Eliciting Risk Perceptions: Does Conditional Question Wording Have a Downside?

BACKGROUND: To assess the impact of risk perceptions on prevention efforts or behavior change, best practices involve conditional risk measures, which ask people to estimate their risk contingent on a course of action (e.g., "if not vaccinated"). PURPOSE: To determine whether the use of conditional wording-and its drawing of attention to one specific contingency-has an important downside that could lead researchers to overestimate the true relationship between perceptions of risk and intended prevention behavior. METHODS: In an online experiment, US participants from Amazon's MTurk (N = 750) were presented with information about an unfamiliar fungal disease and then randomly assigned among 3 conditions. In all conditions, participants were asked to estimate their risk for the disease (i.e., subjective likelihood) and to decide whether they would get vaccinated. In 2 conditional-wording conditions (1 of which involved a delayed decision), participants were asked about their risk if they did not get vaccinated. For an unconditional/benchmark condition, this conditional was not explicitly stated but was still formally applicable because participants had not yet been informed that a vaccine was even available for this disease. RESULTS: When people gave risk estimates to a conditionally worded risk question after making a decision, the observed relationship between perceived risk and prevention decisions was inflated (relative to in the unconditional/benchmark condition). CONCLUSIONS: The use of conditionals in risk questions can lead to overestimates of the impact of perceived risk on prevention decisions but not necessarily to a degree that should call for their omission. HIGHLIGHTS: Conditional wording, which is commonly recommended for eliciting risk perceptions, has a potential downside.It can produce overestimates of the true relationship between perceived risk and prevention behavior, as established in the current work.Though concerning, the biasing effect of conditional wording was small-relative to the measurement benefits that conditioning usually provides-and should not deter researchers from conditioning risk perceptions.More research is needed to determine when the biasing impact of conditional wording is strongest.

Which measures of perceived vulnerability predict protective intentions-and when?

Assessing perceived vulnerability to a health threat is essential to understanding how people conceptualize their risk, and to predicting how likely they are to engage in protective behaviors. However, there is limited consensus about which of many measures of perceived vulnerability predict behavior best. We tested whether the ability of different measures to predict protective intentions varies as a function of the type of information people learn about their risk. Online participants (N = 909) read information about a novel respiratory disease before answering measures of perceived vulnerability and vaccination intentions. Type-of-risk information was varied across three between-participant groups. Participants learned either: (1) only information about their comparative standing on the primary risk factors (comparative-only), (2) their comparative standing as well as the base-rate of the disease in the population (+ base-rate), or (3) their comparative standing as well as more specific estimates of their absolute risk (+ absolute-chart). Experiential and affective measures of perceived vulnerability predicted protective intentions well regardless of how participants learned about their risk, while the predictive ability of deliberative numeric and comparative measures varied based on the type of risk information provided. These results broaden the generalizability of key prior findings (i.e., some prior findings about which measures predict best may apply no matter how people learn about their risk), but the results also reveal boundary conditions and critical points of distinction for determining how to best assess perceived vulnerability.

Effect of Presenting Survival Information as Text or Pictograph During Periviable Birth Counseling: A Randomized, Controlled Trial.

OBJECTIVES: To examine whether presenting a 30% or a 60% chance of survival in different survival information formats would influence hypothetical periviable birth treatment choice and whether treatment choice would be associated with participants' recall or their intuitive beliefs about the chances of survival. STUDY DESIGN: An internet sample of women (n = 1052) were randomized to view a vignette with either a 30% or 60% chance of survival with intensive care during the periviable period. Participants were randomized to survival information presented as text-only, in a static pictograph, or in an iterative pictograph. Participants chose intensive care or palliative care and reported their recall of the chance of survival and their intuitive beliefs about their infant's chance of survival. RESULTS: There was no difference in treatment choice by presentation with a 30% vs 60% chance of survival (P = .48), by survival information format (P = .80), or their interaction (P = .18). However, participants' intuitive beliefs about chance of survival significantly predicted treatment choice (P < .001) and had the most explanatory power of any participant characteristic. Intuitive beliefs were optimistic and did not differ by presentation of a 30% or 60% chance of survival (P = .65), even among those with accurate recall of the chance of survival (P = .09). CONCLUSIONS: Physicians should recognize that parents may use more than outcome data to make treatment choices and in forming their own, often-optimistic, intuitive beliefs about their infant's chance of survival. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04859114.

People express more bias in their predictions than in their likelihood judgments.

The desirability bias refers to when people's expectations about an uncertain event are biased by outcome preferences. Prior work has provided limited evidence that the magnitude of this motivated bias depends on (is moderated by) how expectations are solicited-as discrete outcome predictions or as likelihood judgments expressed on more continuous scales. The present studies extended the generalizability and understanding of the moderating process. The authors proposed that solicitations of predictions and likelihood judgments have different connotations that ultimately affect how much bias is expressed; this varies from a prior account that attributed the moderation effect to response scale differences (dichotomous vs. continuous). Study 1 confirmed the connotation difference, with predictions being viewed as more affording of hunches. Studies 2-4 directly tested the moderation effect, and unlike prior work focusing on expectations for purely stochastic events, the present studies involved more naturalistic events for which likelihood information was not supplied or directly knowable. Before viewing scenes from a basketball game (Study 2) or an endurance race (Studies 3 and 4), participants were led to prefer one contestant over another. After viewing most of the closely fought contest, they made either a prediction or likelihood judgment about the outcome. Participants' tendency to forecast their preferred contestant to win was significantly stronger among those making predictions rather than likelihood judgments. In support of the proposed account, this effect persisted even when both types of solicitations offered only dichotomous response options. Broader implications for measuring and understanding people's expectations or forecasts are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The desirability bias in predictions under aleatory and epistemic uncertainty.

The desirability bias (or wishful thinking effect) refers to when a person's desire regarding an event's occurrence has an unwarranted, optimistic influence on expectations about that event. Past experimental tests of this effect have been dominated by paradigms in which uncertainty about the target event is purely stochastic-i.e., involving only aleatory uncertainty. In six studies, we detected desirability biases using two new paradigms in which people made predictions about events for which their uncertainty was both aleatory and epistemic. We tested and meta-analyzed the impact of two potential moderators: the strength of evidence and the level of stochasticity. In support of the first moderator hypothesis, desirability biases were larger when people were making predictions about events for which the evidence for the possible outcomes was of similar strength (vs. not of similar strength). Regarding the second moderator hypothesis, the overall results did not support the notion that the desirability bias would be larger when the target event was higher vs. lower in stochasticity, although there was some significant evidence for moderation in one of the two paradigms. The findings broaden the generalizability of the desirability bias in predictions, yet they also reveal boundaries to an account of how stochasticity might provide affordances for optimistically biased predictions.

Do People Prescribe Optimism, Overoptimism, or Neither?

Past work has suggested that people prescribe optimism-believing it is better to be optimistic, instead of accurate or pessimistic, about uncertain future events. Here, we identified and addressed an important ambiguity about whether those findings reflect an endorsement of biased beliefs-that is, whether people prescribe likelihood estimates that reflect overoptimism. In three studies, participants (N = 663 U.S. university students) read scenarios about protagonists facing uncertain events with a desired outcome. Results replicated prescriptions of optimism when we used the same solicitations as in past work. However, we found quite different prescriptions when using alternative solicitations that asked about potential bias in likelihood estimations and that did not involve vague terms such as "optimistic." Participants generally prescribed being optimistic, feeling optimistic, and even thinking optimistically about the events, but they did not prescribe overestimating the likelihood of those events.

Context dependency in risky decision making: Is there a description-experience gap?

When making decisions involving risk, people may learn about the risk from descriptions or from experience. The description-experience gap refers to the difference in decision patterns driven by this discrepancy in learning format. Across two experiments, we investigated whether learning from description versus experience differentially affects the direction and the magnitude of a context effect in risky decision making. In Study 1 and 2, a computerized game called the Decisions about Risk Task (DART) was used to measure people's risk-taking tendencies toward hazard stimuli that exploded probabilistically. The rate at which a context hazard caused harm was manipulated, while the rate at which a focal hazard caused harm was held constant. The format by which this information was learned was also manipulated; it was learned primarily by experience or by description. The results revealed that participants' behavior toward the focal hazard varied depending on what they had learned about the context hazard. Specifically, there were contrast effects in which participants were more likely to choose a risky behavior toward the focal hazard when the harm rate posed by the context hazard was high rather than low. Critically, these contrast effects were of similar strength irrespective of whether the risk information was learned from experience or description. Participants' verbal assessments of risk likelihood also showed contrast effects, irrespective of learning format. Although risk information about a context hazard in DART does nothing to affect the objective expected value of risky versus safe behaviors toward focal hazards, it did affect participants' perceptions and behaviors-regardless of whether the information was learned from description or experience. Our findings suggest that context has a broad-based role in how people assess and make decisions about hazards.

Factors Influencing Judgments to Consult Prescription Monitoring Programs: A Factorial Survey Experiment.

BACKGROUND: Prescription monitoring programs (PMPs) can provide health care professionals with valuable information. However, few studies have explored providers' decision making for accessing PMPs. AIMS: This study aimed to identify provider characteristics and situational factors most influencing perceived importance of consulting the PMP for patients in a simulated context. DESIGN: The study used a cross-sectional factorial survey. SETTINGS: The survey was administered electronically. PARTICIPANTS/SUBJECTS: Community pharmacists, advanced practice registered nurses (APRNs), and physicians in Iowa. METHODS: Participants were recruited by mail which included a link to the online survey. The survey consisted of demographic questions, eight randomly generated vignettes, and one ranked item. The vignettes described a hypothetical prescription using eight experimental variables whose levels were randomly varied. Respondents evaluated each vignette for importance to access the PMP. Analyses used linear mixed-effects models in R (Version 3.5.0). RESULTS: A total of 138 responses were available for multilevel analysis. Women, physicians, and APRNs rated it more important to consult the PMP for a given prescription compared with men and pharmacists. Accessing a PMP was perceived as more important with cash payments, quantity dispensed, suspicion for misuse, hydromorphone and oxycodone prescriptions, and headache. Advancing age, postoperative pain, and anxiety or sleep indications were associated with less importance. CONCLUSIONS: Age, indication for prescribing, misuse, and payment mode each independently had greater importance to providers in accessing the PMP. This was the first study to isolate the influence of different controlled substances on how important it was to consult the PMP.

Measuring Cigarette Smoking Risk Perceptions.

Risk perception is an important construct in many health behavior theories. Smoking risk perceptions are thoughts and feelings about the harms associated with cigarette smoking. Wide variation in the terminology, definition, and assessment of this construct makes it difficult to draw conclusions about the associations of risk perceptions with smoking behaviors. To understand optimal methods of assessing adults' cigarette smoking risk perceptions (among both smokers and nonsmokers), we reviewed best practices from the tobacco control literature, and where gaps were identified, we looked more broadly to the research on risk perceptions in other health domains. Based on this review, we suggest assessments of risk perceptions (1) about multiple smoking-related health harms, (2) about harms over a specific timeframe, and (3) for the person affected by the harm. For the measurement of perceived likelihood in particular (ie, the perceived chance of harm from smoking based largely on deliberative thought), we suggest including (4) unconditional and conditional items (stipulating smoking behavior) and (5) absolute and comparative items and including (6) comparisons to specific populations through (7) direct and indirect assessments. We also suggest including (8) experiential (ostensibly automatic, somatic perceptions of vulnerability to a harm) and affective (emotional reactions to a potential harm) risk perception items. We also offer suggestions for (9) response options and (10) the assessment of risk perception at multiple time points. Researchers can use this resource to inform the selection, use, and future development of smoking risk perception measures. IMPLICATIONS: Incorporating the measurement suggestions for cigarette smoking risk perceptions that are presented will help researchers select items most appropriate for their research questions and will contribute to greater consistency in the assessment of smoking risk perceptions among adults.

The unintended impact of smoking-risk information on concerns about radon: A randomized controlled trial.

OBJECTIVE: Health communications are often viewed by people with varying levels of risk. This project examined, in the context of radon risk messages, whether information relevant to high-risk individuals can have an unintended influence on lower-risk individuals. Two studies assessed whether information about lung cancer risk from smoking reduced concerns about lung cancer risk from radon among nonsmokers. METHOD: American nonsmokers viewed radon messages that varied in what they communicated about smoking's effect on lung cancer risk. Study 1 used a 4-arm factorial, randomized, controlled design in which smoking information was included or excluded from messages assembled from 2 existing radon pamphlets. Study 2 used a 3-arm parallel, randomized, controlled design in which a new radon message excluded smoking information, described smoking as a lung cancer risk, or also described smoking's synergistic effect with radon. RESULTS: In Study 1, the inclusion of smoking information reduced nonsmokers' (n = 462) concern-related reactions to possible radon exposure. In Study 2, nonsmokers' (n = 583) concern-related reactions were reduced in both smoking-information conditions; intentions to test their home for radon and perceived importance of testing were reduced in the synergistic condition. CONCLUSION: People reading health-risk information contextualize their risk relative to the risk of others. For people at midlevel risk, concern and related reactions prompted by a health message may be dampened when the message includes information about others who are more at risk. In the case of radon and smoking risks, the inclusion of smoking information can reduce the impact that radon messages have on nonsmokers. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Sources of bias in peoples' social-comparative estimates of food consumption.

Understanding how healthfully people think they eat compared to others has implications for their motivation to engage in dietary change and the adoption of health recommendations. Our goal was to investigate the scope, sources, and measurements of bias in comparative food consumption beliefs. Across 4 experiments, participants made direct comparisons of how their consumption compared to their peers' consumption and/or estimated their personal consumption of various foods/nutrients and the consumption by peers, allowing the measurement of indirect comparisons. Critically, the healthiness and commonness of the foods varied. When the commonness and healthiness of foods both varied, indirect comparative estimates were more affected by the healthiness of the food, suggesting a role for self-serving motivations, while direct comparisons were more affected by the commonness of the food, suggesting egocentrism as a nonmotivated source of comparative bias. When commonness did not vary, the healthiness of the foods impacted both direct and indirect comparisons, with a greater influence on indirect comparisons. These results suggest that both motivated and nonmotivated sources of bias should be taken into account when creating interventions aimed at improving eating habits and highlights the need for researchers to be sensitive to how they measure perceptions of comparative eating habits. (PsycINFO Database Record

Resisting anchoring effects: The roles of metric and mapping knowledge.

The biasing influence of anchors on numerical estimates is well established, but the relationship between knowledge level and the susceptibility to anchoring effects is less clear. In two studies, we addressed the potential mitigating effects of having knowledge in a domain on vulnerability to anchoring effects in that domain. Of critical interest was a distinction between two forms of knowledge-metric and mapping knowledge. In Study 1, participants who had studied question-relevant information-that is, high-knowledge participants-were less influenced by anchors than were participants who had studied irrelevant information. The results from knowledge measures suggested that the reduction in anchoring was tied to increases in metric rather than mapping knowledge. In Study 2, participants studied information specifically designed to influence different types of knowledge. As we predicted, increases in metric knowledge-and not mapping knowledge-led to reduced anchoring effects. Implications for debiasing anchoring effects are discussed.

Optimism following a tornado disaster.

Effects of exposure to a severe weather disaster on perceived future vulnerability were assessed in college students, local residents contacted through random-digit dialing, and community residents of affected versus unaffected neighborhoods. Students and community residents reported being less vulnerable than their peers at 1 month, 6 months, and 1 year after the disaster. In Studies 1 and 2, absolute risk estimates were more optimistic with time, whereas comparative vulnerability was stable. Residents of affected neighborhoods (Study 3), surprisingly, reported less comparative vulnerability and lower "gut-level" numerical likelihood estimates at 6 months, but later their estimates resembled the unaffected residents. Likelihood estimates (10%-12%), however, exceeded the 1% risk calculated by storm experts, and gut-level versus statistical-level estimates were more optimistic. Although people believed they had approximately a 1-in-10 chance of injury from future tornadoes (i.e., an overestimate), they thought their risk was lower than peers.

Hoping for more: the influence of outcome desirability on information seeking and predictions about relative quantities.

People must often engage in sequential sampling in order to make predictions about the relative quantities of two options. We investigated how directional motives influence sampling selections and resulting predictions in such cases. We used a paradigm in which participants had limited time to sample items and make predictions about which side of the screen contained more of a critical item. Sampling selections were biased by monetary desirability manipulations, and participants exhibited a desirability bias for both dichotomous and continuous predictions.

When and why people are comparatively optimistic about future health risks: The role of direct and indirect comparison measures.

The goal of the current research was to test whether direct versus indirect measures of comparative optimism yield different results as a function of health risk severity and prevalence. A random-digit sample of community residents (N = 259) responded to interview questions about perceived vulnerability using both direct (i.e. self-to-peer risk) and indirect comparison measures (i.e. separate questions about self and peer risk). Responses to direct comparison measures were more affected by prevalence, whereas indirect comparison measures were more affected by severity. These results may offer guidance to researchers and practitioners about when it may be more appropriate to use direct versus indirect measures of comparative health risk.

'I'll do what they did": social norm information and cancer treatment decisions.

OBJECTIVE: Using a cancer-treatment scenario, we tested whether descriptive norm information (e.g., the proportion of other people choosing a particular treatment) would influence people's hypothetical treatment choices. METHODS: Women from an Internet sample (Study 1 N=2238; Study 2 N=2154) were asked to imagine deciding whether to take adjuvant chemotherapy following breast cancer surgery. Across participants, we varied the stated proportion of women who chose chemotherapy. This descriptive norm information was presented numerically in Study 1 and non-numerically in Study 2. RESULTS: The descriptive norm information influenced women's decisions, with higher interest in chemotherapy when social norm information suggested that such chemotherapy was popular. Exact statistics about other people's decisions had a greater effect than when norms were described using less precise verbal terms (e.g., "most women"). CONCLUSION: Providing patients with information about what other people have done can significantly influence treatment choices, but the power of such descriptive norms depends on their precision. PRACTICE IMPLICATIONS: Communication of descriptive norms is only helpful if prevailing decisions in the population represent good clinical practice. Strategic presentation of such statistics, when available, may encourage patient outliers to modify their medical decisions in ways that result in improved outcomes.

Evaluating one performance among others: the influence of rank and degree of exposure to comparison referents.

Three studies examined the influence of comparison-referent exposure (i.e., the frequency with which one views comparison referents) on evaluations of the ability of a target person (either oneself or another person). In Experiment 1, participants performed a task and then viewed performances of both upward and downward referents. Participants who saw more performances by the upward referents than the downward referents evaluated their own performances less favorably did than participants who saw more performances by the downward referents than the upward referents. Experiment 2 produced similar findings, showing that comparison exposure also influences people's evaluations about someone other than themselves. In Experiment 3, comparison-exposure effects were significantly reduced when participants were instructed to think deliberatively about the comparison information, consistent with the idea that people typically rely on imprecise representations of comparison information even when they are capable of forming more precise representations from memory if motivated to do so.

Cultural differences in unrealistic optimism and pessimism: the role of egocentrism and direct versus indirect comparison measures.

Recent research has raised questions regarding the consistency of unrealistic optimism and related self-enhancing tendencies, both within cultures and across cultures. The current study tested whether the method used to assess unrealistic optimism influenced cross-cultural patterns in the United States and Japan. The results showed that the direct method (a single comparison judgment between self and peers) produced similar patterns across cultures because of cognitive biases (e.g., egocentrism); specifically, participants were unrealistically optimistic about experiencing infrequent/negative events but pessimistic about experiencing frequent/ negative events. However, the indirect method (separate self- and peer judgments) produced different patterns across cultures because culturally specific motivational biases emerged using this method; specifically, the U.S. sample was more unrealistically optimistic than the Japanese sample. The authors discuss how these results might influence the interpretation of previous findings on culture and self-enhancement.

Are people excessive or judicious in their egocentrism? A modeling approach to understanding bias and accuracy in people's optimism.

People are often egocentric when judging their likelihood of success in competitions, leading to overoptimism about winning when circumstances are generally easy and to overpessimism when the circumstances are difficult. Yet, egocentrism might be grounded in a rational tendency to favor highly reliable information (about the self) more so than less reliable information (about others). A general theory of probability called extended support theory was used to conceptualize and assess the role of egocentrism and its consequences for the accuracy of people's optimism in 3 competitions (Studies 1-3, respectively). Also, instructions were manipulated to test whether people who were urged to avoid egocentrism would show improved or worsened accuracy in their likelihood judgments. Egocentrism was found to have a potentially helpful effect on one form of accuracy, but people generally showed too much egocentrism. Debias instructions improved one form of accuracy but had no impact on another. The advantages of using the EST framework for studying optimism and other types of judgments (e.g., comparative ability judgments) are discussed.

Knowing too much: using private knowledge to predict how one is viewed by others.

People have more information about themselves than others do, and this fundamental asymmetry can help to explain why individuals have difficulty accurately intuiting how they appear to other people. Determining how one appears to observers requires one to utilize public information that is available to observers, but to disregard private information that they do not possess. We report a series of experiments, however, showing that people utilize privately known information about their own past performance (Experiments 1 and 2), the performance of other people (Experiment 3), and imaginary performance (Experiment 4) when intuiting how they are viewed by others. This tendency can help explain why people's beliefs about how they are judged by others often diverge from how they are actually judged.