General practitioners' risk literacy and real-world prescribing of potentially hazardous drugs: a cross-sectional study.

BACKGROUND: Overuse of medical care is a pervasive problem. Studies using hypothetical scenarios suggest that physicians' risk literacy influences medical decisions; real-world correlations, however, are lacking. We sought to determine the association between physicians' risk literacy and their real-world prescriptions of potentially hazardous drugs, accounting for conflicts of interest and perceptions of benefit-harm ratios in low-value prescribing scenarios. SETTING AND SAMPLE: Cross-sectional study-conducted online between June and October 2023 via field panels of Sermo (Hamburg, Germany)-with a convenience sample of 304 English general practitioners (GPs). METHODS: GPs' survey responses on their treatment-related risk literacy, conflicts of interest and perceptions of the benefit-harm ratio in low-value prescribing scenarios were matched to their UK National Health Service records of prescribing volumes for antibiotics, opioids, gabapentin and benzodiazepines and analysed for differences. RESULTS: 204 GPs (67.1%) worked in practices with ≥6 practising GPs and 226 (76.0%) reported 10-39 years of experience. Compared with GPs demonstrating low risk literacy, GPs with high literacy prescribed fewer opioids (mean (M): 60.60 vs 43.88 prescribed volumes/1000 patients/6 months, p=0.016), less gabapentin (M: 23.84 vs 18.34 prescribed volumes/1000 patients/6 months, p=0.023), and fewer benzodiazepines (M: 17.23 vs 13.58 prescribed volumes/1000 patients/6 months, p=0.037), but comparable volumes of antibiotics (M: 48.84 vs 40.61 prescribed volumes/1000 patients/6 months, p=0.076). High-risk literacy was associated with lower conflicts of interest (ϕ = 0.12, p=0.031) and higher perception of harms outweighing benefits in low-value prescribing scenarios (p=0.007). Conflicts of interest and benefit-harm perceptions were not independently associated with prescribing behaviour (all ps >0.05). CONCLUSIONS AND RELEVANCE: The observed association between GPs with higher risk literacy and the prescription of fewer hazardous drugs suggests the importance of risk literacy in enhancing patient safety and quality of care.

Explicit discrimination and ingroup favoritism, but no implicit biases in hypothetical triage decisions during COVID-19.

Disturbingly realistic triage scenarios during the COVID-19 pandemic provide an opportunity for studying discrimination in moral reasoning. Biases and favoritism do not need to be explicit and overt, but can remain implicit and covert. In addition to assessing laypeople's propensity for engaging in overt discrimination, the present study examines whether they reveal implicit biases through seemingly fair random allocations. We present a cross-sectional online study comprising 6 timepoints and a total of 2296 participants. Each individual evaluated 19 hypothetical scenarios that provide an allocation dilemma between two patients who are in need of ventilation and differ only in one focal feature. Participants could either allocate the last ventilator to a patient, or opt for random allocation to express impartiality. Overall, participants exhibited clear biases for the patient who was expected to be favored based on health factors, previous ethical or caretaking behaviors, and in-group favoritism. If one patient had been pre-allocated care, a higher probability of keeping the ventilator for the favored patient indicates persistent favoritism. Surprisingly, the absence of an asymmetry in random allocations indicates the absence of covert discrimination. Our results demonstrate that laypeople's hypothetical triage decisions discriminate overtly and show explicit biases.

How to convince the vaccine-hesitant? An ease-of-access nudge, but not risk-related information increased Covid vaccination-related behaviors in the unvaccinated.

In this study, we contrast how different benefit and harm information formats and the presence or absence of an ease-of-access nudge may facilitate COVID vaccination uptake for a sample of 620 unvaccinated Dutch adults at a timepoint when the vaccine had been widely available for more than a month. Using a 2 × 2 between-subjects factorial design, we varied the information format on mRNA COVID vaccination statistics (generic text vs. facts box) and an affirmative nudge emphasizing the ease of making a vaccination appointment (absent vs. present). We assessed the acceptance of the vaccination information provided, perceptions on the vaccination, and whether participants directly visited a COVID vaccination appointment website. Whereas the facts box did not significantly affect participants' information acceptance, vaccination attitudes, intentions, and link clicking, the affirmative nudge alongside an online link systematically increased the likelihood of clicking on the link to make a vaccination appointment. A verbal nudge emphasizing the ease of vaccine accessibility is more likely to increase vaccination uptake in an unvaccinated population than informational campaigns on vaccine effectiveness.

Humans strategically avoid connecting to others who agree and avert the emergence of network polarization in a coordination task.

Clusters of like-minded individuals can impede consensus in group decision-making. We implemented an online color coordination task to investigate whether control over communication links creates clusters impeding group consensus. In 244 6-member networks, individuals were incentivized to reach a consensus by agreeing on a color, but had conflicting incentives for which color to choose. We varied (1) if communication links were static, changed randomly over time, or were player-controlled; (2) whether links determined who was observed or addressed; and (3) whether a majority existed or equally many individuals preferred each color. We found that individuals preferentially selected links to previously unobserved and disagreeing others, avoiding links with agreeing others. This prevented cluster formation, sped up consensus formation rather than impeding it, and increased the probability that the group agreed on the majority incentive. Overall, participants with a consensus goal avoided clusters by applying strategies that resolved uncertainty about others.

How to debunk misinformation? An experimental online study investigating text structures and headline formats.

OBJECTIVES: Misinformation is a crucial problem, particularly online, and the success of debunking messages has so far been limited. In this study, we experimentally test how debunking text structure (truth sandwich vs. bottom-heavy) and headline format (statement vs. questions) affect the belief in misinformation across topics of the safety of COVID vaccines and GMO foods. DESIGN: Experimental online study. METHODS: A representative German sample of 4906 participants were randomly assigned to reading one of eight debunking messages in the experimentally varied formats and subsequently rated the acceptance of this message and the agreement to misinformation statements about the mentioned topics and an unrefuted control myth. RESULTS: While the debunking messages specifically decreased the belief in the targeted myth, these beliefs and the acceptance of the debunking message were unaffected by the text structures and headline formats. Yet, they were less successful when addressing individuals with strong pre-existing, incongruent attitudes and distrust in science. CONCLUSIONS: The risk of backfire effects in debunking misinformation is low. Text structure and headline format are of relatively little importance for the effectiveness of debunking messages. Instead, writers may need to pay attention to the text being comprehensive, trustworthy and persuasive to maximize effectiveness.

Socializing social sampling models: The limits of explaining norm perceptions and biases with sampling from social circles.

People often overestimate the prevalence of unfavorable behavior. To explain these misperceptions, social sampling models propose that individuals infer the social norm from the behavior of their own social circle. We investigated this idea by asking a friendship network of college freshmen to report their own behavior and norm perceptions across eight domains at two timepoints (N = 104). Assessing this complete social network allows to directly test if sampling from the social circle shapes norm perception. Replicating previous findings, freshmen systematically misperceived the average social norm within their cohort. Yet, these misperceptions persisted even when individuals judged their own social circle, indicating that sampling from social circles does not fully explain normative biases. Moreover, cognitive modelling of norm perceptions suggested that individuals unlikely limited their search to their own social circle.

Link updating strategies influence consensus decisions as a function of the direction of communication.

Consensus decision-making in social groups strongly depends on communication links that determine to whom individuals send, and from whom they receive, information. Here, we ask how consensus decisions are affected by strategic updating of links and how this effect varies with the direction of communication. We quantified the coevolution of link and opinion dynamics in a large population with binary opinions using mean-field numerical simulations of two voter-like models of opinion dynamics: an incoming model (IM) (where individuals choose who to receive opinions from) and an outgoing model (OM) (where individuals choose who to send opinions to). We show that individuals can bias group-level outcomes in their favour by breaking disagreeing links while receiving opinions (IM) and retaining disagreeing links while sending opinions (OM). Importantly, these biases can help the population avoid stalemates and achieve consensus. However, the role of disagreement avoidance is diluted in the presence of strong preferences-highly stubborn individuals can shape decisions to favour their preferences, giving rise to non-consensus outcomes. We conclude that collectively changing communication structures can bias consensus decisions, as a function of the strength of preferences and the direction of communication.

The role of position in consensus dynamics of polarizable networks.

Communication constraints often complicate group decision-making. In this experiment, we investigate how the network position of opinionated group members determines both the speed and the outcome of group consensus in 7-member communication networks susceptible to polarization. To this end, we implemented an online version of a color coordination task within experimentally controlled communication networks. In 72 networks, one individual was incentivized to prefer one of two options. In 156 networks, two individuals were incentivized to prefer conflicting options. The network positions of incentivized individuals were varied. In networks with a single incentivized individual, network position played no significant role in either the speed or outcome of consensus decisions. For conflicts, the incentivized individual with more neighbors was more likely to sway the group to their preferred outcome. Furthermore, consensus emerged more slowly when the opponents had the same number of neighbors, but could not see each other's votes directly. These results suggest that the visibility of an opinion is key to wielding group influence, and that specific structures are sufficient to run communication networks into polarization, hindering a speedy consensus.

How eating-related social media postings influence healthy eating in senders and network members: Two field experiments with intensive longitudinal data.

Young adults are frequently confronted with eating-related social media content. How such exposure influences eating in those who post and their network members is largely unknown. We conducted two intensive longitudinal field experiments combining self-reports with social media data. The posting behavior of young adults was manipulated. We examined how postings about fruit and vegetables affected intake in senders and their network members (Study 1, N = 81) and in senders with a change goal (Study 2, N = 128). Potential mechanisms of action were explored. Descriptively, posting led to a stronger increase of senders' and network members' intake, but this increase was not statistically significant. Posting led to higher perceived social support and injunctive norms of senders (Study 1). Posting supported eating behavior change; the effect size was comparable to picture-based self-monitoring of intake (Study 2). Intraindividual variations in senders' daily eating-related social media activities were associated with daily eating behavior and perceived social support (both studies), daily self-efficacy, experiential and instrumental attitudes, and goal commitment (Study 2). Our studies underline that social media environments should be considered in research and interventions targeting eating behavior of young adults.

The impact of nontransparent health communication during the COVID-19 pandemic on vaccine-hesitant people's perception of vaccines.

Background: Although transparency is crucial for building public trust, public health communication during the COVID-19 pandemic was often nontransparent. Methods: In a cross-sectional online study with COVID-19 vaccine-hesitant German residents (N = 763), we explored the impact of COVID-19 public health communication on the attitudes of vaccine-hesitant individuals toward vaccines as well as their perceptions of incomprehensible and incomplete information. We also investigated whether specific formats of public health messaging were perceived as more trustworthy. Results: Of the 763 participants, 90 (11.8%) said they had become more open-minded toward vaccines in general, 408 (53.5%) reported no change, and 265 (34.7%) said they had become more skeptical as a result of public health communication on COVID-19 vaccines. These subgroups differed in how incomprehensible they found public health communication and whether they thought information had been missing. Participants' ranking of trustworthy public health messaging did not provide clear-cut results: the fully transparent message, which reported the benefit and harms in terms of absolute risk, and the nontransparent message, which reported only the benefit in terms of relative risk were both considered equally trustworthy (p = 0.848). Discussion: Increased skepticism about vaccines during the COVID-19 pandemic may have partly been fueled by subpar public health communication. Given the importance of public trust for coping with future health crises, public health communicators should ensure that their messaging is clear and transparent.

How do we raise media bias awareness effectively? Effects of visualizations to communicate bias.

Media bias has a substantial impact on individual and collective perception of news. Effective communication that may counteract its potential negative effects still needs to be developed. In this article, we analyze how to facilitate the detection of media bias with visual and textual aids in the form of (a) a forewarning message, (b) text annotations, and (c) political classifiers. In an online experiment, we randomized 985 participants to receive a biased liberal or conservative news article in any combination of the three aids. Meanwhile, their subjective perception of media bias in this article, attitude change, and political ideology were assessed. Both the forewarning message and the annotations increased media bias awareness, whereas the political classification showed no effect. Incongruence between an articles' political position and individual political orientation also increased media bias awareness. Visual aids did not mitigate this effect. Likewise, attitudes remained unaltered.

Determinants of information diffusion in online communication on vaccination: The benefits of visual displays.

OBJECTIVE: Social media are an increasingly important source of information on the benefits and risks of vaccinations, but the high prevalence of misinformation provides challenges for informed vaccination decisions. It is therefore important to understand which messages are likely to diffuse online and why, and how relevant aspects-such as scientific facts on vaccination effectiveness-can be made more comprehensible and more likely to be shared. In two studies, we (i) explore which characteristics of messages on flu vaccination facilitate their diffusion in online communication, and (ii) whether visual displays (i.e., icon arrays) facilitate the comprehension and diffusion of scientific effectiveness information. METHODS: In Study 1, 208 participants each rated a random sample of 15 out of 63 messages on comprehensibility, trustworthiness, persuasiveness, familiarity, informativeness, valence, and arousal, and then reported which information they would share with subsequent study participants. In Study 2 (N = 758), we employed the same rating procedure for a selected set of 9 messages and experimentally manipulated how scientific effectiveness information was displayed. RESULTS: Study 1 illustrated that scientific effectiveness information was difficult to understand and thus did not diffuse well. Study 2 demonstrated that visual displays improved the understanding of this information, which could, in turn, increase its social impact. CONCLUSIONS: The comprehensibility of scientific information is an important prerequisite for its diffusion. Visual displays can facilitate informed vaccination decisions by rendering important information on vaccination effectiveness more transparent and increasing the willingness to share this information.

Contagious Health Risk and Precautionary Social Distancing.

BACKGROUND: Since humans are social animals, social relations are incredibly important. However, in cases of contagious diseases such as the flu, social contacts also pose a health risk. According to prominent health behavior change theories, perceiving a risk for one's health motivates precautionary behaviors. The "behavioral immune system" approach suggests that social distancing might be triggered as a precautionary, evolutionarily learned behavior to prevent transmitting contagious diseases through social contact. This study examines the link between personal risk perception for an infectious disease and precautionary behavior for disease-prevention in the context of social relationships. METHODS: At 2-week intervals during the first semester, 100 Psychology freshmen indicated their flu risk perception, whether they had been ill during the previous week, and their friendships within their freshmen network for eight time points. RESULTS: Social network analysis revealed that participants who reported a high flu risk perception listed fewer friends (B = -0.10, OR = 0.91, p = 0.026), and were more likely to be ill at the next measuring point (B = 0.26, OR = 1.30, p = 0.005). Incoming friendship nominations increased the likelihood of illness (B = 0.14, OR = 1.15, p = 0.008), while the reduced number of friendship nominations only marginally decreased this likelihood (B = -0.07, OR = 0.93, p = 0.052). CONCLUSION: In accordance with the concept of a "behavioral immune system," participants with high flu risk perception displayed a social precautionary distancing even when in an environment, in which the behavior was ineffective to prevent an illness.

The echo in flu-vaccination echo chambers: Selective attention trumps social influence.

BACKGROUND: Online discussions may impact the willingness to get vaccinated. This experiment tests how groups of individuals with consistent and inconsistent attitudes towards flu vaccination attend to and convey information online, and how they alter their corresponding risk perceptions. METHODS: Out of 1859 MTurkers, we pre-selected 208 people with negative and 221 people with positive attitudes towards flu vaccinations into homogeneous or heterogeneous 3-link experimental diffusion chains. We assessed (i) which information about flu vaccinations participants conveyed to the subsequent link, (ii) how flu-vaccination related perceptions were altered by incoming messages, and (iii) how participants perceived incoming information. RESULTS: Participants (i) selectively conveyed attitude-consistent information, but exhibited no overall anti-vaccination bias, (ii) were reluctant to alter their flu-vaccination related perceptions in response to messages, and (iii) evaluated incoming information consistent with their prior attitudes as more convincing. DISCUSSION: Flu-vaccination related perceptions are resilient against contradictions and bias online communication. Contrary to expectations, there was no sign of amplification of anti-vaccine attitudes by online communication.

Perceiving college peers' alcohol consumption: temporal patterns and individual differences in overestimation.

OBJECTIVE: This study examines temporal patterns and individual differences of overestimation in alcohol norm perception within a social network. DESIGN: Hundred psychology freshmen indicated biweekly during their first semester the drinks they consumed, the perceived average of their peers' consumption, and with whom they were acquainted. At baseline, trait self-control was assessed. MAIN OUTCOME: The moderation of alcohol consumption overestimation by time and individual characteristics was explored. RESULTS: Results show that students overestimated alcohol consumption of their acquainted peers by 1.22 drinks (p < .001). For time periods at which peers reported high consumption, overestimation decreased. Additionally, individuals reporting high alcohol consumption (b = -0.25, p < .001) and low self-control (b = 0.27, p = .010) showed higher overestimation. CONCLUSIONS: Students overestimate the alcohol consumption of peers not fully accounting for changes in peer-reports. Furthermore, individual differences suggest informational and motivational processes underlying overestimation.

Numeracy of multiple sclerosis patients: A comparison of patients from the PERCEPT study to a German probabilistic sample.

OBJECTIVE: A shared decision-making approach is suggested for multiple sclerosis (MS) patients. To properly evaluate benefits and risks of different treatment options accordingly, MS patients require sufficient numeracy - the ability to understand quantitative information. It is unknown whether MS affects numeracy. Therefore, we investigated whether patients' numeracy was impaired compared to a probabilistic national sample. METHODS: As part of the larger prospective, observational, multicenter study PERCEPT, we assessed numeracy for a clinical study sample of German MS patients (N=725) with a standard test and compared them to a German probabilistic sample (N=1001), controlling for age, sex, and education. Within patients, we assessed whether disease variables (disease duration, disability, annual relapse rate, cognitive impairment) predicted numeracy beyond these demographics. RESULTS: MS patients showed a comparable level of numeracy as the probabilistic national sample (68.9% vs. 68.5% correct answers, P=0.831). In both samples, numeracy was higher for men and the highly educated. Disease variables did not predict numeracy beyond demographics within patients, and predictability was generally low. CONCLUSION: This sample of MS patients understood quantitative information on the same level as the general population. PRACTICE IMPLICATIONS: There is no reason to withhold quantitative information from MS patients.

The Role of Friendship Reciprocity in University Freshmen's Alcohol Consumption.

BACKGROUND: The similarity of friends in the frequency and quantity of alcohol consumption is explored. METHOD: During their first semester, 57 psychology freshmen indicated weekly drinking frequency and quantity and nominated the three peers of this group they liked most. These nominations were then used to derive the weekly alcohol consumption of friends that either did or did not reciprocate a nomination. RESULTS: Multilevel modeling of weekly variations showed that individuals' drinking frequency was similar to peers who reciprocated a friendship (b = 0.15, p = .001), but not to non-reciprocating peers (b = -0.01, p = .720). In contrast, weekly variation in quantity of individual students' drinking was similar to both reciprocating (b = 0.11, p = .018) and non-reciprocating peers' drinking (b = 0.10, p = .014). Yet across all weeks, quantity tended only to be similar to non-reciprocating peers (b = 0.49, p = .020). CONCLUSIONS: Freshmen might spend drinking time with peers who reciprocate a friendship, but are similar regarding the quantity of drinks consumed to all people they find interesting. Thus, alcohol consumption is used strategically for social purposes. This social purpose should also be acknowledged in alcohol-reduction interventions.

The social image of food: Associations between popularity and eating behavior.

One factor that determines what we eat and why we eat is our social environment. In the present research, two online studies examined the relationship between food intake and social images. Specifically, the present research assessed the relationship between the food intake university students ascribed to peers who varied in popularity and own self-reported food intake, and whether this relationship was moderated by identification with the peer group. Participants (N = 97 in Study 1; N = 402 in Study 2) were randomly presented with one of four (Study 1) or two of eight (Study 2) vignettes describing a popular or unpopular student (male or female) from their university without receiving any information about the peer's eating behavior. Subsequently, healthy and unhealthy eating ascribed to the peers and own self-reported eating behavior were assessed. Results indicated that popular peers were perceived to eat more healthily than unpopular peers. Moreover, eating behavior ascribed to popular peers were associated with own healthy and unhealthy eating. Importantly, the relationship between healthy eating behavior ascribed to popular peers and own healthy eating behavior was moderated by identification with the student group - the more participants identified with their peers, the more their own eating was aligned with the healthy eating ascribed to a popular peer. Hence, the popularity of others seems to shape perceptions of the food they eat and may facilitate healthy eating via social influence.

The Environment Makes a Difference: The Impact of Explicit and Implicit Attitudes as Precursors in Different Food Choice Tasks.

Studies show that implicit and explicit attitudes influence food choice. However, precursors of food choice often are investigated using tasks offering a very limited number of options despite the comparably complex environment surrounding real life food choice. In the present study, we investigated how the assortment impacts the relationship between implicit and explicit attitudes and food choice (confectionery and fruit), assuming that a more complex choice architecture is more taxing on cognitive resources. Specifically, a binary and a multiple option choice task based on the same stimulus set (fake food items) were presented to ninety-seven participants. Path modeling revealed that both explicit and implicit attitudes were associated with relative food choice (confectionery vs. fruit) in both tasks. In the binary option choice task, both explicit and implicit attitudes were significant precursors of food choice, with explicit attitudes having a greater impact. Conversely, in the multiple option choice task, the additive impact of explicit and implicit attitudes was qualified by an interaction indicating that, even if explicit and implicit attitudes toward confectionery were inconsistent, more confectionery was chosen than fruit if either was positive. This compensatory 'one is sufficient'-effect indicates that the structure of the choice environment modulates the relationship between attitudes and choice. The study highlights that environmental constraints, such as the number of choice options, are an important boundary condition that need to be included when investigating the relationship between psychological precursors and behavior.

Children's and adolescents' snacking: interplay between the individual and the school class.

OBJECTIVE: In schools, perceived norms of classmates facilitate but can also inhibit unhealthy food intake in children and adolescents. However, the role of actual class behaviors and attitudes is less established. Thus, the present study examined classmates' actual eating behavior and food preferences in relation to actual food intake. In addition, it tested whether these normative effects are facilitated by corresponding individual and class food preferences or a positive social self-concept. METHODS: The food preferences, social self-concept, and unhealthy snacking frequency of 734 Finnish, 829 German, and 555 Romanian children and adolescents (aged 8-19) from 127 school-classes were assessed. RESULTS: Multilevel analysis at individual and class level showed that classmates shared similar snacking habits (14.7% variance). Moreover, the unhealthy food preference of a school-class was associated with its collective snacking [[Formula: see text], p < 0.001, PRV = 0.32). This effect was facilitated by individual, unhealthy food preferences [[Formula: see text], p < 0.001, PRV = 0.57] and a positive social self-concept [[Formula: see text], p = 0.015, PRV = 0.12]. CONCLUSIONS: Actual class norms are related to children's and adolescents' eating, but their impact depends on individual differences in preferences and social self-concept.