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Abstract Background A positive family history of type 2 diabetes (T2D) has been associated with risk awareness and risk‐reducing behaviours among the unaffected relatives. Yet, little is known about how people with a positive family history for diabetes develop and manage their personal sense of risk. Objective To characterize two key concepts, salience and vulnerability, within the familial risk perception (FRP) model among unaffected individuals, at increased familial risk for T2D. Design We conducted a mixed method study. Descriptions of salience and vulnerability were collected through semi‐structured interviews. Participant's perception of self‐reported risk factors (family history, age, race/ethnicity, medical history, weight and exercise) was measured using the Perceived Risk Factors for T2D Tool and was compared to a clinical evaluation of the same risk factors. Results We identified two components of salience: (a) concern for developing T2D and (b) risk awareness triggers, and two features of vulnerability: (a) statement of risk and (b) risk assessment devices. Although few participants (26%) were concordant between their perceived and clinical overall T2D risk, concordance for individual risk factors was higher, ranging from 42% (medical history) to 90% (family history). Discussion and conclusion Both familial and non‐familial events lead people to contemplate their T2D risk, even among people who have a positive family history. Participants often downplayed their overall risk and underestimated their overall risk compared to a clinical risk assessment of the same self‐reported risk factors. Clinicians could leverage key components of the FRP process as way to engage patients in risk reduction strategies earlier.