title: Understanding and using comparative healthcare information; the effect of the amount of information and consumer characteristics and skills.
abstract: BACKGROUND
  Consumers are increasingly exposed to comparative healthcare information (information about the quality of different healthcare providers). Partly because of its complexity, the use of this information has been limited. The objective of this study was to examine how the amount of presented information influences the comprehension and use of comparative healthcare information when important consumer characteristics and skills are taken into account.
  
  
  METHODS
  In this randomized controlled experiment, comparative information on total hip or knee surgery was used as a test case. An online survey was distributed among 800 members of the NIVEL Insurants Panel and 76 hip- or knee surgery patients. Participants were assigned to one of four subgroups, who were shown 3, 7, 11 or 15 quality aspects of three hospitals. We conducted Kruskall-Wallis tests, Chi-square tests and hierarchical multiple linear regression analyses to examine relationships between the amount of information and consumer characteristics and skills (literacy, numeracy, active choice behaviour) on one hand, and outcome measures related to effectively using information (comprehension, perceived usefulness of information, hospital choice, ease of making a choice) on the other hand.
  
  
  RESULTS
  414 people (47%) participated. Regression analysis showed that the amount of information slightly influenced the comprehension and the perceived usefulness of comparative healthcare information. It did not affect consumers' hospital choice and ease of making this choice. Consumer characteristics (especially age) and skills (especially literacy) were the most important factors affecting the comprehension of information and the ease of making a hospital choice. For the perceived usefulness of comparative information, active choice behaviour was the most influencing factor.
  
  
  CONCLUSIONS
  The effects of the amount of information were not unambiguous. It remains unclear what the ideal amount of quality information to be presented would be. Reducing the amount of information will probably not automatically result in more effective use of comparative healthcare information by consumers. More important, consumer characteristics and skills appeared to be more influential factors contributing to information comprehension and use. Consequently, we would suggest that more emphasis on improving consumers' skills is needed to enhance the use of comparative healthcare information.
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, Utrecht 3500 BN, the Netherlands. n.zwijnenberg@nivel.nl
authors.forename: Nicolien C
authors.initials: NC
authors.lastname: Zwijnenberg
authors.forename: Michelle
authors.initials: M
authors.lastname: Hendriks
authors.forename: Olga C
authors.initials: OC
authors.lastname: Damman
authors.forename: Evelien
authors.initials: E
authors.lastname: Bloemendal
authors.forename: Sonja
authors.initials: S
authors.lastname: Wendel
authors.forename: Judith D
authors.initials: JD
authors.lastname: de Jong
authors.forename: Jany
authors.initials: J
authors.lastname: Rademakers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000523:psychology*; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology*; D002755:Choice Behavior; D057186:Comparative Effectiveness Research; D054626:Consumer Health Information; D005260:Female; D057220:Health Literacy; D006801:Humans; D057226:Information Seeking Behavior; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012959:Socioeconomic Factors; D018709:Statistics, Nonparametric