Abstract
Background If communicated adequately, numerical decision-relevant information can support informed and shared decision making. Visual formats are recommended, but which format supports patients depending on their health literacy (HL) levels for specific decisions is unclear. Study aim The aim of this study is to investigate: 1) the effect of survival rates and side-effects presentation formats on comprehension and ‘feeling informed’; 2) differential effects among women with higher/lower HL, with adjuvant systemic breast cancer therapy as case example. Methods Two online experiments among women from the Dutch population without a history of breast cancer were conducted. Experiment 1 had a 3 (survival rate format: text block–bar graph– icon array) x 2 (HL: low–high) between-subjects design. Experiment 2 had a 5 (side-effects format: no probability information–probability information in numbers with or without a visualisation–probability information in numbers with or without a visualisation accompanied by a description of the side-effects) x 2 (HL: low–high) design. Primary outcomes were comprehension and feeling informed (Experiment 2 only). Formats were previously designed in cocreation with patients. PLOS ONE PLOS ONE | September 3, 2024 1 / 23 OPEN ACCESS Citation: van Strien-Knippenberg IS, Timmermans DRM, Engelhardt EG, Konings IRHM, Damman OC (2024) Presenting decision-relevant numerical information to Dutch women aged 50–70 with varying levels of health literacy: Case example of adjuvant systemic therapy for breast cancer. PLoS ONE 19(9): e0309668. journal.pone.0309668 Editor: Felix G. Rebitschek, University of Potsdam: Universitat Potsdam, GERMANY Received: October 17, 2023 Accepted: August 15, 2024 Published: September 3, 2024 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: Copyright: © 2024 van Strien-Knippenberg et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Results In Experiment 1, presentation format did not affect gist or verbatim comprehension. Higher HL was associated with higher gist comprehension. Experiment 2 showed an interaction between presentation format and HL on ‘feeling informed’. When provided with visualised probability information without a description of the side-effects, women with lower HL felt better informed than women with higher HL. Conclusion Visual formats did not enhance comprehension of survival rate info