title: Communicating global cardiovascular risk: are icon arrays better than numerical estimates in improving understanding, recall and perception of risk?
abstract: OBJECTIVE
  Experts recommend that adults have their global cardiovascular risk assessed. We investigated whether icon arrays increase understanding, recall, perception of CVR, and behavioral intent as compared with numerical information.
  
  
  METHODS
  Male outpatient veterans, at an intermediate to high cardiovascular risk participated in a randomized controlled trial of a computer tutorial presenting individualized risk. Message format was presented in 3 formats: percentages, frequencies, and frequencies with icon arrays. We assessed understanding immediately (T1) and recall at 20 min (T2) and 2 weeks (T3) after the intervention. We assessed perceptions of importance/seriousness, intent to adhere, and self-efficacy at T1. Self-reported adherence was assessed at T3.
  
  
  RESULTS
  One-hundred and twenty male veterans participated. Age, education, race, health literacy and numeracy were comparable at baseline. There were no differences in understanding at T1 [p = .31] and recall at T3 [p = .10]. Accuracy was inferior with frequencies with icon arrays than percentages or frequencies at T2 [p ≤ .001]. There were no differences in perception of seriousness and importance for heart disease, behavioral intent, self-efficacy, actual adherence and satisfaction.
  
  
  CONCLUSIONS
  Icon arrays may impair short-term recall of CVR.
  
  
  CONCLUSIONS
  Icon arrays will not necessarily result in better understanding and recall of medical risk in all patients.
authors.affiliation: Laboratory of E-learning and Multimedia Research, Bruce W. Carter VA Geriatric Research Education and Clinical Center (GRECC), Miami, USA; University of Miami Miller School of Medicine, Miami, USA. Electronic address: Jruiz2@med.miami.edu.
authors.forename: Jorge G
authors.initials: JG
authors.lastname: Ruiz
authors.forename: Allen D
authors.initials: AD
authors.lastname: Andrade
authors.forename: Rocio
authors.initials: R
authors.lastname: Garcia-Retamero
authors.forename: Ramanakumar
authors.initials: R
authors.lastname: Anam
authors.forename: Remberto
authors.initials: R
authors.lastname: Rodriguez
authors.forename: Joseph
authors.initials: J
authors.lastname: Sharit
mesh_terms: D000328:Adult; D001296:Audiovisual Aids; D002318:Cardiovascular Diseases / Q000517:prevention & control; D003142:Communication; D032882:Comprehension; D003657:Decision Making; D005260:Female; D057220:Health Literacy; D006801:Humans; D008297:Male; D008433:Mathematics; D011939:Mental Recall; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D010465:Perception; D012306:Risk; D020377:Self Efficacy; D014728:Veterans
keywords: Cardiovascular risk; Decision-making; Graphical literacy; Health literacy; Icon arrays; Numeracy; Perception of risk; Visual aids