Psychology Of Vulnerability Research Paper

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Virtually all major theories of health behavior are based on the assumption that people estimate their vulnerability or susceptibility to a disease and evaluate the costs and benefits of precautionary behavior before taking action. Research on the accuracy of perceived risk or susceptibility is summarized, followed by a discussion of the relation between perceived susceptibility and precautionary behavior. Methodological considerations about how to measure perceived susceptibility and how to investigate its role as a behavioral determinant will be discussed. Implications for health education practice will be briefly discussed.

1. The Role Of Vulnerability In Models Of Health Behavior

Vulnerability or perceived risk is generally conceived as consisting of two components: the likelihood and the severity of negative outcomes. Most of the prevailing models of health behavior assume that decisions about risk behaviors are based on conscious decisions in which perceived risks and benefits determine behavior.

The theory of reasoned action (Fishbein and Ajzen 1975) and the theory of planned Behavior (Ajzen 1991) are frequently used models of health behavior in which the probability and severity of consequences for people’s health of specific behavioral practices are assumed to be a prime determinant of attitudes toward precautionary behavior. These behavioral beliefs can also include risks for health and/or well-being.

The health belief model (HBM) is another frequently used framework to explain preventive health behavior (Janz and Becker 1984). The model aims to describe decisions about the costs and benefits of specific actions and distinguishes several factors that are assumed to determine the adoption of protective action. Among these are the perceived vulnerability to developing a specific health problem and the perceived severity of that problem. Precautionary behavior is assumed to be most likely when perceived severity and vulnerability are high, while the perceived benefits of precautionary behavior are substantial, and the costs of behavior change are low.

Weinstein’s (1988) precaution adoption process is also based on behavioral decision theory, and assumes a series of steps or stages preceding the adoption of preventive action to reduce the threat of negative consequences for people’s health. First, people have to realize that a specific risk exists. Second, they have to realize that the risk is significant and can affect people. Third, they have to realize that they are vulnerable to the risk. After these necessary requirements, behavioral change will be a function of the perceived severity of the consequences for health and the efficacy and costs of preventive behavior.

In protection motivation theory (Rippetoe and Rogers 1987) perceived vulnerability is also a major factor in the motivation to avoid risk. The theory combines perceived vulnerability to the negative event with appraisals of its severity and the efficacy of the recommended (preventive) action and self-efficacy. The latter factor refers to the ability to initiate and/or sustain a specific precautionary behavior.

Thus, most models of preventive health behavior incorporate the recognition of one’s own risk-status or vulnerability as an important condition for adopting behaviors that reduce these risks. The construct of vulnerability basically has the same meaning in all of the models, and it has been assessed with questions that seem more or less interchangeable. One implicit assumption of all these models is that people are able to adequately assess the risks associated with their behavior.

2. Accuracy Of Perceived Risk Vulnerability

There is a substantial amount of research showing that the estimation of risk tends to be a complex process that depends on factors such as the context in which the risk is presented, the way the risk is being described, and also on personal and cultural characteristics. Risks that are more cognitively ‘available’ due to personal experience or media coverage tend to be overestimated. Thus, estimates of the likelihood of risks such as contracting AIDS or being involved in an air crash tend to be too high, while estimates tend to be too low for more common and/or less sensational risks such as heart disease or being involved in a car accident. The magnitude of perceived risk is also affected by how the perceived probability of a negative outcome is measured. For instance verbal methods such as a scale ranging from 1 (very unlikely) to 7 (very likely) lead to different answers than numerical methods such as a percentage scale ranging from 0 to 100 percent. Verbal measures are better predictors of individual preferences than the more difficult numerical scores. Generally, people have a reasonable idea of the relative risks of various activities and behaviors, although their estimates of the magnitude of risks tend to be biased.

Most research on biases in perceived risk focuses on cognitive factors such as availability and tends to ignore motivational factors that may influence the perception of risk. Although people seem quite aware of the relative risk of specific activities or behaviors, things can change when this knowledge is applied to their own behavior. For instance, many smokers accept the association between smoking cigarettes and disease, but do not believe themselves to be personally at risk. Motivational explanations of this perceived invulnerability tend to focus on the need to reduce feelings of fear and anxiety. Support for the role of these mechanisms is provided by research showing more biased risk estimates in situations of increased threat .

In sum: Research shows that estimations of perceived risk tend to be biased, but these biases primarily concern the magnitude of risk; people seem to have a reasonable idea of the relative risk of various activities. This picture can change when dealing with risks associated with people’s own behavioral practices. Under conditions of threat motivational factors could come into play and result in an underestimation of risk.

3. Perceived Risk Or Vulnerability And Behavior

Weinstein (1984) argued that people seem able and willing to incorporate knowledge about their family history, personality, and physical or physiological attributes into their perceptions of risk or vulnerability, but seem much poorer at recognizing the relationships between their own actions and the risks they run. Considerable research effort has been directed to understand the relation between perceived risk or vulnerability and protective behavior. Harrison et al. (1992) conducted a meta-analysis of studies that examined the relation between the four major components of the HBM and various health behaviors. They reported a weighted mean effect for the relation between perceived risk or vulnerability and behavior (risk-reducing practices) in the small to medium range. Sheeran and Abraham (1996), in their review of more than 30 years of research on HBM, point at a number of limitations, and argue that more clarity is needed on the precise role of perceived vulnerability. For instance, it could well be that specific levels of perceived severity and vulnerability function as a threshold variable before perceived vulnerability has an impact on behavior. This could explain the sometimes weak relationship between perceived vulnerability and behavior.

Gerrard et al. (1996) investigated the relationship between perceived vulnerability to HIV and precautionary sexual behavior, and conclude that the often dramatic changes in sexual risk behavior of high-risk groups were only marginally related to beliefs about being at risk. Cross-sectional research suggests that people who engage in more risky behavior tend to be more aware of the increased likelihood of contracting HIV than people who tend to behave less riskily, but only modestly so.

4. Some Methodological Considerations

The assumption shared by many models of health behavior that preventive behavior is the result of the wish to reduce one’s risks has an explicit temporal order; that is, initial perceptions of risk are expected to influence subsequent behavior. This assumption not only implies that perceived risk or vulnerability influences future behavior, but also that it is shaped by prior behavior.

A lot of research relies on correlational data. Moreover, these correlations from cross-sectional studies are often interpreted as bearing upon the perceived risk–precautionary behavior hypothesis, while they actually provided information about the accuracy of risk perceptions. This is for instance the case if people engage in risky practices, claim their risk to be low, and intend to continue their risky behavior. In such a case risk perception is clearly inaccurate (see Weinstein and Nicolich 1993).

Another issue concerns the distinction between unconditional and conditional risk estimates. Unconditional risk estimates refer to the subjective likelihood that a negative consequence will occur, based on whatever factors individuals take into account (e.g., perceptions of control, the perceived efficacy of preventive actions). Conditional risk refers to the probability of adverse consequence for health if no preventive action is taken, or their probability if a specific (preventive) action is taken. A conditional risk estimate thus requires people to indicate their risk or vulnerability given their present behavioral practices, or changes in these practices.

Although most models of health behavior refer to conditional risk estimates, most research tends to rely on unconditional risk estimates (e.g., ‘How likely is it that you will get …’, followed by the health risk(s) under study). The major drawback of unconditional risk estimates is that it is unclear what set of factors people take into account when answering this general question. A conditional risk estimate is more likely to be related to behavioral intentions or expectations in a consistent and interpretable manner (van der Pligt 1998).

5. Conclusions And Future Directions Of Theory And Research

A number of biases affect the perception of risk and vulnerability. Cognitive availability has an effect on the perceived magnitude of risk, but generally people have a fairly accurate view of their relative risk. Motivational factors, such as the tendency to deny risks and/or avoid threatening information about risks, can also affect perceived vulnerability. Unfortunately, research findings concerning the impact of perceived risk on behavior are mixed. Generally, perceived risk is a modest predictor of preventive health behavior. Some argue that the hypothesis that perceived risk is a determinant of protective behavior should be rejected or at least thoroughly re-examined. This skepticism may be premature. The absence of a consistent empirical relationship between perceived risk and precautionary behavior seems partly related to shortcomings in the design of many studies investigating this relationship, and on the way perceived risk is measured. It could well be that at a certain point the status of ‘being at risk’ rather than the amount of risk becomes central in people’s minds. Generally, the perception of personal vulnerability to health risks seems a necessary requirement for people to consider behavioral change, but it is not sufficient actually to induce people to change risky practices.

Programs aiming to increase the prevalence of protective behavior should thus not only provide risk information. It seems essential to develop interventions that also focus on how to change behavior. Future research should help to design interventions that increase risk awareness (without being too threatening), and also help to induce and maintain precautionary behavior.

Bibliography:

  1. Ajzen I 1991 The theory of planned behavior. Organizational Behavior and Human Decision Processes 50: 179–211
  2. Fishbein M, Ajzen I 1975 Belief, Attitude, Intention, and Behavior: An Introduction to Theory and Research. AddisonWesley, Reading, MA
  3. Gerrard M, Gibbons F X, Bushman B J 1996 Relation between perceived vulnerability to HIV and precautionary sexual behavior. Psychological Bulletin 119: 390–409
  4. Harrison J A, Mullen P D, Green L W 1992 A meta-analysis of studies of the health belief model with adults. Health Education Research 7: 107–16
  5. Janz N, Becker M 1984 The health belief model: A decade later. Health Education Quarterly 11: 1–47
  6. Rippetoe P A, Rogers R W 1987 Effects of components of protection-motivation theory on adaptive and maladaptive coping with a health threat. Journal of Personality and Social Psychology 52: 596–604
  7. Sheeran P, Abraham C 1996 The health belief model. In: Conner M C, Norman P (eds.) Predicting Health Behavior. Open University Press, Buckingham, UK pp. 23–61
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  11. Weinstein N D, Nicolich M 1993 Correct and incorrect interpretations of correlations between risk perceptions and risk behaviors. Health Psychology 12: 235–45
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