title: Perceived risk as a barrier to appropriate diagnosis of irritable bowel syndrome.
abstract: OBJECTIVE
  To evaluate perceived risk, diagnostic testing, and acceptance of a diagnosis of irritable bowel syndrome (IBS) among the Korean laypersons.
  
  
  METHODS
  We designed a conceptual framework to evaluate the health-seeking behavior of subjects based on a knowledge, attitude, and practice model. We developed a vignette-based questionnaire about IBS based on a literature review and focused group interviews. The vignette described a 40-year-old woman who meets the Rome III criteria for IBS without red-flag signs. It was followed by questions about demographic characteristics, health behaviors, IBS symptoms, risk perception, perceived need for diagnostic tests, and acceptance of a positive diagnosis of IBS. We planned a nationwide survey targeting laypersons without IBS and between the ages of 20 and 69 years. Survey participants were selected by quota sampling stratified by gender, age, and nationwide location. A multivariate logistic model was constructed based on literature reviews, univariate analysis, and a stepwise selection method to investigate correlations between the perceived risk, need for diagnostic tests, and acceptance of a positive diagnosis.
  
  
  RESULTS
  Of 2354 eligible households, 1000 subjects completed the survey and 983 subjects were analyzed, excluding those who met symptom criteria for IBS. After reading the IBS vignette, the majority of subjects (86.8%) responded that the patient was at increased risk of severe disease. The most frequent concern was colon cancer (59.8%), followed by surgical condition (51.5%). Most subjects responded the patient needs diagnostic tests (97.2%). Colonoscopy was the most commonly required test (79.5%). Less than half of the respondents requested a stool examination (45.0%), blood test (40.7%), abdominal ultrasound (36.0%), or computed tomography (20.2%). The subjects who felt increased risk were more likely to see a need for colonoscopy [adjusted odds ratio (aOR) = 2.10, 95%CI: 1.38-3.18]. When asked about the positive diagnosis, the most frequent response was that "the patient would not be reassured" (65.7%). The increased risk perception group was less likely to be reassured by a positive diagnosis of IBS, compared to the other respondents (aOR = 0.52, 95%CI: 0.34-0.78).
  
  
  CONCLUSIONS
  For IBS diagnosis, increased risk perception is a possible barrier to the appropriate use of diagnostic tests and to the patient's acceptance of a positive diagnosis.
authors.affiliation: Eunmi Ahn, Ki Young Son, Dong Wook Shin, Min Kyu Han, Hyejin Lee, Ah Reum An, Eun Ho Kim, BeLong Cho, Department of Family Medicine, Seoul National University Hospital, Seoul 110-744, South Korea.
authors.forename: Eunmi
authors.initials: E
authors.lastname: Ahn
authors.affiliation: Eunmi Ahn, Ki Young Son, Dong Wook Shin, Min Kyu Han, Hyejin Lee, Ah Reum An, Eun Ho Kim, BeLong Cho, Department of Family Medicine, Seoul National University Hospital, Seoul 110-744, South Korea.
authors.forename: Ki Young
authors.initials: KY
authors.lastname: Son
authors.affiliation: Eunmi Ahn, Ki Young Son, Dong Wook Shin, Min Kyu Han, Hyejin Lee, Ah Reum An, Eun Ho Kim, BeLong Cho, Department of Family Medicine, Seoul National University Hospital, Seoul 110-744, South Korea.
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Shin
authors.affiliation: Eunmi Ahn, Ki Young Son, Dong Wook Shin, Min Kyu Han, Hyejin Lee, Ah Reum An, Eun Ho Kim, BeLong Cho, Department of Family Medicine, Seoul National University Hospital, Seoul 110-744, South Korea.
authors.forename: Min Kyu
authors.initials: MK
authors.lastname: Han
authors.affiliation: Eunmi Ahn, Ki Young Son, Dong Wook Shin, Min Kyu Han, Hyejin Lee, Ah Reum An, Eun Ho Kim, BeLong Cho, Department of Family Medicine, Seoul National University Hospital, Seoul 110-744, South Korea.
authors.forename: Hyejin
authors.initials: H
authors.lastname: Lee
authors.affiliation: Eunmi Ahn, Ki Young Son, Dong Wook Shin, Min Kyu Han, Hyejin Lee, Ah Reum An, Eun Ho Kim, BeLong Cho, Department of Family Medicine, Seoul National University Hospital, Seoul 110-744, South Korea.
authors.forename: Ah Reum
authors.initials: AR
authors.lastname: An
authors.affiliation: Eunmi Ahn, Ki Young Son, Dong Wook Shin, Min Kyu Han, Hyejin Lee, Ah Reum An, Eun Ho Kim, BeLong Cho, Department of Family Medicine, Seoul National University Hospital, Seoul 110-744, South Korea.
authors.forename: Eun Ho
authors.initials: EH
authors.lastname: Kim
authors.affiliation: Eunmi Ahn, Ki Young Son, Dong Wook Shin, Min Kyu Han, Hyejin Lee, Ah Reum An, Eun Ho Kim, BeLong Cho, Department of Family Medicine, Seoul National University Hospital, Seoul 110-744, South Korea.
authors.forename: BeLong
authors.initials: B
authors.lastname: Cho
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People / Q000523:psychology*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003938:Diagnostic Techniques, Digestive System; D018450:Disease Progression; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000175:diagnosis* / Q000208:ethnology / Q000523:psychology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D010465:Perception; D011237:Predictive Value of Tests; D011379:Prognosis; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Diagnostic testing; Functional gastrointestinal disease; Irritable bowel syndrome; Patient attitude; Positive diagnosis