The Effect of Format on Parents' Understanding of the Risks and Benefits of Clinical Research: A Comparison Between Text, Tables, and Graphics

Abstract

There is a paucity of information regarding the optimal method of presenting risk/benefit information to parents of pediatric research subjects. This study, therefore, was designed to examine the effect of different message formats on parents' understanding of research risks and benefits. An Internet-administered survey was completed by 4,685 parents who were randomized to receive risk/benefit information about a study of pediatric postoperative pain control presented in different message formats (text, tables, and pictographs). Survey questions assessed participants' gist and verbatim understanding of the information and their perceptions of the risks and benefits. Pictographs were associated with significantly (p < .05) greater likelihood of adequate gist and verbatim understanding compared with text and tables regardless of the participants' numeracy. Parents who received the information in pictograph format perceived the risks to be lower and the benefits to be higher compared with the other formats (p < .001). Furthermore, compared with text and tables, pictographs were perceived as more “effective,” “helpful,” and “trustworthy” in presenting risk/benefit information. These results underscore the difficulties associated with presenting risk/benefit information for clinical research but suggest a simple method for enhancing parents' informed understanding of the relevant statistics.

Supported in part by a grant to Dr. Tait from The National Institutes of Health, NICHD (R01 HD053594). Dr. Zikmund-Fisher is supported by a career development award from the American Cancer Society (MRSG-06–130-01-CPPB), and Dr. Fagerlin was supported by an MREP early career award from the U.S. Department of Veteran's Affairs. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

The authors are indebted to Bob Burbach and Aaron Pearlman for their help with the design and development of the Internet survey and the specific graphs and tables tested herein. We also thank Julie Parow, Rosemarie Pitsch, and Nicole Exe for their assistance in testing the survey instrument. Finally, we thank Dr. Peter Ubel for his helpful comments during the design of this study.

Notes

*p = .01 vs Pictograph.

Low numeracy = 0–35, High numeracy = 36–48 on the Subjective Numeracy Scale (Fagerlin et al., 2007; Zikmund-Fisher et al., 2007).

*p < .05 vs pictographs, †p < .01 vs low numeracy.

Low numeracy = 0–35, High numeracy = 36–48 on the Subjective Numeracy Scale.

‡Adequate gist knowledge: ≥3 correct answers out of 4.

^§Adequate verbatim knowledge: ≥5 correct answers out of 7.

Data are presented a mean ± SD based on a scale of 1–11 (where 11 = maximum response e.g., extremely worried, likely, etc.).

*p < .025 vs pictographs.

Data are presented a mean ± SD based on a scale of 1–7 (where 7 = “extremely”).

*p < .001 vs pictographs.

†p < .001 vs tables.