Decision Making About Disease-Modifying Treatments for Relapsing-Remitting Multiple Sclerosis: Stated Preferences and Real-World Choices.

BACKGROUND: People with relapsing-remitting multiple sclerosis can benefit from disease-modifying treatments (DMTs). Several DMTs are available that vary in their efficacy, side-effect profile and mode of administration. OBJECTIVE: We aimed to measure the preferences of people with relapsing-remitting multiple sclerosis for DMTs using a discrete choice experiment and to assess which stated preference attributes correlate with the attributes of the DMTs they take in the real world. METHODS: Discrete choice experiment attributes were developed from literature reviews, interviews and focus groups. In a discrete choice experiment, participants were shown two hypothetical DMTs, then chose whether they preferred one of the DMTs or no treatment. A mixed logit model was estimated from responses and individual-level estimates of participants' preferences conditional on their discrete choice experiment choices calculated. Logit models were estimated with stated preferences predicting current real-world on-treatment status, DMT mode of administration and current DMT. RESULTS: A stated intrinsic preference for taking a DMT was correlated with currently taking a DMT, and stated preferences for mode of administration were correlated with the modes of administration of the DMTs participants were currently taking. Stated preferences for treatment effectiveness and adverse effects were not correlated with real-world behaviour. CONCLUSIONS: There was variation in which discrete choice experiment attributes correlated with participants' real-world DMT choices. This may indicate patient preferences for treatment efficacy/risk are not adequately taken account of in prescribing. Treatment guidelines must ensure they take into consideration patients' preferences and improve communication around treatment efficacy/risk.

The Role of Confidence and Knowledge in Intentions to (Not) Seek Care for Hypertension: Evidence From a National Survey.

BACKGROUND: Hypertension (high blood pressure) is a modifiable risk factor for cardiovascular disease. However, patients may lack confidence in their understanding of what constitutes normal/healthy blood pressure, potentially affecting intentions to seek necessary care. The American Heart Association defines normal/healthy blood pressure as <120/80 mm Hg, with a 130/80 mm Hg threshold for hypertension diagnosis. METHODS: Our US sample (N = 6,592) included 1,342 adults with hypertension alone and 795 with hypertension and relevant comorbidities (heart disease, kidney disease, and diabetes mellitus). We assessed confidence in understanding blood pressure numbers, knowledge of thresholds for normal/healthy blood pressure ("normal or healthy blood pressure is below . . ."; counting 120-130/80 mm Hg as correct), and intentions to seek care for randomly assigned blood pressure readings of 142/91 (stage 2 hypertension), 132/69 (stage 1 hypertension), or 118/78 mm Hg (normal/healthy blood pressure). RESULTS: Among nonhypertensive participants, 55% expressed confidence in their understanding of blood pressure numbers, but only 36% knew the upper thresholds for normal/healthy blood pressure. Among participants with hypertension alone, 78% were confident while 47% were knowledgeable. Among participants with hypertension and comorbidities, 81% were confident and 40% were knowledgeable. Participants who were confident (v. not) were more likely to express intentions to act on stage 2 hypertension readings but less likely to express intentions to act on stage 1 readings, even after adjustment for knowledge, hypertension diagnosis, and sociodemographics. LIMITATIONS: Confidence, knowledge, and intentions were each measured with 1 question. CONCLUSIONS: Independent of knowledge, confidence was associated with greater willingness to act on stage 2 hypertension readings but reduced willingness to act on stage 1 hypertension readings. Interventions aiming to improve hypertension care-seeking behavior should improve confidence in accurate knowledge. HIGHLIGHTS: Hypertension or high blood pressure is a major risk factor for heart disease.Most Americans do not know that normal/healthy blood pressure levels are ≤120/80 mm Hg, yet they are confident that they know this information.Inappropriate confidence in understanding of blood pressure numbers undermines intentions to seek care for stage 1 hypertension blood pressure readings.

Papers Please - Predictive Factors of National and International Attitudes Toward Immunity and Vaccination Passports: Online Representative Surveys.

BACKGROUND: In response to the COVID-19 pandemic, countries are introducing digital passports that allow citizens to return to normal activities if they were previously infected with (immunity passport) or vaccinated against (vaccination passport) SARS-CoV-2. To be effective, policy decision-makers must know whether these passports will be widely accepted by the public and under what conditions. This study focuses attention on immunity passports, as these may prove useful in countries both with and without an existing COVID-19 vaccination program; however, our general findings also extend to vaccination passports. OBJECTIVE: We aimed to assess attitudes toward the introduction of immunity passports in six countries, and determine what social, personal, and contextual factors predicted their support. METHODS: We collected 13,678 participants through online representative sampling across six countries-Australia, Japan, Taiwan, Germany, Spain, and the United Kingdom-during April to May of the 2020 COVID-19 pandemic, and assessed attitudes and support for the introduction of immunity passports. RESULTS: Immunity passport support was moderate to low, being the highest in Germany (775/1507 participants, 51.43%) and the United Kingdom (759/1484, 51.15%); followed by Taiwan (2841/5989, 47.44%), Australia (963/2086, 46.16%), and Spain (693/1491, 46.48%); and was the lowest in Japan (241/1081, 22.94%). Bayesian generalized linear mixed effects modeling was used to assess predictive factors for immunity passport support across countries. International results showed neoliberal worldviews (odds ratio [OR] 1.17, 95% CI 1.13-1.22), personal concern (OR 1.07, 95% CI 1.00-1.16), perceived virus severity (OR 1.07, 95% CI 1.01-1.14), the fairness of immunity passports (OR 2.51, 95% CI 2.36-2.66), liking immunity passports (OR 2.77, 95% CI 2.61-2.94), and a willingness to become infected to gain an immunity passport (OR 1.6, 95% CI 1.51-1.68) were all predictive factors of immunity passport support. By contrast, gender (woman; OR 0.9, 95% CI 0.82-0.98), immunity passport concern (OR 0.61, 95% CI 0.57-0.65), and risk of harm to society (OR 0.71, 95% CI 0.67-0.76) predicted a decrease in support for immunity passports. Minor differences in predictive factors were found between countries and results were modeled separately to provide national accounts of these data. CONCLUSIONS: Our research suggests that support for immunity passports is predicted by the personal benefits and societal risks they confer. These findings generalized across six countries and may also prove informative for the introduction of vaccination passports, helping policymakers to introduce effective COVID-19 passport policies in these six countries and around the world.

The Role of Personal Experience and Prior Beliefs in Shaping Climate Change Perceptions: A Narrative Review.

Global climate change is increasing the frequency and intensity of extreme weather events such as heatwaves, droughts, and flooding. This is the primary way many individuals experience climate change, which has led researchers to investigate the influence of personal experience on climate change concern and action. However, existing evidence is still limited and in some cases contradictory. At the same time, behavioral decision research has highlighted the importance of pre-existing values and beliefs in shaping how individuals experience changes in environmental conditions. This is in line with theories of motivated reasoning, which suggest that people interpret and process information in a biased manner to maintain their prior beliefs. Yet, the evidence for directional motivated reasoning in the context of climate change beliefs has recently been questioned. In the current paper, we critically review the literature on the interrelationships between personal experience of local weather anomalies, extreme weather events and climate change beliefs. Overall, our review shows that there is some evidence that local warming can generate climate change concern, but the capacity for personal experience to promote action may rely upon the experience first being attributed to climate change. Rare extreme weather events will likely have limited impact on judgments and decisions unless they have occurred recently. However, even recent events may have limited impact among individuals who hold strong pre-existing beliefs rejecting the reality of climate change. We identify limitations of existing research and suggest directions for future work.

Current Challenges When Using Numbers in Patient Decision Aids: Advanced Concepts.

BACKGROUND: Decision aid developers have to convey complex task-specific numeric information in a way that minimizes bias and promotes understanding of the options available within a particular decision. Whereas our companion paper summarizes fundamental issues, this article focuses on more complex, task-specific aspects of presenting numeric information in patient decision aids. METHODS: As part of the International Patient Decision Aids Standards third evidence update, we gathered an expert panel of 9 international experts who revised and expanded the topics covered in the 2013 review working in groups of 2 to 3 to update the evidence, based on their expertise and targeted searches of the literature. The full panel then reviewed and provided additional revisions, reaching consensus on the final version. RESULTS: Five of the 10 topics addressed more complex task-specific issues. We found strong evidence for using independent event rates and/or incremental absolute risk differences for the effect size of test and screening outcomes. Simple visual formats can help to reduce common judgment biases and enhance comprehension but can be misleading if not well designed. Graph literacy can moderate the effectiveness of visual formats and hence should be considered in tool design. There is less evidence supporting the inclusion of personalized and interactive risk estimates. DISCUSSION: More complex numeric information. such as the size of the benefits and harms for decision options, can be better understood by using incremental absolute risk differences alongside well-designed visual formats that consider the graph literacy of the intended audience. More research is needed into when and how to use personalized and/or interactive risk estimates because their complexity and accessibility may affect their feasibility in clinical practice.

Current Best Practice for Presenting Probabilities in Patient Decision Aids: Fundamental Principles.

BACKGROUND: Shared decision making requires evidence to be conveyed to the patient in a way they can easily understand and compare. Patient decision aids facilitate this process. This article reviews the current evidence for how to present numerical probabilities within patient decision aids. METHODS: Following the 2013 review method, we assembled a group of 9 international experts on risk communication across Australia, Germany, the Netherlands, the United Kingdom, and the United States. We expanded the topics covered in the first review to reflect emerging areas of research. Groups of 2 to 3 authors reviewed the relevant literature based on their expertise and wrote each section before review by the full authorship team. RESULTS: Of 10 topics identified, we present 5 fundamental issues in this article. Although some topics resulted in clear guidance (presenting the chance an event will occur, addressing numerical skills), other topics (context/evaluative labels, conveying uncertainty, risk over time) continue to have evolving knowledge bases. We recommend presenting numbers over a set time period with a clear denominator, using consistent formats between outcomes and interventions to enable unbiased comparisons, and interpreting the numbers for the reader to meet the needs of varying numeracy. DISCUSSION: Understanding how different numerical formats can bias risk perception will help decision aid developers communicate risks in a balanced, comprehensible manner and avoid accidental "nudging" toward a particular option. Decisions between probability formats need to consider the available evidence and user skills. The review may be useful for other areas of science communication in which unbiased presentation of probabilities is important.

The Impact of Reproductive Issues on Preferences of Women with Relapsing Multiple Sclerosis for Disease-Modifying Treatments.

BACKGROUND: Relapsing-remitting multiple sclerosis (RRMS) is an incurable disease characterised by relapses (periods of function loss) followed by full or partial recovery, and potential permanent disability over time. Many disease-modifying treatments (DMTs) exist that help reduce relapses and slow disease progression. Most are contraindicated during conception/pregnancy and some require a discontinuation period before trying to conceive. Although around three-quarters of people with RRMS are women, there is limited knowledge about how reproductive issues impact DMT preference. OBJECTIVE: The aim of this study was to measure the preferences for DMTs of women with RRMS who are considering pregnancy. DESIGN: An online discrete choice experiment (DCE). METHODS: Participants chose between two hypothetical DMTs characterised by a set of attributes, then indicated if they preferred their choice to no treatment. Attributes were identified from interviews and focus groups with people with RRMS and MS professionals, as well as literature reviews, and included the probability of problems with pregnancy, discontinuation of DMTs, and breastfeeding safety. In each DCE task, participants were asked to imagine making decisions in three scenarios: now; when trying to conceive; and when pregnant. ANALYSIS: Two mixed logit models were estimated, one to assess the statistical significance between scenarios and one in maximum acceptable risk space to allow comparison of the magnitudes of parameters between scenarios. SAMPLE: Women with RRMS who were considering having a child in the future, recruited from a UK MS patient register. RESULTS: Sixty respondents completed the survey. Participants preferred no treatment in 12.6% of choices in the 'now' scenario, rising significantly to 37.6% in the 'trying to conceive' scenario and 60.3% in the 'pregnant' scenario (Kruskal-Wallis p < 0.001). This pattern corresponds with results from models that included a no-treatment alternative-specific constant (ASC) capturing differences between taking and not taking a DMT not specified by the attributes. The ASC was lower in the trying to conceive scenario than in the now scenario, and lower still in the pregnant scenario, indicating an intrinsic preference for no treatment. Participants also placed relatively less preference on reducing relapses and avoiding disease progression in the trying to conceive and pregnant scenarios compared with a lower risk of problems with pregnancy. In the trying to conceive scenario, participants' preference for treatments with shorter washout periods increased. CONCLUSION: Women with RRMS considering having a child prefer DMTs with more favourable reproduction-related attributes, even when not trying to conceive. Reproductive issues also influenced preferences for DMT attributes not directly related to pregnancy, with preferences dependent on the life circumstances in which choices were made. The design of the DCE highlights the benefits of considering the scenario in which participants make choices, as they may change over time.

Probability Size Matters: The Effect of Foreground-Only versus Foreground+Background Graphs on Risk Aversion Diminishes with Larger Probabilities.

Graphs are increasingly recommended for improving decision-making and promoting risk-avoidant behaviors. Graphs that depict only the number of people affected by a risk ("foreground-only" displays) tend to increase perceived risk and risk aversion (e.g., willingness to get vaccinated), as compared to graphs that also depict the number of people at risk for harm ("foreground+background" displays). However, previous research examining these "foreground-only effects" has focused on relatively low-probability risks (<10%), limiting generalizability to communications about larger risks. In two experiments, we systematically investigated the moderating role of probability size on foreground-only effects, using a wide range of probability sizes (from 0.1% to 40%). Additionally, we examined the moderating role of the size of the risk reduction, that is, the extent to which a protective behavior reduces the risk. Across both experiments, foreground-only effects on perceived risk and risk aversion were weaker for larger probabilities. Experiment 2 also revealed that foreground-only effects were weaker for smaller risk reductions, while foreground-only displays decreased understanding of absolute risk magnitudes independently of probability size. These findings suggest that the greater effectiveness of foreground-only versus foreground+background displays for increasing perceived risk and risk aversion diminishes with larger probability sizes and smaller risk reductions. Moreover, if the goal is to promote understanding of absolute risk magnitudes, foreground+background displays should be used rather than foreground-only displays regardless of probability size. Our findings also help to refine and extend existing theoretical accounts of foreground-only effects to situations involving a wide range of probability sizes.

Psychological factors related to time to help-seeking for cancer symptoms: a meta-analysis across cancer sites.

The time patients wait before seeking help for cancer symptoms is among the most important factors contributing to diagnostic delays in cancer. We reviewed the association between time to help-seeking and three psychological factors: symptom knowledge, symptom interpretation, and beliefs about cancer. Forty-seven studies met the inclusion criteria, providing data from 22 countries concerning seven cancer sites. Better symptom knowledge was related to lower odds of a long help-seeking interval in both studies with healthy populations (OR = .73, 95% CI [.63, .84], k = 19) and patients (OR = .40, 95% CI [.23, .69], k = 12), and so was interpreting experienced symptoms as cancer-related (OR = .52, 95% CI [.36, .75], k = 13 studies with patients). More positive beliefs about cancer (i.e., that cancer is treatable) were associated with lower odds of a long help-seeking interval in both studies with healthy populations (OR = .70, 95% CI [.52, .92], k = 11) and with patients (OR = .51, 95% CI [.32, .82], k = 7). Symptom knowledge, interpretation, and beliefs about cancer are likely to be universal predictors of help-seeking and should be incorporated into theoretical models of patient help-seeking and interventions aiming to reduce delays.

How is cervical cancer screening information communicated in UK websites? Cross-sectional analysis of content and quantitative presentation formats.

OBJECTIVES: To investigate whether UK websites about cervical cancer screening targeted to the public include (1) information about benefits and risks of screening, possible screening results and cervical cancer statistics, (2) quantitative presentation formats recommended in the risk communication literature and (3) appeals for participation and/or informed decision-making. DESIGN: Cross-sectional analysis of websites using a comprehensive checklist of information items on screening benefits, risks, possible results and cervical cancer statistics. OUTCOME MEASURES: We recorded the number of websites that contained each of the information items, and the presentation format used for probabilistic information (no quantification provided, verbal quantifiers only, different types of numerical formats and/or graphs). We also recorded the number of websites containing appeals for participation and/or informed decision-making. SETTING: Websites were identified through the most common Google search terms used in the UK to find information on cervical screening, according to GoogleTrends and a commercial internet-monitoring programme. Two additional websites were identified by the authors as relevant. RESULTS: After applying exclusion criteria, 14 websites were evaluated, including websites of public and private health service providers, charities, a medical society and a pharmacy. The websites mentioned different benefits, risks of screening and possible results. However, specific content varied between websites. Probabilistic information was often presented using non-recommended formats, including relative risk reductions to express screening benefits, and verbal quantifiers without numbers to express risks. Appeals for participation were present in most websites, with almost half also mentioning informed decision-making. CONCLUSIONS: UK websites about cervical cancer screening were generally balanced. However, benefits and risks were presented using different formats, potentially hindering comparisons. Additionally, recommendations from the literature to facilitate understanding of quantitative information and facilitate informed decisions were often not followed. Designing websites that adhere to existing recommendations may support informed screening uptake.

How Do Women Interpret the NHS Information Leaflet about Cervical Cancer Screening?

Background. Organized screening programs often rely on written materials to inform the public. In the United Kingdom, women invited for cervical cancer screening receive a leaflet from the National Health Service (NHS) to support screening decisions. However, information about screening may be too complex for people to understand, potentially hindering informed decision making. Objectives. We aimed to identify women's difficulties in interpreting the leaflet used in England and negative and positive responses to the leaflet. Methods. We used a sequential mixed-methods design involving 2 steps: cognitive think-aloud interviews (n = 20), followed by an England-wide survey (n = 602). Data were collected between June 2017 and December 2018, and participants included women aged 25 to 64 y with varying sociodemographics. Results. Interview results revealed misunderstandings concerning screening results, benefits, and additional tests and treatment, although participants tended to react positively to numerical information. Participants were often unfamiliar with the potential harms associated with screening (i.e., screening risks), key aspects of human papillomavirus, and complex terms (e.g., dyskaryosis). Survey results indicated that interpretation difficulties were common (M correct items = 12.5 of 23). Lower understanding was associated with lower educational level (ß's >0.15, P's <0.001), lower numeracy scores (ß = 0.36, P < 0.001), and nonwhite ethnicity (ß = 0.10, P = 0.007). The leaflet was evaluated positively overall. Conclusions. Despite previous user testing of the leaflet, key information may be too complex for some recipients. As a consequence, they may struggle to make informed decisions about screening participation based on the information provided. We discuss implications for the improvement of communications about screening and decision support.

Using the Short Graph Literacy Scale to Predict Precursors of Health Behavior Change.

BACKGROUND: Visual displays can facilitate risk communication and promote better health choices. Their effectiveness in improving risk comprehension is influenced by graph literacy. However, the construct of graph literacy is still insufficiently understood, partially because existing objective measures of graph literacy are either too difficult or too long. OBJECTIVES: We constructed a new 4-item Short Graph Literacy (SGL) scale and examined how SGL scores relate to key cognitive, affective, and conative precursors of health behavior change described in common health behavior theories. METHODS: We performed secondary analyses to adapt the SGL scale from an existing 13-item scale. The initial construction was based on data collected in a laboratory setting in Germany ( n = 51). The scale was then validated using data from nationally representative samples in Germany ( n = 495) and the United States ( n = 492). To examine how SGL scores relate to precursors of health behavior change, we performed secondary analyses of a third study involving a nationwide US sample with 47% participants belonging to racial/ethnic minorities and 46% with limited formal education ( n = 835). RESULTS: Graph literacy was significantly associated with cognitive precursors in theoretically expected ways (e.g., positive associations with risk comprehension and response efficacy and a negative association with cognitive risk perception). Patterns for affective precursors generally mirrored those for cognitive precursors, although numeracy was a stronger predictor than graph literacy for some affective factors (e.g., feelings of risk). Graph literacy had predictive value for most cognitive and affective precursors beyond numeracy. In addition, graph literacy (but not numeracy) predicted key conative precursors such as defensive processing. CONCLUSIONS: Our data suggest that the SGL scale is a fast and psychometrically valid method for measuring objective graph literacy. Our findings also highlight the theoretical and practical relevance of graph literacy.

Disfluent fonts lead to more utilitarian decisions in moral dilemas / El tipo de letra difícil de leer ("disfluent") produce más decisiones utilitarias en dilemas morales

Previous research suggests that utilitarian decisions to moral dilemmas often stem from analytic, controlled cognitive processes. Furthermore, processing disfluency can trigger analytic thinking and improve performance on tasks that require logic and cognitive reflection. In the present study we investigated how processing fluency affects the readiness with which people give utilitarian responses to both personal and impersonal dilemmas. Participants were presented in two different experimental blocks with dilemmas written in both easy- (fluent) and hard-to-read (disfluent) fonts. We expected that dilemmas written in a disfluent font would be associated with more utilitarian responses. Results supported this prediction, albeit only when the disfluent dilemmas appeared first, showing that participants endorsed more utilitarian actions in the disfluent condition than in the fluent condition across dilemma types. These data suggest that increasing processing disfluency by manipulating the font affects decisions in the moral domain

Investigaciones previas sugieren que las decisiones utilitarias a dilemas morales a menudo tienen origen en procesos cognitivos controlados y analíticos. Se sabe además que el procesamiento disfluente puede inducir pensamiento analítico y mejorar la ejecución en tareas que requieren lógica y reflexión cognitiva. En este estudio se investigó cómo la fluencia de procesamiento afecta a la disponibilidad con la que se dan repuestas utilitarias a dilemas morales personales e impersonales. Se presentaron a los participantes dilemas escritos tanto en una letra fácil (fluent) como difícil de leer (disfluent) en dos bloques experimentales diferentes. Se esperaba encontrar una asociación entre este último tipo de dilemas y respuestas más utilitarias. Los resultados apoyaron esta predicción cuando los dilemas disfluent se presentaron en primer lugar, mostrando que los participantes subscribían más acciones utilitarias en la condición disfluent que en la fluent, tanto para dilemas personales como impersonales. Estos datos sugieren que incrementar la disfluencia de procesamiento manipulando el tipo de letra utilizado afecta a las decisiones en el ámbito moral

Designing Graphs that Promote Both Risk Understanding and Behavior Change.

Graphs show promise for improving communications about different types of risks, including health risks, financial risks, and climate risks. However, graph designs that are effective at meeting one important risk communication goal (promoting risk-avoidant behaviors) can at the same time compromise another key goal (improving risk understanding). We developed and tested simple bar graphs aimed at accomplishing these two goals simultaneously. We manipulated two design features in graphs, namely, whether graphs depicted the number of people affected by a risk and those at risk of harm ("foreground+background") versus only those affected ("foreground-only"), and the presence versus absence of simple numerical labels above bars. Foreground-only displays were associated with larger risk perceptions and risk-avoidant behavior (i.e., willingness to take a drug for heart attack prevention) than foreground+background displays, regardless of the presence of labels. Foreground-only graphs also hindered risk understanding when labels were not present. However, the presence of labels significantly improved understanding, eliminating the detrimental effect of foreground-only displays. Labels also led to more positive user evaluations of the graphs, but did not affect risk-avoidant behavior. Using process modeling we identified mediators (risk perceptions, understanding, user evaluations) that explained the effect of display type on risk-avoidant behavior. Our findings contribute new evidence to the graph design literature: unlike what was previously feared, we demonstrate that it is possible to design foreground-only graphs that promote intentions for behavior change without a detrimental effect on risk understanding. Implications for the design of graphical risk communications and decision support are discussed.

Disentangling the Effect of Valence and Arousal on Judgments Concerning Moral Transgressions.

An increasing body of research has investigated the effect of emotions on judgments concerning moral transgressions. Yet, few studies have controlled for arousal levels associated with the emotions. High arousal may affect moral processing by triggering attention to salient features of transgressions, independently of valence. Therefore previously documented differences in effects of negative and positive emotions may have been confounded by differences in arousal. We conducted two studies to shed light on this issue. In Study 1 we developed a questionnaire including vignettes selected on the basis of psychometrical properties (i.e., mean ratings of the actions and variability). This questionnaire was administered to participants in Study 2, after presenting them with selected pictures inducing different valence but equivalent levels of arousal. Negative pictures led to more severe moral judgments than neutral (p = .054, d = 0.60) and positive pictures (p = .002, d = 1.02), for vignettes that were not associated with extreme judgments. In contrast, positive pictures did not reliably affect judgments concerning such vignettes. These findings suggest that the observed effects of emotions cannot be accounted for by an increase in attention linked to the arousal which accompanies these emotions.

Improving risk understanding across ability levels: Encouraging active processing with dynamic icon arrays.

Icon arrays have been found to improve risk understanding and reduce judgment biases across a wide range of studies. Unfortunately, individuals with low graph literacy experience only limited benefits from such displays. To enhance the efficacy and reach of these decision aids, the authors developed and tested 3 types of dynamic design features--that is, computerized display features that unfold over time. Specifically, the authors manipulated the sequential presentation of the different elements of icon arrays, the presence of explanatory labels indicating what was depicted in the different regions of the arrays, and the use of a reflective question followed by accuracy feedback. The first 2 features were designed to promote specific cognitive processes involved in graph comprehension, whereas the 3rd feature was designed to promote a more active, elaborative processing of risk information. Explanatory labels were effective in improving risk understanding among less graph-literate participants, whereas reflective questions resulted in large and robust performance benefits among participants with both low and high graph literacy. Theoretical and prescriptive implications are discussed. (PsycINFO Database Record

Habilidades numéricas y salud: una revisión crítica / Numeracy and health: A critical review

A la hora de realizar juicios y tomar decisiones sobre la salud, debemos procesar y comprender información numérica. Por ejemplo, habitualmente recibimos información sobre el riesgo de padecer una enfermedad en probabilidades, porcentajes o fracciones. Sin embargo, muchas personas presentan deficiencias a la hora de comprender esta información. En este trabajo, presentamos una revisión crítica de la evidencia empírica sobre los efectos que tienen las habilidades numéricas en diversos aspectos del proceso que acontece cuando un paciente acude al médico, más concretamente en la percepción de los riesgos médicos y la eficacia de los tratamientos. También describimos los distintos marcos teóricos que pretenden explicar estos efectos y resaltamos algunas de sus limitaciones. Por último, discutimos las ventajas y los inconvenientes de los instrumentos de medida de las habilidades numéricas, y destacamos entre ellos el Berlin Numeracy Test. Concluimos que este test puede evaluar las habilidades numéricas satisfactoriamente en diversos contextos, y planteamos diversas cuestiones que permanecen abiertas, como la relación entre las habilidades numéricas y diversos constructos psicológicos como la inteligencia o la reflexión cognitiva.

When we make judgments and decisions about our health, we are frequently faced with numerical information. For example, we often receive information concerning the risk of suffering an illness in terms of probabilities, percentages or fractions. However, many people have difficulties in understanding this type of information. In this paper, we present a critical review of the existing empirical evidence that documents the influence of numeracy on various aspects of the process that occurs when patients visit their doctor, focusing on perceptions of medical risks and treatment efficacy. We also outline different theoretical frameworks that have attempted to explain the impact of numeracy, highlighting some of their limitations. Finally, we discuss the advantages and disadvantages of existing tools for measuring numeracy, drawing attention to the Berlin Numeracy Test. We concluded that this test can satisfactorily assess numeracy in a wide range of contexts. We also discuss a number of open questions, including the relationship between numeracy and other psychological constructs, such as intelligence or cognitive reflection.

Disentangling the effect of valence and arousal on judgments concerning moral transgressions

An increasing body of research has investigated the effect of emotions on judgments concerning moral transgressions. Yet, few studies have controlled for arousal levels associated with the emotions. High arousal may affect moral processing by triggering attention to salient features of transgressions, independently of valence. Therefore previously documented differences in effects of negative and positive emotions may have been confounded by differences in arousal. We conducted two studies to shed light on this issue. In Study 1 we developed a questionnaire including vignettes selected on the basis of psychometrical properties (i.e., mean ratings of the actions and variability). This questionnaire was administered to participants in Study 2, after presenting them with selected pictures inducing different valence but equivalent levels of arousal. Negative pictures led to more severe moral judgments than neutral (p = .054, d = 0.60) and positive pictures (p = .002, d = 1.02), for vignettes that were not associated with extreme judgments. In contrast, positive pictures did not reliably affect judgments concerning such vignettes. These findings suggest that the observed effects of emotions cannot be accounted for by an increase in attention linked to the arousal which accompanies these emotions (AU)

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