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Med Decis Making. 2011 May-Jun;31(3):432-6. doi: 10.1177/0272989X10391672. Epub 2010 Dec 29.

Informing patients: the influence of numeracy, framing, and format of side effect information on risk perceptions.

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Decision Research, Eugene, Oregon, USA.



Given the importance of effective patient communication, findings about influences on risk perception in nonmedical domains need replication in medical domains.


To examine whether numeracy influences risk perceptions when different information frames and number formats are used to present medication risks.


The authors manipulated the frame and number format of risk information in a 3 (frame: positive, negative, combined) × 2 (number format: frequency, percentage) design. Participants from an Internet sample (N = 298), randomly assigned to condition, responded to a single, hypothetical scenario. The main effects and interactions of numeracy, framing, and number format on risk perception were measured.


Participants given the positive frame perceived the medication as less risky than those given the negative frame. Mean risk perceptions for the combined frame fell between the positive and negative frames. Numeracy did not moderate these framing effects. Risk perceptions also varied by number format and numeracy, with less-numerate participants given risk information in a percentage format perceiving the medication as less risky than when given risk information in a frequency format; highly numerate participants perceived similar risks in both formats. The generalizability of the findings is limited due to the use of non-patients, presented a hypothetical scenario. Given the design, one cannot know whether observed differences would translate into clinically significant differences in patient behaviors.


Frequency formats appear to increase risk perceptions over percentage formats for less-numerate respondents. Health communicators need to be aware that different formats generate different risk perceptions among patients varying in numeracy.

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