Patient Perspectives and Doctor Visits

The primary goal of this research project is to continue building an evidence base on the benefits or pitfalls of introducing genomic information into weight-related primary care encounters. We are particularly interested in how this information will impact patients health-related attitudes, beliefs and behavior, and patient perceptions of stigmatization. Furthermore, this project aims to determine whether a patient s emotional state during a clinical interaction will moderate the consequences of genomic information provision.

Genetic and genomic information are expected to be integrated into personalized prevention and treatment regimens of the future. Such information may influence patient beliefs, attitudes, and behaviors related to weight and obesity. Previous research has shown that provision of genomic information can lead to positive effects, negative effects and often no effect with respect to patient motivation for health-promoting behaviors. The literature describing the influence of emotion on judgment and decision-making suggests that patients emotional state may, in part, account for this discrepancy. By better understanding the influence of emotional state on patients reactions to general, weight-related genomic information, we may be better able to shape clinical communications of the future to increase the likelihood that genomic information will lead to positive, health-promoting behavior. Indeed, there is a need for exploration of strategies through which providers can counsel patients about weight such that patients feel motivated by the counseling, and that it does not make them feel stigmatized.

The current protocol describes two studies; both are randomized, controlled experiments. The first will be conducted through an internet panel via the Time-Sharing Experiments in the Social Sciences program. The current proposal was already reviewed and was successfully approved and funded for fielding through this program. The second study is a lab-based study that will take place in the Immersive Virtual Environment Testing Area in the NIH Clinical Center. In both studies, overweight, adult women will undergo a task designed to elicit mild-to-moderate emotional states. In Study 1 the elicited emotions will include anger, fear and neutral; Study 2 will include only anger and fear. Participants will then participate in a weight counseling encounter with a simulated doctor who will provide weight management information that includes discussions of either behavioral or genomic etiology. Participants in Study 1 will engage with the doctor via video clips over the internet, participants in Study 2 will engage with the doctor in an immersive virtual environment. Primary outcome measures pertain to participants health-related attitudes, behavioral intentions, and perceptions of stigmatization related to weight. Participants will include women who have a BMI of greater than or equal to 25. The final data set in Study 1 will include approximately 600 participants who are already part of an existing, nationally representative internet panel (ceiling n=700). The final data set in Study 2 will include approximately 250 participants recruited from the local area (ceiling n=500).

• All participants will be adult women

Inclusion criteria

ARE:

• being between 18 and 50 years old;
• having a self reported body mass index of greater than or equal to 25;
• having the ability to read, write, and converse in English;
• being able to come to the NIH Clinical Center for one visit.

Exclusion criteria

INCLUDE:

• having a vestibular or seizure disorder;
• having a high propensity for motion sickness;
• known pregnancy;
• uncorrected low vision or hearing;
• inability to complete tasks in the virtual environment;
• being or training to become a physician;