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Objective: Icon arrays have been suggested as a potentially promising format for communicating risks to patients-especially those with low numeracy skills-but experimental studies are lacking. This study investigates whether icon arrays increase accuracy of understanding medical risks, and whether they affect perceived seriousness of risks and helpfulness of treatments. Design: Two experiments were conducted on samples of older adults (n ϭ 59, 62 to 77 years of age) and university students (n ϭ 112, 26 to 35 years of age). Main Outcome Measures: Accuracy of understanding risk reduction; perceived seriousness of risks; perceived helpfulness of treatments. Results: Icon arrays increased accuracy of both low-and high-numeracy people, even when transparent numerical representations were used. Risks presented via icon arrays were perceived as less serious than those presented numerically. With larger icon arrays (1,000 instead of 100 icons) risks were perceived more serious, and risk reduction larger. Conclusions: Icon arrays are a promising way of communicating medical risks to a wide range of patient groups, including older adults with lower numeracy skills.

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Background Effective risk communication is essential for informed decision making. Unfortunately, many people struggle to understand typical risk communications because they lack essential decision-making skills. Objective The aim of this study was to review the literature on the effect of numeracy on risk literacy, decision making, and health outcomes, and to evaluate the benefits of visual aids in risk communication. Method We present a conceptual framework describing the influence of numeracy on risk literacy, decision making, and health outcomes, followed by a systematic review of the benefits of visual aids in risk communication for people with different levels of numeracy and graph literacy. The systematic review covers scientific research published between January 1995 and April 2016, drawn from the following databases: Web of Science, PubMed, PsycINFO, ERIC, Medline, and Google Scholar. Inclusion criteria were investigation of the effect of numeracy and/or graph literacy, and investigation of the effect of visual aids or comparison of their effect with that of numerical information. Thirty-six publications met the criteria, providing data on 27,885 diverse participants from 60 countries. Results Transparent visual aids robustly improved risk understanding in diverse individuals by encouraging thorough deliberation, enhancing cognitive self-assessment, and reducing conceptual biases in memory. Improvements in risk understanding consistently produced beneficial changes in attitudes, behavioral intentions, trust, and healthy behaviors. Visual aids were found to be particularly beneficial for vulnerable and less skilled individuals. Conclusion Well-designed visual aids tend to be highly effective tools for improving informed decision making among diverse decision makers. We identify five categories of practical, evidence-based guidelines for heuristic evaluation and design of effective visual aids.

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