Tailored information for cancer patients on the Internet: Effects of visual cues and language complexity on information recall and satisfaction
Introduction
In recent decades, the Internet has become a widely used medium to access health-related information. Worldwide, more than 12 million sites that contain health information are used each day [1]. Cancer is among the top three diseases that patients research on the Internet [2]. One of the main reasons cancer patients use the Internet is to search for informational support, which can be explained as the need for information on cancer or its treatment [3]. Because it appears that cancer patients consistently have unmet information needs [4], providing high-quality information on the Internet in addition to improving patient-provider communication may help to meet these needs [5]. Indeed, research has demonstrated that cancer patients who use the Internet to search for information about their illness are better able to cope with the illness [6] and feel better informed and better prepared [7]. This result suggests that website use may improve patient understanding and recall of cancer-related information i.e., their ability to understand and reproduce the message. In turn, patients’ accurate recall of information, is likely to improve outcomes in terms of better compliance [8], [9], more adequate disease management and decreased anxiety [10], [11]. In addition, there is a robust relationship between positive affect and memory such that when messages evoke positive feelings (including satisfaction), they cue memories that have previously been associated with positive affect [12]. This concept supports the idea that website satisfaction is important to attract attention, increase information processing and improve information recall.
Although the Internet is acknowledged as a powerful source of information for patients, individuals are not always satisfied with the health information that they find online. First, many people struggle to find the specific information that they need [13]. This challenge may be due to an information overload on the Internet [14], which makes it difficult for patients to find what they are looking for and to filter out the information that is relevant to their specific situation [6]. To overcome this problem, a new information strategy has been proposed, which is the tailored information strategy [15], [16]. Tailored information uses individual characteristics to create a personalised message. Empirical health communication research confirms that tailored interventions are more effective than standard information with respect to, for instance, perceived relevance, information recall and behaviour change [17], [18], [19], [20], [21], [22].
Incomprehensibility is a second cause of dissatisfaction with online health information. Health websites often use complex medical terminology, and much of the medical information that is targeted towards patients on the Internet is written at a reading level that is too high to be easily understood by many patients [23], [24], [25]. This suggests that while tailored websites may greatly improve the relevance of information, the information might still be incomprehensible to many health information seekers. This seems to be the case for personalised websites as well, which have recently emerged as a form of tailored information. Personalised websites are set up to meet the specific information needs of individual patients and contain specific disease and treatment information for the exclusive use of each patient [26]. It is important not to confuse personalised websites with automated systems that deliver personalised health information based on algorithms, which is a different form of tailored interventions [16]. A recent example of a personalised website is the website designed for cancer patients at the Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital (NCI–AVL). Patients obtain a login name and a password that provide them with in-home access to their personalised website. The website provides specific information on the diagnostic tests and treatments that they will receive. A pilot study among 22 students confirmed that the comprehensibility of this website was not optimal, and the following recommendations for improvement were made: (1) the language should be simplified and (2) images should be used to complement textual information. Therefore, the aim of this study was to test whether reducing language complexity (textual health information) and using images or visuals cues (graphical health information) can increase patients’ satisfaction with a personalised website. We distinguished two subdimensions of website satisfaction, i.e., ‘satisfaction with comprehensibility’ and ‘satisfaction with attractiveness’, which refer to the textual and graphic information on the website, respectively. Because the primary purpose of tailored online health information is to inform patients [7] and because the literature suggests that the addition of visual information will result in cognitive gain and improved recall [27], the effects on patient recall of online health information were also be examined.
Section snippets
Theory and hypotheses
Message comprehensibility increases the recipient's opportunity to process information, which might result in improved cognitive responses, such as information recall [28], [29], [30], [31]. The expected positive relationship between comprehensible information and recall scores is supported by numerous health communication studies, which report that non-complex or easy-to-read texts are effective in improving patients’ understanding and recall of information [32], [33], [34], [35], [36], [37],
Design
The experimental study involved a 2 (complex vs. non-complex language) × 3 (text only vs. labelled photograph vs. labelled drawing) between-subjects factorial design (see Fig. 1). The participants were randomly assigned by a computer to one of the six conditions. A page of an existing website, i.e., the personalised website of NCI–AVL, was used with short and global information on surgeries for the treatment of lung cancer, such as segment resection, and more specific information regarding the
Participants
Table 1 shows the background characteristics of the participants. The majority of the participants was female, with a mean age of 39 years, and almost half had completed a high-level education.
There were no significant differences in the conditions of age, gender, education, living situation, online surfing behaviour, cancer experience and medical knowledge about the lungs and lung cancer (treatment) among the participants. There were also no differences in the condition of mean time spent on
Discussion
The results of this study indicate that the use of visual cues is especially important to increase satisfaction with comprehensibility, while the use of non-complex language seems to be more decisive for information recall. Although our literature review did not clearly indicate that visual cues should add value in the complex language conditions (vs. non-complex language conditions), this idea intuitively makes sense. If people do not understand the text because the language is too complex,
Conflict of interest
None declared.
Role of funding
This study was funded by the Amsterdam School of Communication Research ASCoR from the University of Amsterdam, Amsterdam, The Netherlands. ASCoR management was not involved in study design; data collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
Acknowledgements
The authors thank the Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, in particular Carola Koopman, for the nice cooperation and permission to use their personalized website for lung cancer patients. Furthermore, we thank the students Communication Science of the University of Amsterdam who participated in this study for their collaboration in data collection.
References (81)
- et al.
Cancer information: a cost-effective intervention
Eur J Cancer
(1999) - et al.
Ethnic differences in choices of health information by cancer patients using complementary and alternative medicine: an exploratory study with correspondence analysis
Soc Sci Med
(2003) - et al.
Computer-tailored health interventions delivered over the web: review and analysis of key components
Patient Educ Couns
(2009) - et al.
The application and impact of computer-generated personalized nutrition education: a review of the literature
Patient Educ Couns
(1999) Computer-tailored smoking cessation materials: a review and discussion
Patient Educ Couns
(1999)- et al.
A review of computer and Internet-based interventions for smoking behavior
Addict Behav
(2006) - et al.
Discharge instructions: do illustrations help our patients understand them?
Ann Emerg Med
(1995) - et al.
Increased readability improves the comprehension of written information for patients with skin disease
J Am Acad Dermatol
(1988) - et al.
The role of pictures in improving health communication: a review of research attention, comprehension, recall, and adherence
Patient Educ Couns
(2006) - et al.
The influence of text characteristics on perceived and actual difficulty of health information
Int J Med Inf
(2010)
Aids to computer-based multimedia learning
Eur Res Int
Website design: viewing the web as a cognitive landscape
J Bus Res
Pictures and text in instructions for medical devices: effects on recall and actual performance
Patient Educ Couns
Web-based education for low-literate parents in Neonatal Intensive Care Unit: development of a website and heuristic evaluation and usability testing
Int J Med Inform
Designing an electronic commerce interface: attention and product memory as elicited by web design
Electron Commer R A
Aging and motivated cognition: the positivity effect in attention and memory
Trends Cogn Sci
The use of illustration to improve older adults’ comprehension of health-related information: is it helpful?
Patient Educ Couns
Aging memory for pictures: using high-density event-related potentials to understand the effect of aging on the picture superiority effect
Neuropsychologia
Comprehension of illustrated text: pictures help to build mental models
J Mem Lang
At the movies, on the web: an investigation of the effects of entertaining and interactive web content on site and brand evaluations
J Interact Mark
Internet use for cancer information among racial/ethnic populations and low literacy groups
Cancer Control
Racial/ethnic differences and potential psychological benefits in use of the Internet by women with breast cancer
Psycho-Oncology
The communication goals and needs of cancer patients: a review
Psycho-Oncology
How Internet users find, evaluate, and use online health information: a cross-cultural review
Cyberpsychol Behav
Internet use in physician practice and patient interaction
The impact of the internet on cancer outcomes
CA Cancer J Clin
Patients’ memory for medical information
J R Soc Med
Patient compliance: recognition of factors involved and suggestions for promoting compliance with therapeutic regimens
J Adv Nurs
Informational needs of women with a recent diagnosis of breast cancer: development and initial testing of a tool
J Adv Nurs
Thinking positively: using positive affect when designing health messages
Ethnicity and participation in cancer self-help groups
Psycho-Oncology
Advancing tailored health communication: a persuasion and message effects perspective
J Commun
A systematic review of randomized trials on the effectiveness of computer-tailored education on physical activity and dietary behaviors
Ann Behav Med
Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions
Psychol Bull
Interventions to improve recall of medical information in cancer patients: a systematic review of the literature
Psycho-Oncology
Health information on the Internet: accessibility, quality, and readability in English and Spanish
J Amer Med Assoc
Improving comprehension for cancer patients with low literacy skills: strategies for clinicians
CA Cancer J Clin
Readability levels of patient education material on the World Wide Web
J Fam Pract
IVF and Internet. Evaluation of an interactive personal health record for IVF patients
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