Imagine the following scenario. You learn that a family member has been diagnosed with an illness. This illness has a genetic basis and as such, you could be at risk for it as well. There is, however, a screening for the genetic marker, and you can find out whether you are likely to develop this illness. Do you complete the screening or do avoid it?
Though few of us will face this specific scenario, many of us will face something similar. Heart disease runs in many families, as do certain forms of cancer, thyroid problems, etc. If your sibling or a grandparent suffered from one of these, would you get screened as well? What about common illnesses? Again, heart disease is among the top killers worldwide. Have you ever had your heart checked out?
Health screening is an important part of disease prevention and control. Agencies, such as The American Cancer Society or The American Heart Association provide clear guidelines for who should get screened, and when. Doctors are well aware of these guidelines and encourage patients to get screened. Early detection can often prevent or slow the course of a disease. Nevertheless, many people ignore screening recommendations. WHY?
There are likely a variety of factors that influence this decision. Are you aware of screening guidelines? How severe is the illness? Will knowing raise your insurance costs? Do you have a support system available? Is there anything you can do to prevent it or cure it, if indeed you are at risk?
In addition to these latter factors, psychological threat is one important variable that influences health screening behavior. Research has shown that people tend to avoid threatening information of all kinds. Given that the prospect of having an illness is quite scary, it is not surprising that people respond to this threat with behavioral avoidance; steering clear of information connected with the threat – such as a health screening exam.
Jennifer Howell and James Shepperd, researchers at the University of Florida, hypothesized that diminishing the sense of threat one feels could by extension decrease behavioral avoidance of health screenings. But how to reduce threat?
Howell and Shepperd drew on a famous social psychological theory to answer that question. According to self-affirmation theory (e.g. Steele, 1988) people are motivated to maintain a sense of self-worth and integrity. If there is a threat to an aspect of your self, one way to reduce that threat is to reaffirm, or think positively about, other aspects of the self. For example, if you failed an important exam, you might reduce this threat to your self by thinking about how great you are in an unrelated domain, as a romantic partner or an athlete. Research in support of this theory has shown that when an individual’s overall sense of self-worth is affirmed, they will respond less defensively to threatening information of all kinds.
With this in mind, Howell and Sheppard thus evaluated whether reaffirming an aspect of an individual's self-worth reduces their feeling of threat at the scary prospect of a medical screening (a threat to their physical self).
What did they do? After arriving at the lab, participants were asked to list trait words that they felt were descriptive of, or central to, their self-concept (e.g. smart). Participants assigned to the self-affirmation condition then wrote a short essay about a time when they demonstrated that trait (e.g. last week I aced my social psychology midterm – I was in the top 10% of the class). Participants in the control condition did not self-affirm.
Next participants were asked to complete a separate portion of the study ostensibly administered by the university hospital. First participants viewed a video about a (fictitious) disease called thioamine acetylase (TAA). Participants learned that this disease purportedly affects the ability to process nutrients and can lead to severe complications. Moreover, the video stated that 20% of college students have TAA, and do not even know it. After viewing this (relatively scary) video, participants completed a computer program designed to calculate their lifetime risk of TAA. Finally, they were asked whether they would like to avoid seeing their results.
What did they find? Whereas 55% of the control participants requested to avoid seeing their TAA results, only 16 % of the self-affirmation participants requested to do so. As the researchers hypothesized, participants who were given the opportunity to reaffirm their self, were less likely to avoid potentially threatening health information. This same pattern emerged even when there was a greater incentive for avoiding the results, 1) when participants were required to engage in an undesirable behavior - going to the hospital - if they were at high risk for TAA, and 2) when they learned that the disease was untreatable.
These results are striking. First, over half of the control participants avoided potentially important feedback from a health screening exam. This is likely to reflect what people do when presented with screening options for real illnesses. For example, Howell and Shepperd cite a statistic that up to 55% of people who get screened for HIV fail to come back for their results (e.g. Molitor, Bell, & Truax, 1999). Remember, early efforts are critical in slowing the transition from HIV to full-blown AIDS . It is astounding that a simple self-affirmation task could reduce avoidance of screening information to well under 25%. Imagine if this approach was used with heart stress tests or cancer screenings. It has the potential to save thousands of lives. It also underscores the importance of using psychological research and principles to tackle real world problems.
Take home – Before you, or someone close to you, attempts to get out of a health screening exam, take a moment to self-affirm – your traits, behaviors, successes etc. It might just be the push you need to get some scary, but very important, health information.
How do you think these findings could be used by the medical field? What else does social psychology have to say about staying healthy? See any problems with this study? Voice your thoughts here!
Howell JL, & Shepperd JA (2012). Reducing information avoidance through affirmation. Psychological science, 23 (2), 141-5 PMID: 22241812