title: Subjective Numeracy and the Influence of Order and Amount of Audible Information on Perceived Medication Value.
abstract: Order and amount of information influence patients' risk perceptions, but most studies have evaluated patients' reactions to written materials. The objective of this study was to examine the effect of 4 communication strategies, varying in their order and/or amount of information, on judgments related to an audible description of a new medication and among patients who varied in subjective numeracy.
  
  
  
  We created 5 versions of a hypothetical scenario describing a new medication. The versions were composed to elucidate whether order and/or amount of the information describing benefits and adverse events influenced how subjects valued a new medication. After listening to a randomly assigned version, perceived medication value was measured by asking subjects to choose one of the following statements: the risks outweigh the benefits, the risks and benefits are equally balanced, or the benefits outweigh the risks.
  
  
  
  Of the 432 patients contacted, 389 participated in the study. Listening to a brief description of benefits followed by an extended description of adverse events resulted in a greater likelihood of perceiving that the medication's benefits outweighed the risks compared with 1) presenting the extended adverse events description before the benefits, 2) giving a greater amount of information related to benefits, and 3) sandwiching the adverse events between benefits. These associations were only observed among subjects with average or higher subjective numeracy.
  
  
  
  If confirmed in future studies, our results suggest that, for patients with average or better subjective numeracy, perceived medication value is highest when a brief presentation of benefits is followed by an extended description of adverse events.
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA (LF, SS, HC).|VA Connecticut Healthcare System, West Haven, CT, USA (LF).
authors.forename: Liana
authors.initials: L
authors.lastname: Fraenkel
authors.affiliation: Yale Center for Analytical Sciences, Yale University School of Public Health, New Haven, CT, USA (MS).
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stolar
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA (LF, SS, HC).
authors.forename: Sarah
authors.initials: S
authors.lastname: Swift
authors.affiliation: Department of Communication, Texas A&M University, College Station, TX, USA (RLS).|Houston Center for Innovations in Quality, Effectiveness, and Safety and Baylor College of Medicine, Houston, TX, USA (RLS).
authors.forename: Richard L
authors.initials: RL
authors.lastname: Street
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA (LF, SS, HC).
authors.forename: Harjinder
authors.initials: H
authors.lastname: Chowdhary
authors.affiliation: Psychology Department, The Ohio State University, Columbus, OH, USA (EP).
authors.forename: Ellen
authors.initials: E
authors.lastname: Peters
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D032882:Comprehension; D003362:Cost-Benefit Analysis; D003657:Decision Making; D005260:Female; D006801:Humans; D000067010:Literacy; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology*; D057240:Patient Preference / Q000523:psychology*; D010465:Perception; D055553:Prescription Drugs / Q000009:adverse effects*; D018570:Risk Assessment
chemical_list: D055553:Prescription Drugs
keywords: cognitive psychology; numeracy; rheumatology; risk communication; risk perception