title: Making comparative performance information more comprehensible: an experimental evaluation of the impact of formats on consumer understanding.
abstract: We aimed to investigate how different presentation formats influence comprehension and use of comparative performance information (CPI) among consumers.
  
  
  
  An experimental between-subjects and within-subjects design with manipulations of CPI presentation formats. We enrolled both consumers with lower socioeconomic status (SES)/cognitive skills and consumers with higher SES/cognitive skills, recruited through an online access panel. Respondents received fictitious CPI and completed questions about interpretation and information use. Between subjects, we tested (1) displaying an overall performance score (yes/no); (2) displaying a small number of quality indicators (5 vs 9); and (3) displaying different types of evaluative symbols (star ratings, coloured dots and word icons vs numbers and bar graphs). Within subjects, we tested the effect of a reduced number of healthcare providers (5 vs 20). Data were analysed using descriptive analysis, analyses of variance and paired-sampled t tests.
  
  
  
  A total of 902 (43%) respondents participated. Displaying an overall performance score and the use of coloured dots and word icons particularly enhanced consumer understanding. Importantly, respondents provided with coloured dots most often correctly selected the top three healthcare providers (84.3%), compared with word icons (76.6% correct), star ratings (70.6% correct), numbers (62.0%) and bars (54.2%) when viewing performance scores of 20 providers. Furthermore, a reduced number of healthcare providers appeared to support consumers, for example, when provided with 20 providers, 69.5% correctly selected the top three, compared with 80.2% with five providers.
  
  
  
  Particular presentation formats enhanced consumer understanding of CPI, most importantly the use of overall performance scores, word icons and coloured dots, and a reduced number of providers displayed. Public report efforts should use these formats to maximise impact on consumers.
authors.affiliation: Department of Public and Occupational Health and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Olga C
authors.initials: OC
authors.lastname: Damman
authors.affiliation: Dutch National Health Care Institute, Diemen, The Netherlands.
authors.forename: Anco
authors.initials: A
authors.lastname: De Jong
authors.affiliation: Department of Planning, Public Policy & Management, University of Oregon, Eugene, OR, USA.
authors.forename: Judith H
authors.initials: JH
authors.lastname: Hibbard
authors.affiliation: Department of Public and Occupational Health and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Danielle R M
authors.initials: DR
authors.lastname: Timmermans
mesh_terms: D000076363:Academic Success; D032882:Comprehension; D003258:Consumer Behavior; D054626:Consumer Health Information / Q000379:methods*; D057220:Health Literacy; D006282:Health Personnel / Q000592:standards*; D006707:Homes for the Aged / Q000592:standards; D006801:Humans; D033181:Information Dissemination; D009426:Netherlands; D009735:Nursing Homes / Q000592:standards; D010358:Patient Participation; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards*; D012959:Socioeconomic Factors; D000066477:Work Performance / Q000592:standards*
keywords: Communication; Decision making; Nursing homes; Performance measures; Report cards