Measuring feelings about choices and risks: The Berlin Emotional Responses to Risk Instrument (BERRI).

We introduce a brief instrument specifically validated for measuring positive and negative feelings about risks-the Berlin Emotional Responses to Risk Instrument (BERRI). Based on seven studies involving diverse adults from three countries (n = 2120), the BERRI was found to robustly estimate anticipatory affective reactions derived from subjective evaluations of positive (i.e., assured, hopeful, and relieved) and negative emotions (i.e., anxious, afraid, and worried). The brief BERRI outperformed a 14-item assessment, uniquely tracking costs/benefits associated with cancer screening among men and women (Studies 1 and 2). Predictive validity was further documented in paradigmatic risky choice studies wherein options varied over probabilities and severities across six contexts (health, social, financial, technological, ethical, and environmental; Study 3). Studies 4-6, conducted during the Ebola epidemic and COVID-19 pandemic, indicated BERRI responses were sensitive to subtle effects caused by emotion-related framing manipulations presented in different cultures and languages (the United States, Spain, and Poland). Study 7 indicated BERRI responses remained stable for 2 weeks. Although the BERRI can provide an estimate of overall affect, choices were generally better explained by the unique influences of positive and negative affect. Overall, results suggest the novel, brief instrument can be an efficient tool for high-stakes research on decision making and risk communication.

The free will and punishment scale: Efficient measurement and predictive validity across diverse and nationally representative adult samples.

Theoretically, attitudes about freedom and punishment can shape people's decisions and cause pernicious disagreements (e.g., political policies). Several scales measure free will beliefs, partially to help understand disagreements about theoretical and practical issues. We contribute to these efforts by directly comparing existing measures and by introducing a short measure of free will related attitudes. Studies 1, 2, and 3 (Ns = 221, 225, 244) factor analyzed all items in existing scales of free will and moral responsibility, resulting in two prominent factors: Beliefs in Free Will and Beliefs in Punishment. Study 4 (N = 269) presents evidence for the 2-factor structure from a nationally representative sample. Study 5 (N = 108) gives evidence of the utility of the Free Will and Punishment scale in predicting free will relevant beliefs and attitudes. As such, the Free Will and Punishment scale is likely useful when longer instruments are not practically possible.

Numeracy Predicts Risk of Pre-Hospital Decision Delay: a Retrospective Study of Acute Coronary Syndrome Survival.

BACKGROUND: Many patients delay seeking medical attention during acute coronary syndromes (ACS), profoundly increasing their risk for death and major disability. Although research has identified several risk factors, efforts to improve patient decision making have generally been unsuccessful, prompting a call for more research into psychological factors. PURPOSE: The purpose of this study is to estimate the relationship between ACS decision delay and numeracy, a factor closely related to general decision making skill and risk literacy. METHODS: About 5 days after experiencing ACS, 102 survivors (mean age = 58, 32-74) completed a questionnaire including measures of numeracy, decision delay, and other relevant factors (e.g., anxiety, depression, symptom severity, knowledge, demographics). RESULTS: Low patient numeracy was related to longer decision delay, OR = 0.64 [95 % confidence interval (CI) 0.44, 0.92], which was in turn related to higher odds of positive troponin on arrival at the hospital, OR = 1.37 [95 % CI 1.01, 2.01]. Independent of the influence of all other assessed factors, a patient with high (vs. low) numeracy was about four times more likely to seek medical attention within the critical first hour after symptom onset (i.e., ORhigh-low = 3.84 [1.127, 11.65]). CONCLUSIONS: Numeracy may be one of the largest decision delay risk factors identified to date. Results accord with theories emphasizing potentially pivotal roles of patient deliberation, denial, and outcome understanding during decision making. Findings suggest that brief numeracy assessments may predict which patients are at greater risk for life-threatening decision delay and may also facilitate the design of risk communications that are appropriate for diverse patients who vary in risk literacy.

Designing Visual Aids That Promote Risk Literacy: A Systematic Review of Health Research and Evidence-Based Design Heuristics.

Background Effective risk communication is essential for informed decision making. Unfortunately, many people struggle to understand typical risk communications because they lack essential decision-making skills. Objective The aim of this study was to review the literature on the effect of numeracy on risk literacy, decision making, and health outcomes, and to evaluate the benefits of visual aids in risk communication. Method We present a conceptual framework describing the influence of numeracy on risk literacy, decision making, and health outcomes, followed by a systematic review of the benefits of visual aids in risk communication for people with different levels of numeracy and graph literacy. The systematic review covers scientific research published between January 1995 and April 2016, drawn from the following databases: Web of Science, PubMed, PsycINFO, ERIC, Medline, and Google Scholar. Inclusion criteria were investigation of the effect of numeracy and/or graph literacy, and investigation of the effect of visual aids or comparison of their effect with that of numerical information. Thirty-six publications met the criteria, providing data on 27,885 diverse participants from 60 countries. Results Transparent visual aids robustly improved risk understanding in diverse individuals by encouraging thorough deliberation, enhancing cognitive self-assessment, and reducing conceptual biases in memory. Improvements in risk understanding consistently produced beneficial changes in attitudes, behavioral intentions, trust, and healthy behaviors. Visual aids were found to be particularly beneficial for vulnerable and less skilled individuals. Conclusion Well-designed visual aids tend to be highly effective tools for improving informed decision making among diverse decision makers. We identify five categories of practical, evidence-based guidelines for heuristic evaluation and design of effective visual aids.

Injury Risk Estimation Expertise: Cognitive-Perceptual Mechanisms of ACL-IQ.

Instrument-based biomechanical movement analysis is an effective injury screening method but relies on expensive equipment and time-consuming analysis. Screening methods that rely on visual inspection and perceptual skill for prognosticating injury risk provide an alternative approach that can significantly reduce cost and time. However, substantial individual differences exist in skill when estimating injury risk performance via observation. The underlying perceptual-cognitive mechanisms of injury risk identification were explored to better understand the nature of this skill and provide a foundation for improving performance. Quantitative structural and process modeling of risk estimation indicated that superior performance was largely mediated by specific strategies and skills (e.g., irrelevant information reduction), and independent of domain-general cognitive abilities (e.g., mental rotation, general decision skill). These cognitive models suggest that injury prediction expertise (i.e., ACL-IQ) is a trainable skill, and provide a foundation for future research and applications in training, decision support, and ultimately clinical screening investigations.

An Eye Tracking Based Framework for Safety Improvement of Offshore Operations.

Offshore drilling operations consist of complex and high-risk processes. Lack of situational awareness in drilling operations has become an important human factor issue that causes safety accidents. Prolonged work shifts and fatigue are some of the crucial issues that impact performance. Eye tracking technology can be used to distinguish the degree of awareness or alertness of participants that might be related to fatigue or onsite distractions. Oculomotor activity can be used to obtain visual cues that can quantify the drilling operators' situational awareness that might enable us to develop warning alarms to alert the driller. Such systems can help reduce accidents and save non-productive time. In this paper, eye movement char-acteristics were investigated to differentiate the situational awareness between a representa-tive expert and a group of novices using a scenario-based Virtual Reality Drilling Simulator. Significant visual oculomotor activity differences were identified between the expert and the novices that indicate an eye-tracking based system can detect the distraction and alert-ness exhibited by the workers. Results show promise on developing a framework which implements a real-time eye tracking technology in various drilling operations at drilling rigs and Real Time Operation Centers to improve process safety.

Using visual aids to improve communication of risks about health: a review.

Recent research has shown that patients frequently experience difficulties understanding health-relevant numerical concepts. A prominent example is denominator neglect, or the tendency to pay too much attention to numerators in ratios (e.g., number of treated patients who died) with insufficient attention to denominators (e.g., overall number of treated patients). Denominator neglect can lead to inaccurate assessments of treatment risk reduction and thus can have important consequences for decisions about health. Here, we reviewed a series of studies investigating (1) different factors that can influence patients' susceptibility to denominator neglect in medical decision making--including numerical or language-related abilities; (2) the extent to which denominator neglect can be attenuated by using visual aids; and (3) a factor that moderates the effectiveness of such aids (i.e., graph literacy). The review spans probabilistic national U.S. and German samples, as well as immigrant (i.e., Polish people living in the United Kingdom) and undergraduate samples in Spain. Theoretical and prescriptive implications are discussed.

Persistent bias in expert judgments about free will and moral responsibility: a test of the expertise defense.

Many philosophers appeal to intuitions to support some philosophical views. However, there is reason to be concerned about this practice as scientific evidence has documented systematic bias in philosophically relevant intuitions as a function of seemingly irrelevant features (e.g., personality). One popular defense used to insulate philosophers from these concerns holds that philosophical expertise eliminates the influence of these extraneous factors. Here, we test this assumption. We present data suggesting that verifiable philosophical expertise in the free will debate-as measured by a reliable and validated test of expert knowledge-does not eliminate the influence of one important extraneous feature (i.e., the heritable personality trait extraversion) on judgments concerning freedom and moral responsibility. These results suggest that, in at least some important cases, the expertise defense fails. Implications for the practice of philosophy, experimental philosophy, and applied ethics are discussed.

Parental Risk Literacy is Related to Quality of Life in Spanish Families of Children with Autism Spectrum Disorder.

Families of children with autism spectrum disorder (ASD) often experience much more negative perceptions of their family quality of life (FQoL). To investigate key factors that may shape these experiences, we conducted a case-control study of sixty-one Spanish families (29 with a child with ASD) using a broad psychosocial assessment (e.g., ASD severity, social support, demographics), including the first direct test of the relationship between FQoL and parental risk literacy (i.e., the ability to evaluate and understand risk, as measured by numeracy). Results revealed that numeracy was associated with differences in perceived FQoL among families of children with ASD (R2 = .10), a finding that held across several models statistically controlling for the influence of other variables. Findings suggest that parental risk literacy skills may generally be associated with differences in decision making vulnerabilities (e.g., risk evaluation and interpretation) that influence family outcomes including FQoL.

Scientific risk reporting in medical journals can bias expert judgment: Comparing surgeons' risk comprehension across reporting formats.

A recent systematic search of orthopedic surgery literature suggests that scientific risk reporting often deviates from best practices in specific ways (Petrova, Joeris, Sanchez, Salamanca-Fernandez, & Garcia-Retamero, 2018). These deviations could cause dangerous biases in health professionals' risk interpretations and risk communication practices. To investigate potential vulnerabilities, we conducted the first comparative study estimating the effects of common reporting formats on the judgment of experienced orthopedic surgeons during risk evaluations (i.e., interpreting medical research on the risk of suffering postsurgical side effects in patients). Results indicate that highly trained surgeons were often misled and strongly biased by the most commonly used formats identified in the systematic review. In contrast, less common formats following best practice standards (e.g., transparent visual aids) typically reduced or eliminated judgment biases by helping surgeons identify and compare essential information, streamlining deliberation and reducing subjective confusion. Discussion focuses on implications including additional analyses showing that the use of misleading formats in scientific medical literature is frequent, even in recent years, and it is independent of many other factors (e.g., journal impact, study quality). A broad three-category system for characterizing the probable impact of specific risk reporting formats is discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Do judgments about freedom and responsibility depend on who you are? Personality differences in intuitions about compatibilism and incompatibilism.

Recently, there has been an increased interest in folk intuitions about freedom and moral responsibility from both philosophers and psychologists. We aim to extend our understanding of folk intuitions about freedom and moral responsibility using an individual differences approach. Building off previous research suggesting that there are systematic differences in folks' philosophically relevant intuitions, we present new data indicating that the personality trait extraversion predicts, to a significant extent, those who have compatibilist versus incompatibilist intuitions. We argue that identifying groups of people who have specific and diverse intuitions about freedom and moral responsibility offers the possibility for theoretical advancement in philosophy and psychology, and may in part explain why some perennial philosophical debates have proven intractable.

Strengths and Gaps in Physicians' Risk Communication: A Scenario Study of the Influence of Numeracy on Cancer Screening Communication.

OBJECTIVE: Many patients have low numeracy, which impedes their understanding of important information about health (e.g., benefits and harms of screening). We investigated whether physicians adapt their risk communication to accommodate the needs of patients with low numeracy, and how physicians' own numeracy influences their understanding and communication of screening statistics. METHODS: UK family physicians ( N = 151) read a description of a patient seeking advice on cancer screening. We manipulated the level of numeracy of the patient (low v. high v. unspecified) and measured physicians' risk communication, recommendation to the patient, understanding of screening statistics, and numeracy. RESULTS: Consistent with best practices, family physicians generally preferred to use visual aids rather than numbers when communicating information to a patient with low (v. high) numeracy. A substantial proportion of physicians (44%) offered high quality (i.e., complete and meaningful) risk communication to the patient. This was more often the case for physicians with higher (v. lower) numeracy who were more likely to mention mortality rates, OR=1.43 [1.10, 1.86], and harms from overdiagnosis, OR=1.44 [1.05, 1.98]. Physicians with higher numeracy were also more likely to understand that increased detection or survival rates do not demonstrate screening effectiveness, OR=1.61 [1.26, 2.06]. CONCLUSIONS: Most physicians know how to appropriately tailor risk communication for patients with low numeracy (i.e., with visual aids). However, physicians who themselves have low numeracy are likely to misunderstand the risks and unintentionally mislead patients by communicating incomplete information. High-quality risk communication and shared decision making can depend critically on factors that improve the risk literacy of physicians.

The making of an expert.

Popular lore tells us that genius is born, not made. Scientific research, on the other hand, reveals that true expertise is mainly the product of years of intense practice and dedicated coaching. Ordinary practice is not enough: To reach elite levels of performance, you need to constantly push yourself beyond your abilities and comfort level. Such discipline is the key to becoming an expert in all domains, including management and leadership. Those are the conclusions reached by Ericsson, a professor of psychology at Florida State University; Prietula, a professor at the Goizueta Business School; and Cokely, a research fellow at the Max Planck Institute for Human Development, who together studied data on the behavior of experts, gathered by more than 100 scientists. What consistently distinguished elite surgeons, chess players, writers, athletes, pianists, and other experts was the habit of engaging in "deliberate" practice--a sustained focus on tasks that they couldn't do before. Experts continually analyzed what they did wrong, adjusted their techniques, and worked arduously to correct their errors. Even such traits as charisma can be developed using this technique. Working with a drama school, the authors created a set of acting exercises for managers that remarkably enhanced executives' powers of charm and persuasion. Through deliberate practice, leaders can improve their ability to win over their employees, their peers, or their board of directors. The journey to elite performance is not for the impatient or the faint of heart. It takes at least a decade and requires the guidance of an expert teacher to provide tough, often painful feedback. It also demands would-be experts to develop their "inner coach" and eventually drive their own progress.

Sources of individual differences in working memory: contributions of strategy to capacity.

Some research on attentional control in working memory has emphasized theoretical capacity differences. However, strategic behavior, which has been relatively unexplored, can also influence attentional control and its relationship to cognitive performance. In two experiments, we examined the relationship between attentional control (measured with operation span) and interference in a part-list cuing paradigm. Paradoxically, the results indicated that superior attentional control was related to increased interference. This relationship reflected the participants' use of more complex encoding strategies, rather than superior interference control at retrieval, and was eliminated following brief encoding strategy training. The results suggest that complex span measures sometimes predict individual differences in task strategies related to interference control and that these strategies may be amenable to training. The implications for working memory research and the roles of strategies in basic memory and attention paradigms are briefly discussed.

Improving risk literacy in surgeons.

OBJECTIVE: To effectively practice evidence-based medicine, surgeons need to understand and be able to communicate health-relevant numerical information. We present the first study examining risk literacy in surgeons by assessing numeracy and surgical risk comprehension. Our study also investigated whether visual aids improve risk comprehension in surgeons with limited numeracy. METHODS: Participants were 292 surgeons from 60 countries who completed an instrument measuring numeracy and evaluated the results of a randomized controlled trial including post-surgical side-effects. Half of the surgeons received this information in numbers. The other half received the information represented visually. Accuracy of risk estimation, reading latency, and estimate latency (i.e., deliberation) were assessed. RESULTS: Some surgeons have low numeracy and could not correctly interpret surgical risks without additional support. Visual aids made risks transparent and eliminated differences in risk understanding between more and less numerate surgeons, increasing the amount of time that less numerate surgeons spent deliberating about risks. CONCLUSIONS: Visual aids can be an efficient and inexpensive means of improving risk comprehension and clinical judgement in surgeons with low numerical and statistical skills. PRACTICE IMPLICATIONS: Programs designed to help professionals represent and communicate health-relevant numerical information in simple transparent graphs may unobtrusively promote informed decision making.

Measuring Graph Literacy without a Test: A Brief Subjective Assessment.

BACKGROUND: Visual aids tend to help diverse and vulnerable individuals understand risk communications, as long as these individuals have a basic understanding of graphs (i.e., graph literacy). Tests of objective graph literacy (OGL) can effectively identify individuals with limited skills, highlighting vulnerabilities and facilitating custom-tailored risk communication. However, the administration of these tests can be time-consuming and may evoke negative emotional reactions (e.g., anxiety). OBJECTIVES: To evaluate a brief and easy-to-use assessment of subjective graph literacy (SGL) (i.e., self-reported ability to process and use graphically presented information) and to estimate the robustness and validity of the SGL scale and compare it with the leading OGL scale in diverse samples from different cultures. PARTICIPANTS: Demographically diverse residents (n = 470) of the United States, young adults (n = 172) and patients (n = 175) from Spain, and surgeons (n = 175) from 48 countries. DESIGN: A focus group and 4 studies for instrument development and initial validation (study 1), reliability and convergent and discriminant validity evaluation (study 2), and predictive validity estimation (studies 3 and 4). MEASURES: Psychometric properties of the scale. RESULTS: In about 1 minute, the SGL scale provides a reliable, robust, and valid assessment of skills and risk communication preferences and evokes fewer negative emotional reactions than the OGL scale. CONCLUSIONS: The SGL scale can be suitable for use in clinical research and may be useful as a communication aid in clinical practice. Theoretical mechanisms involved in SGL, emerging applications, limitations, and open questions are discussed.

Simple but powerful health messages for increasing condom use in young adults.

In a large longitudinal study involving young adults, we conducted an eight-hour STD educational intervention and examined the impact of the intervention on the efficacy of a message for promoting condom use. The message was framed in positive or negative terms and was presented visually or in numbers (percentages or frequencies). Results indicated that the numerical positive-framed message increased condom use among young adults who did not receive the intervention, whereas the numerical negative-framed message did not. Attitudes toward condom use along with changes in intentions to use condoms mediated this framing effect. In contrast, the positive-framed and negative-framed messages were equally and highly effective for promoting condom use when the messages were presented visually or when young adults received the STD educational intervention before reading the message, suggesting that the simple brochures featuring visual aids were as effective in changing attitudes and behavioral intentions as the extensive intervention. These findings add to a growing body of evidence detailing the mechanisms that allow well-constructed visual aids to be among the most effective, transparent, memorable, and ethically desirable means of risk communication. Clinical and public health implications are discussed.

Brief Messages to Promote Prevention and Detection of Sexually Transmitted Infections.

We review the results of our research program investigating the effects of brief risk awareness interventions for sexually active young adults­the age group most at-risk for sexually transmitted infections (STIs). Our review examines the influence of framed messages, individual differences, and visual aids on key attitudes, behavioral intentions, and health outcomes in three extensive longitudinal studies. Our first study showed that health messages can promote self-reported condom use (screening for STIs) when the messages were framed in positive (negative) terms. This study also showed that adding visual aids to the positive and negative framed messages made them equally and highly effective for promoting self-reported behavior. Visual aids increased self-reported behavior by eliminating the effect of framing on attitudes and behavioral intentions, which in turn influenced self-reported behavior. Our second study showed that visual aids were especially helpful for reducing the effect of message framing among young adults with low numeracy and high graph literacy. Our third study showed that visual aids influenced key attitudes, behavioral intentions, and self-reported behavior as much as a validated 8-hour educational program. Overall, our research suggests that well-constructed visual aids provide simple, effective ways of communicating quantitative information about STIs to at-risk young adults. Theoretical mechanisms, public policy implications, and open questions are discussed.

Understanding the Harms and Benefits of Cancer Screening: A Model of Factors That Shape Informed Decision Making.

OBJECTIVE: Decisions about cancer screenings often involve the consideration of complex and counterintuitive evidence. We investigated psychological factors that promote the comprehension of benefits and harms associated with common cancer screenings and their influence on shared decision making. METHODS: In experiment 1, 256 men received information about PSA-based prostate cancer screening. In experiment 2, 355 women received information about mammography-based breast cancer screening. In both studies, information about potential screening outcomes was provided in 1 of 3 formats: text, a fact box, or a visual aid (e.g., mortality with and without screening and rate of overdiagnosis). We modeled the interplay of comprehension, perceived risks and benefits, intention to participate in screening, and desire for shared decision making. RESULTS: Generally, visual aids were the most effective format, increasing comprehension by up to 18%. Improved comprehension was associated with 1) superior decision making (e.g., fewer intentions to participate in screening when it offered no benefit) and 2) more desire to share in decision making. However, comprehension of the evidence had a limited effect on experienced emotions, risk perceptions, and decision making among those participants who felt that the consequences of cancer were extremely severe. CONCLUSIONS: Even when information is counterintuitive and requires the integration of complex harms and benefits, user-friendly risk communications can facilitate comprehension, improve high-stakes decisions, and promote shared decision making. However, previous beliefs about the effectiveness of screening or strong fears about specific cancers may interfere with comprehension and informed decision making.

Visual aids improve diagnostic inferences and metacognitive judgment calibration.

Visual aids can improve comprehension of risks associated with medical treatments, screenings, and lifestyles. Do visual aids also help decision makers accurately assess their risk comprehension? That is, do visual aids help them become well calibrated? To address these questions, we investigated the benefits of visual aids displaying numerical information and measured accuracy of self-assessment of diagnostic inferences (i.e., metacognitive judgment calibration) controlling for individual differences in numeracy. Participants included 108 patients who made diagnostic inferences about three medical tests on the basis of information about the sensitivity and false-positive rate of the tests and disease prevalence. Half of the patients received the information in numbers without a visual aid, while the other half received numbers along with a grid representing the numerical information. In the numerical condition, many patients-especially those with low numeracy-misinterpreted the predictive value of the tests and profoundly overestimated the accuracy of their inferences. Metacognitive judgment calibration mediated the relationship between numeracy and accuracy of diagnostic inferences. In contrast, in the visual aid condition, patients at all levels of numeracy showed high-levels of inferential accuracy and metacognitive judgment calibration. Results indicate that accurate metacognitive assessment may explain the beneficial effects of visual aids and numeracy-a result that accords with theory suggesting that metacognition is an essential part of risk literacy. We conclude that well-designed risk communications can inform patients about healthrelevant numerical information while helping them assess the quality of their own risk comprehension.