Using health literacy principles to improve understanding of evolving evidence in health emergencies: Optimisation and evaluation of a COVID-19 vaccination risk-benefit calculator.

BACKGROUND: Risk communication tools based on epidemiological models can help inform decision-making, but must be responsive to health literacy needs to be effective. To facilitate informed choice about risks and benefits of COVID-19 vaccination, an epidemiological model called the COVID-19 Risk Calculator (CoRiCal) tool was developed by a multi-disciplinary team. AIM: This paper demonstrates how to use health literacy principles to improve consumer understanding of COVID-19 and vaccine effects, using a range of methods that could be applied to any health emergency. METHODS: Stage 1: Health literacy optimisation and user testing to reduce improve understandability (n = 19). Stage 2: Experiments to explore the effect of risk communication formats on perceived understanding including probability, graphs, evaluative labels and comparison risks (n = 207). Stage 3: Randomised controlled trial (n = 2005) with 4 arms: 1) standard government information; 2) standard CoRiCal output based on bar graphs; 3) animation explaining bar graphs in "x per million" format; 4) animation explaining bar graphs in "1 in x chance" format. The primary outcome was knowledge about COVID-19 risk. RESULTS: Stage 1 reduced the complexity of the text and graphs. Stage 2 showed that different risk communication formats change perceived understanding, with a preference for evaluative labels across 2 experiments and some indication people with lower health literacy had a greater preference for bar graphs. Stage 3 showed both animations increased knowledge compared to standard government information. There was no difference between the probability formats, or by health literacy level. DISCUSSION: The results showed that simple explanations of complex epidemiological models improve knowledge about COVID-19 and vaccination. This demonstrates how health literacy design principles and short animations can be used to support informed decision making about health emergencies.

The effect of noninstrumental information on reward learning.

Investigations of information-seeking often highlight people's tendency to forgo financial reward in return for advance information about future outcomes. Most of these experiments use tasks in which reward contingencies are described to participants. The use of such descriptions leaves open the question of whether the opportunity to obtain such noninstrumental information influences people's ability to learn and represent the underlying reward structure of an experimental environment. In two experiments, participants completed a two-armed bandit task with monetary incentives where reward contingencies were learned via trial-by-trial experience. We find, akin to description-based tasks, that participants are willing to forgo financial reward to receive information about a delayed, unchangeable outcome. Crucially, however, there is little evidence this willingness to pay for information is driven by an inaccurate representation of the reward structure: participants' representations approximated the underlying reward structure regardless of the presence of advance noninstrumental information. The results extend previous conclusions regarding the intrinsic value of information to an experience-based domain and highlight challenges of probing participants' memories for experienced rewards.

Spontaneous discovery of novel task solutions in children.

Children often perform worse than adults on tasks that require focused attention. While this is commonly regarded as a sign of incomplete cognitive development, a broader attentional focus could also endow children with the ability to find novel solutions to a given task. To test this idea, we investigated children's ability to discover and use novel aspects of the environment that allowed them to improve their decision-making strategy. Participants were given a simple choice task in which the possibility of strategy improvement was neither mentioned by instructions nor encouraged by explicit error feedback. Among 47 children (8-10 years of age) who were instructed to perform the choice task across two experiments, 27.5% showed a full strategy change. This closely matched the proportion of adults who had the same insight (28.2% of n = 39). The amount of erroneous choices, working memory capacity and inhibitory control, in contrast, indicated substantial disadvantages of children in task execution and cognitive control. A task difficulty manipulation did not affect the results. The stark contrast between age-differences in different aspects of cognitive performance might offer a unique opportunity for educators in fostering learning in children.