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Wegwarth O, Hoffmann TC, Goldacre B, Spies C, Giese HA. General practitioners' risk literacy and real-world prescribing of potentially hazardous drugs: a cross-sectional study. BMJ Qual Saf 2024:bmjqs-2023-016979. [PMID: 38631907 DOI: 10.1136/bmjqs-2023-016979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Overuse of medical care is a pervasive problem. Studies using hypothetical scenarios suggest that physicians' risk literacy influences medical decisions; real-world correlations, however, are lacking. We sought to determine the association between physicians' risk literacy and their real-world prescriptions of potentially hazardous drugs, accounting for conflicts of interest and perceptions of benefit-harm ratios in low-value prescribing scenarios. SETTING AND SAMPLE Cross-sectional study-conducted online between June and October 2023 via field panels of Sermo (Hamburg, Germany)-with a convenience sample of 304 English general practitioners (GPs). METHODS GPs' survey responses on their treatment-related risk literacy, conflicts of interest and perceptions of the benefit-harm ratio in low-value prescribing scenarios were matched to their UK National Health Service records of prescribing volumes for antibiotics, opioids, gabapentin and benzodiazepines and analysed for differences. RESULTS 204 GPs (67.1%) worked in practices with ≥6 practising GPs and 226 (76.0%) reported 10-39 years of experience. Compared with GPs demonstrating low risk literacy, GPs with high literacy prescribed fewer opioids (mean (M): 60.60 vs 43.88 prescribed volumes/1000 patients/6 months, p=0.016), less gabapentin (M: 23.84 vs 18.34 prescribed volumes/1000 patients/6 months, p=0.023), and fewer benzodiazepines (M: 17.23 vs 13.58 prescribed volumes/1000 patients/6 months, p=0.037), but comparable volumes of antibiotics (M: 48.84 vs 40.61 prescribed volumes/1000 patients/6 months, p=0.076). High-risk literacy was associated with lower conflicts of interest (ϕ = 0.12, p=0.031) and higher perception of harms outweighing benefits in low-value prescribing scenarios (p=0.007). Conflicts of interest and benefit-harm perceptions were not independently associated with prescribing behaviour (all ps >0.05). CONCLUSIONS AND RELEVANCE The observed association between GPs with higher risk literacy and the prescription of fewer hazardous drugs suggests the importance of risk literacy in enhancing patient safety and quality of care.
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Affiliation(s)
- Odette Wegwarth
- Heisenberg Chair for Medical Risk Literacy & Evidence-Based Decisions, Charité Universitätsmedizin Berlin Campus Charite Mitte, Berlin, Germany
- Adpative Rationality, Max-Planck-Institute for Human Development, Berlin, Germany
| | - Tammy C Hoffmann
- Faculty of Health Sciences and Medicine, Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Ben Goldacre
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Helge A Giese
- Heisenberg Chair for Medical Risk Literacy & Evidence-Based Decisions, Charité Universitätsmedizin Berlin Campus Charite Mitte, Berlin, Germany
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Vromans RD, Bol N, van Wezel MMC, Krahmer EJ. "R" you getting this? Factors contributing to the public's understanding, evaluation, and use of basic reproduction numbers for infectious diseases. BMC Public Health 2024; 24:1209. [PMID: 38693508 PMCID: PMC11064422 DOI: 10.1186/s12889-024-18669-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/19/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND We (1) examined the effects of evaluative labels and visual aids on people's understanding, evaluation, and use of the COVID-19 reproduction number (or "r-number"), (2) examined whether people's perceived susceptibility and (intended) adherence to preventive measures changed after being exposed to the r-number, and (3) explored whether these effects and changes depended on people's numeracy skills. METHODS In an online experiment, participants from a large Dutch representative sample (N = 1,168) received information about the COVID-19 r-number displayed on the corona dashboard of the Dutch Ministry of Health, Welfare and Sport. The r-number was either presented with or without a categorical line display (i.e., evaluative label) and with or without an icon-based tree diagram (i.e., visual aid) explaining how the number works. Regarding people's use of the statistic, we measured perceived susceptibility to COVID-19 and adherence (intention) to five preventive measures before and after exposure to the r-number. After exposure, we also measured participants' understanding, perceived usefulness, affective and cognitive evaluation, and objective numeracy. RESULTS About 56% of participants correctly interpreted the r-number, with highly numerate people having better understanding than less numerate people. Information about the r-number was perceived as more useful when presented with a visual aid. There were no differences across experimental conditions in people's understanding, affective, and cognitive evaluations. Finally, independent of experimental conditions, intention to adhere to preventive measures was higher after seeing the r-number, but only among highly numerate people. CONCLUSIONS Although evaluative labels and visual aids did not facilitate people's understanding and evaluation of the r-number, our results show that the statistic is perceived as useful and may be used to stimulate adherence to preventive measures. Policy makers and public health communicators are advised to clearly explain why they are giving these numbers to - especially - the less numerate people, but also how people could use them for behavior change to combat the spread of virus during a pandemic.
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Affiliation(s)
- Ruben D Vromans
- Department of Communication and Cognition, Tilburg center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, P.O. Box 90153, Tilburg, 5037 LE, The Netherlands.
| | - Nadine Bol
- Department of Communication and Cognition, Tilburg center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, P.O. Box 90153, Tilburg, 5037 LE, The Netherlands
| | - Marloes M C van Wezel
- Department of Communication and Cognition, Tilburg center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, P.O. Box 90153, Tilburg, 5037 LE, The Netherlands
| | - Emiel J Krahmer
- Department of Communication and Cognition, Tilburg center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, P.O. Box 90153, Tilburg, 5037 LE, The Netherlands
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Bullock SL, Winthrop HM, Hales D, Lin FC, Yang Y, Ammerman AS, Viera AJ. Who chooses "healthy" meals? An analysis of lunchtime meal quality in a workplace cafeteria. BMC Public Health 2024; 24:921. [PMID: 38553694 PMCID: PMC10979548 DOI: 10.1186/s12889-024-18284-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/05/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND The workplace can play an important role in shaping the eating behaviors of U.S. adults. Unfortunately, foods obtained in the workplace tend to be low in nutritional quality. Questions remain about the best way to approach the promotion of healthy food purchases among employees and to what extent health promotion activities should be tailored to the demographic characteristics of the employees. The purpose of this study was to (1) assess the nutritional quality of lunchtime meal purchases by employees in cafeterias of a large organization, (2) examine associations between lunchtime meal quality selection and the demographic characteristics of employees, and (3) determine the healthfulness of foods and beverages offered in the cafeterias of this organization. METHODS A cross-sectional analysis was conducted using secondary data from a food labeling study implemented in three worksite cafeterias. Demographic data was collected via surveys and meal data was collected using a photo capture system for 378 participants. The Healthy Eating Index 2015 (HEI-2015) was used to determine meal quality and a total score for the menu of options available in the cafeterias during the study period. Summary statistics were generated, and the analysis of variance (ANOVA) was used to compare the HEI-2015 scores between groups. RESULTS The mean HEI-2015 total score for the menu items offered (n = 1,229) in the cafeteria during the study period was 63.1 (SD = 1.83). The mean HEI-2015 score for individual lunchtime meal observations (n = 378) was 47.1 (SD = 6.8). In general, HEI-2015 total scores were higher for non-smokers, individuals who self-identified as Asian, had higher physical activity levels, scored higher on numeracy and literacy assessments, and reported higher education levels, incomes, and health status. CONCLUSIONS The overall HEI-2015 scores indicate that the menu of options offered in the cafeterias and individual meal selections did not align with the Dietary Guidelines for Americans, and there were significant associations between average lunchtime meal quality scores and several demographic characteristics. These results suggest that healthy eating promotion activities in workplaces may need to be tailored to the demographic characteristics of the employees, and efforts to improve the food environment in the workplace could improve meal quality for all employees.
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Affiliation(s)
- Sally L Bullock
- Davidson College, PO Box 5000, 209 Ridge Road, Davidson, NC, 28035, USA.
| | - Hilary M Winthrop
- Duke University School of Medicine, 2200 W Main St, Durham, NC, 27705, USA
| | - Derek Hales
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 MLK Jr. Blvd, CB#7426,, Chapel Hill, NC, 27599, USA
| | - Feng-Chang Lin
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 3101 McGavran-Greenberg Hall, CB #7420,, Chapel Hill, NC, 27599, USA
| | - Yumei Yang
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 3101 McGavran-Greenberg Hall, CB #7420,, Chapel Hill, NC, 27599, USA
| | - Alice S Ammerman
- Department of Nutrition, Gillings School of Global Public Health, Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, CB# 7426, 1700 MLK Jr. Blvd, Room 239,, Chapel Hill, 27599, USA
| | - Anthony J Viera
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2200 W Main St, Suite 400, Durham, NC, 27705, USA
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van Strien-Knippenberg IS, Arjangi-Babetti H, Timmermans DRM, Schrauwen L, Fransen MP, Melles M, Damman OC. Communicating the results of risk-based breast cancer screening through visualizations of risk: a participatory design approach. BMC Med Inform Decis Mak 2024; 24:78. [PMID: 38500098 PMCID: PMC10949766 DOI: 10.1186/s12911-024-02483-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/11/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Risk-based breast cancer (BC) screening raises new questions regarding information provision and risk communication. This study aimed to: 1) investigate women's beliefs and knowledge (i.e., mental models) regarding BC risk and (risk-based) BC screening in view of implications for information development; 2) develop novel informational materials to communicate the screening result in risk-based BC screening, including risk visualizations of both quantitative and qualitative information, from a Human-Centered Design perspective. METHODS Phase 1: Interviews were conducted (n = 15, 40-50 years, 5 lower health literate) on women's beliefs about BC risk and (risk-based) BC screening. Phase 2: In three participatory design sessions, women (n = 4-6 across sessions, 40-50 years, 2-3 lower health literate) made assignments and created and evaluated visualizations of risk information central to the screening result. Prototypes were evaluated in two additional sessions (n = 2, 54-62 years, 0-1 lower health literate). Phase 3: Experts (n = 5) and women (n = 9, 40-74 years) evaluated the resulting materials. Two other experts were consulted throughout the development process to ensure that the content of the information materials was accurate. Interviews were transcribed literally and analysed using qualitative thematic analysis, focusing on implications for information development. Notes, assignments and materials from the participatory design sessions were summarized and main themes were identified. RESULTS Women in both interviews and design sessions were positive about risk-based BC screening, especially because personal risk factors would be taken into account. However, they emphasized that the rationale of risk-based screening and classification into a risk category should be clearly stated and visualized, especially for higher- and lower-risk categories (which may cause anxiety or feelings of unfairness due to a lower screening frequency). Women wanted to know their personal risk, preferably visualized in an icon array, and wanted advice on risk reduction and breast self-examination. However, most risk factors were considered modifiable by women, and the risk factor breast density was not known, implying that information should emphasize that BC risk depends on multiple factors, including breast density. CONCLUSIONS The information materials, including risk visualizations of both quantitative and qualitative information, developed from a Human-Centered Design perspective and a mental model approach, were positively evaluated by the target group.
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Affiliation(s)
- Inge S van Strien-Knippenberg
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Hannah Arjangi-Babetti
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Danielle R M Timmermans
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Laura Schrauwen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Mirjam P Fransen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Marijke Melles
- Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Olga C Damman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
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Tanner B, McDonald P, Mahmoud-Elhaj D, Sabatini D, Chamberlain JF, Nijhawan A, Rainbolt-Forbes E, Feltz A. Not all information is informative: An exploration of educational content on recycled potable water knowledge and acceptance. WATER RESEARCH 2024; 252:121254. [PMID: 38335749 DOI: 10.1016/j.watres.2024.121254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 12/06/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
As drought and water shortages threaten access to safe water supplies globally, finding ways to increase public acceptance of recycled water has become increasingly important. Educational interventions have often been explored as a potential method to help overcome public distaste for recycled water. However, in past research, the effects of educational interventions have tended to be modest, leading to some skepticism over the ability of public information campaigns to truly increase acceptance. We propose that, at least in part, these modest effects of education may be driven by differences in the ability of some types of educational content to increase recycled water knowledge and subsequent acceptance (e.g., some content may be too complex for a lay audience or may be insufficient to adequately address the concerns that drive one's apprehension towards recycled water). Thus, we developed and tested an educational video split into four distinct areas of educational content related to potable water reuse: (1) need for recycled water, (2) approaches to implementing recycled water (e.g., through direct, indirect, or de-facto reuse), (3) purification technology, and (4) locations and testimonials of actual implementation. In two experiments (Ns = 711, 385), we found that content illustrating approaches to implementing recycled water and locations using it led to medium to large increases in knowledge and acceptance. These results imply that given limited time and resources, brief information about these topics may increase acceptance better than alternative information. Moreover, these results underscore a need to more carefully consider the content used in educational campaigns, as not all information is equally likely to produce desired effects.
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Affiliation(s)
- Braden Tanner
- Department of Psychology, University of Oklahoma, 455 W. Lindsey, Norman, OK 73019, US
| | - Portia McDonald
- Department of Psychology, University of Oklahoma, 455 W. Lindsey, Norman, OK 73019, US
| | - Dana Mahmoud-Elhaj
- Department of Psychology, University of Oklahoma, 455 W. Lindsey, Norman, OK 73019, US
| | - David Sabatini
- WaTER Center, School of Civil Engineering and Environmental Science, University of Oklahoma, 202 W. Boyd, Norman, OK 73019, US
| | - Jim F Chamberlain
- WaTER Center, School of Civil Engineering and Environmental Science, University of Oklahoma, 202 W. Boyd, Norman, OK 73019, US
| | - Anisha Nijhawan
- Department of Civil Engineering, University of Bristol, University Walk, Bristol BS8 1TR, UK
| | - Eleanor Rainbolt-Forbes
- Korbel School of International Studies, University of Denver, 2201 S. Gaylord, Denver, CO 80208, US
| | - Adam Feltz
- Department of Psychology, University of Oklahoma, 455 W. Lindsey, Norman, OK 73019, US; Center for Applied Social Research, University of Oklahoma, 201 Stephenson Parkway, Norman, OK 73072, US.
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Maertens R, Götz FM, Golino HF, Roozenbeek J, Schneider CR, Kyrychenko Y, Kerr JR, Stieger S, McClanahan WP, Drabot K, He J, van der Linden S. The Misinformation Susceptibility Test (MIST): A psychometrically validated measure of news veracity discernment. Behav Res Methods 2024; 56:1863-1899. [PMID: 37382812 PMCID: PMC10991074 DOI: 10.3758/s13428-023-02124-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 06/30/2023]
Abstract
Interest in the psychology of misinformation has exploded in recent years. Despite ample research, to date there is no validated framework to measure misinformation susceptibility. Therefore, we introduce Verification done, a nuanced interpretation schema and assessment tool that simultaneously considers Veracity discernment, and its distinct, measurable abilities (real/fake news detection), and biases (distrust/naïvité-negative/positive judgment bias). We then conduct three studies with seven independent samples (Ntotal = 8504) to show how to develop, validate, and apply the Misinformation Susceptibility Test (MIST). In Study 1 (N = 409) we use a neural network language model to generate items, and use three psychometric methods-factor analysis, item response theory, and exploratory graph analysis-to create the MIST-20 (20 items; completion time < 2 minutes), the MIST-16 (16 items; < 2 minutes), and the MIST-8 (8 items; < 1 minute). In Study 2 (N = 7674) we confirm the internal and predictive validity of the MIST in five national quota samples (US, UK), across 2 years, from three different sampling platforms-Respondi, CloudResearch, and Prolific. We also explore the MIST's nomological net and generate age-, region-, and country-specific norm tables. In Study 3 (N = 421) we demonstrate how the MIST-in conjunction with Verification done-can provide novel insights on existing psychological interventions, thereby advancing theory development. Finally, we outline the versatile implementations of the MIST as a screening tool, covariate, and intervention evaluation framework. As all methods are transparently reported and detailed, this work will allow other researchers to create similar scales or adapt them for any population of interest.
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Affiliation(s)
- Rakoen Maertens
- Department of Psychology, University of Cambridge, Downing Street, CB2 3EB, Cambridge, Cambridgeshire, UK.
| | - Friedrich M Götz
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | | | - Jon Roozenbeek
- Department of Psychology, University of Cambridge, Downing Street, CB2 3EB, Cambridge, Cambridgeshire, UK
| | - Claudia R Schneider
- Department of Psychology, University of Cambridge, Downing Street, CB2 3EB, Cambridge, Cambridgeshire, UK
| | - Yara Kyrychenko
- Department of Psychology, University of Cambridge, Downing Street, CB2 3EB, Cambridge, Cambridgeshire, UK
| | - John R Kerr
- Department of Psychology, University of Cambridge, Downing Street, CB2 3EB, Cambridge, Cambridgeshire, UK
| | - Stefan Stieger
- Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - William P McClanahan
- Department of Psychology, University of Cambridge, Downing Street, CB2 3EB, Cambridge, Cambridgeshire, UK
- Max Planck Institute for the Study of Crime, Security and Law, Freiburg im Breisgau, Germany
| | - Karly Drabot
- Department of Psychology, University of Cambridge, Downing Street, CB2 3EB, Cambridge, Cambridgeshire, UK
| | - James He
- Department of Psychology, University of Cambridge, Downing Street, CB2 3EB, Cambridge, Cambridgeshire, UK
| | - Sander van der Linden
- Department of Psychology, University of Cambridge, Downing Street, CB2 3EB, Cambridge, Cambridgeshire, UK
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Svenson O, Isohanni F, Salo I, Lindholm T. Airborne SARS-CoV2 virus exposure, interpersonal distance, face mask and perceived risk of infection. Sci Rep 2024; 14:2285. [PMID: 38280918 PMCID: PMC10821858 DOI: 10.1038/s41598-024-52711-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/23/2024] [Indexed: 01/29/2024] Open
Abstract
Participants judged the risk of an infection during a face to face conversation at different interpersonal distances from a SARS-CoV-2 infected person who wore a face mask or not, and in the same questionnaire answered questions about Corona related issues. Keeping a distance to an infected person serves as a protective measure against an infection. When an infected person moves closer, risk of infection increases. Participants were aware of this fact, but underestimated the rate at which the risk of infection increases when getting closer to an infected person, e.g., from 1.5 to 0.5 m (perceived risk increase = 3.33 times higher, objective = 9.00 times higher). This is alarming because it means that people can take risks of infection that they are not aware of or want to take, when they approach another possibly virus infected person. Correspondingly, when an infected person moves away the speed of risk decrease was underestimated, meaning that people are not aware of how much safer they will be if they move away from an infected person. The perceived risk reducing effects of a face mask were approximately correct. Judgments of infection risk at different interpersonal distances (with or without a mask) were unrelated to how often a person used a mask, avoided others or canceled meetings during the COVID-19 pandemic. Greater worry in general and in particular over COVID-19, correlated positively with more protective behavior during the pandemic, but not with judgments of infection risk at different interpersonal distances. Participants with higher scores on a cognitive numeracy test judged mask efficiency more correctly, and women were more worried and risk avoiding than men. The results have implications for understanding behavior in a pandemic, and are relevant for risk communications about the steep increase in risk when approaching a person who may be infected with an airborne virus.
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Affiliation(s)
- Ola Svenson
- Department of Psychology, Stockholm University, Stockholm, Sweden.
- Decision Research, Eugene, OR, USA.
| | - Freja Isohanni
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Ilkka Salo
- Department of Psychology, Lund University, Lund, Sweden
| | - Torun Lindholm
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Recchia G, Moser KS, Freeman AL. What Affects Perceived Trustworthiness of Online Medical Information and Subsequent Treatment Decision Making? Randomized Trials on the Role of Uncertainty and Institutional Cues. MDM Policy Pract 2024; 9:23814683241226660. [PMID: 38370149 PMCID: PMC10870812 DOI: 10.1177/23814683241226660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/09/2023] [Indexed: 02/20/2024] Open
Abstract
Background. Online, algorithmically driven prognostic tools are increasingly important in medical decision making. Institutions developing such tools need to be able to communicate the precision and accuracy of the information in a trustworthy manner, and so many attempt to communicate uncertainties but also use institutional logos to underscore their trustworthiness. Bringing together theories on trust, uncertainty, and psychological distance in a novel way, we tested whether and how the communication of uncertainty and the presence of institutional logos together affected trust in medical information, the prognostic tool itself, and treatment decisions. Methods. A pilot and 2 online experiments in which UK (experiment 1) and worldwide (experiment 2) participants (Ntotal = 4,724) were randomized to 1 of 12 arms in a 3 (uncertainty cue) × 4 (institutional cue) between-subjects design. The stimulus was based on an existing medical prognostic tool. Results. Institutional trust was consistently associated with trust in the prognostic tool itself, while uncertainty information had no consistent effect. Institutional trust predicted the amount of weight participants reported placing on institutional endorsements in their decision making and the likelihood of switching from passive to active treatment in a hypothetical scenario. There was also a significant effect of psychological distance to (perceived hypotheticality of) the scenario. Conclusions/Implications. These results underline the importance of institutions demonstrating trustworthiness and building trust with their users. They also suggest that users tend to be insensitive to communications of uncertainty and that communicators may need to be highly explicit when attempting to warn of low precision or quality of evidence. The effect of the perceived hypotheticality of the scenario underscores the importance of realistic decision-making scenarios for studies and the role of familiarity with the decision dilemma generally. Highlights In a world where information for medical decision making is increasingly going to be provided through digital, online tools, institutions providing such tools need guidance on how best to communicate about their trustworthiness and precision.We find that people are fairly insensitive to cues designed to communicate uncertainty around the outputs of such tools. Even putting "ATTENTION" in bold font or explicitly pointing out the weaknesses in the data did not appear to affect people's decision making using the tool's outputs. Institutions should take note, and further work is required to determine how best to communicate uncertainty in a way that elicits appropriate caution in lay users.People were much more sensitive to institutional logos associated with the outputs. Generalized institutional trust (rather than trust in the specific institution whose logo was shown) was associated with how trustworthy, accurate, and reliable the tool, its algorithm, and the numbers it produced were perceived to be. This underscores the role of societal trust in institutions at large.Finally, as a note to researchers, we found a significant effect of how hypothetical or believable participants felt the experimental scenario was. This is a variable that seems rarely controlled for in studies and yet played as much of a role as some of our variables of interest, so we suggest that it is measured in future experiments.
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Affiliation(s)
- Gabriel Recchia
- Winton Centre for Risk & Evidence Communication, Department of Pure Maths and Mathematical Statistics, University of Cambridge, Cambridge, UK
| | - Karin S. Moser
- UniDistance Suisse, Faculty of Psychology, Brig, Switzerland
| | - Alexandra L.J. Freeman
- Winton Centre for Risk & Evidence Communication, Department of Pure Maths and Mathematical Statistics, University of Cambridge, Cambridge, UK
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Waters EA, Pogge G, Orom H, Kiviniemi MT, Hay JL, Lewicka M, Allard NC, Webster GD, Shepperd JA. I don't know my child's asthma risk: evidence against satisficing as an explanation for 'don't know' responses. JOURNAL OF RISK RESEARCH 2023; 26:1370-1382. [PMID: 38274030 PMCID: PMC10810301 DOI: 10.1080/13669877.2023.2288006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 11/22/2023] [Indexed: 01/27/2024]
Abstract
Several studies suggest that "don't know" (DK) responses to risk perception items may represent meaningful expressions of uncertainty about disease risk. However, researchers are often discouraged from including a DK response option in survey items due to concerns about respondents overusing it to minimize cognitive effort-a phenomenon often referred to as satisficing. Our objective was to investigate whether patterns of DK responses to risk perception survey items were consistent with satisficing behavior. We conducted a secondary analysis of survey data from 814 parents and guardians (hereafter caregivers) of children with asthma. Caregivers answered 18 items assessing their perceived risk of their child experiencing two types of poor asthma outcomes: asthma exacerbation, and low asthma control. We examined differences in the frequency and distribution of DK responses across all 18 items and by type of risk perception item (i.e., 2 vs. 5 response options, absolute vs. comparative risk). We found that 32% (n=548) of respondents marked DK at least once. Of the 266 caregivers who provided any DK response, most did so for only 1 or 2 items (51.9%, n=138), and only 6% (n=15) answered DK to more than half of the items. Using random coefficient Poisson models, we found more DK responding for dichotomous absolute (30.1%) than ordinal absolute items (5.3%), b=1.72, p<.001. We also found fewer DK responses to the ordinal absolute items than the comparative items (8.2%), b=-0.49, p<.001. Using Chi-square tests, we found that inattentive responding was not associated with responding DK. Our findings suggest that satisficing is unlikely to completely explain DK responding to perceived risk survey items. Researchers who exclude DK response options from risk perception survey items may obtain an incomplete understanding of their study sample's beliefs about risk.
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Affiliation(s)
- Erika A Waters
- Department of Surgery - Public Health Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Gabrielle Pogge
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Heather Orom
- Department of Community Health and Health Behavior, State University of New York at Buffalo
| | - Marc T Kiviniemi
- Department of Health, Behavior and Society, University of Kentucky, Lexington, KY USA
| | - Jennifer L Hay
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Malwina Lewicka
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Natasha C Allard
- Department of Community Health and Health Behavior, State University of New York at Buffalo
| | - Gregory D Webster
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - James A Shepperd
- Department of Psychology, University of Florida, Gainesville, Florida, USA
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10
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Waters EA, Pachur T, Pogge G, Hunleth J, Webster GD, Shepperd JA. Linking cognitive and affective heuristic cues to interpersonal risk perceptions and behavior. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2023; 43:2610-2630. [PMID: 36781299 PMCID: PMC10423305 DOI: 10.1111/risa.14101] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 06/18/2023]
Abstract
People often use cognitive and affective heuristics when judging the likelihood of a health outcome and making health decisions. However, little research has examined how heuristics shape risk perceptions and behavior among people who make decisions on behalf of another person. We examined associations between heuristic cues and caregivers' perceptions of their child's asthma risk, the frequency of caregivers' asthma management behaviors, and child health outcomes. We used Ipsos KnowledgePanel to recruit 814 U.S. adult caregivers of children with asthma of the age <18 years. Participants completed a survey at baseline (T1) and 3 months later (T2). Caregivers who, at T1, reported greater negative affect about their child's asthma (affect heuristic cue), greater ease of imagining their child experiencing asthma symptoms (availability heuristic cue), and greater perceived similarity between their child and a child who has ever experienced asthma symptoms (representativeness heuristic cue) reported statistically significantly (p < 0.05) higher interpersonal perceived risk of their child having an exacerbation or uncontrolled asthma at T1. They also indicated at T2 that their child had poorer asthma control and more frequent exacerbations. Greater T1 negative affect was associated with more frequent T2 actions to reduce inflammation, manage triggers, and manage symptoms, and with poorer T2 child health outcomes. Heuristic cues are likely important for interpersonal-not just personal-risk perceptions. However, the interrelationship between caregivers' ratings of heuristic cues (in particular, negative affect) and risk judgments may signify a struggle with managing their child's asthma and need for extra support from health care providers or systems.
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Affiliation(s)
- Erika A. Waters
- Washington University in St. Louis, Saint Louis, Missouri, USA
| | | | | | - Jean Hunleth
- Washington University in St. Louis, Saint Louis, Missouri, USA
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11
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Loeb S, Sanchez Nolasco T, Siu K, Byrne N, Giri VN. Usefulness of podcasts to provide public education on prostate cancer genetics. Prostate Cancer Prostatic Dis 2023; 26:772-777. [PMID: 36681741 DOI: 10.1038/s41391-023-00648-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Podcasts, or episodic digital audio recordings, represent a novel way to reach large audiences for public education. Genetic evaluation has important implications for prostate cancer (PCa) care but is underutilized. We created a series of five podcasts about PCa genetics and tested their usefulness in raising awareness and providing education to lay audiences. METHODS We recruited 157 men and women from the general public and 100 patients with PCa from across the U.S., who listened to a podcast and completed an online survey. The primary outcome was the perceived usefulness of the podcast (score ≥5 on a published 7-point Likert scale). Secondary outcomes were relevance to informational needs, satisfaction and ease of use, as well as genetic knowledge and attitudes toward genetic testing after listening to the podcasts. RESULTS The podcasts were associated with high mean scores for perceived usefulness (5.6/7), relevance to informational needs (5.6/7), satisfaction (5.8/7), and ease of use (5.9/7). After listening to the podcasts, 80-100% correctly answered most key knowledge questions about PCa genetics, and 85% had a positive attitude toward genetic testing. On multivariable analysis, the perceived usefulness of the podcasts was higher among Black/Hispanic adults (p = 0.05) and those with a family history of PCa (p = 0.01). CONCLUSIONS A podcast series on PCa genetics was perceived as useful and associated with high rates of knowledge for patients with PCa and the general public. Podcasts represent a promising new educational tool to raise awareness about PCa genetic evaluation, particularly for high-risk groups.
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Affiliation(s)
- Stacy Loeb
- Department of Urology, New York University, New York, NY, USA.
- Department of Population Health, New York University, New York, NY, USA.
- The Department of Surgery/Urology, Manhattan Veterans Affairs Medical Center, New York, NY, USA.
| | - Tatiana Sanchez Nolasco
- Department of Urology, New York University, New York, NY, USA
- Department of Population Health, New York University, New York, NY, USA
| | - Katherine Siu
- Department of Urology, New York University, New York, NY, USA
- Department of Population Health, New York University, New York, NY, USA
| | - Nataliya Byrne
- Department of Urology, New York University, New York, NY, USA
- Department of Population Health, New York University, New York, NY, USA
| | - Veda N Giri
- The Division of Clinical Cancer Genetics, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA
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12
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Perez Santangelo A, Solovey G. Understanding belief in political statements using a model-driven experimental approach: a registered report. Sci Rep 2023; 13:21205. [PMID: 38040761 PMCID: PMC10692149 DOI: 10.1038/s41598-023-47939-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 11/20/2023] [Indexed: 12/03/2023] Open
Abstract
Misinformation harms society by affecting citizens' beliefs and behaviour. Recent research has shown that partisanship and cognitive reflection (i.e. engaging in analytical thinking) play key roles in the acceptance of misinformation. However, the relative importance of these factors remains a topic of ongoing debate. In this registered study, we tested four hypotheses on the relationship between each factor and the belief in statements made by Argentine politicians. Participants (N = 1353) classified fact-checked political statements as true or false, completed a cognitive reflection test, and reported their voting preferences. Using Signal Detection Theory and Bayesian modeling, we found a reliable positive association between political concordance and overall belief in a statement (median = 0.663, CI95 = [0.640, 0.685]), a reliable positive association between cognitive reflection and scepticism (median = 0.039, CI95 = [0.006, 0.072]), a positive but unreliable association between cognitive reflection and truth discernment (median = 0.016, CI95 = [- 0.015, 0.046]) and a negative but unreliable association between cognitive reflection and partisan bias (median = - 0.016, CI95 = [- 0.037, 0.006]). Our results highlight the need to further investigate the relationship between cognitive reflection and partisanship in different contexts and formats. PROTOCOL REGISTRATION: The stage 1 protocol for this Registered Report was accepted in principle on 22 August 2022. The protocol, as accepted by the journal, can be found at: https://doi.org/10.17605/OSF.IO/EBRGC .
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Affiliation(s)
- Agustín Perez Santangelo
- Instituto de Investigación en Ciencias de la Computación, Universidad de Buenos Aires (UBA), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), C1428EGA, Buenos Aires, Argentina.
- Laboratorio de Neurociencia, CONICET, Universidad Torcuato Di Tella, C1428BIJ, Buenos Aires, Argentina.
| | - Guillermo Solovey
- Instituto de CálculoFacultad de Ciencias Exactas y Naturales, UBA-CONICET, Buenos Aires, Argentina.
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Chaiken SR, Darney BG, Schenck M, Han L. Public perceptions of abortion complications. Am J Obstet Gynecol 2023; 229:421.e1-421.e8. [PMID: 37467839 DOI: 10.1016/j.ajog.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Misinformation contributes to the perception that abortion has substantial health risks, despite the known safety of medication and aspiration abortion. We lack detailed information about which health risks the public believes are most likely. OBJECTIVE This study aimed to describe public perception of short- and long-term risks of abortion. STUDY DESIGN We conducted a cross-sectional survey of US residents aged ≥18 years using Amazon Mechanical Turk (MTurk). We collected information regarding participant demographics, reproductive history, political views, and position on abortion restrictions. We provided participants with a list of 9 short-term and 15 long-term possible complications and asked them to indicate whether they occurred never (0%), very rarely (<1%), rarely (1%-5%), occasionally (5%-20%), or frequently (>20%) following abortion. We used descriptive statistics to understand our population demographics and to capture the perceived incidence of all complications. We created a binary indicator of answering all risk estimates incorrectly vs at least 1 estimate correctly, separately for all long-term possible complications, and the 2 short-term risks of infection and bleeding. We determined the proportion of individuals who responded incorrectly to all questions in each category and used multivariable logistic regression to identify factors associated with incorrect perceptions about the risks of abortion. RESULTS For all listed complications, participant (N=1057) estimates of risk were higher than the known incidence. For both short-term risks of bleeding and infection, over 40% of participants reported that these outcomes occur occasionally or frequently. Similarly, for both long-term risks of depression and anxiety, over 60% of respondents reported that these outcomes occur occasionally or frequently after abortion. Participants reported that possible complications known to not be associated with abortion, including hair loss, future pregnancy complications, breast cancer, and cosmetic disfigurement, occurred at least rarely. Nearly one-quarter of participants responded that death occurs occasionally or frequently (in over 5% of abortions), and 79% of participants responded that breast cancer can result from abortion. One-quarter (24.9%) of participants incorrectly overestimated both short-term outcomes of infection and bleeding, whereas 19.5% answered all long-term complication questions incorrectly, including outcomes that never occur. On multivariable analyses, we identified that the participants most likely to incorrectly identify risks of abortion identified as Asian or Black race/ethnicity, were from rural communities, or believed that abortion should have more legal restrictions. CONCLUSION The public perceives abortion to be much riskier than it actually is. This information can be used to develop targeted clinical and public health efforts to disseminate the true risks of abortion.
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Affiliation(s)
- Sarina R Chaiken
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, Providence, RI.
| | - Blair G Darney
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR; OHSU-PSU School of Public Health, Portland, OR; National Institute of Public Health, Center for Population Health Research, Cuernavaca, Mexico
| | - Marta Schenck
- Family Medicine Department, University of Utah, Salt Lake City, UT
| | - Leo Han
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
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14
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Slavik CE, Yiannakoulias N, Wilton R, Scott F. An Exploratory Study on the Impacts of Individual Skills and Health Information Exposure on Perceptions of Cancer Control and Expert Competence. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1584-1591. [PMID: 37103679 DOI: 10.1007/s13187-023-02303-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 06/19/2023]
Abstract
People's perceptions of control over their risk of cancer, and their perceptions of health experts' abilities to manage cancer risks, shape their beliefs about the effectiveness of expert-recommended cancer-preventive behaviors and actions. The aims of this exploratory study were to investigate the impact of individual skills and sources of health information on (i) internal locus of cancer control (ILOC) and (ii) perceived expert competence. Using a cross-sectional survey (n = 172), we collected data on individual health expertise, numeracy, health literacy, amounts of health information received from various sources, ILOC for cancer prevention and perceived expert competence (i.e., believing that health experts have the knowledge to correctly estimate cancer risks). Significant associations between health expertise and ILOC, and between health literacy and ILOC, were not observed in this study (OR = 2.15, 95%CI = 0.96-5.98; OR = 1.78, 95%CI = 0.97-3.63, respectively). Participants who received more health information from the news were more likely to perceive experts as competent (OR = 1.86, 95%CI = 1.06-3.57). Logistic regression analyses suggested that higher levels of health literacy among individuals with lower numeracy may promote ILOC but discourage expert competence beliefs. Analyses by gender suggested females with low educational attainment and lower numeracy may especially benefit from educational interventions to improve health literacy and promote ILOC. Our findings build off existing literature that point to a possible interaction between numeracy and health literacy. This research, with follow up work, may have practical implications for health educators aiming to promote specific cancer beliefs that lead to the uptake of expert-recommended cancer-preventive behaviors.
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Affiliation(s)
- Catherine E Slavik
- School of Earth, Environment and Society, General Sciences Building, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Niko Yiannakoulias
- School of Earth, Environment and Society, McMaster University, Hamilton, Canada
| | - Robert Wilton
- School of Earth, Environment and Society, McMaster University, Hamilton, Canada
| | - Fran Scott
- Department of Health, Aging & Society, McMaster University, Hamilton, Canada
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15
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Tiede KE, Gaissmaier W. How Do People Process Different Representations of Statistical Information? Insights into Cognitive Effort, Representational Inconsistencies, and Individual Differences. Med Decis Making 2023; 43:803-820. [PMID: 37842816 PMCID: PMC10625726 DOI: 10.1177/0272989x231202505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/23/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Graphical representation formats (e.g., icon arrays) have been shown to lead to better understanding of the benefits and risks of treatments compared to numbers. We investigate the cognitive processes underlying the effects of format on understanding: how much cognitive effort is required to process numerical and graphical representations, how people process inconsistent representations, and how numeracy and graph literacy affect information processing. METHODS In a preregistered between-participants experiment, 665 participants answered questions about the relative frequencies of benefits and side effects of 6 medications. First, we manipulated whether the medical information was represented numerically, graphically (as icon arrays), or inconsistently (numerically for 3 medications and graphically for the other 3). Second, to examine cognitive effort, we manipulated whether there was time pressure or not. In an additional intervention condition, participants translated graphical information into numerical information before answering questions. We also assessed numeracy and graph literacy. RESULTS Processing icon arrays was more strongly affected by time pressure than processing numbers, suggesting that graphical formats required more cognitive effort. Understanding was lower when information was represented inconsistently (v. consistently) but not if there was a preceding intervention. Decisions based on inconsistent representations were biased toward graphically represented options. People with higher numeracy processed quantitative information more efficiently than people with lower numeracy did. Graph literacy was not related to processing efficiency. LIMITATIONS Our study was conducted with a nonpatient sample, and the medical information was hypothetical. CONCLUSIONS Although graphical (v. numerical) formats have previously been found to lead to better understanding, they may require more cognitive effort. Therefore, the goal of risk communication may play an important role when choosing how to communicate medical information. HIGHLIGHTS This article investigates the cognitive processes underlying the effects of representation format on the understanding of statistical information and individual differences therein.Processing icon arrays required more cognitive effort than processing numbers did.When information was represented inconsistently (i.e., partly numerically and partly graphically), understanding was lower than with consistent representation, and decisions were biased toward the graphically represented options.People with higher numeracy processed quantitative information more efficiently than people with lower numeracy did.
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Affiliation(s)
- Kevin E. Tiede
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Germany
- Department of Psychology, University of Konstanz, Germany
- Graduate School of Decision Sciences, University of Konstanz, Germany
| | - Wolfgang Gaissmaier
- Department of Psychology, University of Konstanz, Germany
- Centre for the Advanced Study of Collective Behaviour, University of Konstanz, Germany
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16
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Kakinohana RK, Pilati R. Differences in decisions affected by cognitive biases: examining human values, need for cognition, and numeracy. PSICOLOGIA-REFLEXAO E CRITICA 2023; 36:26. [PMID: 37676441 PMCID: PMC10485213 DOI: 10.1186/s41155-023-00265-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023] Open
Abstract
A better understanding of factors that can affect preferences and choices may contribute to more accurate decision-making. Several studies have investigated the effects of cognitive biases on decision-making and their relationship with cognitive abilities and thinking dispositions. While studies on behaviour, attitude, personality, and health worries have examined their relationship with human values, research on cognitive bias has not investigated its relationship to individual differences in human values. The purpose of this study was to explore individual differences in biased choices, examining the relationships of the human values self-direction, conformity, power, and universalism with the anchoring effect, the framing effect, the certainty effect, and the outcome bias, as well as the mediation of need for cognition and the moderation of numeracy in these relationships. We measured individual differences and within-participant effects with an online questionnaire completed by 409 Brazilian participants, with an age range from 18 to 80 years, 56.7% female, and 43.3% male. The cognitive biases studied consistently influenced choices and preferences. However, the biases showed distinct relationships with the individual differences investigated, indicating the involvement of diverse psychological mechanisms. For example, people who value more self-direction were less affected only by anchoring. Hence, people more susceptible to one bias were not similarly susceptible to another. This can help in research on how to weaken or strengthen cognitive biases and heuristics.
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Affiliation(s)
- Regis K Kakinohana
- Institute of Psychology, University of Brasilia, Brasilia, DF, 72910-000, Brazil.
| | - Ronaldo Pilati
- Institute of Psychology, University of Brasilia, Brasilia, DF, 72910-000, Brazil
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17
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Matzen LE, Howell BC, Trumbo MCS, Divis KM. Numerical and Visual Representations of Uncertainty Lead to Different Patterns of Decision Making. IEEE COMPUTER GRAPHICS AND APPLICATIONS 2023; 43:72-82. [PMID: 37527307 DOI: 10.1109/mcg.2023.3299875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Although visualizations are a useful tool for helping people to understand information, they can also have unintended effects on human cognition. This is especially true for uncertain information, which is difficult for people to understand. Prior work has found that different methods of visualizing uncertain information can produce different patterns of decision making from users. However, uncertainty can also be represented via text or numerical information, and few studies have systematically compared these types of representations to visualizations of uncertainty. We present two experiments that compared visual representations of risk (icon arrays) to numerical representations (natural frequencies) in a wildfire evacuation task. Like prior studies, we found that different types of visual cues led to different patterns of decision making. In addition, our comparison of visual and numerical representations of risk found that people were more likely to evacuate when they saw visualizations than when they saw numerical representations. These experiments reinforce the idea that design choices are not neutral: seemingly minor differences in how information is represented can have important impacts on human risk perception and decision making.
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18
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Hua SV, Kenney EL, Miller JM, Musicus AA, Roberto CA, Thorndike AN, Rimm EB. Naming Matters: Prompting Smaller Portions in an Online RCT. Am J Prev Med 2023; 64:805-813. [PMID: 36792450 PMCID: PMC10200744 DOI: 10.1016/j.amepre.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Large portions, which can lead people to eat more, are becoming increasingly common in U.S. restaurants. This study tested whether portion-size descriptions on menus and different pricing strategies influence the selection of smaller portion sizes. STUDY DESIGN This was a 4 × 2 between-subjects online randomized controlled experiment. SETTING/PARTICIPANTS This was an online simulated menu-ordering study conducted in 2021 among 2,205 U.S. adults. INTERVENTION Adults viewed a fast-casual and full-service menu with entrées available in 2 sizes and ordered an entrée from each. Participants were randomized to view 1 of 4 portion-size descriptors (smaller/larger portion): (1) no descriptor/large (control), (2) standard/large, (3) just right/large, and (4) no descriptor/hearty. Participants were also randomized to either linear (i.e., reduced price=50% larger portion's price) or nonlinear pricing (i.e., reduced price=70% larger portion's price) (4 × 2 factorial design). MAIN OUTCOME MEASURES In 2022, logistic regression models were used to analyze whether the interventions increased the likelihood of choosing a reduced portion. RESULTS Regardless of pricing scheme, participants in the standard/large condition selected reduced portions by 10 (95% CI=0.04, 0.16) and 13 (95% CI=0.07, 0.18) percentage points more than those in the control condition (fast-casual and full-service menus, respectively). Selection of reduced portions in the just right/large condition increased by 9 (95% CI=0.04, 0.15) and 8 (95% CI=0.02, 0.14) percentage points. For the fast-casual menu, keeping portion-size descriptors constant, participants ordered a reduced portion by 5 percentage points more with nonlinear pricing than with linear pricing. CONCLUSIONS Portion-size descriptions on restaurant menus, even with nonlinear pricing, are a low-cost strategy to promote the selection of lower-calorie, smaller portions without restricting choice.
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Affiliation(s)
- Sophia V Hua
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Erica L Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Aviva A Musicus
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Christina A Roberto
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anne N Thorndike
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Bernard-Arevalo SP, Laforce RJ, Khayat O, Bouchard V, Bruneau MA, Brunelle S, Caron S, Chamelian L, Chénard M, Côté JF, Crépeau-Gendron G, Doré MC, Fortin MP, Gagnon N, Gagnon PR, Giroux C, Jean L, Létourneau G, Marceau É, Moreau V, Morin M, Ouellet C, Poulin S, Radermaker S, Rousseau K, Touchette C, Dumais A. Clinical Assessment of Judgment in Adults and the Elderly: Development and Validation of the Three Domains of Judgment Test-Clinical Version (3DJT-CV). J Clin Med 2023; 12:jcm12113740. [PMID: 37297934 DOI: 10.3390/jcm12113740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
(1) Background: This article discusses the first two phases of development and validation of the Three Domains of Judgment Test (3DJT). This computer-based tool, co-constructed with users and capable of being administered remotely, aims to assess the three main domains of judgment (practical, moral, and social) and learn from the psychometric weaknesses of tests currently used in clinical practice. (2) Method: First, we presented the 3DJT to experts in cognition, who evaluated the tool as a whole as well as the content validity, relevance, and acceptability of 72 scenarios. Second, an improved version was administered to 70 subjects without cognitive impairment to select scenarios with the best psychometric properties in order to build a future clinically short version of the test. (3) Results: Fifty-six scenarios were retained following expert evaluation. Results support the idea that the improved version has good internal consistency, and the concurrent validity primer shows that 3DJT is a good measure of judgment. Furthermore, the improved version was found to have a significant number of scenarios with good psychometric properties to prepare a clinical version of the test. (4) Conclusion: The 3DJT is an interesting alternative tool for assessing judgment. However, more studies are needed for its implementation in a clinical context.
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Affiliation(s)
- Simon-Pierre Bernard-Arevalo
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Robert Jr Laforce
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Department of Neurological Sciences, CHU de Québec-Université Laval, Quebec City, QC G1J 1Z4, Canada
| | - Olivier Khayat
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Vital Bouchard
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Marie-Andrée Bruneau
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Research Center of the Institut Universitaire de Gériatrie de Montréal, Montreal, QC H3W 1W4, Canada
| | - Sarah Brunelle
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, Montreal, QC H3L 1K5, Canada
| | - Stéphanie Caron
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Laury Chamelian
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Department of Psychiatry, Centre Hospitalier Universitaire de Montréal, Montreal, QC H2X 0C1, Canada
| | - Marise Chénard
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Jean-François Côté
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Gabrielle Crépeau-Gendron
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, Montreal, QC H3L 1K5, Canada
| | - Marie-Claire Doré
- Department of Neurological Sciences, CHU de Québec-Université Laval, Quebec City, QC G1J 1Z4, Canada
| | - Marie-Pierre Fortin
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Nadine Gagnon
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Pierre R Gagnon
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Chloé Giroux
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Léonie Jean
- Department of Neurological Sciences, CHU de Québec-Université Laval, Quebec City, QC G1J 1Z4, Canada
| | - Geneviève Létourneau
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal, Montreal, QC H1T 2M4, Canada
| | - Émilie Marceau
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Vincent Moreau
- Institut de Réadaptation en Déficience Physique de Québec, Quebec City, QC G1W 1P7, Canada
| | - Michèle Morin
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Sainte-Marie, QC G6E 3E2, Canada
| | - Christine Ouellet
- Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal, Montreal, QC H1T 2M4, Canada
| | - Stéphane Poulin
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Steve Radermaker
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Katerine Rousseau
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal, Montreal, QC H1T 2M4, Canada
| | - Catherine Touchette
- Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec City, QC G1C 3S2, Canada
| | - Alexandre Dumais
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC H3C 3J7, Canada
- Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, QC H1C 1H1, Canada
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20
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Reyna VF, Brainerd CJ. Numeracy, gist, literal thinking and the value of nothing in decision making. NATURE REVIEWS PSYCHOLOGY 2023; 2:1-19. [PMID: 37361389 PMCID: PMC10196318 DOI: 10.1038/s44159-023-00188-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 06/28/2023]
Abstract
The onus on the average person is greater than ever before to make sense of large amounts of readily accessible quantitative information, but the ability and confidence to do so are frequently lacking. Many people lack practical mathematical skills that are essential for evaluating risks, probabilities and numerical outcomes such as survival rates for medical treatments, income from retirement savings plans or monetary damages in civil trials. In this Review, we integrate research on objective and subjective numeracy, focusing on cognitive and metacognitive factors that distort human perceptions and foment systematic biases in judgement and decision making. Paradoxically, an important implication of this research is that a literal focus on objective numbers and mechanical number crunching is misguided. Numbers can be a matter of life and death but a person who uses rote strategies (verbatim representations) cannot take advantage of the information contained in the numbers because 'rote' strategies are, by definition, processing without meaning. Verbatim representations (verbatim is only surface form, not meaning) treat numbers as data as opposed to information. We highlight a contrasting approach of gist extraction: organizing numbers meaningfully, interpreting them qualitatively and making meaningful inferences about them. Efforts to improve numerical cognition and its practical applications can benefit from emphasizing the qualitative meaning of numbers in context - the gist - building on the strengths of humans as intuitive mathematicians. Thus, we conclude by reviewing evidence that gist training facilitates transfer to new contexts and, because it is more durable, longer-lasting improvements in decision making.
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Affiliation(s)
- Valerie F. Reyna
- Cornell University, Department of Psychology, Human Neuroscience Institute, Ithaca, NY USA
| | - Charles J. Brainerd
- Cornell University, Department of Psychology, Human Neuroscience Institute, Ithaca, NY USA
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Jee WF, Hyun M. "10,000 Available" or "10% Remaining": The Impact of Scarcity Framing on Ticket Availability Perceptions in the Secondary Ticket Market. Behav Sci (Basel) 2023; 13:bs13040338. [PMID: 37102852 PMCID: PMC10135727 DOI: 10.3390/bs13040338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 04/28/2023] Open
Abstract
The aim of this study was to investigate the effect of numeracy framing and demand on participants' perceived ticket availability and likelihood of finding a lower-priced deal in the secondary ticket market for National Football League (NFL) games. A total of 640 participants were recruited via Qualtrics where participants were solicited electronically via 10 date-specific email blasts prior to a New York Giants Sunday Night Football home game. Participants were randomly assigned to one of five treatment conditions (control, percentage frame × low demand, percentage frame × high demand, frequency frame × low demand, frequency frame × high demand) to complete an online survey. Multivariate analysis of variance (MANOVA) was performed to discern overall differences in the mean likelihood scores of the dependent variable between groups. The results showed that participants presented with the "percentage" frame perceived tickets as less available than those presented with the "frequency scarcity" frame, and the effect was greater for high-demand games. Additionally, game demand moderated the effect of scarcity framing on participants' perceived ticket availability and expected lower rate. Several manipulation checks were applied to ensure the study's validity. The findings of this study have practical implications for ticket marketers in the sport industry to effectively frame scarcity information and facilitate transactions for online buyers and sellers.
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Affiliation(s)
- Wonsok Frank Jee
- School of Marketing, Entrepreneurship, Sport Management, Hospitality, and Tourism Management, Western Carolina University, Cullowhee, NC 28723, USA
| | - Moonsup Hyun
- Department of Business and Economics, Utica University, Utica, NY 13502, USA
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22
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Shan Y, Ji M, Xing Z, Dong Z, Xu X. Susceptibility to Breast Cancer Misinformation Among Chinese Patients: Cross-sectional Study. JMIR Form Res 2023; 7:e42782. [PMID: 37018020 PMCID: PMC10131805 DOI: 10.2196/42782] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Currently, breast cancer is the most commonly diagnosed cancer and the sixth-leading cause of cancer-related deaths among Chinese women. Worse still, misinformation contributes to the aggravation of the breast cancer burden in China. There is a pressing need to investigate the susceptibility to breast cancer misinformation among Chinese patients. However, no study has been performed in this respect. OBJECTIVE This study aims to ascertain whether some demographics (age, gender, and education), some health literacy skills, and the internal locus of control are significantly associated with the susceptibility to misinformation about all types of breast cancers among randomly sampled Chinese patients of both genders in order to provide insightful implications for clinical practice, health education, medical research, and health policy making. METHODS We first designed a questionnaire comprising 4 sections of information: age, gender, and education (section 1); self-assessed disease knowledge (section 2); the All Aspects of Health Literacy Scale (AAHLS), the eHealth Literacy Scale (eHEALS), the 6-item General Health Numeracy Test (GHNT-6), and the "Internal" subscale of the Multidimensional Health Locus of Control (MHLC) scales (section 3); and 10 breast cancer myths collected from some officially registered and authenticated websites (section 4). Subsequently, we recruited patients from Qilu Hospital of Shandong University, China, using randomized sampling. The questionnaire was administered via wenjuanxing, the most popular online survey platform in China. The collected data were manipulated in a Microsoft Excel file. We manually checked the validity of each questionnaire using the predefined validity criterion. After that, we coded all valid questionnaires according to the predefined coding scheme, based on Likert scales of different point (score) ranges for different sections of the questionnaire. In the subsequent step, we calculated the sums of the subsections of the AAHLS and the sums of the 2 health literacy scales (the eHEALS and GHNT-6) and the 10 breast cancer myths. Finally, we applied logistic regression modeling to relate the scores in section 4 to the scores in sections 1-3 of the questionnaire to identify what significantly contributes to the susceptibility to breast cancer misinformation among Chinese patients. RESULTS All 447 questionnaires collected were valid according to the validity criterion. The participants were aged 38.29 (SD 11.52) years on average. The mean score for their education was 3.68 (SD 1.46), implying that their average educational attainment was between year 12 and a diploma (junior college). Of the 447 participants, 348 (77.85%) were women. The mean score for their self-assessed disease knowledge was 2.50 (SD 0.92), indicating that their self-assessed disease knowledge status was between "knowing a lot" and "knowing some." The mean scores of the subconstructs in the AAHLS were 6.22 (SD 1.34) for functional health literacy, 5.22 (SD 1.54) for communicative health literacy, and 11.19 (SD 1.99) for critical health literacy. The mean score for eHealth literacy was 24.21 (SD 5.49). The mean score for the 6 questions in the GHNT-6 was 1.57 (SD 0.49), 1.21 (SD 0.41), 1.24 (SD 0.43), 1.90 (SD 0.30), 1.82 (SD 0.39), and 1.73 (SD 0.44), respectively. The mean score for the patients' health beliefs and self-confidence was 21.19 (SD 5.63). The mean score for their response to each myth ranged from 1.24 (SD 0.43) to 1.67 (SD 0.47), and the mean score for responses to the 10 myths was 14.03 (SD 1.78). Through interpreting these descriptive statistics, we found that Chinese female patients' limited ability to rebut breast cancer misinformation is mainly attributed to 5 factors: (1) lower communicative health literacy, (2) certainty about self-assessed eHealth literacy skills, (3) lower general health numeracy, (4) positive self-assessment of general disease knowledge, and (5) more negative health beliefs and lower levels of self-confidence. CONCLUSIONS Drawing on logistic regression modeling, we studied the susceptibility to breast cancer misinformation among Chinese patients. The predicting factors of the susceptibility to breast cancer misinformation identified in this study can provide insightful implications for clinical practice, health education, medical research, and health policy making.
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Affiliation(s)
- Yi Shan
- School of Foreign Studies, Nantong University, Nantong, China
| | - Meng Ji
- School of Languages and Cultures, The University of Sydney, Sydney, Australia
| | - Zhaoquan Xing
- Department of Urology, Qilu Hospital of Shandong University, Ji'nan, China
| | - Zhaogang Dong
- Department of Clinical Laboratory, Qilu Hospital of Shandong University, Ji'nan, China
| | - Xiaofei Xu
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Qilu Hospital of Shandong University, Ji'nan, China
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23
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Rosen JE, Agrawal N, Flum DR, Liao JM. Verbal Descriptions of the Probability of Treatment Complications Lead to High Variability in Risk Perceptions: A Survey Study. Ann Surg 2023; 277:e766-e771. [PMID: 35129504 PMCID: PMC9035471 DOI: 10.1097/sla.0000000000005255] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether different methods for communicating the probability of treatment complications for operative and nonoperative appendicitis treatments result in differences in risk perception. BACKGROUND Surgeons must communicate the probability of treatment complications to patients, and how risks are communicated may impact the accuracy and variability in patient risk perceptions and ultimately their decision making. METHODS A series of online surveys of American adults communicated the probability of complications associated with surgical or antibiotic treatment of acute appendicitis. Probability was communicated with verbal descriptors (eg, "uncommon"), point estimates (eg, "3% risk"), or risk ranges (eg, "1% to 5%"). Respondents then estimated the probability of a complication for a "typical patient with appendicitis." The Fligner-Killeen test of homogeneity of variance was used to compare the variability in respondent risk estimates based on the method of probability communication. RESULTS Among 296 respondents, variance in probability estimates was significantly higher when verbal descriptions were used compared to point estimates ( P < 0.001) or risk ranges ( P < 0.001). Identical verbal descriptors produced meaningfully different risk estimates depending on the complication being described. For example, "common" was perceived as a 45.6% for surgical site infection but 61.7% for antibiotic-associated diarrhea. CONCLUSION Verbal probability descriptors are associated with widely varying and inaccurate perceptions about treatment risks. Surgeons should consider alternative ways to communicate probability during informed consent and shared decision-making discussions.
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Affiliation(s)
- Joshua E. Rosen
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, WA
- Decision Science Group, University of Washington, Seattle, WA
| | - Nidhi Agrawal
- Decision Science Group, University of Washington, Seattle, WA
- Foster School of Business, University of Washington, Seattle, WA
| | - David R. Flum
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, WA
- Decision Science Group, University of Washington, Seattle, WA
| | - Joshua M. Liao
- Decision Science Group, University of Washington, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
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24
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Dennison RA, Taylor LC, Morris S, Boscott RA, Harrison H, Moorthie SA, Rossi SH, Stewart GD, Usher-Smith JA. Public Preferences for Determining Eligibility for Screening in Risk-Stratified Cancer Screening Programs: A Discrete Choice Experiment. Med Decis Making 2023; 43:374-386. [PMID: 36786399 PMCID: PMC10021112 DOI: 10.1177/0272989x231155790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND Risk stratification has been proposed to improve the efficiency of population-level cancer screening. We aimed to describe and quantify the relative importance of different attributes of potential screening programs among the public, focusing on stratifying eligibility. METHODS We conducted a discrete choice experiment in which respondents selected between 2 hypothetical screening programs in a series of 9 questions. We presented the risk factors used to determine eligibility (age, sex, or lifestyle or genetic risk scores) and anticipated outcomes based on eligibility criteria with different sensitivity and specificity levels. We performed conditional logit regression models and used the results to estimate preferences for different approaches. We also analyzed free-text comments on respondents' views on the programs. RESULTS A total of 1,172 respondents completed the survey. Sensitivity was the most important attribute (7 and 11 times more important than specificity and risk factors, respectively). Eligibility criteria based on age and sex or genetics were preferred over age alone and lifestyle risk scores. Phenotypic and polygenic risk prediction models would be more acceptable than screening everyone aged 55 to 70 y if they had high discrimination (area under the receiver-operating characteristic curve ≥0.75 and 0.80, respectively). LIMITATIONS Although our sample was representative with respect to age, sex, and ethnicity, it may not be representative of the UK population regarding other important characteristics. Also, some respondents may have not understood all the information provided to inform decision making. CONCLUSIONS The public prioritized lives saved from cancer over reductions in numbers screened or experiencing unnecessary follow-up. Incorporating personal-level risk factors into screening eligibility criteria is acceptable to the public if it increases sensitivity; therefore, maximizing sensitivity in model development and communication could increase uptake. HIGHLIGHTS The public prioritized lives saved when considering changing from age-based eligibility criteria to risk-stratified cancer screening over reductions in numbers of people being screened or experiencing unnecessary follow-up.The risk stratification strategy used to do this was the least important component, although age plus sex or genetics were relatively preferable to using age alone and lifestyle risk scores.Communication strategies that emphasize improvements in the numbers of cancers detected or not missed across the population are more likely to be salient than reductions in unnecessary investigations or follow-up among some groups.Future research should focus on developing implementation strategies that maximize gains in sensitivity within the context of resource constraints and how to present attributes relating to specificity to facilitate understanding and informed decision making.
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Affiliation(s)
- Rebecca A Dennison
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Lily C Taylor
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Morris
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Rachel A Boscott
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Hannah Harrison
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Sabrina H Rossi
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Juliet A Usher-Smith
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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25
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Petrova D, Cokely ET, Sobkow A, Traczyk J, Garrido D, Garcia-Retamero R. Measuring feelings about choices and risks: The Berlin Emotional Responses to Risk Instrument (BERRI). RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2023; 43:724-746. [PMID: 35606164 DOI: 10.1111/risa.13946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We introduce a brief instrument specifically validated for measuring positive and negative feelings about risks-the Berlin Emotional Responses to Risk Instrument (BERRI). Based on seven studies involving diverse adults from three countries (n = 2120), the BERRI was found to robustly estimate anticipatory affective reactions derived from subjective evaluations of positive (i.e., assured, hopeful, and relieved) and negative emotions (i.e., anxious, afraid, and worried). The brief BERRI outperformed a 14-item assessment, uniquely tracking costs/benefits associated with cancer screening among men and women (Studies 1 and 2). Predictive validity was further documented in paradigmatic risky choice studies wherein options varied over probabilities and severities across six contexts (health, social, financial, technological, ethical, and environmental; Study 3). Studies 4-6, conducted during the Ebola epidemic and COVID-19 pandemic, indicated BERRI responses were sensitive to subtle effects caused by emotion-related framing manipulations presented in different cultures and languages (the United States, Spain, and Poland). Study 7 indicated BERRI responses remained stable for 2 weeks. Although the BERRI can provide an estimate of overall affect, choices were generally better explained by the unique influences of positive and negative affect. Overall, results suggest the novel, brief instrument can be an efficient tool for high-stakes research on decision making and risk communication.
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Affiliation(s)
- Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública, Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Universidad de Granada, Granada, Spain
| | - Edward T Cokely
- University of Oklahoma, Norman, Oklahoma, USA
- Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany
| | - Agata Sobkow
- Center for Research on Improving Decision Making (CRIDM), Faculty of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Jakub Traczyk
- Center for Research on Improving Decision Making (CRIDM), Faculty of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Dunia Garrido
- Departamento de Psicología Evolutiva y de la Educación, Universidad de Granada, Granada, Spain
| | - Rocio Garcia-Retamero
- Universidad de Granada, Granada, Spain
- Departamento de Psicología Evolutiva y de la Educación, Universidad de Granada, Granada, Spain
- Departamento de Psicología Experimental, Universidad de Granada, Granada, Spain
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26
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Walker AC, Stange M, Dixon MJ, Fugelsang JA, Koehler DJ. Using Icon Arrays to Communicate Gambling Information Reduces the Appeal of Scratch Card Games. J Gambl Stud 2023; 39:363-382. [PMID: 35044578 DOI: 10.1007/s10899-021-10103-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 12/11/2022]
Abstract
Past work has demonstrated that presenting statistical information in a foreground-background icon array can improve risk understanding, reduce decision-making biases, and decrease the salience of low-probability risks. In the present study, we assess whether presenting readily available gambling information within a foreground-background icon array influences individuals' gambling-related judgments (e.g., their perceived likelihood of winning a prize). Across two experiments (N = 1151), we find that using icon arrays to present gambling information reduces the appeal of scratch card games. That is, participants presented with gambling information in a foreground-background icon array, as opposed to a non-graphical numerical format, reported feeling less likely to win a prize, less excitement to play, and less urge to gamble on a scratch card game presented in a hypothetical gambling task. Overall, we conclude that presenting gambling information in an icon array format represents a simple yet promising tool for correcting gamblers' often overly-optimistic perceptions and reducing the appeal of negative expected value scratch card games.
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Affiliation(s)
- Alexander C Walker
- Department of Psychology, University of Waterloo, Waterloo, ON, N2L 3G1, Canada.
| | - Madison Stange
- Department of Psychology, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Mike J Dixon
- Department of Psychology, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | | | - Derek J Koehler
- Department of Psychology, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
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27
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Armstrong D. The social life of risk probabilities in medicine. Soc Sci Med 2023; 323:115811. [PMID: 36905758 DOI: 10.1016/j.socscimed.2023.115811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/12/2023] [Accepted: 02/23/2023] [Indexed: 03/05/2023]
Abstract
In the closing decades of the 20th century, a method of calculating numerical probabilities based on populations-at-risk emerged in public health/epidemiology and then moved into clinical medicine. This new method had its own autonomous social life as it reorganised the fields of clinical perception and clinical practice. This paper documents that revolution in the epistemological basis of medicine by investigating, through primary sources, when and how the social life of a new method undermined the professional status of medicine and changed the doctor-patient relationship.
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Affiliation(s)
- David Armstrong
- King's College London, Department of Population Health Sciences, Addison House, Guy's Campus, London, SE1 1UL, UK.
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28
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Numeracy levels influence shared decision-making and surgical outcomes: A scoping review of the literature. Am J Surg 2023; 225:967-974. [PMID: 36623965 DOI: 10.1016/j.amjsurg.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/18/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023]
Abstract
BACKGROUND Health literacy has been widely studied with regard to medical decision-making and health care access, however research regarding numeracy - the ability to comprehend and attach meaning to numbers - is more limited. METHODS A scoping review following PRISMA guidelines was conducted. We screened 132 abstracts and 12 studies were included in the analysis. RESULTS Surgical population numeracy ranged from 47 to 86.1%. We found heterogeneity in the scales used to measure numeracy and the cutoff values used to define adequate numeracy. Low numeracy was shown to influence the accuracy of patients' responses to quality of life measures used to determine surgical outcomes and was associated with patient overestimation of pre-operative risk. Adequate numeracy was correlated with improved outcomes 2-4 years after bariatric surgery. CONCLUSIONS Patient numeracy is generally poor and has important implications for pre-operative risk understanding, accuracy of health measurement tools and long-term surgical outcomes.
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Ancker JS, Benda NC, Sharma MM, Johnson SB, Weiner S, Zikmund-Fisher BJ. Taxonomies for synthesizing the evidence on communicating numbers in health: Goals, format, and structure. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2022; 42:2656-2670. [PMID: 35007354 PMCID: PMC10241486 DOI: 10.1111/risa.13875] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Many people, especially those with low numeracy, are known to have difficulty interpreting and applying quantitative information to health decisions. These difficulties have resulted in a rich body of research about better ways to communicate numbers. Synthesizing this body of research into evidence-based guidance, however, is complicated by inconsistencies in research terminology and researcher goals. In this article, we introduce three taxonomies intended to systematize terminology in the literature, derived from an ongoing systematic literature review. The first taxonomy provides a systematic nomenclature for the outcome measures assessed in the studies, including perceptions, decisions, and actions. The second taxonomy is a nomenclature for the data formats assessed, including numbers (and different formats for numbers) and graphics. The third taxonomy describes the quantitative concepts being conveyed, from the simplest (a single value at a single point in time) to more complex ones (including a risk-benefit trade-off and a trend over time). Finally, we demonstrate how these three taxonomies can be used to resolve ambiguities and apparent contradictions in the literature.
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Affiliation(s)
- Jessica S Ancker
- Vanderbilt University Medical Center, Department of Biomedical Informatics, Nashville, TN
| | - Natalie C Benda
- Weill Cornell Medicine, Department of Population Health Sciences, New York, NY
| | - Mohit M Sharma
- Weill Cornell Medicine, Department of Population Health Sciences, New York, NY
| | - Stephen B Johnson
- New York University Langone Health, Department of Population Health, New York, NY
| | - Stephanie Weiner
- Weill Cornell Medicine, Department of Population Health Sciences, New York, NY
| | - Brian J Zikmund-Fisher
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, Ann Arbor, MI
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30
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Fallowfield L, Solis-Trapala I, Starkings R, May S, Matthews L, Eccles D, Evans DG, Turnbull C, Crawford G, Jenkins V. Talking about Risk, UncertaintieS of Testing IN Genetics (TRUSTING): development and evaluation of an educational programme for healthcare professionals about BRCA1 & BRCA2 testing. Br J Cancer 2022; 127:1116-1122. [PMID: 35715636 PMCID: PMC9470577 DOI: 10.1038/s41416-022-01871-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Mainstreaming of germline testing demands that all healthcare professionals have good communication skills, but few have genetic testing and counselling experience. We developed and evaluated educational workshops-Talking about Risk & UncertaintieS of Testing IN Genetics (TRUSTING). Contents included: presentations and exercises, an interview with a geneticist about BRCA testing, screening and prevention implications, filmed interactions between surgeons, a genetic counsellor and geneticists with a fictitious family (proband had a BRCA2 pathogenic variant with triple-negative breast cancer, her older sister-BRCA2 heterozygous, and cousin-negative for BRCA2 variant). METHODS Twenty-one surgeons, 5 oncologists, 18 nurses and 9 genetic counsellors participated. Knowledge (18 item MCQ), communication skills (responses to 6 questions from proband and relatives) and self-confidence (discussing 9 genetic testing issues) were assessed pre- and post workshop. RESULTS Knowledge scores improved significantly post workshop (mean change = 7.06; 95% confidence interval (CI) 6.37-7.74; P < 0.001), as did communication (mean change = 5.38; 95% CI 4.37-6.38; P < 0.001) and self-confidence (P < 0.001). DISCUSSION Healthcare professionals' knowledge and self-confidence when discussing the risks and uncertainties in genetics are often poor. TRUSTING workshops significantly enhanced attendees' navigation of communication difficulties encountered and will be rolled out more widely.
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Affiliation(s)
- Lesley Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, UK.
| | | | - Rachel Starkings
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, UK
| | - Shirley May
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, UK
| | - Lucy Matthews
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, UK
| | - Diana Eccles
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - D Gareth Evans
- Division of Evolution Infection and Genomic Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Clare Turnbull
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - Gillian Crawford
- Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Valerie Jenkins
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, UK
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Roozenbeek J, van der Linden S, Goldberg B, Rathje S, Lewandowsky S. Psychological inoculation improves resilience against misinformation on social media. SCIENCE ADVANCES 2022; 8:eabo6254. [PMID: 36001675 PMCID: PMC9401631 DOI: 10.1126/sciadv.abo6254] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Online misinformation continues to have adverse consequences for society. Inoculation theory has been put forward as a way to reduce susceptibility to misinformation by informing people about how they might be misinformed, but its scalability has been elusive both at a theoretical level and a practical level. We developed five short videos that inoculate people against manipulation techniques commonly used in misinformation: emotionally manipulative language, incoherence, false dichotomies, scapegoating, and ad hominem attacks. In seven preregistered studies, i.e., six randomized controlled studies (n = 6464) and an ecologically valid field study on YouTube (n = 22,632), we find that these videos improve manipulation technique recognition, boost confidence in spotting these techniques, increase people's ability to discern trustworthy from untrustworthy content, and improve the quality of their sharing decisions. These effects are robust across the political spectrum and a wide variety of covariates. We show that psychological inoculation campaigns on social media are effective at improving misinformation resilience at scale.
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Affiliation(s)
- Jon Roozenbeek
- Department of Psychology, University of Cambridge, Cambridge, UK
- Corresponding author.
| | | | | | - Steve Rathje
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Stephan Lewandowsky
- School of Psychological Science, University of Bristol, Bristol, UK
- School of Psychological Sciences, University of Western Australia, Perth, WA, Australia
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Maguire A, Persson E, Västfjäll D, Tinghög G. COVID-19 and Politically Motivated Reasoning. Med Decis Making 2022; 42:1078-1086. [PMID: 35993415 PMCID: PMC9583281 DOI: 10.1177/0272989x221118078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background During the COVID-19 pandemic, the world witnessed a partisan segregation of
beliefs toward the global health crisis and its management. Politically
motivated reasoning, the tendency to interpret information in accordance
with individual motives to protect valued beliefs rather than objectively
considering the facts, could represent a key process involved in the
polarization of attitudes. The objective of this study was to explore
politically motivated reasoning when participants assess information
regarding COVID-19. Design We carried out a preregistered online experiment using a diverse sample
(N = 1,500) from the United States. Both Republicans
and Democrats assessed the same COVID-19–related information about the
health effects of lockdowns, social distancing, vaccination,
hydroxychloroquine, and wearing face masks. Results At odds with our prestated hypothesis, we found no evidence in line with
politically motivated reasoning when interpreting numerical information
about COVID-19. Moreover, we found no evidence supporting the idea that
numeric ability or cognitive sophistication bolster politically motivated
reasoning in the case of COVID-19. Instead, our findings suggest that
participants base their assessment on prior beliefs of the matter. Conclusions Our findings suggest that politically polarized attitudes toward COVID-19 are
more likely to be driven by lack of reasoning than politically motivated
reasoning—a finding that opens potential avenues for combating political
polarization about important health care topics. Highlights
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Affiliation(s)
- Allegra Maguire
- Department of Management and Engineering, Division of Economics, Linköping University, Linköping, Sweden
| | - Emil Persson
- Department of Management and Engineering, Division of Economics, Linköping University, Linköping, Sweden
| | - Daniel Västfjäll
- Division of Psychology, Department of Behavioral Sciences and Learning, Linköping, Sweden
| | - Gustav Tinghög
- Department of Management and Engineering, Division of Economics, Linköping University, Linköping, Sweden; The National Center for Priority Setting in Health Care, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Grayek E, Yang Y, Fischhoff B, Schifferdecker KE, Woloshin S, Kerlikowske K, Miglioretti DL, Tosteson ANA. A Procedure for Eliciting Women's Preferences for Breast Cancer Screening Frequency. Med Decis Making 2022; 42:783-794. [PMID: 35067067 PMCID: PMC9277327 DOI: 10.1177/0272989x211073320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND We evaluate the construct validity of a proposed procedure for eliciting lay preferences among health care policy options, suited for structured surveys. It is illustrated with breast cancer screening, a domain in which people may have heterogeneous preferences. METHODS Our procedure applies behavioral decision research principles to eliciting preferences among policy options expressed in quantitative terms. Three-hundred women older than 18 y without a history of breast cancer were recruited through Amazon MTurk. Participants evaluated 4 screening options for each of 4 groups of women, with varying risk of breast cancer. Each option was characterized by estimates of 3 primary outcomes: breast cancer deaths, false alarms, and overdiagnosis resulting in unnecessary treatment of cancers that would not progress. These estimates were based on those currently being developed by the Breast Cancer Surveillance Consortium. For each risk group, participants stated how frequently they would wish to receive screening, if the predicted outcomes applied to them. RESULTS A preregistered test found that preferences were robust enough to be unaffected by the order of introducing and displaying the outcomes. Other tests of construct validity also suggested that respondents generally understood the task and expressed consistent preferences. Those preferences were related to participants' age and mammography history but not to measures of their numeracy, subjective numeracy, or demographics. There was considerable heterogeneity in their preferences. CONCLUSIONS Members of the public can be engaged more fully in informing future screening guidelines if they evaluate the screening options characterized by the expected health outcomes expressed in quantitative terms. We offer and evaluate such a procedure, in terms of its construct validity with a diverse sample of women. HIGHLIGHTS A novel survey method for eliciting lay preferences for breast cancer screening is proposed and evaluated in terms of its construct validity.Participants were generally insensitive to irrelevant task features (e.g., order of presentation) and sensitive to relevant ones (e.g., quantitative estimates of breast cancer risk, harms from screening).The proposed method elicits lay preferences in terms that can inform future screening guidelines, potentially improving communication between the public and policy makers.
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Affiliation(s)
- Emily Grayek
- Department of Engineering and Public Policy,
Carnegie Mellon University, Pittsburgh, PA, USA
| | - Yanran Yang
- Department of Engineering and Public Policy,
Carnegie Mellon University, Pittsburgh, PA, USA
| | - Baruch Fischhoff
- Department of Engineering and Public Policy,
Carnegie Mellon University, Pittsburgh, PA, USA
- College of Engineering, Institute for Politics
and Strategy, Carnegie Mellon University,Pittsburgh, PA, USA
| | - Karen E. Schifferdecker
- The Dartmouth Institute for Health Policy and
Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine
at Dartmouth, Lebanon, NH, USA
| | - Steven Woloshin
- The Dartmouth Institute for Health Policy and
Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine
at Dartmouth, Lebanon, NH, USA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, CA, USA
- General Internal Medicine Section, Department
of Veterans Affairs, University of California, San Francisco, CA, USA
| | - Diana L. Miglioretti
- Division of Biostatistics, Department of Public
Health Sciences, University of California, Davis, Davis, CA, USA
| | - Anna N. A. Tosteson
- The Dartmouth Institute for Health Policy and
Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine
at Dartmouth, Lebanon, NH, USA
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Abstract
Four studies demonstrate that the public's understanding of government budgetary expenditures is hampered by difficulty in representing large numerical magnitudes. Despite orders of magnitude difference between millions and billions, study participants struggle with the budgetary magnitudes of government programs. When numerical values are rescaled as smaller magnitudes (in the thousands or lower), lay understanding improves, as indicated by greater sensitivity to numerical ratios and more accurate rank ordering of expenses. A robust benefit of numerical rescaling is demonstrated across a variety of experimental designs, including policy relevant choices and incentive-compatible accuracy measures. This improved sensitivity ultimately impacts funding choices and public perception of respective budgets, indicating the importance of numerical cognition for good citizenship.
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Shinn EH, Busch BE, Jasemi N, Lyman CA, Toole JT, Richman SC, Symmans WF, Chavez-MacGregor M, Peterson SK, Broderick G. Network Modeling of Complex Time-Dependent Changes in Patient Adherence to Adjuvant Endocrine Treatment in ER+ Breast Cancer. Front Psychol 2022; 13:856813. [PMID: 35903747 PMCID: PMC9315289 DOI: 10.3389/fpsyg.2022.856813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022] Open
Abstract
Early patient discontinuation from adjuvant endocrine treatment (ET) is multifactorial and complex: Patients must adapt to various challenges and make the best decisions they can within changing contexts over time. Predictive models are needed that can account for the changing influence of multiple factors over time as well as decisional uncertainty due to incomplete data. AtlasTi8 analyses of longitudinal interview data from 82 estrogen receptor-positive (ER+) breast cancer patients generated a model conceptualizing patient-, patient-provider relationship, and treatment-related influences on early discontinuation. Prospective self-report data from validated psychometric measures were discretized and constrained into a decisional logic network to refine and validate the conceptual model. Minimal intervention set (MIS) optimization identified parsimonious intervention strategies that reversed discontinuation paths back to adherence. Logic network simulation produced 96 candidate decisional models which accounted for 75% of the coordinated changes in the 16 network nodes over time. Collectively the models supported 15 persistent end-states, all discontinued. The 15 end-states were characterized by median levels of general anxiety and low levels of perceived recurrence risk, quality of life (QoL) and ET side effects. MIS optimization identified 3 effective interventions: reducing general anxiety, reinforcing pill-taking routines, and increasing trust in healthcare providers. Increasing health literacy also improved adherence for patients without a college degree. Given complex regulatory networks’ intractability to end-state identification, the predictive models performed reasonably well in identifying specific discontinuation profiles and potentially effective interventions.
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Affiliation(s)
- Eileen H. Shinn
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- *Correspondence: Eileen H. Shinn,
| | - Brooke E. Busch
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Neda Jasemi
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cole A. Lyman
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
| | - J. Tory Toole
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
| | - Spencer C. Richman
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
| | - William Fraser Symmans
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mariana Chavez-MacGregor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Susan K. Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Gordon Broderick
- Center for Clinical Systems Biology, Rochester General Hospital, Rochester, NY, United States
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Jia J, Levy DE, McCurley JL, Anderson E, Gelsomin ED, Porneala B, Thorndike AN. Health Literacy, Numeracy, and Health Promotion: A Secondary Analysis of the Choosewell 365 Workplace Trial. Am J Prev Med 2022; 63:93-101. [PMID: 35282955 PMCID: PMC9232847 DOI: 10.1016/j.amepre.2021.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Health literacy and numeracy are linked to obesity and dietary behaviors. This study investigates whether the effect of a workplace behavioral intervention to prevent weight gain and improve diet differed by employee health literacy and numeracy. METHODS ChooseWell 365 was an RCT of hospital employees testing a 12-month intervention using nudges and feedback to promote healthier choices, building on existing cafeteria traffic light labels (e.g., green=healthy, red=unhealthy). Health literacy and numeracy were measured with the Newest Vital Sign (range=0-6) and General Numeracy Scale (range=0-3). Mixed-effects linear models examined if intervention effects on cafeteria purchases, diet quality (Healthy Eating Index 2015, range=0-100), and weight change over 24 months differed by higher versus lower health literacy or numeracy. Data were collected in 2016-2020 and analyzed in 2020-2021. RESULTS In 12 months, 510 participants completed the Newest Vital Sign and General Numerancy Scale; 36.7% had Newest Vital Sign<6 (lower health literacy) and 31.6% had General Numerancy Scale<2 (lower numeracy). Intervention participants increased healthy purchases over 24 months compared with controls in both higher and lower health literacy and numeracy groups. At 12 months, Healthy Eating Index 2015 scores increased in intervention versus control participants with lower health literacy (5.5 points, 95% CI=1.51, 9.54) but not in those with higher health literacy (p-interaction=0.040). BMI did not differ by health literacy or numeracy. CONCLUSIONS A behavioral intervention improved cafeteria food choices of hospital employees of varying health literacy and numeracy levels and improved diet quality among employees with lower health literacy, suggesting this group also improved food choices outside of work.
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Affiliation(s)
- Jenny Jia
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Douglas E Levy
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jessica L McCurley
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Emma Anderson
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Emily D Gelsomin
- Department of Nutrition and Food Services, Massachusetts General Hospital, Boston, Massachusetts
| | - Bianca Porneala
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Anne N Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Korenstein D, Scherer LD, Foy A, Pineles L, Lydecker AD, Owczarzak J, Magder L, Brown JP, Pfeiffer CD, Terndrup C, Leykum L, Stevens D, Feldstein DA, Weisenberg SA, Baghdadi JD, Morgan DJ. Clinician Attitudes and Beliefs Associated with More Aggressive Diagnostic Testing. Am J Med 2022; 135:e182-e193. [PMID: 35307357 PMCID: PMC9728553 DOI: 10.1016/j.amjmed.2022.02.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Variation in clinicians' diagnostic test utilization is incompletely explained by demographics and likely relates to cognitive characteristics. We explored clinician factors associated with diagnostic test utilization. METHODS We used a self-administered survey of attitudes, cognitive characteristics, and reported likelihood of test ordering in common scenarios; frequency of lipid and liver testing in patients on statin therapy. Participants were 552 primary care physicians, nurse practitioners, and physician assistants from practices in 8 US states across 3 regions, from June 1, 2018 to November 26, 2019. We measured Testing Likelihood Score: the mean of 4 responses to testing frequency and self-reported testing frequency in patients on statins. RESULTS Respondents were 52.4% residents, 36.6% attendings, and 11.0% nurse practitioners/physician assistants; most were white (53.6%) or Asian (25.5%). Median age was 32 years; 53.1% were female. Participants reported ordering tests for a median of 20% (stress tests) to 90% (mammograms) of patients; Testing Likelihood Scores varied widely (median 54%, interquartile range 43%-69%). Higher scores were associated with geography, training type, low numeracy, high malpractice fear, high medical maximizer score, high stress from uncertainty, high concern about bad outcomes, and low acknowledgment of medical uncertainty. More frequent testing of lipids and liver tests was associated with low numeracy, high medical maximizer score, high malpractice fear, and low acknowledgment of uncertainty. CONCLUSIONS Clinician variation in testing was common, with more aggressive testing consistently associated with low numeracy, being a medical maximizer, and low acknowledgment of uncertainty. Efforts to reduce undue variations in testing should consider clinician cognitive drivers.
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Affiliation(s)
- Deborah Korenstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Laura D Scherer
- Adult and Child Consortium of Health Outcomes Research and Delivery Science (ACCORDS); Division of Cardiology, University of Colorado School of Medicine, Aurora; Center of Innovation for Veteran-Centered and Value-Driven Care, VA Denver, Colo
| | - Andrew Foy
- Department of Medicine; Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pa
| | - Lisa Pineles
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Alison D Lydecker
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Jill Owczarzak
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Larry Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Jessica P Brown
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Christopher D Pfeiffer
- Division of Infectious Diseases, Department of Medicine, Oregon Health & Science University, Portland; Division of Hospital and Specialty Medicine, VA Portland Health Care System, Ore
| | - Christopher Terndrup
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland
| | - Luci Leykum
- Department of Medicine, Dell Medical School, the University of Texas at Austin; South Texas Veterans Health Care System, San Antonio
| | - Deborah Stevens
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - David A Feldstein
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Scott A Weisenberg
- Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Jonathan D Baghdadi
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore
| | - Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore
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38
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Loeb S, Cheng HH, Leader A, Gross L, Nolasco TS, Byrne N, Wise DR, Hollifield L, Brown LH, Slater E, Pieczonka C, Gomella LG, Kelly WK, Trabulsi EJ, Handley N, Lallas CD, Chandrasekar T, Mille P, Mann M, Mark JR, Brown G, Chopra S, Wasserman J, Phillips J, Somers P, Giri VN. Technology-enhanced AcceleRation of Germline Evaluation for Therapy (TARGET): A randomized controlled trial of a pretest patient-driven webtool vs. genetic counseling for prostate cancer germline testing. Contemp Clin Trials 2022; 119:106821. [PMID: 35710085 DOI: 10.1016/j.cct.2022.106821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Germline testing has an increasingly important role in prostate cancer care. However, a relative shortage of genetic counselors necessitates alternate strategies for delivery of pre-test education for germline testing. This study, funded by the Prostate Cancer Foundation, seeks to address the need for novel methods of delivery of pre-test germline education beyond traditional germline counseling to facilitate informed patient decision-making for germline testing. METHODS This is a two-armed randomized controlled trial (RCT) with a target enrollment of 173 participants with prostate cancer per study arm (total anticipated n = 346). Patients who meet criteria for germline testing based on tumor features, family history or Ashkenazi Jewish ancestry are being recruited from 5 US sites including academic, private practice and Veterans healthcare settings. Consenting participants are randomized to the interactive pretest webtool or germline counseling with assessment of key patient-reported outcomes involved in informed decision-making for germline germline testing. RESULTS Participants complete surveys at baseline, after pretest education/counseling, and following disclosure of germline germline results. The primary outcome of the study is decisional conflict for germline testing. Secondary outcomes include germline knowledge, satisfaction, uptake of germline testing, and understanding of results. CONCLUSION Our hypothesis is that the web-based germline education tool is non-inferior to traditional germline counseling regarding key patient-reported outcomes involved in informed decision-making for germline testing. If proven, the results would support deploying the webtool across various practice settings to facilitate pre-test germlines education for individuals with prostate cancer and developing collaborative care strategies with germline counseling. CLINICALTRIALS gov Identifier: NCT04447703.
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Affiliation(s)
- Stacy Loeb
- NYU-Langone Health and NYU Perlmutter Cancer Center, New York, NY, United States of America; Manhattan Veteran Affairs, New York, NY, United States of America
| | - Heather H Cheng
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA, United States of America
| | - Amy Leader
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Laura Gross
- Cancer Risk Assessment and Clinical Cancer Germlines, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Tatiana Sanchez Nolasco
- NYU-Langone Health and NYU Perlmutter Cancer Center, New York, NY, United States of America; Manhattan Veteran Affairs, New York, NY, United States of America
| | - Nataliya Byrne
- NYU-Langone Health and NYU Perlmutter Cancer Center, New York, NY, United States of America; Manhattan Veteran Affairs, New York, NY, United States of America
| | - David R Wise
- NYU-Langone Health and NYU Perlmutter Cancer Center, New York, NY, United States of America
| | - Lucas Hollifield
- NYU-Langone Health and NYU Perlmutter Cancer Center, New York, NY, United States of America
| | - Lauren H Brown
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA, United States of America
| | - Elias Slater
- Prostate Cancer Foundation, Santa Monica, CA, United States of America
| | | | - Leonard G Gomella
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - William K Kelly
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Edouard J Trabulsi
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Nathan Handley
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Costas D Lallas
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Thenappan Chandrasekar
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Patrick Mille
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Mark Mann
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - James Ryan Mark
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Gordon Brown
- New Jersey Urology, Voorhees, NJ, United States of America
| | - Sameer Chopra
- New Jersey Urology, Voorhees, NJ, United States of America
| | - Jenna Wasserman
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Jade Phillips
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Patrick Somers
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Veda N Giri
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States of America; Cancer Risk Assessment and Clinical Cancer Germlines, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States of America; Department of Urology, Thomas Jefferson University, Philadelphia, PA, United States of America.
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Scheibe DA, Fitzsimmons CJ, Mielicki MK, Taber JM, Sidney PG, Coifman K, Thompson CA. Confidence in COVID problem solving: What factors predict adults' item-level metacognitive judgments on health-related math problems before and after an educational intervention? METACOGNITION AND LEARNING 2022; 17:989-1023. [PMID: 35645635 PMCID: PMC9127482 DOI: 10.1007/s11409-022-09300-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 04/12/2022] [Indexed: 06/15/2023]
Abstract
UNLABELLED The advent of COVID-19 highlighted widespread misconceptions regarding people's accuracy in interpreting quantitative health information. How do people judge whether they accurately answered health-related math problems? Which individual differences predict these item-by-item metacognitive monitoring judgments? How does a brief intervention targeting math skills-which increased problem-solving accuracy-affect people's monitoring judgments? We investigated these pre-registered questions in a secondary analysis of data from a large Qualtrics panel of adults (N = 1,297). Pretest performance accuracy, math self-efficacy, gender, and math anxiety were associated with pretest item-level monitoring judgments. Participants randomly assigned to the intervention condition, relative to the control condition, made higher monitoring judgments post intervention. That is, these participants believed they were more accurate when answering problems. Regardless of experimental condition, those who actually were correct on health-related math problems made higher monitoring judgments than those who answered incorrectly. Finally, consistent with prior research, math anxiety explained additional variance in monitoring judgments beyond trait anxiety. Together, findings indicated the importance of considering both objective (e.g., problem accuracy) and subjective factors (e.g., math self-efficacy, math anxiety) to better understand adults' metacognitive monitoring. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s11409-022-09300-3.
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Affiliation(s)
| | | | | | | | - Pooja G. Sidney
- University of Kentucky (Psychological Sciences), Lexington, KY USA
| | - Karin Coifman
- Kent State University (Clinical Psychology), Kent, OH USA
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Peters E, Shoots-Reinhard B. Numeracy and the Motivational Mind: The Power of Numeric Self-efficacy. Med Decis Making 2022; 42:729-740. [PMID: 35583117 DOI: 10.1177/0272989x221099904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Objective numeracy appears to support better medical decisions and health outcomes. The more numerate generally understand and use numbers more and make better medical decisions, including more informed medical choices. Numeric self-efficacy-an aspect of subjective numeracy that is also known as numeric confidence-also relates to decision making via emotional reactions to and inferences from experienced difficulty with numbers and via persistence linked with numeric comprehension and healthier behaviors over time. Furthermore, it moderates the effects of objective numeracy on medical outcomes. PURPOSE We briefly review the numeracy and decision-making literature and then summarize more recent literature on 3 separable effects of numeric self-efficacy. Although dual-process theories can account for the generally superior decision making of the highly numerate, they have neglected effects of numeric self-efficacy. We discuss implications for medical decision-making (MDM) research and practice. Finally, we propose a modification to dual-process theories, adding a "motivational mind" to integrate the effects of numeric self-efficacy on decision-making processes (i.e., inferences from experienced difficulty with numbers, greater persistence, and greater use of objective-numeracy skills) important to high-quality MDM. CONCLUSIONS The power of numeric self-efficacy (confidence) has been little considered in MDM, but many medical decisions and behaviors require persistence to be successful over time (e.g., comprehension, medical-recommendation adherence). Including numeric self-efficacy in research and theorizing will increase understanding of MDM and promote development of better decision interventions. HIGHLIGHTS Research demonstrates that objective numeracy supports better medical decisions and health outcomes.The power of numeric self-efficacy (aka numeric confidence) has been little considered but appears critical to emotional reactions and inferences that patients and others make when encountering numeric information (e.g., in decision aids) and to greater persistence in medical decision-making tasks involving numbers.The present article proposes a novel modification to dual-process theory to account for newer findings and to describe how numeracy mechanisms can be better understood.Because being able to adapt interventions to improve medical decisions depends in part on having a good theory, future research should incorporate numeric self-efficacy into medical decision-making theories and interventions.
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Affiliation(s)
- Ellen Peters
- Center for Science Communication Research, School of Journalism and Communication, University of Oregon, Eugene, OR, USA.,Psychology Department, University of Oregon, Eugene, OR, USA
| | - Brittany Shoots-Reinhard
- Center for Science Communication Research, School of Journalism and Communication, University of Oregon, Eugene, OR, USA.,Psychology Department, The Ohio State University, Columbus, OH, USA
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Caroti D, Adam‐Troian J, Arciszewski T. Reducing Teachers’ Unfounded Beliefs Through Critical‐Thinking Education: A Non‐Randomized Controlled Trial. APPLIED COGNITIVE PSYCHOLOGY 2022. [DOI: 10.1002/acp.3969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Denis Caroti
- Aix Marseille Univ. Marseille France
- CORTECS team Marseille France
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Recchia G, Lawrence ACE, Capacchione L, Freeman ALJ. Making BRCA1 genetic test reports easier to understand through user-centered design: A randomized trial. Genet Med 2022; 24:1684-1696. [PMID: 35522238 DOI: 10.1016/j.gim.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Our objective was to apply a user-centered design process to identify phrases, graphics, and ways of communicating numerical risks that could be used to help patients understand their cancer risk and next steps on receiving BRCA1 genetic test results (positive, negative, and variants of uncertain significance). METHODS The first phase of the study, a user-centered design process, consisted of 4 rounds of interviews (N = 42, including 13 health care professionals and 16 patients having undergone BRCA testing). The second was a randomized, between-participants experimental study of 456 United Kingdom residents that compared the resulting reports to reports used in a United Kingdom national genomic laboratory hub. Outcomes were subjective and objective comprehension, communication efficacy, actionability, and perceived risk. RESULTS Subjective comprehension, communication efficacy, and actionability were all higher for the user-centered reports, with no difference in perceived risk. Comprehension of participants viewing user-centered reports was significantly better on 2 items, directionally (but not significantly) better on 6 items, and directionally (but not significantly) worse on 2 items. CONCLUSION Our results imply that user-centered design is a promising approach for developing materials about complex genetic risks. We suggest wordings that are likely to lead to improved comprehension when communicating BRCA-associated risks.
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Affiliation(s)
- Gabriel Recchia
- Winton Centre for Risk and Evidence Communication, Department of Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, United Kingdom.
| | - Alice C E Lawrence
- Winton Centre for Risk and Evidence Communication, Department of Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, United Kingdom
| | | | - Alexandra L J Freeman
- Winton Centre for Risk and Evidence Communication, Department of Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, United Kingdom
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Baghdadi JD, Korenstein D, Pineles L, Scherer LD, Lydecker AD, Magder L, Stevens DN, Morgan DJ. Exploration of Primary Care Clinician Attitudes and Cognitive Characteristics Associated With Prescribing Antibiotics for Asymptomatic Bacteriuria. JAMA Netw Open 2022; 5:e2214268. [PMID: 35622364 PMCID: PMC9142875 DOI: 10.1001/jamanetworkopen.2022.14268] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/11/2022] [Indexed: 01/21/2023] Open
Abstract
Importance Antibiotic treatment for asymptomatic bacteriuria is not recommended in guidelines but is a major driver of inappropriate antibiotic use. Objective To evaluate whether clinician culture and personality traits are associated with a predisposition toward inappropriate prescribing. Design, Setting, and Participants This survey study involved secondary analysis of a previously completed survey. A total of 723 primary care clinicians in active practice in Texas, the Mid-Atlantic, and the Pacific Northwest, including physicians and advanced practice clinicians, were surveyed from June 1, 2018, to November 26, 2019, regarding their approach to a hypothetical patient with asymptomatic bacteriuria. Clinician culture was represented by training background and region of practice. Attitudes and cognitive characteristics were represented using validated instruments to assess numeracy, risk-taking preferences, burnout, and tendency to maximize care. Data were analyzed from November 8, 2021, to March 29, 2022. Interventions The survey described a male patient with asymptomatic bacteriuria and changes in urine character. Clinicians were asked to indicate whether they would prescribe antibiotics. Main Outcomes and Measures The main outcome was self-reported willingness to prescribe antibiotics for asymptomatic bacteriuria. Willingness to prescribe antibiotics was hypothesized to be associated with clinician characteristics, background, and attitudes, including orientation on the Medical Maximizer-Minimizer Scale. Individuals with a stronger orientation toward medical maximizing prefer treatment even when the value of treatment is ambiguous. Results Of the 723 enrolled clinicians, 551 (median age, 32 years [IQR, 29-44 years]; 292 [53%] female; 296 [54%] White) completed the survey (76% response rate), including 288 resident physicians, 202 attending physicians, and 61 advanced practice clinicians. A total of 303 respondents (55%) were from the Mid-Atlantic, 136 (25%) were from Texas, and 112 (20%) were from the Pacific Northwest. A total of 392 clinicians (71% of respondents) indicated that they would prescribe antibiotic treatment for asymptomatic bacteriuria in the absence of an indication. In multivariable analyses, clinicians with a background in family medicine (odds ratio [OR], 2.93; 95% CI, 1.53-5.62) or a high score on the Medical Maximizer-Minimizer Scale (indicating stronger medical maximizing orientation; OR, 2.06; 95% CI, 1.38-3.09) were more likely to prescribe antibiotic treatment for asymptomatic bacteriuria. Resident physicians (OR, 0.57; 95% CI, 0.38-0.85) and clinicians in the Pacific Northwest (OR, 0.49; 95% CI, 0.33-0.72) were less likely to prescribe antibiotics for asymptomatic bacteriuria. Conclusions and Relevance The findings of this survey study suggest that most primary care clinicians prescribe inappropriate antibiotic treatment for asymptomatic bacteriuria in the absence of risk factors. This tendency is more pronounced among family medicine physicians and medical maximizers and is less common among resident physicians and clinicians in the US Pacific Northwest. Clinician characteristics should be considered when designing antibiotic stewardship interventions.
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Affiliation(s)
- Jonathan D. Baghdadi
- Department of Epidemiology and Public Health, University of Maryland, Baltimore
- Veterans Affairs (VA) Maryland Healthcare System, Baltimore
| | - Deborah Korenstein
- Division of General Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lisa Pineles
- Department of Epidemiology and Public Health, University of Maryland, Baltimore
| | - Laura D. Scherer
- Adult and Child Consortium of Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora
- Division of Cardiology, University of Colorado School of Medicine, Aurora
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Denver, Denver, Colorado
| | - Alison D. Lydecker
- Department of Epidemiology and Public Health, University of Maryland, Baltimore
| | - Larry Magder
- Department of Epidemiology and Public Health, University of Maryland, Baltimore
| | - Deborah N. Stevens
- Department of Epidemiology and Public Health, University of Maryland, Baltimore
| | - Daniel J. Morgan
- Department of Epidemiology and Public Health, University of Maryland, Baltimore
- Veterans Affairs (VA) Maryland Healthcare System, Baltimore
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Susceptibility to misinformation is consistent across question framings and response modes and better explained by myside bias and partisanship than analytical thinking. JUDGMENT AND DECISION MAKING 2022. [DOI: 10.1017/s1930297500003570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AbstractMisinformation presents a significant societal problem. To measure individuals’ susceptibility to misinformation and study its predictors, researchers have used a broad variety of ad-hoc item sets, scales, question framings, and response modes. Because of this variety, it remains unknown whether results from different studies can be compared (e.g., in meta-analyses). In this preregistered study (US sample; N = 2,622), we compare five commonly used question framings (eliciting perceived headline accuracy, manipulativeness, reliability, trustworthiness, and whether a headline is real or fake) and three response modes (binary, 6-point and 7-point scales), using the psychometrically validated Misinformation Susceptibility Test (MIST). We test 1) whether different question framings and response modes yield similar responses for the same item set, 2) whether people’s confidence in their primary judgments is affected by question framings and response modes, and 3) which key psychological factors (myside bias, political partisanship, cognitive reflection, and numeracy skills) best predict misinformation susceptibility across assessment methods. Different response modes and question framings yield similar (but not identical) responses for both primary ratings and confidence judgments. We also find a similar nomological net across conditions, suggesting cross-study comparability. Finally, myside bias and political conservatism were strongly positively correlated with misinformation susceptibility, whereas numeracy skills and especially cognitive reflection were less important (although we note potential ceiling effects for numeracy). We thus find more support for an “integrative” account than a “classical reasoning” account of misinformation belief.
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Raymer DS, Allen LA, Chaussee EL, McIlvennan CK, Thompson JS, Fairclough DL, Dunlay SM, Matlock DD, LaRue SJ. Health Literacy in Patients Considering a Left Ventricular Assist Device: Findings from the DECIDE-LVAD Trial. J Card Fail 2022; 28:1318-1325. [DOI: 10.1016/j.cardfail.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 04/01/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
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Sutherland H, Recchia G, Dryhurst S, Freeman AL. How People Understand Risk Matrices, and How Matrix Design Can Improve their Use: Findings from Randomized Controlled Studies. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2022; 42:1023-1041. [PMID: 34523141 PMCID: PMC9544625 DOI: 10.1111/risa.13822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 08/02/2021] [Accepted: 08/19/2021] [Indexed: 06/13/2023]
Abstract
Risk matrices are a common way to communicate the likelihood and potential impacts of a variety of risks. Until now, there has been little empirical work on their effectiveness in supporting understanding and decision making, and on how different design choices affect these. In this pair of online experiments (total n = 2699), we show that risk matrices are not always superior to text for the presentation of risk information, and that a nonlinear/geometric labeling scheme helps matrix comprehension (when the likelihood/impact scales are nonlinear). To a lesser degree, results suggested that changing the shape of the matrix so that cells increase in size nonlinearly facilitates comprehension as compared to text alone, and that comprehension might be enhanced by integrating further details about the likelihood and impact onto the axes of the matrix rather than putting them in a separate key. These changes did not affect participants' preference for reducing impact over reducing likelihood when making decisions about risk mitigation. We recommend that designers of risk matrices consider these changes to facilitate better understanding of relationships among risks.
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Affiliation(s)
- Holly Sutherland
- Winton Centre for Risk and Evidence Communication, Department of Pure Mathematics and Mathematical StatisticsUniversity of CambridgeCambridgeUK
- Salvesen Mindroom Research CentreUniversity of EdinburghEdinburghUK
| | - Gabriel Recchia
- Winton Centre for Risk and Evidence Communication, Department of Pure Mathematics and Mathematical StatisticsUniversity of CambridgeCambridgeUK
| | - Sarah Dryhurst
- Winton Centre for Risk and Evidence Communication, Department of Pure Mathematics and Mathematical StatisticsUniversity of CambridgeCambridgeUK
| | - Alexandra L.J. Freeman
- Winton Centre for Risk and Evidence Communication, Department of Pure Mathematics and Mathematical StatisticsUniversity of CambridgeCambridgeUK
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Talboy A, Schneider S. Reference Dependence in Bayesian Reasoning: Value Selection Bias, Congruence Effects, and Response Prompt Sensitivity. Front Psychol 2022; 13:729285. [PMID: 35369253 PMCID: PMC8970303 DOI: 10.3389/fpsyg.2022.729285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
This work examines the influence of reference dependence, including value selection bias and congruence effects, on diagnostic reasoning. Across two studies, we explored how dependence on the initial problem structure influences the ability to solve simplified precursors to the more traditional Bayesian reasoning problems. Analyses evaluated accuracy and types of response errors as a function of congruence between the problem presentation and question of interest, amount of information, need for computation, and individual differences in numerical abilities. Across all problem variations, there was consistent and strong evidence of a value selection bias in that incorrect responses almost always conformed to values that were provided in the problem rather than other errors including those related to computation. The most consistent and unexpected error across all conditions in the first experiment was that people were often more likely to utilize the superordinate value (N) as part of their solution rather than the anticipated reference class values. This resulted in a weakened effect of congruence, with relatively low accuracy even in congruent conditions, and a dominant response error of the superordinate value. Experiment 2 confirmed that the introduction of a new sample drew attention away from the provided reference class, increasing reliance on the overall sample size. This superordinate preference error, along with the benefit of repeating the PPV reference class within the question, demonstrated the importance of reference dependence based on the salience of information within the response prompt. Throughout, higher numerical skills were generally associated with higher accuracy, whether calculations were required or not.
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Affiliation(s)
- Alaina Talboy
- Microsoft, Redmond, WA, United States
- Department of Psychology, University of South Florida, Tampa, FL, United States
| | - Sandra Schneider
- Department of Psychology, University of South Florida, Tampa, FL, United States
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Peck L, Borle K, Folkersen L, Austin J. Why do people seek out polygenic risk scores for complex disorders, and how do they understand and react to results? Eur J Hum Genet 2022; 30:81-87. [PMID: 34276054 PMCID: PMC8738734 DOI: 10.1038/s41431-021-00929-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/18/2021] [Accepted: 06/17/2021] [Indexed: 01/03/2023] Open
Abstract
We sought to explore individuals' motivations for using their direct-to-consumer genetic testing data to generate polygenic risk scores (PRSs) using a not-for-profit third-party tool, and to assess understanding of, and reaction to their results. Using a cross-sectional design, users of Impute.me who had already accessed PRS results were invited to complete an online questionnaire asking about demographics, motivations for seeking PRSs, understanding and interpretation of PRSs, and two validated scales regarding reactions to results-the Impact of Event Scale Revised (IES-R) and the Feelings About genomiC Testing Results (FACToR). Independent samples T-tests and ANOVA were used to explore associations between the variables. 227 individuals participated in the study. The most frequently reported motivation was general curiosity (98.2%). Only 25.6% of participants correctly answered all questions assessing understanding/interpretation of PRSs. Over half of participants (60.8%) experienced a negative reaction (upset, anxious, and/or sad on FACToR scale) after receiving their PRSs and 5.3% scored over the threshold for potential post-traumatic stress disorder on the IES-R. Lower understanding about PRS was associated with experiencing a negative psychological reaction (P values <0.001). Higher quality pre-test information, particularly to improve understanding, and manage expectations for PRS may be useful in limiting negative psychological reactions.
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Affiliation(s)
- Larissa Peck
- grid.17091.3e0000 0001 2288 9830Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia Canada ,grid.412745.10000 0000 9132 1600London Health Sciences Centre, London, Ontario Canada
| | - Kennedy Borle
- grid.17091.3e0000 0001 2288 9830Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia Canada
| | - Lasse Folkersen
- Institute of Biological Psychiatry, Mental Health Centre Sankt Hans, Copenhagen, Denmark
| | - Jehannine Austin
- grid.17091.3e0000 0001 2288 9830Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia Canada ,grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, British Columbia Canada
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Otero I, Salgado JF, Moscoso S. Cognitive reflection, cognitive intelligence, and cognitive abilities: A meta-analysis. INTELLIGENCE 2022. [DOI: 10.1016/j.intell.2021.101614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Beaudart C, Hiligsmann M, Li N, Lewiecki EM, Silverman S. Effective communication regarding risk of fracture for individuals at risk of fragility fracture: a scoping review. Osteoporos Int 2022; 33:13-26. [PMID: 34559256 PMCID: PMC8758611 DOI: 10.1007/s00198-021-06151-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 09/03/2021] [Indexed: 12/28/2022]
Abstract
Two scoping reviews were conducted to review recommendations and guidelines for communication regarding general health risk, and to investigate communication strategies regarding risk of fracture. Healthcare professionals are invited to apply these recommendations to optimize a patient-centered approach to reducing risk of fracture. INTRODUCTION To conduct a scoping review of the medical literature regarding recommendations and tools for effective communication between healthcare professionals and patients regarding general health risk and risk of fracture. METHODS The scoping review was divided into two parts to search for (1) studies presenting recommendations and guidelines for communication regarding general health risk; (2) studies investigating communication regarding risk of fracture for individuals at risk for fractures. Medline was searched in April 2020 to identify relevant studies. RESULTS The scoping review included 43 studies on communication with regard to general health risk and 25 studies about communication regarding risk of fracture. Recommendations for effective communication with regard to risk are presented. Communication of numeric data on risk should be adapted to the literacy and numeracy levels of the individual patient. Patient understanding of numerical data can be enhanced with appropriate use of visual aids (e.g., pie charts, icon arrays, bar charts, pictograms). The FRAX® tool is the most recommended and most used tool for assessing risk of fracture. Communication sent as individualized letters to patients following DXA scans has been studied, although patient understanding of their risk of fracture is often reported as low using this technique. Use of visual aids may improve patient understanding. CONCLUSION Healthcare professionals are encouraged to apply recommendations presented in this scoping review in their clinical practice. Patient understanding of risk of fracture should be confirmed by making sure that patients feel free to ask questions and express their concerns. This will contribute to an optimal patient-centered approach. Developing online tools to convert the probability of fracture into patient-friendly visual presentations could facilitate communication between healthcare professionals and patients about risk of fracture.
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Affiliation(s)
- Charlotte Beaudart
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Nannan Li
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | | | - Stuart Silverman
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
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