“People tend to comprehend more and make better-informed decisions when the presentation format makes the most important information easier to evaluate and when less cognitive effort is required.” Ellen Peters, PhD, research scientist; associate professor of psychology, Ohio State University
After more than 20 years as a healthcare professional and health educator, I wonder if we have become desensitized to the weight and complexity of treatment decisions for patients and care partners. At the end of the day, patients and care partners universally ask 2 questions: “Will this treatment work?” and “What are the side effects?” It has always fascinated me that patients and care partners often ask these 2 questions even after they’ve reviewed educational materials and received counseling from their healthcare providers.
So, why are these questions so common when almost all branded websites and materials offer a “Benefits of Brand X” section? The most common approach to presenting benefits and risk information is through numerical trial data. During a recent market research interview, a patient said, “I have never heard of ‘placebo’ is this another treatment? The moderator of the interview went on to describe the placebo as a “sugar pill.” The patient responded, “does sugar help with this condition?”
Because we work with trial data every day, we forget that most patients don’t live in the world of clinical trials. To complicate matters, regulatory guidelines often require the inclusion of robust study design, which is important but only adds to the complexity and diverts attention from the information that patients and care partners are most interested in: benefits and risks.
Defining health numeracy
Peters et al (2007) define health numeracy as “an element of health literacy that refers to the ability to understand numbers.” Findings from the National Adult Literacy Survey show “almost half of the general population has difficulty with relatively simple numeric tasks such as calculating the difference between a regular price and a sales price or estimating the cost per ounce of a grocery item.” They have difficulty while using a calculator. If you add the emotional weight of treatment decisions and health challenges to this situation, it is easy to see why patients and care partners are struggling.
Here is a list of best practices for driving health numeracy when presenting benefit/risk information.
Less is more. Marketers, medical/legal/regulatory, and agencies need to work collaboratively to identify the most effective, responsible, and balanced approach to presenting what patients and caregivers most want and need to know. For example, onerous study design can be confusing and may be less important to patients. Is there an opportunity to minimize some study design or present study background in a way that does not compete with priority benefit/risk information.
Reduce required inferences and calculations. Studies have shown that percentages are difficult for patients to process and relate to. Patients struggle to see how such numerical concepts relate to their own situation, and they often misinterpret the information. Steps for simplifying calculations include:
- Use ratios, and keep the denominator constant to reduce effort and increase comprehension (20 of 1000; 1 of 1000)
- Choose using absolute risks (for example, 3 of 1000) will have a stroke) over using relative risks (50 percent higher chance of stroke)
- Avoid using decimals
- Use the same time span when expressing efficacy and risk
- Use meaningful visual cues and displays to highlight the meaning of information
- Summarize key information
- Avoid using confidence intervals because people tend to accept or reject information fully without adjusting for data quality
Test and revise formats carefully to reduce the effects of low numeracy. Approaches to presenting numeric information should be tested with target audiences whenever possible. Without usability testing, time and resources are invested with no real guide as to whether the content will impact the target.
The decisions of people with low numeracy are likely to be informed more by non-numeric sources of information. In reality, it is NOT “all in the numbers.” Treatment decisions are also a subjective, emotional experience. It is very difficult to validate or capture these emotions through numbers. This may be one reason why patients and care partners are so active on social media portals seeking the stories and experiences from other patients and care partners.
It is important to know and involve your audience and as you develop benefit and risk communications. This can help educators and marketers to develop the optimal approach to presenting clear numerical presentation of outcomes with relatable, balanced stories of patients, care partners, and healthcare providers.
Christopher G. Kelly, MEd
VP, Health Education