The RISK group showed statistically significant group differences across all three of these BMQ outcomes (p < 0.001) while no significant group changes were detected in the NO RISK group. Post-intervention, the RISK group reported significantly lower scores on the necessity subscale (mean change score −1.31, 95% CI (−2.3, −0.4)), significantly higher scores on the concerns subscale (mean change score 3.72, 95% CI (2.9, 4.5)) and a statistically greater necessity-concerns differential (mean change score −5.03, 95% CI (−6.4, −3.6)), compared to the NO RISK group. According to an operational definition

of cognitive dissonance predicated upon a change in knowledge and a change in beliefs about benzodiazepine consumption

due to receipt of the intervention, 44/65 (68%) of participants in the RISK group and 19/79 (24%) of participants Epigenetics inhibitor SB203580 in vivo in the NO RISK group experienced cognitive dissonance. The experience of cognitive dissonance was associated with a six-fold higher likelihood of patients reporting increased risk perception about their benzodiazepine prescription (OR = 6.61 95%CI (3.2, 13.8)). The RISK group reported significantly greater improvements in self-efficacy for discontinuing benzodiazepines following the intervention (mean change score 31.24 95% CI (17.9, 44.6)) compared to the NO RISK group. The added benefit of the tapering protocol on self-efficacy scores for discontinuing benzodiazepines within the RISK group was an extra 6.05 points on the self-efficacy scale, 95% CI (3.0, 9.1). No statistically significant differences in self-efficacy were found in the NO RISK group. Fig. 1 shows correlates and anticipated behaviors associated with an increased risk perception post-intervention. The RISK group reported a significantly higher likelihood of reading the tool more than once (OR = 8.34 95% CI (3.9, 17.9)), intention

to discuss the mafosfamide intervention with family and friends (OR = 2.65 95% CI (1.3, 5.5)), and intention to discuss discontinuation with a physician (OR = 6.17 95% CI (2.8, 13.5)), or pharmacist (OR = 6.29 95% CI (2.8, 14.3)), compared to the NO RISK group. Findings from this study indicate that a personalized patient-targeted benzodiazepine educational intervention delivered directly to the individual consumer via written material was effective in changing medication risk perceptions in 45% of older chronic users. Heightened risk perception was explained by significant changes in knowledge and beliefs about benzodiazepines due to receipt of the tool. Our study suggests that participants in whom the intervention elicited changes in knowledge and beliefs may have experienced cognitive dissonance as the mechanism underlying increased risk perception.