Fact Boxes: What gets through? A focus group study.

BACKGROUND

The "fact box" format was developed to present the benefits and side effects of medical treatments without distortion and in a comprehensible manner. Few studies were able to show that fact boxes, when compared with other formats, significantly improve risk perception, comprehensibility and readability. The fact boxes available in Germany, however, vary with regard to how tables and accompanying texts are presented. It is unclear to what extent the existing evidence can be applied to these formats. Hardly any fact boxes have been piloted systematically. The aim was to pilot the fact box "Antibiotics for acute bronchitis" as a model for the format in terms of feasibility.

METHOD

We used print and online media to recruit adults (> 18 years). The characteristics gender, age and level of education were considered for sampling. The feasibility was explored by means of a semi-structured interview guideline. The focus group interviews were audio-taped and then transcribed. Data analysis was conducted as content analysis according to Mayring.

RESULTS

Five focus groups with a total of 28 participants took place between April 2018 and May 2019 (Halle/Saale, Saxony-Anhalt: n=3; St. Ingbert, Saarland: n=1; Trier, Rhineland-Palatinate: n=1). The fact box was piloted in an iterative process; the results were revised accordingly and checked again in focus groups until information saturation was achieved. The analysis identified the following main categories: interpretation of contents, readability, low reliability; credibility, relevance of the information, relevance of the presentation; superfluous information; completeness and layout. Overall, the fact box was hardly understood, especially regarding the numerical presentation given and the technical terms used. Both the objective and the intended addressees of the fact box were not clear. After revision, feasibility was established.

DISCUSSION

The iterative revision process resulted in a final version that was well understood and perceived as a decision aid.

CONCLUSION

The results support the demand of the guideline "Evidence-based Health Information" for piloting evidence-based health information prior to their dissemination and further evaluation. The next step will be to evaluate the fact box format in a randomised controlled trial.