April 15, 2021 • By Keith Giles
Improving risk communications is a stated priority of the U.S. health care system. Mixed outcomes show that there is plenty of room for improvement in how risk probabilities are presented to consumers. L. Robin Keller, professor of operations and decision technologies at the UCI Paul Merage School of Business and James Leonhardt, Ph.D ’13, set out to test whether visual aids might improve the understanding of probable side effect risk. The results will be published in an article titled “Communicating Health Risks to the Public,” which is forthcoming from Organization Review.
“People aren’t good at understanding probabilities,” Keller says. “So, to help people visualize risk information for example, we proposed utilizing a visual display—literally, a pictograph checkerboard with rows of boxes—to hopefully allow people see the likelihood of possible side effects.”
Painting a Clearer Picture
To determine whether or not these pictorial graphs were more effective at communicating information to patients, Keller and her colleagues James Leonhardt and Ronald Lembke, both professors at the University of Nevada, Reno, conducted a study using a hypothetical childhood vaccine with different possible side effects. As Keller explains: “Each side effect had a different probability associated with it. In our experiment we listed those possible side-effects—vomiting, or high fever, et cetera—using pictographs to illustrate the likelihood of experiencing each.”
By placing the information in a simplified visual graphic, Keller and Leonhardt discovered that participants perceived the vaccine to be less risky. “We found that combining the visual and the written description together decreased people’s perceived risk,” she says, “especially when there were multiple side-effects.”
Dispelling misperceptions of risk
When medication labeling describes more than one set of potential side effects, the patient’s perception of risk can become cumulative. Patients who read a long list of side effects tend to become fearful that the larger the number of listed side effects, the greater their risk of experiencing one, or more, of those reactions must be. As Keller explains, “When I give you a list, you tend to focus on the side effects, but if we can communicate clearly how low the probabilities of those reactions really are, then you can focus more on the positive outcomes from taking the medication or vaccine.”
Therefore, the more side-effects listed, the greater the perceived risk. In reality, serious side effects tend to be extremely rare. What patients should be focused on is the likelihood of experiencing one or more of those reactions. This is where the pictographs really help to reduce anxiety and improve perceptions regarding actual risks.
“If it’s just a single side-effect, we found that people could more easily understand the information,” says Keller. “If it’s a mild fever, for example, and its probability is 10%, we found that people did pretty well understanding that. But when there was a larger list with multiple side-effects, the pictographs were more useful in clearing up any confusion.”
Calming the conversation about side effects
Improving communications regarding the potential side-effects serves not only to alleviate individual patient fears, it also helps to dispel some of the more alarmist propaganda surrounding vaccines and medications. “Both of us were definitely motivated to counteract some of the anti-vax messages going around. Jim’s wife is a nurse,” says Keller, “and so we wanted people to understand what the real side-effects are and how low the probability factors are.”
We’ve all watched ads for medications on TV with their interminable lists of possible side effects. The problem, of course, is that those ads never take the time to explain how low the percentage of experiencing those side effects might be. Without that information, people tend to imagine the cure is worse than the disease. “Those types of ads are not very helpful,” says Keller. “To just list out the bad outcomes without indicating how likely—or unlikely—they are to occur tends to have the opposite effect. People are focused on down-sides of taking the medication rather than focusing on the positive results of taking the medication.”
Keller’s point is straightforward. If the risk of suffering from a childhood disease, for example, were to be displayed alongside the relatively low probability of potential vaccine side-effects, the public would have a better grasp of the true ratio between risks and rewards.
Pictographs can communicate the information visually, much better than verbally, and it can help to overcome language barriers too. “People tend to process visual information more easily,” says Keller. “Communicating the risks in ways people can understand, and providing information that is clearly understandable, is the best way to help educate patients,” says Keller.
Robin Keller is a professor of operations and decision technologies at the UCI Paul Merage School of Business. Her decision analysis research spans the areas of multiple attribute decision making, fairness, perceived risk, probability biases, problem structuring, temporal discounting, and planning protection against terrorism, environmental, health and safety risks. In addition to her research, she has held numerous prestigious positions both at UCI and with professional organizations and governmental agencies. Over the course of her career, she has published more than 60 journal articles, technical reports, book chapters and reviews.