TY - JOUR
T1 - Does Animation Improve Comprehension of Risk Information in Patients with Low Health Literacy? A Randomized Trial
AU - Housten, Ashley J.
AU - Kamath, Geetanjali R.
AU - Bevers, Therese B.
AU - Cantor, Scott B.
AU - Dixon, Nickell
AU - Hite, Andre
AU - Kallen, Michael A.
AU - Leal, Viola B.
AU - Li, Liang
AU - Volk, Robert J.
N1 - Funding Information:
https://orcid.org/0000-0002-7379-0678 Housten Ashley J. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA Kamath Geetanjali R. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA Bevers Therese B. Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, USA Cantor Scott B. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA Dixon Nickell Michigan Department of Health, Southern New Hampshire University, Lansing, MI, USA Hite Andre Department of Surgery, Baylor College of Medicine, Houston, TX, USA Kallen Michael A. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA https://orcid.org/0000-0001-9885-823X Leal Viola B. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA Li Liang Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA https://orcid.org/0000-0001-8811-5854 Volk Robert J. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA Robert J. Volk, Department of Health Services Research, Unit 1444, The University of Texas MD Anderson Cancer Center, Unit 1444, P.O. Box 301402, Houston, TX 77230-1402, USA ( bvolk@mdanderson.org ). 12 2019 0272989X19890296 24 5 2019 13 10 2019 © The Author(s) 2019 2019 Society for Medical Decision Making Introduction. Enhanced visual effects, like animation, have the potential to improve comprehension of probabilistic risk information, particularly for those with lower health literacy. We tested the effect of presentation format on comprehension of colorectal cancer (CRC) screening probabilities to identify optimal risk communication strategies. Methods. Participants from a community foodbank and a cancer prevention center were randomized to 1 of 3 CRC screening risk presentations. The presentations used identical content but varied in format: 1) video with animated pictographs, 2) video with static pictographs, and 3) audiobooklet with static pictographs. Participants completed pre- and postpresentation surveys. The primary outcome was knowledge of probability/risk information regarding CRC screening, calculated as total, verbatim, and gist scores. Results. In total, 187 participants completed the study and were included in this analysis. Median age was 58 years (interquartile range [IQR]: 14 years), most participants were women (63%), and almost half had a high school education or less (46%). Approximately one-quarter had inadequate health literacy (Short Test of Functional Health Literacy in Adults marginal/inadequate: 28%; Brief Health Literacy Screener low: 18%), and about half had low numeracy (Subjective Numeracy Scale low: 54%; Graphical Literacy Measure low: 50%). We found no significant differences in total, verbatim, or gist knowledge across presentation formats (all P > 0.05). Discussion. Use of an animated pictograph to communicate risk does not appear to augment or impede knowledge of risk information. Regardless of health literacy level, difficulty understanding pictographs presenting numerical information persists. There may be a benefit to teaching or priming individuals on how to interpret numerical information presented in pictographs before communicating risk using visual methods. Trial Registry: NCT02151032 cancer screening health literacy shared decision making (SDM) National Cancer Institute https://doi.org/10.13039/100000054 P30 CA016672 informed medical decisions foundation https://doi.org/10.13039/100005613 Research Grant 0169-1 university of texas md anderson cancer center https://doi.org/10.13039/100007313 National Institute on Minority Health and Health Disparities https://doi.org/10.13039/100006545 K99 MD011485 edited-state corrected-proof typesetter ts1 We acknowledge the contributions of Brian J. Zikmund-Fisher, PhD; Paul K. J. Han, MD, MA, MPH; and Steve Woloshin, MD, MS, who served as expert panel members. We also acknowledge the significant contributions of Suzanne K. Linder, PhD. The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the Foundation for Informed Medical Decision Making (Research Grant 0169-1), National Cancer Institute at the National Institutes of Health (P30 CA016672) to The University of Texas MD Anderson Cancer Center as a Cancer Center Support Grant and used the Shared Decision Making Core and Clinical Protocol and Data Management, National Institute on Minority Health and Health Disparities of the National Institutes of Health (K99 MD011485), and The University of Texas MD Anderson Cancer Center’s Duncan Family Institute for Cancer Prevention and Risk Assessment. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. Authors’ Note Previous presentation: International Shared Decision Making Conference, Sydney, Australia, July 2015. ORCID iDs Ashley J. Housten https://orcid.org/0000-0002-7379-0678 Viola B. Leal https://orcid.org/0000-0001-9885-823X Robert J. Volk https://orcid.org/0000-0001-8811-5854 Supplemental Material Supplementary material for this article is available on the Medical Decision Making Web site at http://journals.sagepub.com/home/mdm .
Publisher Copyright:
© The Author(s) 2019.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Introduction. Enhanced visual effects, like animation, have the potential to improve comprehension of probabilistic risk information, particularly for those with lower health literacy. We tested the effect of presentation format on comprehension of colorectal cancer (CRC) screening probabilities to identify optimal risk communication strategies. Methods. Participants from a community foodbank and a cancer prevention center were randomized to 1 of 3 CRC screening risk presentations. The presentations used identical content but varied in format: 1) video with animated pictographs, 2) video with static pictographs, and 3) audiobooklet with static pictographs. Participants completed pre- and postpresentation surveys. The primary outcome was knowledge of probability/risk information regarding CRC screening, calculated as total, verbatim, and gist scores. Results. In total, 187 participants completed the study and were included in this analysis. Median age was 58 years (interquartile range [IQR]: 14 years), most participants were women (63%), and almost half had a high school education or less (46%). Approximately one-quarter had inadequate health literacy (Short Test of Functional Health Literacy in Adults marginal/inadequate: 28%; Brief Health Literacy Screener low: 18%), and about half had low numeracy (Subjective Numeracy Scale low: 54%; Graphical Literacy Measure low: 50%). We found no significant differences in total, verbatim, or gist knowledge across presentation formats (all P > 0.05). Discussion. Use of an animated pictograph to communicate risk does not appear to augment or impede knowledge of risk information. Regardless of health literacy level, difficulty understanding pictographs presenting numerical information persists. There may be a benefit to teaching or priming individuals on how to interpret numerical information presented in pictographs before communicating risk using visual methods.
AB - Introduction. Enhanced visual effects, like animation, have the potential to improve comprehension of probabilistic risk information, particularly for those with lower health literacy. We tested the effect of presentation format on comprehension of colorectal cancer (CRC) screening probabilities to identify optimal risk communication strategies. Methods. Participants from a community foodbank and a cancer prevention center were randomized to 1 of 3 CRC screening risk presentations. The presentations used identical content but varied in format: 1) video with animated pictographs, 2) video with static pictographs, and 3) audiobooklet with static pictographs. Participants completed pre- and postpresentation surveys. The primary outcome was knowledge of probability/risk information regarding CRC screening, calculated as total, verbatim, and gist scores. Results. In total, 187 participants completed the study and were included in this analysis. Median age was 58 years (interquartile range [IQR]: 14 years), most participants were women (63%), and almost half had a high school education or less (46%). Approximately one-quarter had inadequate health literacy (Short Test of Functional Health Literacy in Adults marginal/inadequate: 28%; Brief Health Literacy Screener low: 18%), and about half had low numeracy (Subjective Numeracy Scale low: 54%; Graphical Literacy Measure low: 50%). We found no significant differences in total, verbatim, or gist knowledge across presentation formats (all P > 0.05). Discussion. Use of an animated pictograph to communicate risk does not appear to augment or impede knowledge of risk information. Regardless of health literacy level, difficulty understanding pictographs presenting numerical information persists. There may be a benefit to teaching or priming individuals on how to interpret numerical information presented in pictographs before communicating risk using visual methods.
KW - cancer screening
KW - health literacy
KW - shared decision making (SDM)
UR - http://www.scopus.com/inward/record.url?scp=85077219465&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85077219465&partnerID=8YFLogxK
U2 - 10.1177/0272989X19890296
DO - 10.1177/0272989X19890296
M3 - Article
C2 - 31795820
AN - SCOPUS:85077219465
SN - 0272-989X
VL - 40
SP - 17
EP - 28
JO - Medical Decision Making
JF - Medical Decision Making
IS - 1
ER -
