The Effect of Format on Parents' Understanding of the Risks and Benefits of Clinical Research: a Comparison Between Text, Tables, and Graphics

Overview

Journal J Health Commun

Specialties Health Services
Public Health

Date 2010 Aug 3

PMID 20677054

Citations 70

Authors

Alan R Tait

Terri Voepel-Lewis

Brian J Zikmund-Fisher

Angela Fagerlin

Affiliations

Soon will be listed here.

Abstract

There is a paucity of information regarding the optimal method of presenting risk/benefit information to parents of pediatric research subjects. This study, therefore, was designed to examine the effect of different message formats on parents' understanding of research risks and benefits. An Internet-administered survey was completed by 4,685 parents who were randomized to receive risk/benefit information about a study of pediatric postoperative pain control presented in different message formats (text, tables, and pictographs). Survey questions assessed participants' gist and verbatim understanding of the information and their perceptions of the risks and benefits. Pictographs were associated with significantly (p < .05) greater likelihood of adequate gist and verbatim understanding compared with text and tables regardless of the participants' numeracy. Parents who received the information in pictograph format perceived the risks to be lower and the benefits to be higher compared with the other formats (p < .001). Furthermore, compared with text and tables, pictographs were perceived as more "effective," "helpful," and "trustworthy" in presenting risk/benefit information. These results underscore the difficulties associated with presenting risk/benefit information for clinical research but suggest a simple method for enhancing parents' informed understanding of the relevant statistics.

Citing Articles

Scope, Methods, and Overview Findings for the Making Numbers Meaningful Evidence Review of Communicating Probabilities in Health: A Systematic Review.

Ancker J, Benda N, Sharma M, Johnson S, Demetres M, Delgado D MDM Policy Pract. 2025; 10(1):23814683241255334.

PMID: 39995784 PMC: 11848889. DOI: 10.1177/23814683241255334.

How Point (Single-Probability) Tasks Are Affected by Probability Format, Part 1: A Making Numbers Meaningful Systematic Review.

Ancker J, Benda N, Sharma M, Johnson S, Demetres M, Delgado D MDM Policy Pract. 2025; 10(1):23814683241255333.

PMID: 39995779 PMC: 11848880. DOI: 10.1177/23814683241255333.

How Synthesis Tasks Are Affected by Probability Format: A Making Numbers Meaningful Systematic Review.

Benda N, Sharma M, Ancker J, Demetres M, Delgado D, Johnson S MDM Policy Pract. 2025; 10(1):23814683241293796.

PMID: 39995777 PMC: 11848887. DOI: 10.1177/23814683241293796.

How Difference Tasks Are Affected by Probability Format, Part 1: A Making Numbers Meaningful Systematic Review.

Benda N, Zikmund-Fisher B, Sharma M, Johnson S, Demetres M, Delgado D MDM Policy Pract. 2025; 10(1):23814683241294077.

PMID: 39995776 PMC: 11848882. DOI: 10.1177/23814683241294077.

How Point (Single-Probability) Tasks Are Affected by Probability Format, Part 2: A Making Numbers Meaningful Systematic Review.

Ancker J, Benda N, Sharma M, Johnson S, Demetres M, Delgado D MDM Policy Pract. 2025; 10(1):23814683241255337.

PMID: 39995775 PMC: 11848894. DOI: 10.1177/23814683241255337.

References

Tait A, Voepel-Lewis T, Robinson A, Malviya S . Priorities for disclosure of the elements of informed consent for research: a comparison between parents and investigators. Paediatr Anaesth. 2002; 12(4):332-6. DOI: 10.1046/j.1460-9592.2002.00851.x. View

OConnor A . Effects of framing and level of probability on patients' preferences for cancer chemotherapy. J Clin Epidemiol. 1989; 42(2):119-26. DOI: 10.1016/0895-4356(89)90085-1. View

Schwartz L, Woloshin S, Black W, Welch H . The role of numeracy in understanding the benefit of screening mammography. Ann Intern Med. 1997; 127(11):966-72. DOI: 10.7326/0003-4819-127-11-199712010-00003. View

Tait A, Voepel-Lewis T, Malviya S . Do they understand? (part I): parental consent for children participating in clinical anesthesia and surgery research. Anesthesiology. 2003; 98(3):603-8. DOI: 10.1097/00000542-200303000-00005. View

Mazur D, Merz J . How the manner of presentation of data influences older patients in determining their treatment preferences. J Am Geriatr Soc. 1993; 41(3):223-8. DOI: 10.1111/j.1532-5415.1993.tb06696.x. View

Paling J . Strategies to help patients understand risks. BMJ. 2003; 327(7417):745-8. PMC: 200818. DOI: 10.1136/bmj.327.7417.745. View

Forrow L, Taylor W, Arnold R . Absolutely relative: how research results are summarized can affect treatment decisions. Am J Med. 1992; 92(2):121-4. DOI: 10.1016/0002-9343(92)90100-p. View

Woloshin S, Schwartz L . How can we help people make sense of medical data?. Eff Clin Pract. 1999; 2(4):176-83. View

Fagerlin A, Zikmund-Fisher B, Ubel P, Jankovic A, Derry H, Smith D . Measuring numeracy without a math test: development of the Subjective Numeracy Scale. Med Decis Making. 2007; 27(5):672-80. DOI: 10.1177/0272989X07304449. View

10.

Zikmund-Fisher B, Smith D, Ubel P, Fagerlin A . Validation of the Subjective Numeracy Scale: effects of low numeracy on comprehension of risk communications and utility elicitations. Med Decis Making. 2007; 27(5):663-71. DOI: 10.1177/0272989X07303824. View

11.

Peters E, Dieckmann N, Dixon A, Hibbard J, Mertz C . Less is more in presenting quality information to consumers. Med Care Res Rev. 2007; 64(2):169-90. DOI: 10.1177/10775587070640020301. View

12.

Edwards A, Elwyn G, Mulley A . Explaining risks: turning numerical data into meaningful pictures. BMJ. 2002; 324(7341):827-30. PMC: 1122766. DOI: 10.1136/bmj.324.7341.827. View

13.

Schapira M, Nattinger A, McHorney C . Frequency or probability? A qualitative study of risk communication formats used in health care. Med Decis Making. 2002; 21(6):459-67. DOI: 10.1177/0272989X0102100604. View

14.

Burkell J . What are the chances? Evaluating risk and benefit information in consumer health materials. J Med Libr Assoc. 2004; 92(2):200-8. PMC: 385301. View

15.

Timmermans D, Molewijk B, Stiggelbout A, Kievit J . Different formats for communicating surgical risks to patients and the effect on choice of treatment. Patient Educ Couns. 2004; 54(3):255-63. DOI: 10.1016/S0738-3991(03)00238-6. View

16.

Malenka D, Baron J, Johansen S, Wahrenberger J, Ross J . The framing effect of relative and absolute risk. J Gen Intern Med. 1993; 8(10):543-8. DOI: 10.1007/BF02599636. View

17.

Brundage M, Feldman-Stewart D, Leis A, Bezjak A, Degner L, Velji K . Communicating quality of life information to cancer patients: a study of six presentation formats. J Clin Oncol. 2005; 23(28):6949-56. DOI: 10.1200/JCO.2005.12.514. View

18.

Rostom A, OConnor A, Tugwell P, Wells G . A randomized trial of a computerized versus an audio-booklet decision aid for women considering post-menopausal hormone replacement therapy. Patient Educ Couns. 2002; 46(1):67-74. DOI: 10.1016/s0738-3991(01)00167-7. View

19.

Schapira M, Nattinger A, McAuliffe T . The influence of graphic format on breast cancer risk communication. J Health Commun. 2006; 11(6):569-82. DOI: 10.1080/10810730600829916. View

20.

Slovic P, Monahan J, MacGregor D . Violence risk assessment and risk communication: the effects of using actual cases, providing instruction, and employing probability versus frequency formats. Law Hum Behav. 2000; 24(3):271-96. DOI: 10.1023/a:1005595519944. View