Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis, Saint Louis, MO, USA.
University of Washington, Merced, CA, USA.
Med Decis Making. 2021 Jan;41(1):74-88. doi: 10.1177/0272989X20968070. Epub 2020 Oct 26.
Personalized medicine may increase the amount of probabilistic information patients encounter. Little guidance exists about communicating risk for multiple diseases simultaneously or about communicating how changes in risk factors affect risk (hereafter "risk reduction").
To determine how to communicate personalized risk and risk reduction information for up to 5 diseases associated with insufficient physical activity in a way laypeople can understand and that increases intentions.
We recruited 500 participants with <150 min weekly of physical activity from community settings. Participants completed risk assessments for diabetes, heart disease, stroke, colon cancer, and breast cancer (women only) on a smartphone. Then, they were randomly assigned to view personalized risk and risk reduction information organized as a bulleted list, a simplified table, or a specialized vertical bar graph ("risk ladder"). Last, they completed a questionnaire assessing outcomes. Personalized risk and risk reduction information was presented as categories (e.g., "very low"). Our analytic sample ( = 372) included 41.3% individuals from underrepresented racial/ethnic backgrounds, 15.9% with vocational-technical training or less, 84.7% women, 43.8% aged 50 to 64 y, and 71.8% who were overweight/obese.
Analyses of covariance with post hoc comparisons showed that the risk ladder elicited higher gist comprehension than the bulleted list ( = 0.01). There were no significant main effects on verbatim comprehension or physical activity intentions and no moderation by sex, race/ethnicity, education, numeracy, or graph literacy ( > 0.05). Sequential mediation analyses revealed a small beneficial indirect effect of risk ladder versus list on intentions through gist comprehension and then through perceived risk ( = 0.02, 95% confidence interval: 0.00, 0.04).
Risk ladders can communicate the gist meaning of multiple pieces of risk information to individuals from many sociodemographic backgrounds and with varying levels of facility with numbers and graphs.
个性化医学可能会增加患者接触到的概率信息量。目前，关于如何同时传达多种疾病的风险，以及如何传达风险因素变化如何影响风险（以下简称“风险降低”）的指导很少。
确定如何以一种非专业人士能够理解的方式传达与身体活动不足相关的多达 5 种疾病的个性化风险和风险降低信息，并且这种方式可以提高意向。
我们从社区环境中招募了 500 名每周身体活动不足 150 分钟的参与者。参与者使用智能手机完成了糖尿病、心脏病、中风、结肠癌和乳腺癌（仅限女性）的风险评估。然后，他们被随机分配查看以项目符号列表、简化表格或专业垂直条形图（“风险阶梯”）组织的个性化风险和风险降低信息。最后，他们完成了一份评估结果的问卷。个性化风险和风险降低信息以类别呈现（例如，“非常低”）。我们的分析样本（n=372）包括 41.3%来自代表性不足的种族/族裔背景的个体、15.9%接受过职业技术培训或以下的个体、84.7%的女性、43.8%年龄在 50 至 64 岁之间、71.8%的超重/肥胖个体。
协方差分析和事后比较显示，风险阶梯比项目符号列表更能引起主旨理解（p=0.01）。在逐字理解或身体活动意向方面没有显著的主要影响，也没有性别、种族/族裔、教育、计算能力或图表素养的调节作用（p>0.05）。顺序中介分析显示，风险阶梯与列表对意向的间接影响较小，通过主旨理解，然后通过感知风险（p=0.02，95%置信区间：0.00，0.04）。
风险阶梯可以向来自许多社会人口统计学背景和具有不同数字和图表处理能力的个体传达多种风险信息的主旨意义。
