How Do Women Interpret the NHS Information Leaflet about Cervical Cancer Screening?

Background. Organized screening programs often rely on written materials to inform the public. In the United Kingdom, women invited for cervical cancer screening receive a leaflet from the National Health Service (NHS) to support screening decisions. However, information about screening may be too complex for people to understand, potentially hindering informed decision making. Objectives. We aimed to identify women’s difficulties in interpreting the leaflet used in England and negative and positive responses to the leaflet. Methods. We used a sequential mixedmethods design involving 2 steps: cognitive think-aloud interviews (n = 20), followed by an England-wide survey (n = 602). Data were collected between June 2017 and December 2018, and participants included women aged 25 to 64 y with varying sociodemographics. Results. Interview results revealed misunderstandings concerning screening results, benefits, and additional tests and treatment, although participants tended to react positively to numerical information. Participants were often unfamiliar with the potential harms associated with screening (i.e., screening risks), key aspects of human papillomavirus, and complex terms (e.g., dyskaryosis). Survey results indicated that interpretation difficulties were common (M correct items = 12.5 of 23). Lower understanding was associated with lower educational level (b’s .0.15, P’s \0.001), lower numeracy scores (b = 0.36, P \ 0.001), and nonwhite ethnicity (b = 0.10, P = 0.007). The leaflet was evaluated positively overall. Conclusions. Despite previous user testing of the leaflet, key information may be too complex for some recipients. As a consequence, they may struggle to make informed decisions about screening participation based on the information provided. We discuss implications for the improvement of communications about screening and decision support

I can take the risk, but you should be safe: Self-other differences in situations involving physical safety

Prior research on self-other differences involving risk have found that individuals make riskier decisions for others than for the self in situations where risk taking is valued. We expand this research by examining whether the direction of self-other differences reverses when risk aversion is valued, as predicted by social values theory (Stone & Allgaier, 2008). Two studies tested for self-other differences in physical safety scenarios, a domain where risk aversion is valued. In Study 1, participants read physical safety and romantic relationship scenarios and selected what they would decide for themselves, what they would decide for a friend, or what they would predict their friend would decide. In Study 2, participants read public health scenarios and either decided or predicted for themselves and for a friend. In keeping with social values theory, participants made more risk-averse decisions for others than for themselves in situations where risk aversion is valued (physical safety scenarios) but more risk-taking decisions for others than for themselves in situations where risk taking is valued (relationship scenarios). Further, we show that these self-other differences in decision making do not arise from incorrectly predicting others’ behaviors, as participants predicted that others’ decisions regarding physical safety scenarios would be either similar (Experiment 1) or more risk taking (Experiment 2) than their own decisions

Decision-making competence in younger and older adults: which cognitive abilities contribute to the application of decision rules?

Older adults perform worse than younger adults when applying decision rules to choose between options that vary along multiple attributes. Although previous studies have shown that general fluid cognitive abilities contribute to the accurate application of decision rules, relatively little is known about which specific cognitive abilities play the most important role. We examined the independent roles of working memory, verbal fluency, semantic knowledge, and components of executive functioning. We found that age-related decline in applying decision rules was statistically mediated by age-related decline in working memory and verbal fluency. Our results have implications for theories of aging and decision-making

Know Your Epidemic, Know Your Response: COVID-19 in the United States

We document that during the week of March 10-16, the Covid-19 pandemic fundamentally affected the perceptions of U.S. residents about the health risks and socioeconomic consequences entailed by the pandemic. During this week, it seems, everything changed. Not only did the pandemic progress rapidly across the United States, but U.S. residents started to realize that the threat was real: increasing Covid-19 caseloads heightened perceptions of infection risks and excess mortality risks, concerns about the economic implications increased substantially, and behavioral responses became widespread as the pandemic expanded rapidly in the U.S. In early to mid-March 2020, average perceptions about the coronavirus infection risks are broadly consistent with projections about the pandemic, while expectations about dying conditional on infection and expectations about Covid-19-related excess mortality during the next months are possibly too pessimistic. However, some aspects of Covid-19 perceptions are disconcerting from the perspective of implementing and sustaining an effective societal response to the pandemic. For instance, the education gradient in expected infection risks entails the possibility of having different perceptions of the reality of the pandemic between people with and without a college education, potentially resulting in two different levels of behavioral and policy-responses across individuals and regions. Unless addressed by effective health communication that reaches individuals across all social strata, some of the misperceptions about Covid-19 epidemic raise concerns about the ability of the United States to implement and sustain the widespread and harsh policies that are required to curtail the pandemic. Our analyses also reveal perceptions of becoming infected with the virus, and dying from Covid-19, were driven upwards by a rapidly increasing national caseload, and perceptions of the economic consequences and the adaptation of social distancing were affected by both national and state-level cases

Heat protection behaviour in the UK: Results of an online survey after the 2013 heatwave

Background: The Heatwave Plan for England provides guidance for personal and home protection measures during heatwaves. Although studies in the USA, Australia and Europe have surveyed heat-related behaviours during heatwaves, few have been conducted in the UK. This study assesses personal and housing (at-home) behaviour and housing characteristics of the UK population during the 2013 heatwave. Methods: This paper analyses data from 1497 respondents of an online survey on heat protection measures and behaviour. Participants were asked questions about their behaviour during the 2013 heatwave, the characteristics of their current housing as well as about any negative health outcomes experienced due to the hot weather. We used multinomial logit regression to analyse personal and home heat protection behaviour and logistic regression to analyse characteristics of participants' current home (installed air conditioner, curtains etc.). We stratified the outcomes by age, sex, ethnicity, income, education and regional location. Results: In 2013, for all heat-related illness (except tiredness), a higher proportion of those in the younger age groups reported symptoms compared with those in the older age groups. Women, higher income groups and those with higher education levels were found to be more likely to report always/often taking personal heat protective measures. The elderly were less likely to take some personal and home protective measures but were more likely to live in insulated homes and open windows at night to keep their home cool. Conclusion: Our study has found a high level of awareness of the actions to take during heatwaves in the UK, and has identified important demographic indicators of sections of the UK population that might benefit from additional or more targeted information. The health agencies should attempt to provide better information about heatwaves to those vulnerable (elderly, those at risk living in London, low income earners) or identify any barriers that might be preventing them from undertaking protective behaviour

Reflections on an interdisciplinary collaboration to inform public understanding of climate change, mitigation, and impacts

We describe two interdisciplinary projects in which natural scientists and engineers, as well as psychologists and other behavioral scientists, worked together to better communicate about climate change, including mitigation and impacts. One project focused on understanding and informing public perceptions of an emerging technology to capture and sequester carbon dioxide from coal-fired power plants, as well as other low-carbon electricity-generation technologies. A second project focused on public understanding about carbon dioxide’s residence time in the atmosphere. In both projects, we applied the mental-models approach, which aims to design effective communications by using insights from interdisciplinary teams of experts and mental models elicited from intended audience members. In addition to summarizing our findings, we discuss the process of interdisciplinary collaboration that we pursued in framing and completing both projects. We conclude by describing what we think we have learned about the conditions that supported our ongoing interdisciplinary collaborations

Effects of simplifying outreach materials for energy conservation programs that target low-income consumers

Critics have speculated that the limited success of energy conservation programs among low-income consumers may partly be due to recipients having insufficient literacy to understand the outreach materials. Indeed, we found outreach materials for low-income consumers to require relatively high levels of reading comprehension. We therefore improved the Flesch-Kincaid readability statistics for two outreach brochures, by using shorter words and shorter sentences to describe their content. We examined the effect of that simplification on low-income consumers' responses. Participants from low-income communities in the greater Pittsburgh area, who varied in literacy, were randomly assigned to either original communications about energy conservation programs or our simplified versions. Our findings suggest that lowering readability statistics successfully simplified only the more straightforward brochure in our set of two, likely because its content lent itself better to simplification. Findings for this brochure showed that simplification improved understanding of its content among both low-literacy and high-literacy recipients, without adversely affecting their evaluation of the materials, or their intention to enroll in the advertised programs. We discuss strategies for improving communication materials that aim to reach out to low-income populations

Consumers' perceptions of energy use and energy savings: A literature review

Background. Policy makers and program managers need to better understand consumers' perceptions of their energy use and savings to design effective strategies for promoting energy savings. Methods. We reviewed 14 studies from the emerging interdisciplinary literature examining consumers' perceptions electricity use by specific appliances, and potential savings. Results. We find that: (1) electricity use is often overestimated for low-energy consuming appliances, and underestimated for high-energy consuming appliances; (2) curtailment strategies are typically preferred over energy efficiency strategies; (3) consumers lack information about how much electricity can be saved through specific strategies; (4) consumers use heuristics for assessing the electricity use of specific appliances, with some indication that more accurate judgments are made among consumers with higher numeracy and stronger pro-environmental attitudes. However, design differences between studies, such as variations in reference points, reporting units and assessed time periods, may affect consumers' reported perceptions. Moreover, studies differ with regard to whether accuracy of perceptions was evaluated through comparisons with general estimates of actual use, self-reported use, household-level meter readings, or real-time smart meter readings. Conclusion. Although emerging findings are promising, systematic variations in the measurement of perceived and actual electricity use are potential cause for concern. We propose avenues for future research, so as to better understand, and possibly inform, consumers' perceptions of their electricity use. Ultimately, this literature will have implications for the design of effective electricity feedback for consumers, and related policies

Measuring risk perceptions: What does the excessive use of 50% mean?

Objectives. Risk perceptions are central to good health decisions. People can judge valid probabilities but use 50% disproportionately. The authors hypothesized that 50% is more likely than other responses to reflect not knowing the probability, especially among individuals with low education and numeracy, and evaluated the usefulness of eliciting “don’t know” explanations. Methods. Respondents (n = 1020) judged probabilities for living or dying in the next 10 years, indicating whether they gave a good estimate or did not know the chances. They completed demographics, medical history, and numeracy questions. Results. Overall, 50% was more likely than other probabilities to be explained as “don’t know” (v. “a good estimate”). Correlations of using 50% with low education and numeracy were mediated by expressing “don’t know.” Judged probabilities for survival and mortality explained as “don’t know” had lower correlations with age, diseases, and specialist visits. Conclusions. When judging risks, 50% may reflect not knowing the probability, especially among individuals with low numeracy and education. Probabilities expressed as “don’t know” are less valid. Eliciting uncertainty could benefit theoretical models and educational efforts