title: Impact of literacy and numeracy on motivation for behavior change after diabetes genetic risk testing.
abstract: Type 2 diabetes genetic risk testing might motivate at-risk patients to adopt diabetes prevention behaviors. However, the influence of literacy and numeracy on patient response to diabetes genetic risk is unknown.
  
  
  
  The authors investigated the association of health literacy, genetic literacy, and health numeracy with patient responses to diabetes genetic risk.
  
  
  
  and Measurements Overweight patients at high phenotypic risk for type 2 diabetes were recruited for a clinical trial of diabetes genetic risk testing. At baseline, participants predicted how their motivation for lifestyle modification to prevent diabetes might change in response to hypothetical scenarios of receiving "high" and "low" genetic risk results. Responses were analyzed according to participants' health literacy, genetic literacy, and health numeracy.
  
  
  
  Two-thirds (67%) of participants (n = 175) reported very high motivation to prevent diabetes. Despite high health literacy (92% at high school level), many participants had limited health numeracy (30%) and genetic literacy (38%). Almost all (98%) reported that high-risk genetic results would increase their motivation for lifestyle modification. In contrast, response to low-risk genetic results varied. Higher levels of health literacy (P = 0.04), genetic literacy (P = 0.02), and health numeracy (P = 0.02) were associated with an anticipated decrease in motivation for lifestyle modification in response to low-risk results.
  
  
  
  While patients reported that high-risk genetic results would motivate them to adopt healthy lifestyle changes, response to low-risk results varied by patient numeracy and literacy. However, anticipated responses may not correlate with true behavior change. If future research justifies the clinical use of genetic testing to motivate behavior change, it may be important to assess how patient characteristics modify that motivational effect.
authors.affiliation: General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts (JLV, KEO, JBM, RWG)|Department of Medicine, Harvard Medical School, Boston, Massachusetts (JLV, ERP, LMD, JCF, JBM, RWG)
authors.forename: Jason L
authors.initials: JL
authors.lastname: Vassy
authors.affiliation: General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts (JLV, KEO, JBM, RWG)
authors.forename: Kelsey E
authors.initials: KE
authors.lastname: O'Brien
authors.affiliation: Partners Center for Human Genetics, Boston, Massachusetts (JLW)
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Waxler
authors.affiliation: Department of Medicine, Harvard Medical School, Boston, Massachusetts (JLV, ERP, LMD, JCF, JBM, RWG)|Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts (ERP)
authors.forename: Elyse R
authors.initials: ER
authors.lastname: Park
authors.affiliation: Department of Medicine, Harvard Medical School, Boston, Massachusetts (JLV, ERP, LMD, JCF, JBM, RWG)|Diabetes Research Center, Massachusetts General Hospital, Boston, Massachusetts (LMD, JCF)
authors.forename: Linda M
authors.initials: LM
authors.lastname: Delahanty
authors.affiliation: Department of Medicine, Harvard Medical School, Boston, Massachusetts (JLV, ERP, LMD, JCF, JBM, RWG)|Diabetes Research Center, Massachusetts General Hospital, Boston, Massachusetts (LMD, JCF)|Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts (JCF)|Program in Medical and Population Genetics, Broand Institute, Cambridge, Massachusetts (JCF)
authors.forename: Jose C
authors.initials: JC
authors.lastname: Florez
authors.affiliation: General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts (JLV, KEO, JBM, RWG)|Department of Medicine, Harvard Medical School, Boston, Massachusetts (JLV, ERP, LMD, JCF, JBM, RWG)
authors.forename: James B
authors.initials: JB
authors.lastname: Meigs
authors.affiliation: General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts (JLV, KEO, JBM, RWG)|Department of Medicine, Harvard Medical School, Boston, Massachusetts (JLV, ERP, LMD, JCF, JBM, RWG)
authors.forename: Richard W
authors.initials: RW
authors.lastname: Grant
mesh_terms: D000368:Aged; D003657:Decision Making; D003661:Decision Support Techniques; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000235:genetics* / Q000523:psychology*; D005260:Female; D005820:Genetic Testing; D015438:Health Behavior; D057220:Health Literacy; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009042:Motivation; D050177:Overweight / Q000453:epidemiology / Q000523:psychology; D018570:Risk Assessment; D012959:Socioeconomic Factors