Clear communication of medical risk helps to ensure proper patient understanding of health care options and supports informed decision making. Communication involving visual and written risk typically conveys risk more effectively than conversations alone between a patient and a clinician. However, perception of risk is context-dependent, and the efficacy of and preferences for commonly-used risk communication formats are not well-understood during pregnancy, which is a time of complex decision making. We sought to address this knowledge gap.
This study aimed to assess pregnant and recently pregnant people's understanding and preferences for different risk communication formats.
We conducted an open online REDCap survey of pregnant and recently pregnant people over a one-month period in 2022. Study participants were aged 16 to 49, pregnant or recently pregnant, and able to provide informed consent in English. Data collected included demographics, measurements of accuracy of understanding including both gist accuracy (general understanding) and verbatim accuracy (numerical quantification), and preferences for risk communication formats including icon arrays, pie charts, bar graphs, and text. Descriptive analyses of the proportion of correctly answered questions were calculated.
247 participants completed one or more items on accuracy and risk communication preferences, including 230 with complete responses. Gist (general) understanding was accurate between 74% and 89% of the time for most graphical formats. Verbatim understanding (exact numerical quantification) was accurate approximately 90% for most formats. Respondents preferred that figures be used over circles to display risk in icon arrays, both for themselves and for infants, although figures generated more worry. However, participants substantially preferred pie charts over bar graphs (59%-70% vs. 19%-25%). Respondents preferred risk to be expressed with a lower denominator of 200 rather than a higher denominator of 1000 (79% vs. 13%, although the lower denominator generated more worry), and in terms of chance of survival rather than chance of death (50% vs. 33%).
In a survey of pregnant and recently pregnant people, most respondents preferred pie charts over other graph formats and preferred that text use lower denominators rather than higher ones. Presentations of survival estimates rather than those of death were also preferred. Approximately 75-90% of respondents accurately understood risk presented with visual and written communication. For the remaining participants, for whom accurate understanding was challenging, new strategies need to be developed.
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Accepted: March 9, 2023
Received in revised form: February 2, 2023
Received: December 13, 2022
Publication stageIn Press Accepted Manuscript
© 2023 Published by Elsevier Inc.