Abstract and Background
Abstract
Background: Lifestyle-related diseases, including diabetes, cardiovascular disease, and some cancers represent the greatest global health threat. Greater insight into health needs and beliefs, using broad community samples, is vital to reduce the burden of chronic disease. This study aimed to investigate gender, age, screening practices, health beliefs, and perceived future health needs for healthy ageing.
Methods: Random probability sampling using self-completion surveys in 1456 adults residing in Australia.
Results: Screening behaviors were associated with gender and age. Men and women >51 years were more likely (27%) to have screening health checks than those <50 years (2%). Factors nominated to influence health were lifestyle (92%), relationships (82%), and environment (80%). Women were more likely to nominate preparedness to have an annual health check, willingness to seek advice from their medical practitioner and to attend education sessions. Numerous health fears were associated with ageing, however participants were more likely to have a financial (72%) rather than a health plan (42%). More women and participants >51 years wanted information regarding illness prevention than men or those aged <30 years.
Conclusion: Age and gender are associated with health related behaviors. Optimal health is perceived as a priority, yet often this perception is not translated into preventative action. These findings will inform future research and policy makers as we strive towards a healthier ageing society and the prevention of chronic disease.
Background
The greatest cause of mortality is lifestyle-related disease and illness, including diabetes (DM2), cardiovascular disease (CVD) and colon cancer. Even though it is estimated that 90% of heart disease is preventable, in western populations we have failed to institute effective preventative lifestyle changes, have persisted with unhealthy lifestyles and are sedentary and increasingly overweight. To reduce the incidence and burden of chronic illness, it is vital to understand health related behaviors, including risk perception, particularly around preventative health care. This understanding should incorporate screening behaviors, health beliefs and perceived future needs for health.
Community chronic disease prevention practices, perceived responsibility for healthy lifestyle and disease prevention, health information needs, education opportunities and preparedness to undertake an active role in health have not been adequately explored. With regard to screening behaviors, past studies have evaluated specific practices; mammography or prostate checks, for example, or there has been a focus on physical activity or diet. Past research has also often been limited to one gender, or to specific age groups. There has been little population evaluation of health fears and behaviors associated with prevention of chronic disease in both men and women across the adult lifespan. Research in this area needs to take a broad population-wide approach to exploration of disease prevention, across a range of conditions, behaviors and lifestyle.
Previous literature on prevention has often been based on quality assurance data from the general practice setting. Steven et al 1999 found in a study of preventative care by general practitioners (GPs) that there is significant variability in reports of preventative health screening practices: BP checks (range from 36–100%), pap smears (range 10–91%) and lifestyle advice (9–10%). Screening can be opportunistic, driven by patients, and/or occur opportunistically with medical contact, or take a population-based approach (e.g. pap smears and mammograms). Lifestyle-related disease screening in most western countries is currently opportunistic and is heavily reliant on risk perception and on the beliefs of individuals. This highlights the need for greater research and understanding of behaviors and beliefs in these areas.
Risk perception motivates attendance to healthcare providers, promotes behavioral and lifestyle changes and influences decisions regarding treatments. An understanding of risk perception as it relates to prevention of chronic disease management is, therefore, important. Literature on risk perception and consequent behavior change (or not), is often limited to specific factors such as substance use including alcohol and smoking, sexual activity and transmitted disease, HIV, cancer risk, increasing physical activity and, more recently, the risk of SARS. Risk perception is complex and influenced by many factors, including the immediacy of the risk, the severity of consequences, knowledge of the risk, attitude, personal experience, personality, emotional wellbeing, the influence of affect and the social and cultural context. Due to the complexity of risk perception, before trying to understand why people may participate in health behaviors in order to reduce their risk of chronic disease, it will be helpful to understand what their priorities, beliefs and fears about future ill health and age might be.
Gender, age and sociocultural factors are likely to influence health related behavior including screening. Women are more likely to attend for screening if they are 'health conscious', have had prior screening, or are aware, for example, that mammography reduces the risk of developing advanced breast cancer. If women attend for mammography however, it is not known if they also attend for other screening tests (e.g. cholesterol). Often women become the family health managers, encouraging male partners and family members to attend for health checks. Exploration of gender differences in health behaviors is an important step towards an understanding of preventative practices and future education needs. Again, little is understood about age differences in screening practices and perceived needs as they relate to prevention of illness. It is also unclear whether individuals perceive that their health is their own responsibility, if they act on these perceptions, or if they rely on health professionals to implement health checks. What is known is that barriers to screening include the perceived need for a referral, lack of discussion with health care providers and unsatisfactory relationships with GPs.
The aim of the present study was to report on health beliefs, behaviors (including screening practices and preventative health practices), education and information needs, future health fears, and perceived responsibility relevant for improving health outcomes across gender and age groups. These data will contribute to the current evidence base to inform the development of educational programs at a population, community and individual level, targeting both general community and health professionals.