Does Animation Improve Comprehension of Risk Information in Patients with Low Health Literacy? A Randomized Trial

Ashley J. Housten, Geetanjali R. Kamath, Therese B. Bevers, Scott B. Cantor, Nickell Dixon, Andre Hite, Michael A. Kallen, Viola B. Leal, Liang Li and Robert J. Volk
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Ashley J. Housten: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Geetanjali R. Kamath: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Therese B. Bevers: Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Scott B. Cantor: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Nickell Dixon: Michigan Department of Health, Southern New Hampshire University, Lansing, MI, USA
Andre Hite: Department of Surgery, Baylor College of Medicine, Houston, TX, USA
Michael A. Kallen: Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
Viola B. Leal: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Liang Li: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Robert J. Volk: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

Medical Decision Making, 2020, vol. 40, issue 1, 17-28

Abstract: Introduction. Enhanced visual effects, like animation, have the potential to improve comprehension of probabilistic risk information, particularly for those with lower health literacy. We tested the effect of presentation format on comprehension of colorectal cancer (CRC) screening probabilities to identify optimal risk communication strategies. Methods. Participants from a community foodbank and a cancer prevention center were randomized to 1 of 3 CRC screening risk presentations. The presentations used identical content but varied in format: 1) video with animated pictographs, 2) video with static pictographs, and 3) audiobooklet with static pictographs. Participants completed pre- and postpresentation surveys. The primary outcome was knowledge of probability/risk information regarding CRC screening, calculated as total, verbatim, and gist scores. Results. In total, 187 participants completed the study and were included in this analysis. Median age was 58 years (interquartile range [IQR]: 14 years), most participants were women (63%), and almost half had a high school education or less (46%). Approximately one-quarter had inadequate health literacy (Short Test of Functional Health Literacy in Adults marginal/inadequate: 28%; Brief Health Literacy Screener low: 18%), and about half had low numeracy (Subjective Numeracy Scale low: 54%; Graphical Literacy Measure low: 50%). We found no significant differences in total, verbatim, or gist knowledge across presentation formats (all P > 0.05). Discussion. Use of an animated pictograph to communicate risk does not appear to augment or impede knowledge of risk information. Regardless of health literacy level, difficulty understanding pictographs presenting numerical information persists. There may be a benefit to teaching or priming individuals on how to interpret numerical information presented in pictographs before communicating risk using visual methods. Trial Registry: NCT02151032

Keywords: cancer screening; health literacy; shared decision making (SDM) (search for similar items in EconPapers)
Date: 2020
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:40:y:2020:i:1:p:17-28

DOI: 10.1177/0272989X19890296

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