Communicating global cardiovascular risk: Are icon arrays better than numerical estimates in improving understanding, recall and perception of risk?

Jorge G. Ruiz, Allen D. Andrade, Rocio Garcia-Retamero, Ramanakumar Anam, Remberto Rodriguez, Joseph Sharit

Research output: Contribution to journalArticle

10 Scopus citations


Objective: Experts recommend that adults have their global cardiovascular risk assessed. We investigated whether icon arrays increase understanding, recall, perception of CVR, and behavioral intent as compared with numerical information. Methods: Male outpatient veterans, at an intermediate to high cardiovascular risk participated in a randomized controlled trial of a computer tutorial presenting individualized risk. Message format was presented in 3 formats: percentages, frequencies, and frequencies with icon arrays. We assessed understanding immediately (T1) and recall at 20. min (T2) and 2 weeks (T3) after the intervention. We assessed perceptions of importance/seriousness, intent to adhere, and self-efficacy at T1. Self-reported adherence was assessed at T3. Results: One-hundred and twenty male veterans participated. Age, education, race, health literacy and numeracy were comparable at baseline. There were no differences in understanding at T1 [p= .31] and recall at T3 [p= .10]. Accuracy was inferior with frequencies with icon arrays than percentages or frequencies at T2 [p≤ .001]. There were no differences in perception of seriousness and importance for heart disease, behavioral intent, self-efficacy, actual adherence and satisfaction. Conclusion: Icon arrays may impair short-term recall of CVR. Practice implications: Icon arrays will not necessarily result in better understanding and recall of medical risk in all patients.

Original languageEnglish (US)
Pages (from-to)394-402
Number of pages9
JournalPatient Education and Counseling
Issue number3
StatePublished - Dec 1 2013



  • Cardiovascular risk
  • Decision-making
  • Graphical literacy
  • Health literacy
  • Icon arrays
  • Numeracy
  • Perception of risk
  • Visual aids

ASJC Scopus subject areas

  • Medicine(all)

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