Perceptions of family history across common diseases: a qualitative study in primary care

Background. Having an affected relative is a strong predictor of an individual's lifetime risk of developing many diseases. In primary care this is of importance in preventive healthcare. Aim. To compare and contrast perceptions of family history across common diseases among primary care patients using the theoretical framework of Leventhal's Common Sense Model (CSM). Methods. Thirty semi-structured interviews were conducted with patients identified in general practice, who had a family history of either cancer, heart disease or diabetes. We performed qualitative constant comparative analysis of transcript data. Results. People with a family history of cancer had a greater sense of personal vulnerability than people with a family history of heart disease: family history of diabetes was generally viewed as the least threatening. Using the CSM constructs we identified factors which determine individual perceptions of family history. Beliefs about consequences and timeline were influenced by witnessing painful, lingering or sudden familial death; people who felt their risk was determined by inheritance were more likely to feel vulnerable and have less control, while those who felt able to change lifestyle or behaviour felt more able to control their perceived risk. Conclusion. Factors influencing perceptions of family history may vary between individuals and between diseases. To use the family history as a tool in preventive healthcare we will need to consider the individual's personal understanding of disease risk and their ideas about cause and controllability of the familial illness. Perceived risk may then be used to motivate preventive health behaviours.