Blocks, ovals, or people? Icon type affects risk perceptions and recall of pictographs.
Research has demonstrated that icon arrays (also called "pictographs") are an effective method of communicating risk statistics and appear particularly useful to less numerate and less graphically literate people. Yet research is very limited regarding whether icon type affects how people interpret and remember these graphs.



1502 people age 35-75 from a demographically diverse online panel completed a cardiovascular risk calculator based on Framingham data using their actual age, weight, and other health data. Participants received their risk estimate in an icon array graphic that used 1 of 6 types of icons: rectangular blocks, filled ovals, smile/frown faces, an outline of a person's head and shoulders, male/female "restroom" person icons (gender matched), or actual head-and-shoulder photographs of people of varied races (gender matched). In each icon array, blue icons represented cardiovascular events and gray icons represented those who would not experience an event. We measured perceived risk magnitude, approximate recall, and opinions about the icon arrays, as well as subjective numeracy and an abbreviated measure of graphical literacy.



Risk recall was significantly higher with more anthropomorphic icons (restroom icons, head outlines, and photos) than with other icon types, and participants rated restroom icons as most preferred. However, while restroom icons resulted in the highest correlations between perceived and actual risk among more numerate/graphically literate participants, they performed no better than other icon types among less numerate/graphically literate participants.



Icon type influences both risk perceptions and risk recall, with restroom icons in particular resulting in improved outcomes. However, optimal icon types may depend on numeracy and/or graphical literacy skills.
Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI (BJZF).|Division of General Medicine, Department of Internal Medicine, University of Michigan,
Ann Arbor, MI (BJZF, AF)|Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI (BJZF, HOW, MD,
AFF, VCK, NLE, MV, LGH, LDS, AF)|Risk Science Center, University of Michigan, Ann Arbor, MI (BJZF)
Brian J
BJ
Zikmund-Fisher
Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI (BJZF, HOW, MD,
AFF, VCK, NLE, MV, LGH, LDS, AF)|Office of Education and Continuing Professional Development, Faculty of Medicine, Universite´ Laval, Quebec
City, Quebec, Canada (HOW)|Department of Family and Emergency Medicine, Faculty of Medicine, Universite´ Laval, Quebec City, Quebec, Canada (HOW)|Research Centre of the CHU de Que´ bec, Quebec City, Quebec, Canada (HOW)
Holly O
HO
Witteman
Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI (BJZF, HOW, MD,
AFF, VCK, NLE, MV, LGH, LDS, AF)|Sitesteaders Development, Ann Arbor, MI (MD)
Mark
M
Dickson
Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI (BJZF, HOW, MD,
AFF, VCK, NLE, MV, LGH, LDS, AF)|Research Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor, MI (AFF)
Andrea
A
Fuhrel-Forbis
Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI (BJZF, HOW, MD,
AFF, VCK, NLE, MV, LGH, LDS, AF)
Valerie C
VC
Kahn
Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI (BJZF, HOW, MD,
AFF, VCK, NLE, MV, LGH, LDS, AF)
Nicole L
NL
Exe
Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI (BJZF, HOW, MD,
AFF, VCK, NLE, MV, LGH, LDS, AF)|Division of Health Promotion and Behavioral Science, University of Texas School of Public Health at Houston, San Antonio Regional Campus, San Antonio, TX (MV)
Melissa
M
Valerio
ReThink Health, Morristown, NJ (LGH)
Lisa G
LG
Holtzman
Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI (BJZF, HOW, MD,
AFF, VCK, NLE, MV, LGH, LDS, AF)|Department of Psychological Sciences, University of Missouri, Columbia, MO (LDS)|Department of Psychology, University of Michigan, Ann Arbor, MI (LDS, AF)
Laura D
LD
Scherer
Division of General Medicine, Department of Internal Medicine, University of Michigan,
Ann Arbor, MI (BJZF, AF)|Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI (BJZF, HOW, MD,
AFF, VCK, NLE, MV, LGH, LDS, AF)|Department of Psychology, University of Michigan, Ann Arbor, MI (LDS, AF)|Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI (AF)
Angela
A
Fagerlin
D000328:Adult; D000367:Age Factors; D000368:Aged; D001154:Art; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000523:psychology*; D002784:Cholesterol / Q000097:blood; D003142:Communication; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors
D002784:Cholesterol
decision aids; patient education as topic; patient-provider communication; risk; visual aids