Ample evidence has shown that romantic couples are concordant in health behaviors such as physical activity (Myers Virtue et al., 2015
), smoking (Christakis & Fowler, 2008
), and alcohol consumption (Torvik et al., 2013
). However, fewer studies have examined dyadic concordance in health beliefs
(e.g., perceived risk of developing a health outcome) or the extent to which partners’ health beliefs predict each other’s health behaviors and outcomes. One domain in which partners’ health beliefs may affect each other’s behavior is genomic sequencing—specifically pertaining to detection of carrier status for autosomal recessive conditions that could be passed on to a couple’s offspring. For couples who procreate, not only are their own carrier sequencing results valuable; their partner’s results are also valuable and important for understanding their descendants’ risk of having a child with a genetic condition.
From a clinical perspective, there is utility in understanding partner influence on intentions to learn carrier results. Social exchange processes—such as how and why partners influence each other’s health behaviour—often play minor roles in traditional theories and research on health decision-making, yet they offer a promising avenue for clinical interventions because partners can have potent effects on each other’s behavior (Rothman et al., 2020
). In fact, couple-oriented interventions can be more efficacious than traditional psychosocial interventions at changing behavior (Martire et al., 2010
). In the context of decisions regarding genomic sequencing, family members, including partners, may be particularly influential, as the sequencing results have implications for the family, rather than solely affecting the individual.
Research has shown that one’s own health beliefs—such as information avoidance (Taber et al., 2015b
), attitudes and perceived social norms (Facio et al., 2013
), and optimism (Taber et al., 2015a
) play an important role in one’s own decisions to learn genomic carrier results. Many of these variables are considered standard in health behavior theories. However, few studies have examined the role of one’s romantic partner’s beliefs in the decision to learn carrier results. One study found that couples in which both members were more comfortable with the screening process, were highly knowledgeable about the process, and perceived fewer barriers, were more likely to participate in carrier screening than couples who reported low comfort, low knowledge, and more barriers (Henneman et al., 2001
). Another study found that although worry about risk of a genetic condition in the family and intentions to share carrier results with family were correlated between partners, there were no associations of one’s partner’s attitudes, beliefs about the perceived value of results, or worry on one’s own intentions to share results with one’s family (Turbitt et al., 2018
). The proposed analysis builds on the latter research by (a) incorporating additional constructs that have been shown to be associated with individuals’ own genome sequencing behavior [e.g., information avoidance (Taber et al., 2015b
)] and b) assessing intentions to learn genome sequencing results.
The central contribution of this study is the finding that one’s partner’s information avoidance tendencies are associated with one’s own intentions to learn carrier results, even when accounting for one’s own information avoidance tendencies. Specifically, people reported lower intentions to learn carrier sequencing results if their partner had higher information avoidance. Arguably, learning carrier results can be beneficial, such that it could inform reproductive decisions of one’s descendants. If tendencies to avoid information serve as a barrier to obtaining this potentially useful information, then this may be a factor for genetic counselors to explore when meeting with patients. Another important finding was that there were no partner effects of risk perceptions, worry, or attitudes. This suggests that partner beliefs do not have equal effect on one’s own intentions and some beliefs appear to have greater effects than others.
An important next step for future research is to understand the mechanisms that explain how one’s partner’s information avoidance affects one’s own intentions to learn results. In order for one’s partners’ beliefs to affect one’s own behavior, it is likely that partners must communicate their beliefs to each other. Conversely, behaviors themselves are likely observable by one’s partner, which could explain the more frequently observed couple concordance among health behaviors (Christakis & Fowler, 2008
; Myers Virtue et al., 2015
; Torvik et al., 2013
). In the current research, information avoidance was the only measure that is not specific to genome sequencing; rather, information avoidance was assessed with regards to health, more generally. Thus, it could be that partners have better awareness of each other’s overall interest in health information because there may be more opportunities for each partner to communicate and observe the other’s interest in health information in comparison with health beliefs that are context-specific. Future research can examine this question by assessing partners’ meta-beliefs, which refer to one partner’s beliefs about the other partner’s beliefs (e.g., “What are my partner’s attitudes about genome sequencing?”) and the extent to which those meta-beliefs are accurate.
There are several limitations in this research. One limitation is that carrier results were more relevant to participants’ grandchildren than to their children, as almost all participants were past reproductive age. Stronger partner effects may have been obtained if the results were more pertinent to reproductive decision making. A second limitation is that the carrier results were for health outcomes ranging from low to high severity and probability; the findings may be stronger if limited to more impactful genomic sequencing results. For instance, it is unknown to what extent findings would generalize to contexts where individuals can learn about genetic risk for severe diseases, such as genetic testing for high-penetrance familial risk such as BRCA1/2
genetic testing for hereditary breast and ovarian cancer. A third limitation is that a single item was used to assess two of the predictors (risk perceptions and worry) and intentions, which could have made it difficult to obtain reliable effects for these predictors. This strategy is typical in large scale, nationally representative studies and one- and two-item measures of variables such as self-affirmation have shown predictive validity in other studies (e.g., Taber et al., 2015b
A final limitation is selection bias. People who are willing to participate in studies like ClinSeq® are likely to be different from people who do not participate, such that they may be more interested in receiving information about their health. Overall tendencies to avoid information were low (the mean was 2.03 and 2 SDs above and below the mean = 0.89–3.17, which are below the midpoint of 4) and intentions to learn results were skewed and quite high, which makes sense given that the sample included people who were interested in receiving genomic information. We expect that stronger associations would be observed for people who are higher in information avoidance. These findings are likely to generalize to other individuals who undergo genomic sequencing and are presumably interested in learning genomic sequencing results. Additionally, dyadic studies are often prone to selection bias; for instance, people who participate in studies with their romantic partner are less likely to experience breakup than people who participate solo (Park et al., 2020
). The findings from the current research will be most generalizable to couples who are interested in participating in genome sequencing together.”
Although some interventions and public health programs are beginning to incorporate close others as agents of influence, it is important to understand how social exchange processes function before implementing large-scale programs. For instance, pilot research studies of population-based carrier screening are currently being conducted in the Netherlands and Australia (Schuurmans et al., 2019
; “What is Mackenzie’s Mission?”, 2019
). In these programs, both members of the couple need to participate in order to learn their carrier results; thus, if one partner declines to participate, the couple is ineligible. The results of the current research have implications for these types of screening programs; people whose partners’ have higher information avoidance may be less likely to participate.
Conflicts of interest
Chloe O. Huelsnitz, Erin Turbitt, Jennifer M. Taber, Katie L. Lewis, Barbara B. Biesecker, and William M.P. Klein declare that they have no conflicts of interest. Leslie G. Biesecker is an uncompensated consultant to the Illumina Corporation Medical Ethics Board, receives in kind research support from Merck, Inc., and Novartis, and spousal salary is from RTI international.
Human and animal rights
All procedures were reviewed and approved by the National Human Genome Research Institute Institutional Review Board. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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