Whilst biomedical innovation continues to deliver spectacular progress within areas such as oncology, neurology and genetics, non-adherence remains a key stumbling block in many areas of medicine. The challenges of non-adherence within chronic disease in particular is now seen as one of the most pressing issues facing healthcare providers.
One of the barriers for researchers is the complexity and scope of non-adherence influence. It is often sub-conscious, driven by conflicting goals and highly context sensitive. What can appear as a series of uncomplicated and rational decision choices, can be subverted for example a patient’s self-esteem goals, inappropriate social comparisons or misattributions of causality. There appears to be no definitive lens or paradigm in which patient adherence has been fully captured.
One area that shows potential is the role of risk perception bias. Biased perceptions of risk can distort perceptions of susceptibility and the motivations to adhere to health protective medication or lifestyle interventions. In many chronic disease areas such as cardiovascular disease, patients face a multiplicity of choices often accompanied by complex probabilistic outcome scenarios. Information availability rarely equates to information symmetry. What can appear to the physician as shared decision making can often mask significant confusion and or anxiety and can encourage disengagement on behalf of the patient. Under threat and uncertainty, straightforward choices can become surprisingly complex and challenging. In these situations, biased risk perceptions can dominate, often having a substantial impact on assumptions, attitudes, beliefs and intentions towards health preventation.
Unrealistic optimism (the unjustified belief that a health threat is less serious than objective evidence would indicate), is of particular interest. In many areas of healthcare, it can play both positive and negative roles in optimising health behaviour. In cardiovascular disease, this dual role is particularly relevant. In prevention, unrealistic optimism can encourage the formation of adherence barriers by reducing the perception of personal risk. Conversely, in patients with established CVD morbidity, it can play an important role in maintaining positive health behaviours and preventing the development of psychosocial complications.
Whilst unrealistic optimism has been widely studied within cardiovascular disease, often the research has been heterogeneous and held back by definitional and methodological differences in study design. In other cases, conflicting results have been left unaddressed by future studies. After a flurry of research over the past few decades unrealistic optimism continues to raise as many answers to our understanding of health behaviour as it provides answers.
This research undertook to address a number of inconsistencies within the understanding of health risk perception bias. It included a systematic review which pulled together the important recent research and looked to provide additional synthesis and insight. Additionally it explored a number of the key antecedents that appeared to influence the development of unrealistic optimism during CVD screening and preventative intervention. The intended objective of the combined studies was to provide additional clinical insight to help guide clinicians manage the phenomenon of health risk bias within cardiovascular disease.
