Editorial: The implications of the optimistic bias for nursing and health

Abstract

The tendency to believe that negative events are less likely and positive events more likely to happen to oneself than to others is known as the optimistic bias (Weinstein 1980). In a health setting, this can manifest as a serious underestimation of health risk. Biases can be highly resistant to change and this can contribute to an unwillingness to take preventative or restorative action. This editorial will explore the impact that the optimistic bias can have on health care. Several health behaviour models hypothesise a link between the extent to which individuals perceive themselves to be at risk of a negative health outcome and engagement in behaviour directed at reducing risk (DiClemente et al. 2009). Optimistically biased judgements can cause individuals to underestimate their vulnerability to a wide range of health conditions, including cancer, cardiac, substance abuse and HIV (Weinstein & Klein 1995, Klein & Weinstein 1997, Helweg-Larsen & Shepperd 2001, Katapodi et al. 2009). It is also associated with greater risk of health-related factors such as high cholesterol (Radcliffe & Klein 2002). In certain circumstances, the optimistic bias can result in specific plans of action for dealing with risks (Armor & Taylor 1998) and increase behaviours which are protective of health (Taylor et al. 1992). Overall, however, the evidence suggests that having an optimistic bias is more likely to have a net negative impact on health (Klein 2006). Evidence suggests that both motivational factors, which serve to preserve self-esteem and avoid anxiety (Alicke & Govorun 2005), and non-motivational factors, such as errors in comparative judgements, interact to produce and maintain an optimistic bias (Kruger et al. 2008). Thus, any intervention must target both. Most interventions to date have, however, focused on non-motivational aspects of optimistic biases. Weinstein and Klein (1995), for example, attempted to reduce participant reliance on inaccurate information by providing information about their relevant risk factors and highlighting aspects of the information that would be expected to produce unfavourable comparative judgements. These interventions, however, failed to produce a consistent reduction in bias. Even educating participants about the optimistic bias cannot eliminate it entirely (Pronin et al. 2002), suggesting that a purely educational approach is likely to have limited impact. Interventions, then, must also address motivational aspects of the optimistic bias. Motivational mediation models of the optimistic bias suggest that it encourages attitudes and behaviour which minimise awareness of undesirable and anxiety-provoking information which may threaten a positive self-image (Klein & Weinstein 1997). Evidence for this comes from research indicating that individuals who express an optimistic bias are less likely to be aware of risks to their health, less open to novel health-relevant information (Radcliffe & Klein 2002) and more susceptible to believing health myths (Dillard et al. 2006). Indeed a significant predictor of an individual’s health relevant behaviour is his/her feelings about health risk (Klein & Zajac 2009) which can outweigh a rational evaluation of risk (Klein & Zajac 2009). As well as identifying the major causal pathways in the optimistic bias in health it is also important to know how to apply this knowledge in practice to encourage health-promoting behaviour. Researchers have identified two key factors: the controllability of physical illness and the emotional state of the patient. The extent to which the patients can influence their standing on a dimension has implications for how prone they are to optimistically biased judgments (Alicke & Govorun 2005). If the dimension is perceived to be positive and controllable, then individuals are likely to be more biased in their comparative judgments than if the dimension is positive but uncontrollable. This implies that patients affected by health problems that are amenable to protective behaviour, such as taking regular exercise, are most likely to underestimate their health risk. Ironically, those for whom there is the most scope for health improvement are likely to be the least motivated to take steps to make these improvements. There are also optimal times to challenge the optimistic bias; the emotional state of the patient is key, with angry patients being more likely to adhere to optimistic biases (Lerner & Keltner 2001). Challenging optimistic biases inappropriately can also result in the patient adopting an angry or defensive reaction, particularly as people tend to believe that they are less prone to biased judgments than others and perceive others who disagree with them as being biased themselves (Ehrlinger et al. 2005). This can lead to conflict (Kennedy & Pronin 2008) and even greater resistance to change. The message to be communicated is, in itself, uncomplicated, providing the individual with information about his/her own particular risk. The difficulty is in communicating this in such a way that it will be understood and accepted (Gilkey et al. 2008). For example, it is predicted that the likelihood of accepting messages about risk is increased by presenting information in terms of losses rather than gains (Kahneman & Tversky 1979). This suggests that patients should be more receptive to the idea that they have a 1% chance of experiencing a negative outcome than the idea that they have a 99% chance of not experiencing a negative outcome (Gilkey et al. 2008). One problem with this approach, however, is that it can increase worry which is likely to be counterproductive (Entwistle et al. 2005). It is, therefore, important to provide patients with a means to take action to reduce their health risk alongside information about risk. Witte’s (1992) health model suggests that messages about an individual’s health risk are most effective when provided in conjunction with clear strategies for improving health. Timing is key and advice on decreasing health risk should be provided when the patient reaches a critical level in his/her perception of risk. Alm-Roijer et al. (2006) found evidence to support this view, finding that patients with coronary heart disease who were aware of their specific risks had better adherence to guidance pertaining to lifestyle changes and medication. It is also important to be aware that nurses, as with all health care providers, are not immune to the effects of optimistic bias and that they are also susceptible to the belief that their judgments are less biased than those of others (Ehrlinger et al. 2005). This may result in nurses holding the belief that their interventions or contributions are more effective than they actually are (Green 2001). This highlights the importance of using evidence-based practice, audit, evaluation and research to counter such cognitive biases and ensure that the treatments and approaches that are used are actually as effective as they are believed to be. The optimistic bias is ubiquitous and robust (Alicke & Govorun 2005). The evidence suggests that it can be detrimental to health, although more studies are needed which examine optimistic biases in the context of objective risk and which account for possible mediating or moderating factors. While the optimistic bias is relatively resistant to change, research has indicated some ways in which it might be ameliorated. Nurses need, however, to reflect on the potential risks of challenging optimistic biases inappropriately, of providing information about health risks without providing patients with a clear means of reducing these risks and the role that their own cognitive biases may have on patient care. None.

Cite this work

No public copy is stored for this record, so only the metadata is cited.

Stored only when both papers are in the corpus — 5 citations exist upstream.

Papers that cite the same references — the relational fallback while embeddings are still backfilling.