Age, education and health literacy affects how people understand risk

We know that people have difficulties interpreting risk information correctly. This is a challenge for researches who want to know how people weigh possible risks against benefits. A recent study shows that age, education and health literacy affect the ability to understand risks. This means researchers need to have strategies in place for accurately measuring preferences regarding risk.

One way to measure how people weigh risks and benefits when making decisions about treatments is discrete choice experiments (DCE’s). These DCE questionnaires allow researchers to see the relative importance of certain treatment characteristics for respondents when they make a treatment decision. But if people do not understand risks, the accuracy of their trade-offs and the relative importance they assign is limited. This is also true if people group these numbers in categories that make sense for them, like high, medium and low.

Most people use complex decision strategies and are able to complete a DCE questionnaire, but there are some groups that stand out. A study that was recently published in BMC Medical Research Methodology shows that people with lower education and health literacy find it difficult to understand all the information they are provided with. These groups tend to use less complex decision strategies to make their choices. According to the authors, these groups also showed to have difficulties with interpreting and understanding the risk attributes of the questionnaires correctly.

Jorien Veldwijk is the academic co-lead for the case studies (Link removed) that will be conducted in PREFER. She is also one of the authors and has worked with DCE’s for several years. According to her, age, education and health literacy should be included in DCE questionnaires as a standard measure. She also recommends a thorough pilot testing phase the questionnaire is developed, including think-aloud testing.

The study is based on structured interviews with 70 participants that evaluated and completed four discrete choice tasks aloud. According to the authors, researchers who want to use DCE’s should take some preventative steps to avoid bias based on the participants’ age, education and health literacy. The authors recommend a kind of mini-lab setup, where participants can complete the questionnaire in the presence of a researcher who can explain the questionnaire and answer questions. In online research setups, they believe researchers should provide explanations of the attributes in pop-up texts or audio, and offering the option to repeat explanations when participants complete the choice tasks.

Read article BMC Medical Research Methodology: Exploring how individuals complete the choice tasks in a discrete choice experiment: an interview study

By Josepine Fernow

(Image removed) Jorien Veldwijk is academic co-lead of the case studies work conducted in PREFER





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The Patient Preferences in Benefit-Risk Assessments during the Drug Life Cycle (PREFER) project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 115966. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and the European Federation of Pharmaceutical Industries and Associations (EFPIA).