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.
Competing Interests: Declaration of Competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Carissa Bonner reports financial support was provided by Public Health Association of Australia (GSK Immunisation Award; CDIC 2022). Colleen Lau and John Litt report a relationship with Immunisation Coalition that includes: funding grants and non-financial support. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024. Published by Elsevier Ltd.)