J Am Med Inform Assoc 17:220-223 doi:10.1136/jamia.2009.002717
  • Case report

Perils of providing visual health information overviews for consumers with low health literacy or high stress

  1. Trudi Miller
  1. 1Information Systems and Technology, Claremont Graduate University, Claremont, California, USA
  2. 2Computing & New Media Technologies, University of Wisconsin-Stevens Point, Stevens Point, Wisconsin, USA
  1. Correspondence to Dr Gondy Leroy, School of Information Systems and Technology, Claremont Graduate University, 130 E Ninth Street, Claremont, CA 91711, USA; gondy.leroy{at}
  • Received 26 February 2009
  • Accepted 23 December 2009


This pilot study explores the impact of a health topics overview (HTO) on reading comprehension. The HTO is generated automatically based on the presence of Unified Medical Language System terms. In a controlled setting, we presented health texts and posed 15 questions for each. We compared performance with and without the HTO. The answers were available in the text, but not always in the HTO. Our study (n=48) showed that consumers with low health literacy or high stress performed poorly when the HTO was available without linking directly to the answer. They performed better with direct links in the HTO or when the HTO was not available at all. Consumers with high health literacy or low stress performed better regardless of the availability of the HTO. Our data suggests that vulnerable consumers relied solely on the HTO when it was available and were misled when it did not provide the answer.


  • Competing interests None.

  • Ethics approval The Claremont Graduate University Institutional Review Board approved the study.

  • Funding This work has been funded by a grant from the National Library of Medicine / National Institutes of Health, R21- LM008860.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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