September 10, 2014 — Blog Post
Risk Perception and Health Communication
“Reason itself is fallible, and this fallibility must find a place in our logic” –Nicola Abbagnano
Healthcare is becoming more patient-centered, and patients are responsible for an increasing portion of the cost of their healthcare.
Neither of these statements are news, nor do they adequately describe the magnitude of the shifts occurring in the healthcare industry that lead to them. What both points do highlight, however, is that patients—or really, consumers—play in increasingly important role in determining what and how much care is appropriate for them. Locating this authority with the consumer drives many of the outcomes healthcare reform hopes to achieve, and results in measurable improvements across metrics that everyone can agree are desirable. However, like the statements above, it’s not that simple.
Humans have evolved what is, by any standard an awe-inspiring ability to perceive and interpret the world. We observe and internalize patterns of occurrences and other human behaviors that then guide our own actions and reactions, we unconsciously weigh and balance potential outcomes, and we constantly learn and build on our comprehension of the world around us.
But, we’re also emotional. Molded by the culture in which we are raised and our individual experiences, humans reach subjective judgments that inform their perception. Despite our incredible aptitude for logic and reason, we are still emotional—think “fight or flight” response—before we are Vulcan-like logic machines. As Dr. Joseph LeDoux, author of “The Emotional Brain,” explains: “the wiring of the brain at this point in our evolutionary history is such that connections from the emotional systems to the cognitive systems are stronger than connections from the cognitive systems to the emotional systems.” In essence, emotion informs our logic more than logic informs our emotion.
One subject on which the primacy of emotion can dramatically affect judgment is accurate perception of risk. Humans are terrible at assessing how dangerous something is, and are very easily manipulated and biased. Consider the social media explosion of concern over Ebola here in the United States. Ebola is trending, and often the tweets and posts reflect fears and reactions, not reality. In reality, a host of diseases endemic to or common in the United States (meningitis, tuberculosis, West Nile Virus, hepatitis, influenza) pose a far more significant risk to Americans than two closely monitored and extremely isolated patients at Emory. But none of those other diseases are a hemorrhagic fever. Now that is scary.
What does this have to do with patient-centered healthcare or paying more out of pocket?
Actually, quite a bit. If we’re asking patients to be informed consumers of their own healthcare—to weigh pros and cons, to assess risk and reward, and to accept the ramifications of their decisions—then it’s essential that they really understand their options, and the risks inherent in each. We need to take people who may have little to no experience in healthcare and explain complicated topics in ways that are meaningful and relevant to them. Truly patient-centered medicine requires an educated consumer who carefully weighs options and makes a choice based on their preferences. Informed consumers also weigh the economic trade offs between quality and cost, experience of physician and appointment availability, and seeking out or delaying preventive care. We cannot expect to reap the rewards of patient-centeredness and cost sharing without providing support for these new decision-makers. They must be educated, and thus far, our healthcare system hasn’t proven adept at doing so.
Luckily for the healthcare world, these are old challenges. Even without the recent attention, quite a bit of research has gone on over the past two decades surrounding health communications and risk perception. World-renowned universities and medical centers—including the Mayo Clinic, Carnegie Mellon University, Harvard University in partnership with Massachusetts General Hospital, and the University of Michigan, to name a few—have developed centers and institutes supporting research on exactly these subjects. Even more importantly, the newfound economic interest in these topics has driven the translation of this body of research into innovative, user-friendly, and evidence-based tools.
Visualizing Health, a partnership between CHCR and the Robert Wood Johnson Foundation, took on the challenge of visually communicating health-related statistics (including risk and prevalence) to patients in ways that were meaningful and clear. Enlisting graphic designers, the Visualizing Health team created dozens of visual depictions of common kinds of health statistics and tested how effective they were in communicating the takeaway messages. They then published a library of these graphics, and even more importantly, created a “Wizard” through which providers and public health practitioners can determine which of the tested and proven graphics would most effectively address a specific communication need. In doing so, the Visualizing Health team created an easy-to-access and an easy-to-use resource that enables evidence-based, high-impact communication of health risks by anyone, anywhere.
The Michigan Tailoring System is open-source software that takes specific characteristics and preferences of individual people, and generates health messages most relevant to their personal situation and needs. This incredibly powerful tool takes the efficacy of one-on-one counseling, which is personalized to each individual, and makes it available to thousands of people at once. CHCR has partnered with a variety of organizations, including health systems, to test the efficacy of such “tailored” messaging. From improving asthma management in Detroit teens to increasing mammogram compliance among high-risk populations in St. Louis, the programs have had significant impact.
Just think: in utilizing these two tools, we can not only ensure that we’re communicating only the most relevant and meaningful information, but also that we’re doing so in a way that we know people are most likely to understand. Building on this, one can imagine future health communications being completely personalized—from demographic information, to current health conditions, to an individual’s better comprehension of pie charts over other visualization options. We can account for the biases, the subjectivity, and the risk perception gap which with all humans view the world—including their health information. And in doing so, we can empower patients to be truly engaged, informed consumers of their healthcare.