Academic journal article The Journal of Consumer Affairs

Do Pictographs Affect Probability Comprehension and Risk Perception of Multiple-Risk Communications?

Academic journal article The Journal of Consumer Affairs

Do Pictographs Affect Probability Comprehension and Risk Perception of Multiple-Risk Communications?

Article excerpt

The US health care system regards improving risk communication as a top priority (Rimer et al. 2004). Pictographs may serve as a valuable tool for communicating health-related risks to the public (for reviews, see Ancker et al. 2006; Garcia-Retamero and Cokely 2017). Pictographs use a matrix of icons (e.g. 100) to illustrate the frequencies of occurrence and nonoccurrence of an event (Garcia-Retamero, Galesic, and Gigerenzer 2010). For example, a pictograph could illustrate that among 100 users of a medication, 20 users experienced drowsiness as a side effect, while 80 users did not.

A limitation of previous research on pictographs is that it has focused on single rather than multiple-risk options (Ancker et al. 2006). A single-risk option has only one risk; e.g. a medication with one possible side effect (e.g. drowsiness). A multiple-risk option has more than one risk; e.g., a medication with several possible side effects (e.g. drowsiness, mild fever, and vomiting). Multiple-risk options are present in a variety of health contexts, including when considering childhood immunizations (Fredrickson et al. 2004), invasive health screenings (Waters et al. 2006), insurance coverage (Hibbard and Peters 2003), participation in medical studies (Fuller, Dudley, and Blacktop 2002), and genetic counseling (Grimes and Snively 1999).

In the context of childhood vaccines, the present research tests whether the inclusion of pictographs affects probability comprehension and risk perception for single and multiple-risk options. Probability comprehension refers to the accurate understanding of probabilistic information (Miron-Shatz et al. 2009), and risk perception refers to affective feelings that arise from exposure to risk information (Slovic and Peters 2006). The present research finds that the presence (vs. absence) of pictographs, alongside numeric (e.g. 1/5) probability information, increases probability comprehension and lowers risk perception for multiple-risk options; however, these effects are not observed for single-risk options. The results have implications for how pictographs are used to communicate health-related risks to the public.


Multiple-risk options are common in health-related decision making and communications. Medications, immunizations, and medical treatments often entail multiple risks or side effects (Fredrickson et al. 2004; Waters et al. 2006). For example, the Centers for Disease Control and Prevention (CDC) reports that the Measles, Mumps, and Rubella (MMR) vaccine has the following possible side effects: fever (1/6), mild rash (1/20), swelling of glands in the cheeks or neck (1/75), seizure (1/3,000), temporary pain or stiffness in the joints (1/4), temporary low platelet count (1/30,000), serious allergic reaction (1/one million), and other possible side effects, including deafness, long-term seizures, and permanent brain damage, that are reported as too rare to know whether they are caused by the vaccine. Given the ubiquity of multiple-risk options, research is needed on how pictographs affect consumer perceptions of multiple-risk options, in addition to single-risk options.

Both single- and multiple-risk options involve risks (e.g. side effects), and risks have categorical (e.g., side effect symptom) and incremental (side effect probability) attributes. General evaluability theory describes how people evaluate categorical versus incremental attributes (Hsee 1996; Hsee and Zhang 2010). When evaluating a single-risk option, which has one risk with one categorical and one incremental attribute, the theory suggests that consumers will attend more to the option's categorical attribute and give less attention to the option's incremental attribute. This bias in attention is thought to be the result of categorical attributes being easier to evaluate in isolation than incremental attributes (Hsee et al. 1999). As a result, when evaluating a single-risk option, such as a vaccine with only one side effect, the theory suggests that greater attention will be given to the side effect symptom (e. …

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