There are several implications of these results for translational research going forward [12
]. It is important to consider the public health implications of providing personalized genetic risk information to individuals with little or no involvement of genetic health professionals. On the one hand, although we found that neuroticism was associated with greater perceived susceptibility and disease-related worry as hypothesized, neuroticism was not found to differentiate participants who sought online genetic information from those who did not. On the other hand, conscientiousness—reporting a sense of responsibility, diligence, and a willingness to see things through—was positively associated with logging on to learn about the genetic test. It is possible that participants who scored high in conscientiousness perceived the pursuit of additional information about the Multiplex genetic susceptibility test to be a responsible thing to do. Thus, respondents scoring high on conscientiousness may have been interested in the potential health benefits of genetic testing, inducing them to learn more about the genetic test and what it might mean for them and their families’ health. Alternatively, participants high in conscientiousness might have viewed logging on to the website as important to being a responsible study participant.
Contrary to our expectations, the odds of logging onto the Multiplex website were lower for respondents who were more open to experience. This association was only significant when controlling for the influence of conscientiousness, suggesting that shared variance between the two indicators masked the association between openness and information seeking in the bivariate model.
Still, it is unclear how to theoretically account for why there was a negative association between openness and logging on. It is possible that the offer of genetic susceptibility testing for common chronic disease risk did not represent new or particularly novel information to the Multiplex participants. Although study participants had no prior diagnosis with diabetes mellitus, atherosclerotic cardiovascular disease, osteoporosis, or cancer, there was a relatively high prevalence of behavioral risk factors including cigarette smoking, physical inactivity, and obesity [37
]. Moreover, these individuals reported high levels of awareness of behavioral risk factors associated with the diseases included on the multiplex test [37
]. Also, it is worth considering that some participants may have had other chronic diseases not represented in the exclusion criteria, but which are associated with an elevated risk for one or more of the multiplex diseases. If the likelihood of information seeking increases with greater openness to experience, but only when that information is in some respect novel, the negative association observed in this study might reflect that. Though not aware of their genetic risk for disease, study participants may have felt well informed about their risk in general. In that case, those with greater openness to experience may have been especially averse to seeking what they might have considered redundant information. That is, their professed ability to handle a lot of information and to engage in thought may have led them to more quickly determine that they had sufficient information about the test, obviating the need to seek out more.
Another possibility is that respondents who were more open to experience may have been less responsive to the brochure that was sent to participants with instructions for accessing the Multiplex website. Specifically, the use of an “old media” technique to cue participants about the next phase of the study may have led to a kind of selective exposure bias. If they were indeed more likely to disregard the brochure, participants with greater openness to experience might have been disproportionately less likely to log on because, in effect, they did not receive the instructions to do so.
Lastly, the lack of association between risk perceptions and information seeking also deviates from previous findings in other health contexts [13
] and suggests that information about genetic testing may differ from other types of health information. In contrast to the RISP model, we found that risk perceptions had no effect on information-seeking behavior. For example, although conscientiousness was associated with increased perceptions of disease severity, these perceptions did not have a discernable influence on accessing the Multiplex website when controlling for demographic and health-related variables. Likewise, openness to experience was revealed to be positively associated with all three facets of disease risk perceptions and negatively related to logging on. However, our mediation analysis provided no evidence that the association between openness and information seeking can be attributed to perceptions of disease risk. It is relevant to note that the current study does not account for a number of other variables used in the RISP model to predict information seeking. In particular, information insufficiency is thought to further mediate associations between perceptions of risk and information seeking, as well as between individual characteristics and information seeking [15
]. If increased perceptions of risk did not lead respondents to believe that the information they already had about the Multiplex genetic test was inadequate, then we may not expect to find an association between risk perceptions and information seeking. Unfortunately, measures of information insufficiency were not included on the baseline questionnaire and so a comprehensive test of the RISP model was not possible. In light of this, it may be that conscientiousness and openness to experience have a direct influence on genetic information seeking, or that this relationship is mediated by variables other than risk perceptions.
Several caveats should be considered when interpreting the results of this study. Genetic testing through the Multiplex Initiative was provided free of charge to study participants. This situation does not reflect the majority of current genetic testing options. However, it should have reduced barriers to seeking genetic testing. It is unclear how cost of genetic testing might interact with dispositional traits to influence online information seeking. Further, the Multiplex Initiative was conducted at a single site. Although this study drew on a sizeable population-based sample, our findings nonetheless only represent patients enrolled in the Henry Ford Health System. Future studies might expand the scope of these results by replicating this work in other study populations.
Our measure of the dependent variable, logging on to the Multiplex Initiative’s website, does not account for the full range of possible genetic information seeking and avoidance behaviors. Even though the internet serves as the primary source for gathering genetic information [44
], participants could have sought information through other websites, other media channels, or interpersonal communication with healthcare providers, family, or friends. These forms of genetic information seeking are not reflected in these data. Moreover, with increased levels of perceived risk, it is conceivable that some individuals may actively avoid additional information that would confirm those concerns. We were unable to directly explore these many possibilities with the current dataset. Even so, the use of a specific behavioral indicator offers unique insight into online genetic information seeking among healthy adults.
Also, a number of the measures used to assess individual dispositional differences had relatively low reliability when assessed in our sample, and some variables were based on only two items. The need to assess a large number of variables as part of the Multiplex Initiative restricted the number of items that could be dedicated to measuring any one construct. As such, fewer items were selected from more comprehensive scales that had been shown previously to have suitable reliability. However, differences between the test sample and our target population may account for the disparate psychometric properties that we observed. Even though all scales were above the threshold of an unacceptable level of reliability (α
], the items used in this study may be limited in their ability to capture the full range of personality and trait-like individual differences that we examined. We pursued structural equation modeling to assess whether latent constructs aligned with each of our dispositional constructs. Results of the measurement model confirmed that each of our dispositional constructs were indeed unidimensional and that construct reliabilities all fell within the generally acceptable range. Thus, while these results must be replicated in other samples, the associations we observed likely were not compromised by reduced reliability of the dispositional measures.
Despite these limitations, the results of this study can begin to inform the debate about who shows up to consider DTC genetic tests. Such information is critically important for anticipating the potential social and psychological consequences of DTC approaches.