title: Cool but counterproductive: interactive, Web-based risk communications can backfire.
abstract: BACKGROUND
  Paper-based patient decision aids generally present risk information using numbers and/or static images. However, limited psychological research has suggested that when people interactively graph risk information, they process the statistics more actively, making the information more available for decision making. Such interactive tools could potentially be incorporated in a new generation of Web-based decision aids.
  
  
  OBJECTIVE
  The objective of our study was to investigate whether interactive graphics detailing the risk of side effects of two treatments improve knowledge and decision making over standard risk graphics.
  
  
  METHODS
  A total of 3371 members of a demographically diverse Internet panel viewed a hypothetical scenario about two hypothetical treatments for thyroid cancer. Each treatment had a chance of causing 1 of 2 side effects, but we randomly varied whether one treatment was better on both dimensions (strong dominance condition), slightly better on only one dimension (mild dominance condition), or better on one dimension but worse on the other (trade-off condition) than the other treatment. We also varied whether respondents passively viewed the risk information in static pictograph (icon array) images or actively manipulated the information by using interactive Flash-based animations of "fill-in-the-blank" pictographs. Our primary hypothesis was that active manipulation would increase respondents' ability to recognize dominance (when available) and choose the better treatment.
  
  
  RESULTS
  The interactive risk graphic conditions had significantly worse survey completion rates (1110/1695, 65.5% vs 1316/1659, 79.3%, P < .001) than the static image conditions. In addition, respondents using interactive graphs were less likely to recognize and select the dominant treatment option (234/380, 61.6% vs 343/465, 73.8%, P < .001 in the strong dominance condition).
  
  
  CONCLUSIONS
  Interactivity, however visually appealing, can both add to respondent burden and distract people from understanding relevant statistical information. Decision-aid developers need to be aware that interactive risk presentations may create worse outcomes than presentations of static risk graphic formats.
authors.affiliation: Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States. bzikmund [at] umich.edu
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Zikmund-Fisher
authors.forename: Mark
authors.initials: M
authors.lastname: Dickson
authors.forename: Holly O
authors.initials: HO
authors.lastname: Witteman
mesh_terms: D002755:Choice Behavior; D003142:Communication; D003256:Community Participation; D003194:Computer-Assisted Instruction / Q000379:methods*; D003661:Decision Support Techniques; D006801:Humans; D020407:Internet / Q000458:organization & administration*; D015397:Program Evaluation; D012984:Software; D013964:Thyroid Neoplasms / Q000628:therapy; D014584:User-Computer Interface