| Even with positive genetic test results, a woman's risk for breast cancer is uncertain. There is a paucity of research on how people deal with ambiguity inherent in the communication of disease probability. This project studied the impact of individual differences in tolerance for ambiguity (TFA) on the effect of the Health Belief Model to explain mammography practices, and on women's awareness of genetic testing for breast cancer risk. The research has important implications for genetic counselors who communicate genetic risk information. The hypotheses were: (1) The items for TFA are valid and reliable measures of tolerance for ambiguity; (2) TFA moderates the effect of Perceived Susceptibility on mammography practices; and (3) High TFA is associated with greater awareness of genetic testing for breast cancer. Methods: Secondary analyses were conducted from data collected in an ongoing research study. Participants were 711 female patients in a Women's Health Clinic, not selected for breast cancer risk. Participants completed baseline surveys and were randomized either to receive breast cancer risk information or not. A variety of analytic methods was used to test the research hypotheses including univariate techniques, multiple regression, and structural equation modeling. Results. Hypothesis 1. TFA was positively correlated with indicators of good psychological health, and negatively correlated with anxiety, suggesting convergent validity. There was evidence for two sub-factors of TFA---one factor indicating how much one is bothered by ambiguity (BOTHER), and another indicating one's need for certainty. Analyses suggested lower reliability for TFA measures compared to values reported from previous samples. Hypothesis 2. Multi-group analyses and moderated structural equation modeling confirmed that TFA (and the BOTHER sub-factor) moderates the effect of Perceived Susceptibility on time since last mammogram. No moderation effect was found for mammography intentions. Hypothesis 3. There was evidence for a positive association between TFA and awareness of genetic testing for breast cancer. Conclusions. TFA is an important factor for genetic counselors and preventive healthcare advocates to consider when communicating risk information. The field could benefit from future research that improves the TFA measure and uses prospective designs in various populations. |
