What’s in a name? Would you rather catch horse flu or Yarramin flu?


Horse flu has been used in a study to show the vagaries of human nature when it comes to digesting information about an illness that may affect them.

Leading health and news organizations regularly publish reports on public health issues, including infectious disease outbreaks, bringing information to millions of people.

However, little research has been done to gauge how subtle differences in the ways in which the information is presented shapes public perception.

To investigate, researchers distributed an online survey within nine European countries, Britain and the United States.

Participants read a mock news article that described the spread of a pandemic flu among citizens within their country.

They then completed a survey measuring their attitudes toward vaccination, knowledge about information in the article, and concern for contracting the flu.

Participants read the mock story with one of three random flu names and graphic visualizations.

The mock stories described either the exotic sounding “Yarraman flu” (Yarraman is an Aboriginal word for “horse”), the scientific “H11N3 influenza,” or “horse flu”.

Alternatively, each article included one of three types of graphics, each showing a rise in the prevalence of influenza, and number of related deaths, over three months.

Participants who read about “horse flu” were significantly less motivated to get themselves vaccinated compared to those who read about “Yarraman flu” or “H11N3 influenza.”

That same trend echoed across each of the 11 countries surveyed.

Out of a 7-point scale, with the highest number meaning “definitely would get a vaccination” and the lowest indicating “definitely would not get a vaccination,” the sentiment dropped from 4.66 to 4.54.

“In public health, relatively small effects can have relatively large impacts on a population level,” explains first author of the flu label study, Aaron Scherer, from the University of Iowa.

Graphics, too, altered perceptions of risk.

The heat map, left, was more likely to persuade readers to vaccinate than the other visualizations which presented the same information.
The heat map, left, was more likely to persuade readers to vaccinate than the other visualizations which presented the same information.

Even though each of three graphics presented the same information, colorful heat maps in which the point of outbreak blazed red consistently triggered stronger reactions than dot maps that punctuate geographical distribution of the influenza, and bar-type graphs.

Readers indicated they preferred the heat maps, and those who used them to interpret the hypothetical outbreak said they were more likely to vaccinate than those who saw bar-type graphs.

Heat map viewers also thought they were more likely to get the flu, had a better grasp of the facts about the outbreak, and a greater interest in learning more.

More than that, the findings suggest that some tactics work better than others to inform health decisions.

“It is incredibly important that we communicate effectively, as it has the potential to improve public health,” says co-author and pulmonologist Thomas Valley, from the University of Michigan.

Angie Fagerlin, who heads population health sciences at University of Utah Health, says: “Our results highlight that choices for public communications about health issues cannot be made simply by convenience or without consideration.

“If we can present information in ways that increase the public’s understanding, it’s a win for everybody.”

The survey involved 16,510 participants across the 11 countries.

The findings of the collaborative research between scientists at the Utah and Michigan universities, as well as Radboud University in the Netherlands, were published as two studies: one recently in Vaccine and the second in Emerging Infectious Diseases on June 21.

The authors say additional studies are needed to examine whether messaging can go beyond changing readers’ intent to actually altering behavior, driving more people to get vaccinated during critical times.

In addition to Fagerlin, Scherer and Valley, co-authors of both studies included Megan Knaus, Brian Zikmund-Fisher, and Enny Das.

The research was supported by the European Union’s Seventh Framework Programme for research, technological development and demonstration.

Aaron M. Scherer, Megan Knaus, Brian J. Zikmund-Fisher, Enny Das, and Angela Fagerlin. Effect of Influenza Label on Worry and Behavioral Intentions: A Multi-Country Web-Based Experiment. Emerging Infectious Diseases, June 2017 DOI: 10.3201/eid2308.170364

Angela Fagerlin, Thomas S. Valley, Aaron M. Scherer, Megan Knaus, Enny Das, Brian J. Zikmund-Fisher. Communicating infectious disease prevalence through graphics: Results from an international survey. Vaccine, 2017; DOI: 10.1016/j.vaccine.2017.05.048


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