Effects of Game-Like Interactive Graphics on Risk Perceptions and Decisions

Background. Many patients have difficulty interpreting risks described in statistical terms as percentages. Computer game technology offers the opportunity to experience how often an event occurs, rather than simply read about its frequency. Objective. To assess effects of interactive graphics on risk perceptions and decisions. Design. Electronic questionnaire. Participants and setting. Respondents (n = 165) recruited online or at an urban hospital. Intervention. Health risks were illustrated by either static graphics or interactive game-like graphics. The interactive search graphic was a grid of squares, which, when clicked, revealed stick figures underneath. Respondents had to click until they found a figure affected by the disease. Measurements. Risk feelings, risk estimates, intention to take preventive action. Results. Different graphics did not affect mean risk estimates, risk feelings, or intention. Low-numeracy participants reported significantly higher risk feelings than high-numeracy ones except with the interactive search graphic. Unexpectedly, respondents reported stronger intentions to take preventive action when the intention question followed questions about efficacy and disease severity than when it followed perceived risk questions (65% v. 34%; P < 0.001). When respondents reported risk feelings immediately after using the search graphic, the interaction affected perceived risk (the longer the search to find affected stick figures, the higher the risk feeling: ρ = 0.57; P = 0.009). Limitations. The authors used hypothetical decisions. Conclusions. A game-like graphic that allowed consumers to search for stick figures affected by disease had no main effect on risk perception but reduced differences based on numeracy. In one condition, the game-like graphic increased concern about rare risks. Intentions for preventive action were stronger with a question order that focused first on efficacy and disease severity than with one that focused first on perceived risk.

[1]  P. Ubel,et al.  Measuring Numeracy without a Math Test: Development of the Subjective Numeracy Scale , 2007, Medical decision making : an international journal of the Society for Medical Decision Making.

[2]  Melissa L. Finucane,et al.  Risk as Analysis and Risk as Feelings: Some Thoughts about Affect, Reason, Risk, and Rationality , 2004, Risk analysis : an official publication of the Society for Risk Analysis.

[3]  A. Tversky,et al.  Prospect theory: an analysis of decision under risk — Source link , 2007 .

[4]  J. G. Hollands,et al.  The visual communication of risk. , 1999, Journal of the National Cancer Institute. Monographs.

[5]  Kim Witte,et al.  Fear as motivator, fear as inhibitor: Using the extended parallel process model to explain fear appeal successes and failures. , 1996 .

[6]  Edward D. Thimons,et al.  Using the Extended Parallel Process Model to Prevent Noise-Induced Hearing Loss Among Coal Miners in Appalachia , 2004, Health education & behavior : the official publication of the Society for Public Health Education.

[7]  S. Epstein,et al.  The Generality of the Ratio-Bias Phenomenon , 1995 .

[8]  Erika A. Waters,et al.  Formats for Improving Risk Communication in Medical Tradeoff Decisions , 2006, Journal of health communication.

[9]  M. Schapira,et al.  The Influence of Graphic Format on Breast Cancer Risk Communication , 2006, Journal of health communication.

[10]  N. Weinstein,et al.  Risk perceptions: assessment and relationship to influenza vaccination. , 2007, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[11]  M. Schapira,et al.  Predictors of pessimistic breast cancer risk perceptions in a primary care population , 2004, Journal of General Internal Medicine.

[12]  E. Weber,et al.  Affective and deliberative processes in risky choice: age differences in risk taking in the Columbia Card Task. , 2009, Journal of experimental psychology. Learning, memory, and cognition.

[13]  A. Tversky,et al.  Prospect theory: analysis of decision under risk , 1979 .

[14]  P. Ubel,et al.  Validation of the Subjective Numeracy Scale: Effects of Low Numeracy on Comprehension of Risk Communications and Utility Elicitations , 2007, Medical decision making : an international journal of the Society for Medical Decision Making.

[15]  D. Baker,et al.  Development of a brief test to measure functional health literacy. , 1999, Patient education and counseling.

[16]  D. Grimes,et al.  Patients' understanding of medical risks: implications for genetic counseling. , 1999, Obstetrics and gynecology.

[17]  Richard L. Street,et al.  Health promotion and interactive technology : theoretical applications and future directions , 1997 .

[18]  Alexander J. Rothman,et al.  Message framing and sunscreen use: gain-framed messages motivate beach-goers. , 1999, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[19]  R Fuller,et al.  How informed is consent? Understanding of pictorial and verbal probability information by medical inpatients , 2002, Postgraduate medical journal.

[20]  Gerd Gigerenzer,et al.  Communicating Statistical Information , 2000, Science.

[21]  G Gigerenzer,et al.  Medicine. Communicating statistical information. , 2000, Science.

[22]  Duane T. Wegener,et al.  The elaboration likelihood model: Current status and controversies. , 1999 .

[23]  Jonathan Baron,et al.  The Effect of Numerical Statements of Risk on Trust and Comfort with Hypothetical Physician Risk Communication , 2004, Medical decision making : an international journal of the Society for Medical Decision Making.

[24]  Sankey V. Williams,et al.  Measuring Perceptions of Breast Cancer Risk , 2006, Cancer Epidemiology Biomarkers & Prevention.

[25]  Amanda L Golbeck,et al.  A definition and operational framework for health numeracy. , 2005, American journal of preventive medicine.

[26]  D. Lieberman,et al.  Educational video game for juvenile diabetes: results of a controlled trial. , 1997, Medical informatics = Medecine et informatique.

[27]  C. McHorney,et al.  Frequency or Probability? A Qualitative Study of Risk Communication Formats Used in Health Care , 2001, Medical decision making : an international journal of the Society for Medical Decision Making.

[28]  Student.  BELIEF IN THE LAW OF SMALL NUMBERS , 1994 .

[29]  E. Weber,et al.  Predicting Risk-Sensitivity in Humans and Lower Animals: Risk as Variance or Coefficient of Variation , 2004, Psychological review.

[30]  M A Blajchman,et al.  A new tool for communicating transfusion risk information , 1998, Transfusion.

[31]  R. Hertwig,et al.  Decisions from Experience and the Effect of Rare Events in Risky Choice , 2004, Psychological science.

[32]  C. K. Mertz,et al.  PSYCHOLOGICAL SCIENCE Research Article Numeracy and Decision Making , 2022 .

[33]  P M Sandman,et al.  Testing a visual display to explain small probabilities. , 1994, Risk analysis : an official publication of the Society for Risk Analysis.

[34]  Debra A. Lieberman,et al.  Interactive Video Games for Health Promotion: Effects on Knowledge , 1997 .

[35]  Noel T Brewer,et al.  Meta-analysis of the relationship between risk perception and health behavior: the example of vaccination. , 2007, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[36]  Connie V. Chan,et al.  Interactive Graphics for Expressing Health Risks: Development and Qualitative Evaluation , 2009, Journal of health communication.

[37]  Fischhoff,et al.  Verbal and Numerical Expressions of Probability: "It's a Fifty-Fifty Chance" , 2000, Organizational behavior and human decision processes.

[38]  Stacey L. Sheridan,et al.  Promoting Informed Choice: Transforming Health Care To Dispense Knowledge for Decision Making , 2005, Annals of Internal Medicine.

[39]  B. Rimer,et al.  General Performance on a Numeracy Scale among Highly Educated Samples , 2001, Medical decision making : an international journal of the Society for Medical Decision Making.

[40]  M. Allen,et al.  A Meta-Analysis of Fear Appeals: Implications for Effective Public Health Campaigns , 2000, Health education & behavior : the official publication of the Society for Public Health Education.

[41]  Jonathan Baron,et al.  Intended Message Versus Message Received in Hypothetical Physician Risk Communications: Exploring the Gap , 2004, Risk analysis : an official publication of the Society for Risk Analysis.

[42]  D. Berry,et al.  Effects of active information processing on the understanding of risk information , 2005 .

[43]  N. Weinstein.  The precaution adoption process. , 1988, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[44]  M. Becker.  The Health Belief Model and Sick Role Behavior* , 1974 .

[45]  Jessica S. Ancker,et al.  The Practice of Informatics: Design Features of Graphs in Health Risk Communication: A Systematic Review , 2006, J. Am. Medical Informatics Assoc..

[46]  Lee Dh,et al.  A new tool for communicating transfusion risk information , 1998 .

[47]  Judith H Hibbard,et al.  Supporting informed consumer health care decisions: data presentation approaches that facilitate the use of information in choice. , 2003, Annual review of public health.

[48]  Jessica S Ancker,et al.  Rethinking health numeracy: a multidisciplinary literature review. , 2007, Journal of the American Medical Informatics Association : JAMIA.

[49]  A. Tversky,et al.  Judgment under Uncertainty: Heuristics and Biases , 1974, Science.

[50]  Lisa M. Schwartz,et al.  The Role of Numeracy in Understanding the Benefit of Screening Mammography , 1997, Annals of Internal Medicine.

[51]  G. Gigerenzer,et al.  Using icon arrays to communicate medical risks: overcoming low numeracy. , 2009, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[52]  M. Becker,et al.  Health Belief Model and Personal Health Behavior , 1976 .

[53]  J. March.  Learning to be risk averse. , 1996 .

[54]  G. Elwyn,et al.  Presenting risk information--a review of the effects of "framing" and other manipulations on patient outcomes. , 2001, Journal of health communication.