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      • Record: found
      • Abstract: found
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      Is Open Access

      Cool but Counterproductive: Interactive, Web-Based Risk Communications Can Backfire

      research-article
      Author(s): , PhD 1 , 2 , 3 , 4 , , , MA 3 , , PhD 2 , 3
      Editor(s):
      Other contributor(s): (Reviewer), (Reviewer)
      Publication date (Electronic):
      Journal: Journal of Medical Internet Research
      Publisher: Gunther Eysenbach
      Keywords: Patient-provider communication

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          Abstract

          Background

          Paper-based patient decision aids generally present risk information using numbers and/or static images. However, limited psychological research has suggested that when people interactively graph risk information, they process the statistics more actively, making the information more available for decision making. Such interactive tools could potentially be incorporated in a new generation of Web-based decision aids.

          Objective

          The objective of our study was to investigate whether interactive graphics detailing the risk of side effects of two treatments improve knowledge and decision making over standard risk graphics.

          Methods

          A total of 3371 members of a demographically diverse Internet panel viewed a hypothetical scenario about two hypothetical treatments for thyroid cancer. Each treatment had a chance of causing 1 of 2 side effects, but we randomly varied whether one treatment was better on both dimensions (strong dominance condition), slightly better on only one dimension (mild dominance condition), or better on one dimension but worse on the other (trade-off condition) than the other treatment. We also varied whether respondents passively viewed the risk information in static pictograph (icon array) images or actively manipulated the information by using interactive Flash-based animations of “fill-in-the-blank” pictographs. Our primary hypothesis was that active manipulation would increase respondents’ ability to recognize dominance (when available) and choose the better treatment.

          Results

          The interactive risk graphic conditions had significantly worse survey completion rates (1110/1695, 65.5% vs 1316/1659, 79.3%, P < .001) than the static image conditions. In addition, respondents using interactive graphs were less likely to recognize and select the dominant treatment option (234/380, 61.6% vs 343/465, 73.8%, P < .001 in the strong dominance condition).

          Conclusions

          Interactivity, however visually appealing, can both add to respondent burden and distract people from understanding relevant statistical information. Decision-aid developers need to be aware that interactive risk presentations may create worse outcomes than presentations of static risk graphic formats.

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          Most cited references35

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          The affect heuristic in judgments of risks and benefits

          Melissa L Finucane, Ali Alhakami, Paul Slovic … (2000)
          Article 0 comments Cited 502 times – based on 0 reviews     Review now
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            Measuring numeracy without a math test: development of the Subjective Numeracy Scale.

            Angela Fagerlin, Brian J Zikmund-Fisher, Peter Ubel … (2007)
            Basic numeracy skills are necessary before patients can understand the risks of medical treatments. Previous research has used objective measures, similar to mathematics tests, to evaluate numeracy. To design a subjective measure (i.e., self-assessment) of quantitative ability that distinguishes low- and high-numerate individuals yet is less aversive, quicker to administer, and more usable for telephone and Internet surveys than existing numeracy measures. Paper-and-pencil questionnaires. The general public (N = 703) surveyed at 2 hospitals. Forty-nine subjective numeracy questions were compared to measures of objective numeracy. An 8-item measure, the Subjective Numeracy Scale (SNS), was developed through several rounds of testing. Four items measure people's beliefs about their skill in performing various mathematical operations, and 4 measure people's preferences regarding the presentation of numerical information. The SNS was significantly correlated with Lipkus and others' objective numeracy scale (correlations: 0.63-0.68) yet was completed in less time (24 s/item v. 31 s/item, P < 0.05) and was perceived as less stressful (1.62 v. 2.69, P < 0.01) and less frustrating (1.92 v. 2.88, P < 0.01). Fifty percent of participants who completed the SNS volunteered to participate in another study, whereas only 8% of those who completed the Lipkus and others scale similarly volunteered (odds ratio = 11.00, 95% confidence interval = 2.14-56.65). The SNS correlates well with mathematical test measures of objective numeracy but can be administered in less time and with less burden. In addition, it is much more likely to leave participants willing to participate in additional research and shows much lower rates of missing or incomplete data.
            Article 0 comments Cited 245 times – based on 0 reviews     Review now
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              Affect, risk, and decision making.

              Paul Slovic, D MacGregor, Ellen Peters … (2005)
              Risk is perceived and acted on in 2 fundamental ways. Risk as feelings refers to individuals' fast, instinctive, and intuitive reactions to danger. Risk as analysis brings logic, reason, and scientific deliberation to bear on risk management. Reliance on risk as feelings is described with "the affect heuristic." The authors trace the development of this heuristic across a variety of research paths. The authors also discuss some of the important practical implications resulting from ways that this heuristic impacts how people perceive and evaluate risk, and, more generally, how it influences all human decision making. Finally, some important implications of the affect heuristic for communication and decision making pertaining to cancer prevention and treatment are briefly discussed.
              Article 0 comments Cited 179 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                :
                Department of Health Behavior and Health EducationSchool of Public HealthUniversity of Michigan1415 Washington HeightsAnn Arbor, MI, 48109-2029United States1 734 936 91791 734 763 7379bzikmund@umich.edu
                Journal
                Journal ID (nlm-ta): J Med Internet Res
                Journal ID (publisher-id): JMIR
                Title: Journal of Medical Internet Research
                Publisher: Gunther Eysenbach (JMIR Publications Inc., Toronto, Canada )
                ISSN (Electronic): 1438-8871
                Publication date Collection: Jul-Sep 2011
                Publication date (Electronic): 25 August 2011
                Volume: 13
                Issue: 3
                Electronic Location Identifier: e60
                Affiliations
                [1] 1simpleDepartment of Health Behavior and Health Education simpleSchool of Public Health simpleUniversity of Michigan Ann Arbor, MIUnited States
                [2] 2simpleDivision of General Medicine simpleDepartment of Internal Medicine simpleUniversity of Michigan Ann Arbor, MIUnited States
                [3] 3simpleCenter for Bioethics and Social Sciences in Medicine simpleMedical School simpleUniversity of Michigan Ann Arbor, MIUnited States
                [4] 4simpleRisk Science Center simpleSchool of Public Health simpleUniversity of Michigan Ann Arbor, MIUnited States
                Article
                Publisher ID: v13i3e60
                DOI: 10.2196/jmir.1665
                PMC ID: 3222175
                PubMed ID: 21868349
                SO-VID: dcba3134-82f0-4ac1-b4ab-961ff83eeb92
                Copyright © ©Brian J Zikmund-Fisher, Mark Dickson, Holly O Witteman. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 25.08.2011.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                Date received : 05 October 2010
                Date revision requested : 26 January 2011
                Date revision received : 24 February 2011
                Date accepted : 05 May 2011
                Categories
                Subject: Original Paper

                ScienceOpen disciplines: Medicine
                Keywords: patient-provider communication
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: patient-provider communication

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