) Optimism (revised-LOT, Scheier & Carver,1994) Neuroticism (NEO-FFI subscale, Costa & Mc Crae, 1992) Depression (HADS-subscale, Zigmund & Snaith, 1983)

6. Self-concept questionnaire Malleability of personal attributes: 10 items based on Kind of person Implicit Theories-self form (Dweck, 1999) Personal control beliefs: 9 items selected from Locus of Control scale (Rotter, 1966) 8 items selected from different generalized self-efficacy scales (Pearlin & Schooler, 1978, Sherer et al.,1982, Chen et al. 2001)

7. Results I Student sample (n=94) After factor analyses, 3 factors (explaining 35.8% of total variance) emerged roughly corresponding with the original constructs (9 items were removed) Malleablity of Self (MOS) - 7 items (α=0.83) Self-Efficacy (SEff) - 8 items (α=0.81 Locus Of Control (LOC) - 4 items (α=0.67) (1item in common with SEff) Patient sample (n=96) The factor structure was confirmed Reliability of the scales: MOS α=0.84, SEff α=0.78 and LOC α=0.58)

8. Results I: correlations MHLC Depress. Self-Est. Neurot. Optim. InternalPhysicianChance MOS-.188-.085.034-.190*.027-.150.091 SEff.116-.090-.084-.078.458**-.369**.378** LOC.214*.106.061-.069.362**-.061.114 * correlation is significant at the 0.05 level (two tailed) ** correlation is significant at the 0.01 level (two tailed)  MOS is not correlated with SEff and LOC  SEff en LOC are moderately correlated (r=.551, p=000))

9. Method II II: Predictive validity Participants: University students (n=94) Materials: 3 Scenario’s depicting different types of (genetic) risk for cardiovascular heart disease (CVD) - in counter balanced order Measures: MOS Perceived control over cholesterol levels and CVD risk (an index of fatalistic responses) in each scenario –6 items (0.80 < α < 0.85)

10. Scenario Family History and DNA-information scenario: Try to imagine yourself in the following situation: A few years ago your uncle (a brother of your mother) died of a heart attack. A DNA-test revealed he had Familial Hypercholesterolemia (a genetic condition causing an increased risk for CVD). This FH-mutation was also detected in your mother. Consequently cholesterol levels in her blood were too high. Her physician prescribed cholesterol lowering drugs and advised her to change her lifestyle. A DNA-test showed you also carry the FH-mutation in addition your cholesterol levels are too high.

11. “Malleability of Self” Figure 1: “Malleability of Self” (mean item-score) 123 45 6 0 Participants were divided in a group with a static self-concept; mean item-score 4 (n=32), the middle group was excluded in subsequent analyses.

12. Results II Figure 2: Type of information concerning CVD risk, “Malleablity of Self” and perceived control over cholesterol levels and CVD risk (n=63)

13. Conclusions 1.The “Malleability of self” scale is a valid instrument for the assessment of individual differences in the way people look at their personal attributes (static or dynamic) 2.Providing people at risk for a disease, especially those with a static self-concept, with (additional) genetic risk information may induce them to adopt a more fatalistic attitude towards the risk

14. Acknowledgements Prof. M.G.A.AM. Nijpels, MD, PhD Prof. G.H.M.B. van Rens, MD, PHD M.A.H. Engels, MD