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Markell J, Odouard I, Anderson GF, DiStefano MJ. Consumer Perceptions of Safety Information in Direct-to-Consumer Print Advertisements for Alzheimer Drugs. JAMA Netw Open 2024; 7:e2431110. [PMID: 39212994 PMCID: PMC11364991 DOI: 10.1001/jamanetworkopen.2024.31110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 07/06/2024] [Indexed: 09/04/2024] Open
Abstract
This survey study assesses the effectiveness of drug advertisement to shape perception of the benefits and risks of and personal willingness to use and recommend an advertised drug.
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Affiliation(s)
- Jenny Markell
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ilina Odouard
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gerard F. Anderson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michael J. DiStefano
- Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora
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Behnam S, Arabin B. Systematic Reviews on the Prevention of Adverse Pregnancy Outcomes Related to Maternal Obesity to Improve Evidence-Based Counselling. Geburtshilfe Frauenheilkd 2024; 84:564-572. [PMID: 38884029 PMCID: PMC11175830 DOI: 10.1055/a-2295-1725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 03/13/2024] [Indexed: 06/18/2024] Open
Abstract
Background Health professionals and their patients should understand the importance of evidence. In the case of gestational diabetes mellitus, which is often associated with an abnormally high body mass index, the immediate and long-term outcome of women and their offspring depends in part on advice and implementation of lifestyle changes before, during and after pregnancy. Methods Up to September 2023, MEDLINE, CENTRAL, and WEB OF SCIENCE were used to identify systematic reviews and meta-analyses on the prevention of gestational diabetes. The ROBIS and AMSTAR criteria were analyzed for all systematic reviews. Results A total of 36 systematic reviews were identified. Dietary interventions, physical activity or a combined approach all reduced adverse pregnancy outcomes such as gestational diabetes, pregnancy-induced hypertension and related morbidities. Within the randomized controlled trials included in the 36 systematic reviews, the type, intensity and frequency of interventions varied widely. The primary outcomes, reporting and methodological quality of the 36 systematic reviews and meta-analyses also varied.The meta-analysis with the highest ROBIS and AMSTAR-2 scores was selected to design an icon array based on a fact box simulating 100 patients. Conclusions We propose a methodology for selecting the best evidence and transforming it into a format that illustrates the benefits and harms in a way that can be understood by lay patients, even if they cannot read. This model can be applied to counselling for expectant mothers in low and high-income countries, regardless of socioeconomic status, provided that women have access to appropriately trained healthcare providers.
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Affiliation(s)
- Susann Behnam
- Clara Angela Foundation Witten und Berlin, Witten, Germany
- Philipps University Marburg, Marburg, Germany
- Dr. Horst Schmidt Hospital, Wiesbaden, Germany
| | - Birgit Arabin
- Clara Angela Foundation Witten und Berlin, Witten, Germany
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Aikin KJ, Sullivan HW, Caporaso A, Hoverman V, Yan T, Williams D, Crafts J. Attention to risk information in direct-to-consumer prescription drug print ads: An eye-tracking study. Pharmacoepidemiol Drug Saf 2023; 32:312-320. [PMID: 35864719 DOI: 10.1002/pds.5511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/22/2022] [Accepted: 07/16/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE FDA regulations state print ads for prescription drugs must provide a true statement of information "in brief summary" describing "side effects, contraindications and effectiveness." To fulfill these requirements, these ads typically display risk information both as important safety information (ISI) on the "main" ad page with the product claims and on a separate "brief summary" page. The ISI can be lengthy and may repeat brief summary content. METHODS The authors tested two versions of the ISI (short versus long) and the presence or absence of a brief summary in direct-to-consumer prescription drug print ads for two medical conditions: overactive bladder (N = 181) and rheumatoid arthritis (N = 179). Attention was measured with eye-tracking and self-report methods. Risk retention and perceptions were self-reported. RESULTS Participants spent more time viewing ads with a long ISI or a brief summary and in some instances, recalled more risks. The combination of a long ISI and a brief summary did not increase or decrease attention to or retention of risk information. CONCLUSION A long ISI and a brief summary may perform similar functions.
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Affiliation(s)
- Kathryn J Aikin
- US Food and Drug Administration, Office of Prescription Drug Promotion, Silver Spring, Maryland, USA
| | - Helen W Sullivan
- US Food and Drug Administration, Office of Prescription Drug Promotion, Silver Spring, Maryland, USA
| | | | | | - Ting Yan
- Westat, Rockville, Maryland, USA
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Recchia G, Lawrence AC, Freeman AL. Investigating the presentation of uncertainty in an icon array: A randomized trial. PEC INNOVATION 2022; 1:None. [PMID: 36518604 PMCID: PMC9731905 DOI: 10.1016/j.pecinn.2021.100003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/20/2021] [Accepted: 10/26/2021] [Indexed: 06/17/2023]
Abstract
BACKGROUND Clinicians are often advised to use pictographs to communicate risk, but whether they offer benefits when communicating risk imprecision (e.g., 65%-79%) is unknown. PURPOSE To test whether any of three approaches to visualizing imprecision would more effectively communicate breast and ovarian cancer risk for BRCA1 pathogenic variant carriers. METHODS 1,300 UK residents were presented with a genetic report with information about BRCA1-related risks, with random assignment to one of four formats: no visualization (text alone), or a pictograph using shaded icons, a gradient, or arrows marking range endpoints. We also tested pictographs in two layouts. Analysis of variance (ANOVA) and regression was employed. RESULTS There was no effect of format. Participants shown pictographs vs. text alone had better uptake of breast cancer risk messages (p < .05, η 2 = 0.003). Pictographs facilitated memory for the specific amount of risk (p < 0.001, η 2 = 0.019), as did the tabular layout. Individuals not having completed upper secondary education may benefit most. CONCLUSIONS We found weak evidence in favor of using simple pictographs with ranges to communicate BRCA risk (versus text alone), and of the tabular layout. INNOVATION Testing different ways of communicating imprecision within pictographs is a novel and promising line of research.
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Affiliation(s)
- Gabriel Recchia
- Corresponding author at: Centre for Mathematical Sciences, Wilberforce Rd, Cambridge CB3 0WA, UK.
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Ruiz JI, Singh G, Erck M, Geng Y, Suarez-Almazor ME, Lopez-Olivo MA. Quality and content evaluation of websites with information about immune checkpoint inhibitors: An environmental scan. PLoS One 2022; 17:e0275676. [PMID: 36215234 PMCID: PMC9550065 DOI: 10.1371/journal.pone.0275676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Trustworthy educational information for patients is critical for increasing their knowledge base and preparing them for shared decision making with clinicians. As the internet has become an important source of health information for many patients, the purpose of this study was to assess the quality and content of websites with educational content about immune checkpoint inhibitors. METHODS We performed an environmental scan of the currently available websites providing educational information for patients about immune checkpoint inhibitors. We used three search engines: Google, Bing, and Yahoo! (9/20/2021). Two independent investigators selected relevant uniform resource locators (URLs), appraised the quality of the websites, and collected their characteristics. We evaluated the accuracy, completeness, technical elements, design and aesthetics, readability, usability, and accessibility of the websites. The user experience was also evaluated. RESULTS We identified 37 websites for analysis. In 10 websites (27%), it was not possible to know the source of the information provided. Thirty-three (89%) provided a definition with a simple explanation of cancer and treatment and 30 (81%) on complications of immune checkpoint inhibitors; only seven (19%) provided information about the balance between risks and benefits. Thirty-five (95%) provided a statement of purpose. Regarding the design, all 37 (100%) had appropriate visual aspects, typography, and grammar. Thirty-six (97%) were well organized. For most of the websites (n = 35, 95%) the content was easy to find. Only two websites had a readability score of 6, while the others had higher scores. Regarding the user experience, the overall quality of websites was rated as excellent in 16 (43%), good in 14 (38%), and fair in 7 (19%). CONCLUSIONS Our findings reveal that websites with information about immune checkpoint inhibitors mostly have general information about cancer, the treatments, and adverse events. Few websites provide information about the balance between harms and benefits of treatment, costs, the source of the information, or the hierarchy of evidence. These findings identify the gap in the quality and content of websites for patients treated with immune checkpoint inhibitors and can help website creators and developers.
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Affiliation(s)
- Juan Ignacio Ruiz
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Gagandeep Singh
- Division of Gastroenterology & Hepatology, Johns Hopkins University, Baltimore, MD, United States of America
| | - McKenna Erck
- Texas A&M University, College Station, TX, United States of America
| | - Yimin Geng
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Maria E. Suarez-Almazor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Maria A. Lopez-Olivo
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
- * E-mail:
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Sullivan HW, O'Donoghue AC, Lynch M, Johnson M, Davis C, Amoozegar JB, Rupert DJ. Visual images of prescription drug benefits in direct-to-consumer television advertisements. PATIENT EDUCATION AND COUNSELING 2021; 104:2240-2249. [PMID: 33618970 PMCID: PMC8362835 DOI: 10.1016/j.pec.2021.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Images demonstrating a prescription drug's efficacy are often included in direct-to-consumer television advertisements. The current research assessed whether exaggerated efficacy images can mislead individuals, and whether providing accurate quantitative information can reduce these misperceptions. METHODS We conducted two experimental studies with internet panelists 60 years and older testing drug efficacy images in television ads for wet age-related macular degeneration (N = 901) and plaque psoriasis (N = 902). In each study, participants viewed one of six ads that varied in the efficacy images included (no image, accurate image, exaggerated image) and the presentation of quantitative information (absent, present). Measures included recall, perceptions, and numeracy. RESULTS In both studies, participants who saw exaggerated images were more likely than those who saw no image or accurate images to overestimate efficacy. Presenting quantitative information increased participants' gist and verbatim recall of drug efficacy, and in some cases, led participants to have more accurate perceptions of the drug's efficacy even in the presence of exaggerated images. Higher numeracy was associated with better gist and verbatim recall. CONCLUSIONS These results support visual persuasion theory. Moreover, they show that exaggerating benefits visually can mislead viewers. PRACTICE IMPLICATIONS Stakeholders should ensure that images in direct-to-consumer promotion are accurate and non-misleading.
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Affiliation(s)
- Helen W Sullivan
- Office of Prescription Drug Promotion, U.S. Food and Drug Administration, Silver Spring, MD, USA.
| | - Amie C O'Donoghue
- Office of Prescription Drug Promotion, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Molly Lynch
- Center for Communication Science, RTI International, Research Triangle Park, NC, USA
| | - Mihaela Johnson
- Center for Communication Science, RTI International, Research Triangle Park, NC, USA
| | - Christine Davis
- Center for Communication Science, RTI International, Research Triangle Park, NC, USA
| | - Jacqueline B Amoozegar
- Center for Health Informatics Research, RTI International, Research Triangle Park, NC, USA
| | - Douglas J Rupert
- Center for Communication Science, RTI International, Research Triangle Park, NC, USA
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Kahrass H, Bossert S, Schürmann C, Strech D. Details of risk-benefit communication in informed consent documents for phase I/II trials. Clin Trials 2020; 18:71-80. [PMID: 33231107 PMCID: PMC7876653 DOI: 10.1177/1740774520971770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Informed consent documents for clinical studies should disclose all reasonably foreseeable risks and benefits. Little guidance exists on how to navigate the complexities of risk-benefit communication, especially in early clinical research. Practice-oriented development of such guidance should be informed by evidence on what and how details of risks and benefits are currently communicated. METHOD We surveyed the responsible parties of phase I/II trials registered in ClinicalTrials.gov that started 2007 or later and completed between 2012 and 2016 to sample informed consent documents from a broad spectrum of early phase clinical trials. Based on an assessment matrix, we qualitatively and quantitatively assessed the informed consent documents for details of risk-benefit communication. RESULTS The risk-benefit communication in the 172 informed consent documents differed substantially in several regards. The outcome, extent, and likelihood of health risks, for example, were described in 83%, 32%, and 63% of the informed consent documents. Only 45% of informed consent documents specified the outcome of mentioned health benefits, and the extent and likelihood of health benefits were never specified. From those informed consent documents reporting risk likelihoods, only 57% added frequency numbers to words such as "common" or "rare," and even in these cases, we found strong variations for presented frequency ranges. Substantial heterogeneity also exists for how informed consent documents communicate other risk and benefit types and related safeguards. CONCLUSION Our study points to several shortcomings and heterogeneities in how informed consent documents communicate risks and benefits to potential research participants. Health risks, for example, should be specified with frequency numbers, and health benefits should be specified at least by mentioning their outcomes. Further demand for research and policy development is needed to harmonize risk-benefit communication and to clarify ways to specify the likelihood of health benefits.
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Affiliation(s)
- Hannes Kahrass
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Sabine Bossert
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Hannover, Germany.,Forschungszentrum Jülich, Jülich, Germany
| | - Christopher Schürmann
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Daniel Strech
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Hannover, Germany.,QUEST Center, Berlin Institute of Health (BIH), Berlin, Germany.,Charité-Universitätsmedizin-Berlin, Berlin, Germany
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Smith LE, Webster RK, Rubin GJ. A systematic review of factors associated with side-effect expectations from medical interventions. Health Expect 2020; 23:731-758. [PMID: 32282119 PMCID: PMC7495066 DOI: 10.1111/hex.13059] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Fear of side-effects can result in non-adherence to medical interventions, such as medication and chemotherapy. Side-effect expectations have been identified as strong predictors of later perception of side-effects. However, research investigating predictors of side-effect expectations is disparate. OBJECTIVE To identify factors associated with side-effect expectations. SEARCH STRATEGY We systematically searched Embase, Ovid MEDLINE, Global Health, PsycARTICLES, PsycINFO, Web of Science and Scopus. INCLUSION CRITERIA Studies were included if they investigated associations between any predictive factor and expectations of side-effects from any medical intervention. DATA EXTRACTION AND SYNTHESIS We extracted information about participant characteristics, medication, rates of side-effects expected and predictors of side-effect expectations. Data were narratively synthesized. MAIN RESULTS We identified sixty-four citations, reporting on seventy-two studies. Predictors fell into five categories: personal characteristics, clinical characteristics, psychological traits and state, presentation format of information, and information sources used. Using verbal risk descriptors (eg 'common') compared to numerical descriptors (eg percentages), having lower quality of life or well-being, and currently experiencing symptoms were associated with increased side-effect expectations. DISCUSSION AND CONCLUSIONS Decreasing unrealistic side-effect expectations may lead to decreased experience of side-effects and increased adherence to medical interventions. Widespread communications about medical interventions should describe the incidence of side-effects numerically. Evidence suggests that clinicians should take particular care with patients with lower quality of life, who are currently experiencing symptoms and who have previously experienced symptoms from treatment. Further research should investigate different clinical populations and aim to quantify the impact of the media and social media on side-effect expectations.
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Affiliation(s)
- Louise E Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - G James Rubin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Pillitteri JL, Shiffman S, Sembower MA, Polster MR, Curtin GM. Assessing comprehension and perceptions of modified-risk information for snus among adult current cigarette smokers, former tobacco users, and never tobacco users. Addict Behav Rep 2020; 11:100254. [PMID: 32467843 PMCID: PMC7244929 DOI: 10.1016/j.abrep.2020.100254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/05/2020] [Accepted: 01/21/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Snus, a low nitrosamine smokeless tobacco product, presents less risks to health than cigarettes. Effectively communicating such risk information could facilitate smokers switching completely to snus, thereby benefiting public health. METHODS This study assessed comprehension and perceptions of modified-risk information regarding snus. Adult cigarette smokers, former tobacco users, and never tobacco users (N = 3,922) from a US internet panel viewed an advertisement stating that smokers who switched completely to snus could greatly reduce risk of lung cancer, respiratory disease, heart disease, and oral cancer. Respondents answered questions regarding the modified-risk information and rated perceived risks of snus relative to cigarettes and other smokeless tobacco products. RESULTS Across the four diseases mentioned in the advertisement, most respondents (49.7%-68.6%, across tobacco user groups) understood that snus presents less risk than cigarettes but is not completely safe. Some indicated snus presents the same risk as cigarettes; this was highest for oral cancer (33.7%-42.02%) and lowest for lung cancer (15.4%-23.1%) and respiratory disease (15.6%-23.4%). Majorities understood snus is addictive (77.7%-87.9%), quitting all tobacco is the best option for smokers (83.6%-93.1%), and non-users of tobacco should not use snus (80.4%-87.8%). Only 2.1%-5.8% indicated smokers would receive a health benefit if they continued to smoke while using snus. CONCLUSIONS The modified-risk information, conveying that snus presents less risk than cigarettes but is not completely safe, was understood by majorities of respondents. Differential risk beliefs across diseases suggest responses were shaped not only by the modified-risk information, but also by intuitions and pre-existing beliefs about tobacco products.
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Affiliation(s)
- Janine L. Pillitteri
- PinneyAssociates, Inc., 201 North Craig Street, Suite 320, Pittsburgh, PA 15213, United States
| | - Saul Shiffman
- PinneyAssociates, Inc., 201 North Craig Street, Suite 320, Pittsburgh, PA 15213, United States
| | - Mark A. Sembower
- PinneyAssociates, Inc., 201 North Craig Street, Suite 320, Pittsburgh, PA 15213, United States
| | | | - Geoffrey M. Curtin
- RAI Services Company, 401 North Main Street, Winston-Salem, NC 27101, United States
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Abstract
The Innovative Medicines Initiative (IMI) WEB-RADR (Web-Recognising Adverse Drug Reactions) project looked at opportunities and challenges in using social media in pharmacovigilance as a rapidly evolving source of large, real-time data, which could provide new information on the actual use of medicines and potential safety issues. Two of the objectives were to develop principles for continuous monitoring of the safety of medicines without overburdening established pharmacovigilance systems and to propose a regulatory framework on the use of social media in pharmacovigilance. As a starting point, a review of existing legal requirements and regulatory guidance on social media use in pharmacovigilance was performed based on a survey conducted in 2014–2015. Furthermore, input from two large stakeholder workshops and evidence gathered from the research performed by WEB-RADR on the analysis of social media data were taken into consideration. Whilst analytical results of WEB-RADR indicated limited value of social media in detecting or confirming signals for a majority of the drugs studied, it is important to establish a regulatory framework for the use of social media in pharmacovigilance. Thus, the screening and reporting of suspected adverse reactions remains an important pillar in monitoring the safety and efficacy of medicines and the identification of new safety issues. Principles as to how social media can be used in pharmacovigilance are absolutely needed to provide clarity to patients, healthcare professionals, medicines regulators and the pharmaceutical industry.
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Brick C, McDowell M, Freeman ALJ. Risk communication in tables versus text: a registered report randomized trial on 'fact boxes'. ROYAL SOCIETY OPEN SCIENCE 2020; 7:190876. [PMID: 32269779 PMCID: PMC7137953 DOI: 10.1098/rsos.190876] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 02/27/2020] [Indexed: 06/09/2023]
Abstract
OBJECTIVES identifying effective summary formats is fundamental to multiple fields including science communication, systematic reviews, evidence-based policy and medical decision-making. This study tested whether table or text-only formats lead to better comprehension of the potential harms and benefits of different options, here in a medical context. DESIGN pre-registered, longitudinal experiment: between-subjects factorial 2 (message format) × 2 topic (therapeutic or preventative intervention) on comprehension and later recall (CONSORT-SPI 2018). SETTING longitudinal online survey experiment. PARTICIPANTS 2305 census-matched UK residents recruited through the survey panel firm YouGov. PRIMARY OUTCOME MEASURE comprehension of harms and benefits and knowledge recall after six weeks. RESULTS fact boxes-simple tabular messages-led to more comprehension (d = 0.39) and slightly more knowledge recall after six weeks (d = 0.12) compared to the same information in text. These patterns of results were consistent between the two medical topics and across all levels of objective numeracy and education. Fact boxes were rated as more engaging than text, and there were no differences between formats in treatment decisions, feeling informed or trust. CONCLUSIONS the brief table format of the fact box improved the comprehension of harms and benefits relative to the text-only control. Effective communication supports informed consent and decision-making and brings ethical and practical advantages. Fact boxes and other summary formats may be effective in a wide range of communication contexts.
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Affiliation(s)
- Cameron Brick
- Winton Centre for Risk and Evidence Communication, Centre for Mathematical Sciences, University of Cambridge, Wilberforce Road, Cambridge, CB3 0WA, UK
- Department of Psychology, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
| | - Michelle McDowell
- Harding Center for Risk Literacy, University of Potsdam, 14469 Potsdam, Germany
- Max Planck Institute for Human Development, 14195 Berlin, Germany
| | - Alexandra L. J. Freeman
- Winton Centre for Risk and Evidence Communication, Centre for Mathematical Sciences, University of Cambridge, Wilberforce Road, Cambridge, CB3 0WA, UK
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Sullivan HW, O'Donoghue AC, Lynch M, Johnson M, Davis C, Rupert DJ. The Effect of Including Quantitative Information on Multiple Endpoints in Direct-to-Consumer Prescription Drug Television Advertisements. Med Decis Making 2019; 39:975-985. [PMID: 31583947 DOI: 10.1177/0272989x19875946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Previous research found that adding a single piece of quantitative information about prescription drug benefits to direct-to-consumer (DTC) ads helps consumers understand how well the drug works. However, drug information often includes quantitative information on multiple benefit outcomes and risks. Thus, we examined whether consumer understanding was similarly improved when DTC television ads include varying amounts of quantitative information. Methods. We randomly assigned participants (945 Internet panelists ≥ 60 years old) to view 1 of 9 fictitious prescription drug television ads that varied the presentation of quantitative information for benefits (none, single outcome, 2 outcomes) and risks (none, 1 risk category, 3 risk categories) and then measured gist and verbatim recall/estimation and drug perceptions. Results. Adding a single benefit outcome and a single risk category replicated past results. Compared with an ad containing no quantitative information, presenting 2 benefit outcomes and multiple risk categories increased gist and verbatim recall and affected drug perceptions. Compared with presenting a single benefit outcome, presenting 2 benefit outcomes increased verbatim recall for the second outcome but decreased verbatim recall for the first outcome. Likewise, compared with presenting a single risk category, presenting multiple risk categories increased gist and verbatim recall for the multiple risk categories but decreased gist recall for a concept more closely associated with the single risk category. Adding multiple risk categories decreased risk perceptions even more than did the single risk category. Limitations. This study may have limited generalizability because it examined an ad for only 1 medical condition. Conclusions. There are tradeoffs to adding multiple quantitative benefit outcomes in DTC ads. However, presenting multiple quantitative risk categories helps consumers better understand a drug's risks.
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Affiliation(s)
| | | | - Molly Lynch
- RTI International, Research Triangle Park, NC, USA
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13
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McDowell M, Gigerenzer G, Wegwarth O, Rebitschek FG. Effect of Tabular and Icon Fact Box Formats on Comprehension of Benefits and Harms of Prostate Cancer Screening: A Randomized Trial. Med Decis Making 2019; 39:41-56. [PMID: 30799691 DOI: 10.1177/0272989x18818166] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fact boxes employ evidence-based guidelines on risk communication to present benefits and harms of health interventions in a balanced and transparent format. However, little is known about their short- and long-term efficacy and whether designing fact boxes to present multiple outcomes with icon arrays would increase their efficacy. METHOD In study 1, 120 men (30-75 y) completed a lab study. Participants were randomly assigned to 1 of 3 fact box formats on prostate cancer screening: a tabular fact box with numbers, a fact box with numbers and icon array, and a fact box with numbers, separate icon arrays, and text to describe each benefit and harm. Comprehension of information (while materials were present) and short-term knowledge recall were assessed. Study 2 recruited an online sample of 244 German men (40-75 y). Participants were randomly assigned to 1 of the 3 fact box formats or widely distributed health information, and knowledge was assessed at baseline, shortly after presentation, and at 6-mo follow-up, along with comprehension while materials were present. RESULTS In both studies, comprehension and knowledge-recall scores were similar when comparing tabular and icon fact boxes. In the 6-mo follow-up, this positive effect on knowledge recall disappeared. Fact boxes increased knowledge relative to baseline but did not affect decision intentions or perceptions of having complete information to make decisions. CONCLUSIONS This study shows that fact boxes with and without icon arrays are equally effective at improving comprehension and knowledge recall over the short-term and are simple formats that can improve on current health information. Specifically, if fact boxes are used at the time or immediately before a decision is made, they promote informed decisions about prostate cancer screening.
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Affiliation(s)
- Michelle McDowell
- Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany
| | - Gerd Gigerenzer
- Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany
| | - Odette Wegwarth
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
| | - Felix G Rebitschek
- Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany
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Gerlach K, Shiffman S, Battista D, Polster M, Curtin G. Assessing likelihood of product use for snus with modified-risk information among adult current cigarette smokers, former tobacco users, and never tobacco users. Addict Behav Rep 2019; 10:100208. [PMID: 31467967 PMCID: PMC6710553 DOI: 10.1016/j.abrep.2019.100208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/16/2019] [Accepted: 07/19/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction Switching from cigarettes to snus by smokers unlikely to quit would be expected to benefit overall population health, with any potential benefit needing to be weighed against potential harms from snus use by tobacco non-users and smokers likely to quit. This study evaluates likelihood of snus use among tobacco users and non-users provided modified-risk information. Methods An online sample of 11,302 U.S. adults was randomized to view advertisements for snus that either provided modified-risk information or only described snus. Intent to purchase ratings were converted to projected purchase (use) rates using an empirically derived algorithm. Results Projected product use for snus was significantly higher among current smokers than former or never tobacco users (p < 0.0001) for both the modified-risk and control information. A significant interaction effect between information and tobacco user group (p < 0.0001) indicated the modified-risk information differentially increased projected use among smokers (8.2% vs. 6.9%), with much lower projections for both the test and control information among former (1.2%) and never tobacco users (0.4%). Among never users, projected use was highest among those susceptible to smoking. These findings were generally similar for young adults, ages 18–24. Smokers expecting to quit who viewed modified-risk information had lower projected use (4.2%) than those not expecting to quit (8.7%). Conclusions Results suggest that providing modified-risk information for snus is unlikely to increase use among those not using tobacco. Interest in snus was greatest among current smokers who would benefit by switching to snus as communicated in the modified-risk advertisement. We tested the effect of communicating the reduced risk of snus compared to smoking. Such communication increased likely use of snus among smokers. Likely use of snus did not increase in never and former tobacco users. Projected use of snus was highest among smokers not likely to quit. Providing risk information is unlikely to cause harm and may confer benefits.
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Affiliation(s)
- Karen Gerlach
- PinneyAssociates, Inc., 201 North Craig Street, Suite 320, Pittsburgh, PA 15213, United States of America
| | - Saul Shiffman
- PinneyAssociates, Inc., 201 North Craig Street, Suite 320, Pittsburgh, PA 15213, United States of America
| | - Deena Battista
- PinneyAssociates, Inc., 201 North Craig Street, Suite 320, Pittsburgh, PA 15213, United States of America
| | - Michael Polster
- NAXION, 1835 Market Street, Philadelphia, PA 19103, United States of America
| | - Geoffrey Curtin
- RAI Services Company, 401 North Main Street, Winston-Salem, NC 27101, United States of America
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15
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Abstract
IMPORTANCE Manufacturers, companies, and health care professionals and organizations use an array of promotional activities to sell and increase market share of their products and services. These activities seek to shape public and clinician beliefs about laboratory testing, the benefits and harms of prescription drugs, and some disease definitions. OBJECTIVE To review the marketing of prescription drugs, disease awareness campaigns, health services, and laboratory tests and the related consequences and regulation in the United States over a 20-year period (1997-2016). EVIDENCE Analysis (1997-2016) of consumer advertising (Kantar Media data for spending and number of ads); professional marketing (IQVIA Institute for Human Data Science, Open Payments Data [Centers for Medicare & Medicaid Services]); regulations and legal actions of the US Food and Drug Administration (FDA), Federal Trade Commission (FTC), state attorneys general, and US Department of Justice; and searches (1975-2018) of peer-reviewed medical literature (PubMed), business journals (Business Source Ultimate), and news media (Lexis Nexis) for articles about expenditures, content, and consequences and regulation of consumer and professional medical marketing. Spending is reported in 2016 dollars. FINDINGS From 1997 through 2016, spending on medical marketing of drugs, disease awareness campaigns, health services, and laboratory testing increased from $17.7 to $29.9 billion. The most rapid increase was in direct-to-consumer (DTC) advertising, which increased from $2.1 billion (11.9%) of total spending in 1997 to $9.6 billion (32.0%) of total spending in 2016. DTC prescription drug advertising increased from $1.3 billion (79 000 ads) to $6 billion (4.6 million ads [including 663 000 TV commercials]), with a shift toward advertising high-cost biologics and cancer immunotherapies. Pharmaceutical companies increased DTC marketing about diseases treated by their drugs with increases in disease awareness campaigns from 44 to 401 and in spending from $177 million to $430 million. DTC advertising for health services increased from $542 million to $2.9 billion, with the largest spending increases by hospitals, dental centers, cancer centers, mental health and addiction clinics, and medical services (eg, home health). DTC spending on advertising for laboratory tests (such as genetic testing) increased from $75.4 million to $82.6 million, although the number of ads increased more substantially (from 14 100 to 255 300), reflecting an increase in less expensive electronic media advertising. Marketing to health care professionals by pharmaceutical companies accounted for most promotional spending and increased from $15.6 billion to $20.3 billion, including $5.6 billion for prescriber detailing, $13.5 billion for free samples, $979 million for direct physician payments (eg, speaking fees, meals) related to specific drugs, and $59 million for disease education. Manufacturers of FDA-approved laboratory tests paid $12.9 million to professionals in 2016. From 1997 through 2016, the number of consumer and professional drug promotional materials that companies submitted for FDA review increased from 34 182 to 97 252, while FDA violation letters for misleading drug marketing decreased from 156 to 11. Since 1997, 103 financial settlements between drug companies and federal and state governments resulted in more than $11 billion in fines for off-label or deceptive marketing practices. The FTC has acted against misleading marketing by a single for-profit cancer center. CONCLUSIONS AND RELEVANCE Medical marketing increased substantially from 1997 through 2016, especially DTC advertising for prescription drugs and health services. Pharmaceutical marketing to health professionals accounted for most spending and remains high even with new policies to limit industry influence. Despite the increase in marketing over 20 years, regulatory oversight remains limited.
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Affiliation(s)
- Lisa M Schwartz
- The Center for Medicine in the Media, Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Steven Woloshin
- The Center for Medicine in the Media, Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
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16
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Sharp ML, Hall L, Eleftherion A, Simpson K, Neuhauser L. Comparison of Brief Summary Formats Through a Health Literacy Lens. Ther Innov Regul Sci 2018; 53:100-109. [PMID: 29714598 DOI: 10.1177/2168479018769291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Print pharmaceutical advertisements in the United States require inclusion of a brief summary of side effects, warnings, precautions, and contraindications from the labeling. The full package insert, which sponsors have traditionally used to fulfill the brief summary requirement, does not adhere to health literacy best practices, limiting its value to consumers. This study compared the understandability and usability of brief summaries in 3 formats designed to be more consumer friendly. METHODS Three brief summary formats were tested: (1) 2-column "Question and Answer"; (2) "Prescription Drug Facts Box," similar to current US over-the-counter drug facts labeling; and (3) "Health Literacy," based on clear communication principles. Researchers evaluated the formats using the Suitability Assessment of Materials (SAM) tool and conducted structured, scripted, one-on-one interviews (usability tests) with participants with estimated low to average education levels. This research was replicated across 2 therapeutic areas (type 2 diabetes and plaque psoriasis). RESULTS SAM scores showed that the Health Literacy format outperformed the Question and Answer format and the Prescription Drug Facts Box format in both therapeutic areas, with both Health Literacy brief summaries rated on the SAM as "superior." Qualitative usability tests supported the SAM findings, with the Health Literacy format preferred consistently over the Question and Answer format, and more often than not over the Prescription Drug Facts Box format. CONCLUSIONS Sponsors can employ a user-tested Health Literacy format to improve the understandability and usability of brief summaries with patients.
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Affiliation(s)
| | - Lori Hall
- 1 Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Katherine Simpson
- 2 Health Research for Action, University of California, Berkeley, CA, USA
| | - Linda Neuhauser
- 2 Health Research for Action, University of California, Berkeley, CA, USA
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17
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Sullivan HW, Aikin KJ, Squiers LB. Quantitative Information on Oncology Prescription Drug Websites. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:371-374. [PMID: 27589969 PMCID: PMC5334459 DOI: 10.1007/s13187-016-1107-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Our objective was to determine whether and how quantitative information about drug benefits and risks is presented to consumers and healthcare professionals on cancer-related prescription drug websites. We analyzed the content of 65 active cancer-related prescription drug websites. We assessed the inclusion and presentation of quantitative information for two audiences (consumers and healthcare professionals) and two types of information (drug benefits and risks). Websites were equally likely to present quantitative information for benefits (96.9 %) and risks (95.4 %). However, the amount of the information differed significantly: Both consumer-directed and healthcare-professional-directed webpages were more likely to have quantitative information for every benefit (consumer 38.5 %; healthcare professional 86.1 %) compared with every risk (consumer 3.1 %; healthcare professional 6.2 %). The numeric and graphic presentations also differed by audience and information type. Consumers have access to quantitative information about oncology drugs and, in particular, about the benefits of these drugs. Research has shown that using quantitative information to communicate treatment benefits and risks can increase patients' and physicians' understanding and can aid in treatment decision-making, although some numeric and graphic formats are more useful than others.
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Affiliation(s)
- Helen W Sullivan
- U.S. Food and Drug Administration, 10903 New Hampshire Ave, Bldg 51, Silver Spring, MD, 20993-0002, USA.
| | - Kathryn J Aikin
- U.S. Food and Drug Administration, 10903 New Hampshire Ave, Bldg 51, Silver Spring, MD, 20993-0002, USA
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18
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Ju I. The effects of advertising skepticism in consumer prescription drug advertising. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2017. [DOI: 10.1108/ijphm-10-2016-0054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this study is to examine the effects of consumers’ prescription drug advertising (DTCA) skepticism on their advertising evaluation. In addition, the study investigates the moderating role of health risk information location in DTCA and the mediating role of perceived message effectiveness to address when and how the skepticism effects are maximized or minimized.
Design/methodology/approach
The study used a controlled lab experiment to enhance internal validity.
Findings
This study found that when risk information was presented earlier in a more prominent manner, it appeared to reduce the DTCA skepticism effects. In contrast, the DTCA skepticism effects remained considerable when benefit information was presented earlier.
Research limitations/implications
The artificial nature of the controlled lab setting suggests conducting future research in a more natural setting using various therapeutic and product categories to enhance ecological and external validity.
Practical implications
Pharmaceutical marketers could reduce consumers’ DTCA skepticism effects on their advertising evaluation by using situational message strategies. The prominence of health risk disclosure could be one of such strategies.
Social implications
The FDA’s industry guidance for DTCA risk communication suggests that the location of risk information in the ad may play an important role in determining its prominence. However, little is known about how complying with the FDA’s risk communication guidance by presenting a more prominent risk disclosure can affect consumers’ ad evaluation by affecting the DTCA skepticism effects. The current study provides empirical evidence for the importance of the health risk disclosure prominence.
Originality/value
Because the FDA’s release of the DTCA risk communication guidance, little empirical research has been conducted to examine a wide range of situational message factors that may affect consumers’ response to DTCA risk communication. The current study filled the gap in the literature by addressing the interplay between consumer and message factors in the DTCA context.
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19
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Ju I. Thinking about fair balance: how prescription drug advertising disclosure prominence works? INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2017. [DOI: 10.1108/ijphm-09-2016-0051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of the study was to examine the effects of prescription drug advertising health risk disclosure prominence and the mediating role of introspective message attention.
Design/methodology/approach
An experiment was conducted to test varying levels of health risk disclosure prominence in prescription drug advertising (high vs low).
Findings
The results showed that a more prominent health risk disclosure than a less prominent one enhanced introspective message attention, risk knowledge and risk perception of the drug’s side effects. In addition, the introspective attention mediated the health risk disclosure effects on risk knowledge and risk perception.
Research limitations/implications
The artificial experimental setting should be considered. In addition, various therapeutic categories and health risk disclosure formats need to be examined.
Practical implications
To ensure fair balance in prescription drug advertising, message designers should present a sufficient level of health risk disclosure prominence.
Social implications
To encourage consumers to make informed prescription drug decisions, health risk information provided through prescription drug advertising may be important. Health-marketing promotional messages should address fair balance by considering health risk disclosure prominence.
Originality/value
Although the FDA has issued its risk communication guidance draft for pharmaceutical manufacturers to ensure fair balance between benefit and risk information in pharmaceutical promotion, little empirical research has been conducted to test the health risk disclosure prominence effects on consumers’ health-related perception about the drug. This study fills the gap in the literature.
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20
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Curtis JR, Chen L, Higginbotham P, Nowell WB, Gal-Levy R, Willig J, Safford M, Coe J, O'Hara K, Sa'adon R. Social media for arthritis-related comparative effectiveness and safety research and the impact of direct-to-consumer advertising. Arthritis Res Ther 2017; 19:48. [PMID: 28270190 PMCID: PMC5341200 DOI: 10.1186/s13075-017-1251-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 02/01/2017] [Indexed: 11/10/2022] Open
Abstract
Background Social media may complement traditional data sources to answer comparative effectiveness/safety questions after medication licensure. Methods The Treato platform was used to analyze all publicly available social media data including Facebook, blogs, and discussion boards for posts mentioning inflammatory arthritis (e.g. rheumatoid, psoriatic). Safety events were self-reported by patients and mapped to medical ontologies, resolving synonyms. Disease and symptom-related treatment indications were manually redacted. The units of analysis were unique terms in posts. Pre-specified conditions (e.g. herpes zoster (HZ)) were selected based upon safety signals from clinical trials and reported as pairwise odds ratios (ORs); drugs were compared with Fisher’s exact test. Empirically identified events were analyzed using disproportionality analysis and reported as relative reporting ratios (RRRs). The accuracy of a natural language processing (NLP) classifier to identify cases of shingles associated with arthritis medications was assessed. Results As of October 2015, there were 785,656 arthritis-related posts. Posts were predominantly US posts (75%) from patient authors (87%) under 40 years of age (61%). For HZ posts (n = 1815), ORs were significantly increased with tofacitinib versus other rheumatoid arthritis therapies. ORs for mentions of perforated bowel (n = 13) were higher with tocilizumab versus other therapies. RRRs associated with tofacitinib were highest in conditions related to baldness and hair regrowth, infections and cancer. The NLP classifier had a positive predictive value of 91% to identify HZ. There was a threefold increase in posts following television direct-to-consumer advertisement (p = 0.04); posts expressing medication safety concerns were significantly more frequent than favorable posts. Conclusion Social media is a challenging yet promising data source that may complement traditional approaches for comparative effectiveness research for new medications.
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Affiliation(s)
- Jeffrey R Curtis
- The University of Alabama at Birmingham, FOT 802, 1720 2nd Ave S, Birmingham, AL, 35294-3408, USA.
| | - Lang Chen
- The University of Alabama at Birmingham, FOT 802, 1720 2nd Ave S, Birmingham, AL, 35294-3408, USA
| | - Phillip Higginbotham
- The University of Alabama at Birmingham, FOT 802, 1720 2nd Ave S, Birmingham, AL, 35294-3408, USA
| | | | | | - James Willig
- The University of Alabama at Birmingham, FOT 802, 1720 2nd Ave S, Birmingham, AL, 35294-3408, USA
| | | | - Joseph Coe
- Global Healthy Living Foundation/CreakyJoints, Upper Nyack, NY, USA
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21
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Dickinson R, Raynor DK, Knapp P, MacDonald J. How much information about the benefits of medicines is included in patient leaflets in the European Union? – A survey. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 25:147-158. [PMID: 27405658 DOI: 10.1111/ijpp.12285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 06/10/2016] [Indexed: 11/28/2022]
Abstract
Abstract
Introduction
Patient information leaflets (PILs) are required with all licensed medicines throughout the European Union (EU) and they must include information about all side effects and their likelihood. This has led to criticism of a lack of balance, with little information included about potential benefits. Recent European Medicines Agency guidance proposed the inclusion of benefit information, and this study examined the current prevalence and type of such information in PILs in the EU.
Methods
A survey and content analysis of the English translation of PILs in the EUwas carried out. Random quota sampling was used on the most frequently dispensed (n = 50) and newly licensed medicines (n = 50) in 2011/2. Leaflets were searched for benefit information meeting predefined criteria, and data synthesised and categorised into 10 categories.
Results
Eighty-five (85%) leaflets described how the medicine works, with 45 providing information about the rationale for treatment (more commonly for newly licensed (32/50) than most commonly dispensed medicines (13/50; P < 0.001). Nearly half (47) did not describe whether the medicine was curative, symptomatic or preventative. The terms used to communicate uncertainty were imprecise (such as ‘may help’). None communicated numerical benefit information.
Conclusion
Current PILs do not appropriately communicate information about benefit. At the basic level, around a half did not include information about treatment rationale or whether the treatment was to treat symptoms, curative or preventative. However, for true informed decision making, patients need quantitative information about benefits and none of the leaflets provided this.
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Affiliation(s)
| | | | | | - Jan MacDonald
- Medicines and Healthcare products Regulatory Agency, London, UK
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22
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McDowell M, Rebitschek FG, Gigerenzer G, Wegwarth O. A Simple Tool for Communicating the Benefits and Harms of Health Interventions: A Guide for Creating a Fact Box. MDM Policy Pract 2016; 1:2381468316665365. [PMID: 30288405 PMCID: PMC6125040 DOI: 10.1177/2381468316665365] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/29/2016] [Indexed: 12/21/2022] Open
Abstract
One of the major hurdles to promoting informed decision making in health is the continued use of poor risk presentation formats. This article offers a guide to develop a Fact Box, a simple decision tool to present data about the benefits and harms of treatments that has been demonstrated to improve understanding of health risks, an important part of risk literacy. The article offers guidance about how to determine the evidence basis for a health topic, select outcomes to report, extract and present numbers or outcomes, and design the layout. The guide also addresses potential challenges for summarizing evidence and provides alternatives for addressing issues related to missing, insufficient, imprecise, or conflicting evidence and for dealing with issues related to statistical and clinical significance. The guide concludes with details on how to document the development of the Fact Box for the purpose of transparency and reproducibility. Fact Boxes are an efficient tool to promote risk literacy and should be available in every physician's office.
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Affiliation(s)
- Michelle McDowell
- Harding Center for Risk Literacy, Max Planck
Institute for Human Development, Berlin, Germany (MM, FGR, GG, OW)
| | - Felix G. Rebitschek
- Harding Center for Risk Literacy, Max Planck
Institute for Human Development, Berlin, Germany (MM, FGR, GG, OW)
| | - Gerd Gigerenzer
- Harding Center for Risk Literacy, Max Planck
Institute for Human Development, Berlin, Germany (MM, FGR, GG, OW)
| | - Odette Wegwarth
- Harding Center for Risk Literacy, Max Planck
Institute for Human Development, Berlin, Germany (MM, FGR, GG, OW)
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