Effects of Symptom Presentation Order on Perceived Disease Risk
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Abstract
Objective: The ability to distinguish meaningful patterns from meaningless coincidences is a vital part of human cognition. However, the mind is often too quick to infer meaning from coincidences. People expect random processes to produce fewer and shorter repetitions of the same event than is actually the case – the so-called “gambler’s fallacyâ€). This research examines how the appearance of streaks in symptom checklists influences personal assessments of risk.
Methods: We carried this investigation in two fashions. First, we ran a pilot study examining the order of symptoms - whether they were presented as general (e.g., fatigue) followed by specific (e.g., convulsions), the other way around, or in reverse order. To survey the presentation formats of disease symptoms online, we reviewed the five most popular health information websites produced by a Google search for “cancerâ€: the American Cancer Society, the National Cancer Institute (NCI), WebMD, MedicineNet.com, and the New York Times Health Guide. We conducted pilot studies to identify the presentation formats of the individual webpages for the 12 deadliest forms of cancer in 2008.
We report two studies exploring the effects of symptom presentation order on perceived disease risk.
Study 1 (119 participants) investigates whether presenting streaks of general and specific symptoms leads to higher perceived cancer risk than alternating the presentation of these two types of symptoms, and identifies a mechanism underlying the effects of symptom presentation order on perceived risk. Study 2 examines whether this effect varies with the length of the symptom list.
In Study 2, 102 university participants received information about Meningioma, before being randomly assigned to one of 6 conditions in a 2 (Length of symptom list: short vs. long) ï‚´ 3 (Presentation order of symptoms: G-to-S, S-to-G, and Alternating) between-subjects design. Participants were presented with 6 symptoms in the short-list conditions and 12 symptoms in the long-list conditions.
Additionally, we identify a psychological mechanism underlying the effect of symptom presentation streaks and show how risk estimates vary with the length of the symptom list.
Results: In the pilot web study, we found that these websites present a mix of “general†symptoms (mild, common, and considered minor) and “specific†symptoms (rare and severe; seldom experienced; considered major), and that both types of symptoms are listed in streaks.
In Study 1 we found a significant effect of symptom presentation order, F(2, 114) = 4.74, p = .011, ηp2 = .08 (Figure 1). Participants who were exposed to streaks of general and specific symptoms perceived their personal cancer risk to be higher than those exposed to an alternating symptom presentation. While perceived risk did not differ between the two streak conditions (p = .605), participants in the alternating condition reported lower levels of personal risk than participants in either the G-to-S condition (p = .047) or S-to-G condition (p = .009).
In Study 2 we found a significant interaction between presentation order and symptom-list-length, F(2, 95) = 4.17, p = .018, ηp2 = .08 (Figure 2). To probe this interaction, we performed separate one-way ANOVAs for each length condition. Presentation order had a significant effect on perceived risk in the 6-item condition, F(2, 52) = 5.27, p = .008, ηp2 = .17.
Conclusions:
Our findings reveal a tendency to infer meaning from streaks in medical and health decision-making. Participants perceive a higher risk of having an illness when presented with a checklist in which common symptoms are grouped together, compared to when these same symptoms are separated by rare symptoms. This research demonstrates how something as arbitrary as symptom presentation order can affect perceived risk of disease. The findings carry implications for the design of online materials, and demonstrate that no such thing exists such as an 'objective' order of presenting information, online, or otherwise.
Methods: We carried this investigation in two fashions. First, we ran a pilot study examining the order of symptoms - whether they were presented as general (e.g., fatigue) followed by specific (e.g., convulsions), the other way around, or in reverse order. To survey the presentation formats of disease symptoms online, we reviewed the five most popular health information websites produced by a Google search for “cancerâ€: the American Cancer Society, the National Cancer Institute (NCI), WebMD, MedicineNet.com, and the New York Times Health Guide. We conducted pilot studies to identify the presentation formats of the individual webpages for the 12 deadliest forms of cancer in 2008.
We report two studies exploring the effects of symptom presentation order on perceived disease risk.
Study 1 (119 participants) investigates whether presenting streaks of general and specific symptoms leads to higher perceived cancer risk than alternating the presentation of these two types of symptoms, and identifies a mechanism underlying the effects of symptom presentation order on perceived risk. Study 2 examines whether this effect varies with the length of the symptom list.
In Study 2, 102 university participants received information about Meningioma, before being randomly assigned to one of 6 conditions in a 2 (Length of symptom list: short vs. long) ï‚´ 3 (Presentation order of symptoms: G-to-S, S-to-G, and Alternating) between-subjects design. Participants were presented with 6 symptoms in the short-list conditions and 12 symptoms in the long-list conditions.
Additionally, we identify a psychological mechanism underlying the effect of symptom presentation streaks and show how risk estimates vary with the length of the symptom list.
Results: In the pilot web study, we found that these websites present a mix of “general†symptoms (mild, common, and considered minor) and “specific†symptoms (rare and severe; seldom experienced; considered major), and that both types of symptoms are listed in streaks.
In Study 1 we found a significant effect of symptom presentation order, F(2, 114) = 4.74, p = .011, ηp2 = .08 (Figure 1). Participants who were exposed to streaks of general and specific symptoms perceived their personal cancer risk to be higher than those exposed to an alternating symptom presentation. While perceived risk did not differ between the two streak conditions (p = .605), participants in the alternating condition reported lower levels of personal risk than participants in either the G-to-S condition (p = .047) or S-to-G condition (p = .009).
In Study 2 we found a significant interaction between presentation order and symptom-list-length, F(2, 95) = 4.17, p = .018, ηp2 = .08 (Figure 2). To probe this interaction, we performed separate one-way ANOVAs for each length condition. Presentation order had a significant effect on perceived risk in the 6-item condition, F(2, 52) = 5.27, p = .008, ηp2 = .17.
Conclusions:
Our findings reveal a tendency to infer meaning from streaks in medical and health decision-making. Participants perceive a higher risk of having an illness when presented with a checklist in which common symptoms are grouped together, compared to when these same symptoms are separated by rare symptoms. This research demonstrates how something as arbitrary as symptom presentation order can affect perceived risk of disease. The findings carry implications for the design of online materials, and demonstrate that no such thing exists such as an 'objective' order of presenting information, online, or otherwise.
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