{
  "abstract": "Background and Aims Explaining that medical tests are unnecessary or harmful often fails to dissuade individuals from wanting to proceed with the testing. It seems that individuals still want these tests because they attach other beliefs and values to them, such as valuing the information they provide and believing the tests may be reassuring. This is a challenge for messaging about overdiagnosis, which tends to rely on risk/benefit framing, and seldom accounts for these broader beliefs and values. Unfortunately, not enough is presently known about such beliefs and values to account for them in messaging.We examined the attitudes of Australians towards finding harmless abnormalities on tests, and the broader beliefs linked to these attitudes. This examination enabled us to uncover many of the values and beliefs that motivate testing even where there is no obvious benefit for identifying disease.Methods We used a mixed-methods survey design. We examined attitudes to finding harmless abnormalities using a Likert question with free text follow-up to explain those attitudes. We also measured a range of health beliefs using other Likert questions.Associations between attitudes to identifying harmless abnormalities and other beliefs and demographics were analysed using regression. Free text was analysed using comparative content and interpretative analyses, to examine inter-group differences.Results Almost three-fifths of the N=655 participants considered it valuable to identify harmless abnormalities using tests. Under a quarter were ambivalent and almost a fifth believed identifying such abnormalities would be harmful.In regression, beliefs that it would be ‘valuable’ to find such abnormalities on tests were predicted by higher confidence in doctors, lesser concerns about overtreatment, and a stronger belief in the importance of gathering data about one’s own body. Age, healthcare training, education and income were also significant predictors.The comparative qualitative analyses suggested that individuals held these positive attitudes to finding harmless abnormalities on tests because they thought doing so would provide psychological reassurance, inform them about their own bodies, and allow them to monitor and manage the harmless abnormalities. We believe these beliefs were underpinned by difficulties believing that any abnormalities could be truly harmless, and several ideas and values related to the broader utility of medical testing. On the other hand, people who believed it harmful to find such abnormalities on tests thought it would make them anxious and predispose them to receiving unnecessary health care.Conclusions The findings have a range of implications for preventing overdiagnosis. Encouragingly, people who held negative attitudes to identifying harmless abnormalities were cognisant of overdiagnosis and psychological challenges that can arise from knowing about even benign ‘abnormalities’. However, the findings also show why overdiagnosis messages fail to resonate with many individuals. Many struggle with the notion that any abnormality could be ‘harmless’, believe they can minimise the risk of overtreatment, and expect to gain many additional benefits from finding such abnormalities. Messages about overdiagnosis should consider addressing the broader beliefs and values that promote unnecessary health care, alongside risks and benefit information.",
  "authors": [
    {
      "affiliations": [
        "Monash University, Melbourne, Australia"
      ],
      "name": "Tomas Rozbroj"
    },
    {
      "affiliations": [
        "Monash University, Melbourne, Australia"
      ],
      "name": "Ming Hui Hoo"
    },
    {
      "affiliations": [
        "Monash University, Melbourne, Australia"
      ],
      "name": "Alexandra Gorelik"
    },
    {
      "affiliations": [
        "Monash University, Melbourne, Australia"
      ],
      "name": "Denise A O’Connor"
    },
    {
      "affiliations": [
        "Monash University, Melbourne, Australia"
      ],
      "name": "Rachelle Buchbinder"
    }
  ],
  "title": "111 Why most Australians consider it valuable to identify harmless abnormalities with diagnostic tests: mixed-methods study",
  "uid": "0b308a7a-8e4e-5726-ab5c-95347cf263f5"
}