Article Text

Original research
Effect of different visual presentations on the public’s comprehension of prognostic information using acute and chronic condition scenarios: two online randomised controlled trials
  1. Eman Abukmail,
  2. Mina Bakhit,
  3. Mark Jones,
  4. Chris Del Mar,
  5. Tammy Hoffmann
  1. Institute for Evidence-Based Healthcare (IEBH), Faculty of Health Sciences and Medicine (HSM), Bond University, Robina, Queensland, Australia
  1. Correspondence to Dr Eman Abukmail; eabukmai{at}bond.edu.au

Abstract

Objectives To assess the effectiveness of bar graph, pictograph and line graph compared with text-only, and to each other, for communicating prognosis to the public.

Design Two online four-arm parallel-group randomised controlled trials. Statistical significance was set at p<0.016 to allow for three-primary comparisons.

Participants and setting Two Australian samples were recruited from members registered at Dynata online survey company. In trial A: 470 participants were randomised to one of the four arms, 417 were included in the analysis. In trial B: 499 were randomised and 433 were analysed.

Interventions In each trial four visual presentations were tested: bar graph, pictograph, line graph and text-only. Trial A communicated prognostic information about an acute condition (acute otitis media) and trial B about a chronic condition (lateral epicondylitis). Both conditions are typically managed in primary care where ‘wait and see’ is a legitimate option.

Main outcome Comprehension of information (scored 0–6).

Secondary outcomes Decision intention, presentation satisfaction and preferences.

Results In both trials, the mean comprehension score was 3.7 for the text-only group. None of the visual presentations were superior to text-only. In trial A, the adjusted mean difference (MD) compared with text-only was: 0.19 (95% CI −0.16 to 0.55) for bar graph, 0.4 (0.04 to 0.76) for pictograph and 0.06 (−0.32 to 0.44) for line graph. In trial B, the adjusted MD was: 0.1 (−0.27 to 0.47) for bar graph), 0.38 (0.01 to 0.74) for pictograph and 0.1 (−0.27 to 0.48) for line graph. Pairwise comparisons between the three graphs showed all were clinically equivalent (95% CIs between −1.0 and 1.0). In both trials, bar graph was the most preferred presentation (chosen by 32.9% of trial A participants and 35.6% in trial B).

Conclusions Any of the four visual presentations tested may be suitable to use when discussing quantitative prognostic information.

Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12621001305819).

  • general medicine (see internal medicine)
  • primary care
  • internal medicine
  • prognosis

Data availability statement

Data are available in a public, open access repository. All data relevant to the study are included in the article or uploaded as supplementary information. Data is available in a public, open access repository. Analysed data relevant to the study are included in the article or uploaded as supplementary information.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available in a public, open access repository. All data relevant to the study are included in the article or uploaded as supplementary information. Data is available in a public, open access repository. Analysed data relevant to the study are included in the article or uploaded as supplementary information.

View Full Text

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

Footnotes

  • Twitter @EAbukmail, @Mina_Bakhit

  • Deceased Prof. Chris Del Mar made invaluable contributions to this work, leaving a lasting impact on its development, with deep gratitude for his profound insights and expertise, we fondly remember him following his passing in 2022.

  • Contributors EA, TH and CDM conceived the idea of this study. EA developed the interventions with support from TH, CDM and MB. MB helped in the refinement of pictographs intervention. EA, TH and CDM developed the survey. TH was reviewing and giving feedback on all the steps. Data collection was managed by Dynata under the direction of EA, TH. Data were analysed by EA, MJ and MB. EA drafted the main manuscript and developed all tables and figures with support and feedback from all authors. EA is responsible for the overall content as the guarantor. All authors reviewed the final version of the manuscript and approved it for submission.

  • Funding This work was supported by the Centre for Research Excellence in Minimizing Antibiotic Resistance in the Community (CRE-MARC), funded by the Australian National Health and Medical Research Council grant number (1153299).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.