Cognitions Pertaining to Illness

Cognitions Pertaining to Illness

The role of risk estimates in preventive behaviour

The hypothesis that was formulated by Students X and Y can best be confirmed or refuted, at least generally, by asking the Likert-scaled questions, "How likely do you think it is that you will develop liver disease in future?" At the same time as they ask the question, "How much alcohol do you drink in the average week?" The superiority of this single approach to posing both questions to the respondents relates primarily to the efficiency of the survey administration and the reliability of the results that emerge. A delay of 4 months between posing these survey questions to all of their subjects would introduce a number of significant constraints to this study that could potentially adversely affect the ability of these researchers to accurately evaluate any responses they received.

First and foremost, 4 months is a prohibitively long time and it is reasonable to suggest that many of the same respondents may not be available for the subsequent survey administration, making Student X's recommendation to ask both questions at the same time a legitimate and viable alternative. Second, 4 months is an arbitrary period of time that does not appear to be based on any corresponding supporting rationale, only the fact that it apparently sounded like a reasonable amount of time to allow to elapse to Student Y.

It is important to note, though, that the recommendation by Student Y to ask the two questions 4 months apart, though, may have some merit as well. For instance, by introducing a lengthy delay between asking these questions, respondents may help provide additional insights concerning the relationship between the respondents' beliefs about acquiring a disease and one of the factors that can precipitate it.

A superior solution would be to administer the survey with both questions to one-half of the respondents at the same time and introduce the 4-month delay in asking the second question for the other one-half and compare the results (taking into account any subjects lost in the delayed administration). Any statistically significant differences in the responses may point to cognitive processes that occurred during the 4-month interval concerning the respondents' perceptions about how much they drank and its potential connection to the disease they had been asked about initially.

Respondents asked the first question only and then provided with a 4-month period in which to think about it might well modify their drinking behaviors, even subconsciously, to the extent that they will be able to truthfully answer that they are drinking less to conform to their original speculation about the likelihood of their developing liver disease. By contrast, the respondents who are compelled to answer both questions at the same time might try to diminish the perceived risk of developing liver, at least from an emotional point-of-view, by falsifying or hedging their answers to indicate they drink less alcohol on a regular basis than they do in reality. Therefore, perhaps the superior alternative to all of the foregoing research approaches would be to ask the respondents both questions at the same time and then survey them again later (this delay could be 4 months or more) with both questions to determine if completing the first survey and learning about the potential for their behaviors to cause liver disease affected their drinking behaviors in substantive ways.

Part B: Variables affecting judgments of disease seriousness

Main strengths of the study

The researchers had a respectable sample size (n=60) of subjects (the researchers eliminated four respondents from the data analysis due to the weaknesses or limitations described below) and they developed an innovative approach to assessing perceived prevalence of a disease by manipulating the respondents' personal relevance.

Weaknesses or limitations of the study

The major weakness of this study was that the researchers were entirely duplicitous from outset in ways that may have endangered the well-being of their subjects. For example, during their recruitment of subjects, they administered a hypochondriasis scale test without their knowledge or permission, and depending on the results of this test, subjects were invited to participate in a fictitious study about a fictitious disease in a deceptive health care-appearing setting in return for an undisclosed amount of money. More importantly, the researchers were not health care professionals but still based their eligibility criteria on their lay interpretation of the results that emerged from this telephonic administration of the hypochondriasis scale test to exclude diabetic and hypoglycemic individuals. The potential for error here was high and the implications of a mistake could have been severe. In addition, the saliva test used by the researchers was also a fake and provided consistent results irrespective of the health care status of the individual respondents.

More significantly, despite the researchers assurances that none of the subjects appeared to experience any distress from being falsely advised about their test results, it is reasonable to conclude that at least some of these young people experienced significant distress upon learning they suffered from a condition that might have serious health care implications, even if just for a little while. Indeed, it is entirely possible that some of the subjects, preoccupied with their newfound diseased state, might not have listened to or understood the information provided in the debriefing and may still believe that they suffer from this deficiency and are at risk of developing pancreatic disorders, including diabetes. There was no follow-up indicated to ensure that the subjects fully understood the nature of this study. Finally, there was no institutional review board approval mentioned by the researchers.

Suggested possible explanations of the findings

The finding that the subjects in the high-prevalence conditions estimated that a greater percentage of the college-age population suffers from the fictitious deficiency described to the subjects by the researchers is explainable by the fact that misery loves company and no one wants to feel like an isolated leper in a population of otherwise-healthy people. Likewise, the finding that the subjects in the low-prevalence group rated the fictitious condition as being more serious compared to those in the low-prevalence group is explainable by the fact that the former were comfortably excluded from the deficiency and therefore did not have a personal investment in the condition, while the latter did have a personal investment in the condition and therefore elected to view it as less serious as a coping mechanism.