The impact of item order on ratings of cancer risk perception.

Although perceived risk is central to most theories of health behavior, there is little consensus on its measurement with regard to item wording, response set, or the number of items to include. In a methodological assessment of perceived risk, we assessed the impact of changing the order of three commonly used perceived risk items: quantitative personal risk, quantitative population risk, and comparative risk. Participants were 432 men and women enrolled in an ancillary study of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Three groups of consecutively enrolled participants responded to the three items in one of three question orders. Results indicated that item order was related to the perceived risk ratings of both ovarian (P < 0.05) and colorectal (P < 0.05) cancers. Perceptions of risk were significantly lower when the comparative rating was made first. The findings suggest that compelling participants to consider their own risk relative to the risk of others results in lower ratings of perceived risk. Although the use of multiple items may provide more information than when only a single method is used, different conclusions may be reached depending on the context in which an item is assessed.