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Background/Method. Decision aids have not been widely tested in diverse audiences. The authors conducted interviews in a 2 2 race by education design with participants who were 50 years old (n = 188). The decision aid was a be Informed decision making by patients is the gold standard in health care, particularly for utility-sensitive decisions such as treatment for benign prostatic hyperplasia.1-3 Patient decision aids (DAs) using print, video, and Internet media are increasingly being developed to explicitly inform patients about treatment choices and to involve them in decision making. Since DAs have grown out of expected utility theory and technology assessment, little research has focused on DAs as communication media. DA evaluations have used knowledge as an outcome measure, implicitly recognizing the importance of their communication function. However, further investigation of their effectiveness as communication instruments is needed. In a recent report, "Speaking of Health: Assessing Health Communication Strategies for Diverse Populations," the Institute of Medicine (IOM) pointed to the research implications of health communication and behavior change research. 4 The insights are important for emerging research into the efficacy and effectiveness of decision aids. The IOM report indicates that diversity may influence the effectiveness of health communication. For example, a given health behavior change may be attitudinally driven in one population, normatively driven in another, and primarily under the influence of personal agency in a 3rd population. Furthermore, theories of communication and behavior change recognize that sources and channels that are perceived as credible by one population may be distrusted or not used by another. For DAs to be broadly applicable across the population, it is important to investigate potential influences of race/ethnicity* and education on *The term race has several controversial and unsettled connotations. We use the word in its common usage, recognizing its lack of biologic meaning but its importance as a social construct. the interpretation of information and acceptability of shared decision making. The IOM summary findings and recommendations indicate that few studies of communication interventions address their relative effectiveness across relevant diverse groups, and they found none that systematically compare various approaches to addressing diversity or compare those approaches with efforts that ignore diversity altogether. As part of a larger study, we investigated the effects of race and education on knowledge and readiness to make a treatment decision following use of a previously developed DA videotape program for benign prostatic hyperplasia (BPH). The program, produced by the Foundation for Informed Medical Decision Making (FIMDM), is already in wide use and respects diversity in subtle ways. Black and white men are included in the program in patient and professional roles, but the program is meant for a general audience. This preliminary investigation ...

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