Tuesday, October 21, 2014: 10:45 AM

Suzanne K. Linder, Ph.D.1, Andre W. Hite, MPH2, Scott B. Cantor, Ph.D.3, Michael A. Kallen, PhD4, Therese B. Bevers, M.D., F.A.A.F.P.2 and Robert J. Volk, PhD2, (1)The University of Texas Medical Branch, Galveston, TX, (2)The University of Texas MD Anderson Cancer Center, Houston, TX, (3)The University of Texas MD Anderson Cancer Center, Department of Health Services Research, Houston, TX, (4)Northwestern University Feinberg School of Medicine, Chicago, IL

Purpose: Enhanced visual effects have the potential to improve patients' comprehension of probabilistic risk information, particularly for those with lower literacy skills. We tested the effect of presentation format on comprehension of risks related to colorectal cancer screening (CRCS) to identify optimal visual effect strategies when communicating risks.

Methods:   Participants from a community-based center and a cancer prevention center completed a baseline survey and were then randomized to receive one of three CRCS risk presentations. Pictographs (i.e., icon arrays) were used to present colorectal cancer incidence, mortality risk, and the incremental benefit of screening. The presentations had the same content and 3.5-minute audio narration but varied in format: 1) video with animated pictographs, 2) video with static pictographs, and 3) narrated print booklet with static pictographs. After viewing the presentation, participants answered a post-intervention survey. The primary outcome was comprehension of risk information regarding CRCS, calculated as total score (percent correct) and as separate verbatim and gist scores. We also assessed health literacy and graphical literacy, and then we categorized both as low or high.

Results: One hundred eighty-seven individuals completed the study and were included in the analysis. After interventions, we found no significant differences in risk comprehension (total, verbatim, or gist) across presentation format (all p-values > 0.10). In addition, there was no significant interaction between literacy and presentation format for the risk knowledge outcomes. In supplemental analyses, the interaction effect between graphical and health literacy was significant for each risk knowledge outcome (total, gist, verbatim, all p-values < 0.05). For verbatim-based risk comprehension, the best performers were those with high graphical literacy, regardless of health literacy (see table below). For gist-based comprehension, those with high skills in both literacy areas performed the best, followed by those with high skills in only one literacy area. Those with low skills in both areas performed the poorest for both types of risk comprehension.  

Conclusion: Using animation when presenting pictographs to communicate risk information does not appear to enhance or hinder risk comprehension when compared to well-designed static formats. Overall, individuals with low graphical literacy skills may have difficulty understanding pictographs. Teaching or priming individuals how to interpret graphs may be necessary before communicating risk using visual methods.