title: The effect of modality and narration style on recall of online health information: results from a Web-based experiment.
abstract: BACKGROUND
  Older adults are increasingly using the Internet for health information; however, they are often not able to correctly recall Web-based information (eHealth information). Recall of information is crucial for optimal health outcomes, such as adequate disease management and adherence to medical regimes. Combining effective message strategies may help to improve recall of eHealth information among older adults. Presenting information in an audiovisual format using conversational narration style is expected to optimize recall of information compared to other combinations of modality and narration style.
  
  
  OBJECTIVE
  The aim of this paper is to investigate the effect of modality and narration style on recall of health information, and whether there are differences between younger and older adults.
  
  
  METHODS
  We conducted a Web-based experiment using a 2 (modality: written vs audiovisual information) by 2 (narration style: formal vs conversational style) between-subjects design (N=440). Age was assessed in the questionnaire and included as a factor: younger (<65 years) versus older (≥65 years) age. Participants were randomly assigned to one of four experimental webpages where information about lung cancer treatment was presented. A Web-based questionnaire assessed recall of eHealth information.
  
  
  RESULTS
  Audiovisual modality (vs written modality) was found to increase recall of information in both younger and older adults (P=.04). Although conversational narration style (vs formal narration style) did not increase recall of information (P=.17), a synergistic effect between modality and narration style was revealed: combining audiovisual information with conversational style outperformed combining written information with formal style (P=.01), as well as written information with conversational style (P=.045). This finding suggests that conversational style especially increases recall of information when presented audiovisually. This combination of modality and narration style improved recall of information among both younger and older adults.
  
  
  CONCLUSIONS
  We conclude that combining audiovisual information with conversational style is the best way to present eHealth information to younger and older adults. Even though older adults did not proportionally recall more when audiovisual information was combined with conversational style than younger adults, this study reveals interesting implications for improving eHealth information that is effective for both younger and older adults.
authors.affiliation: Amsterdam School of Communication Research / ASCoR, Department of Communication Science, University of Amsterdam, Amsterdam, Netherlands. n.bol@uva.nl.
authors.forename: Nadine
authors.identifier: http://orcid.org/0000-0002-6895-9512
authors.initials: N
authors.lastname: Bol
authors.forename: Julia C M
authors.identifier: http://orcid.org/0000-0002-2259-5864
authors.initials: JC
authors.lastname: van Weert
authors.forename: Hanneke C J M
authors.identifier: http://orcid.org/0000-0001-6541-0543
authors.initials: HC
authors.lastname: de Haes
authors.forename: Eugene F
authors.identifier: http://orcid.org/0000-0002-5563-935X
authors.initials: EF
authors.lastname: Loos
authors.forename: Ellen M A
authors.identifier: http://orcid.org/0000-0002-8145-8595
authors.initials: EM
authors.lastname: Smets
mesh_terms: D000328:Adult; D000368:Aged; D001296:Audiovisual Aids; D003142:Communication; D006801:Humans; D057226:Information Seeking Behavior; D020407:Internet; D008570:Memory, Short-Term; D011939:Mental Recall; D011897:Random Allocation; D017216:Telemedicine
keywords: age groups; consumer health information; instructional films and videos; memory; mental recall; narration; patient education; personal narratives