• cardiovascular disease;
  • culture;
  • diabetes;
  • health-world views;
  • nursing;
  • perceived risk;
  • risk perception;
  • Samoans;
  • theory-building strategy



This article presents a discussion of development of a mid-range theory of risk perception.


Unhealthy behaviours contribute to the development of health inequalities worldwide. The link between perceived risk and successful health behaviour change is inconclusive, particularly in vulnerable populations. This may be attributed to inattention to culture.

Data sources

The synthesis strategy of theory building guided the process using three methods: (1) a systematic review of literature published between 2000–2011 targeting perceived risk in vulnerable populations; (2) qualitative and (3) quantitative data from a study of Samoan Pacific Islanders at high risk of cardiovascular disease and diabetes.


Main concepts of this theory include risk attention, appraisal processes, cognition, and affect. Overarching these concepts is health-world view: cultural ways of knowing, beliefs, values, images, and ideas. This theory proposes the following: (1) risk attention varies based on knowledge of the health risk in the context of health-world views; (2) risk appraisals are influenced by affect, health-world views, cultural customs, and protocols that intersect with the health risk; (3) strength of cultural beliefs, values, and images (cultural identity) mediate risk attention and risk appraisal influencing the likelihood that persons will engage in health-promoting behaviours that may contradict cultural customs/protocols.


Interventions guided by a culturally sensitive mid-range theory may improve behaviour-related health inequalities in vulnerable populations.


The synthesis strategy is an intensive process for developing a culturally sensitive mid-range theory. Testing of the theory will ascertain its usefulness for reducing health inequalities in vulnerable groups.