Justin W. Owens

The Effect of Patient Narratives on Information Search in a Web-Based Breast Cancer Decision Aid: An Eye-Tracking Study

Background Previous research has examined the impact of patient narratives on treatment choices, but to our knowledge, no study has examined the effect of narratives on information search. Further, no research has considered the relative impact of their format (text vs video) on health care decisions in a single study. Objective Our goal was to examine the impact of video and text-based narratives on information search in a Web-based patient decision aid for early stage breast cancer. Methods Fifty-six women were asked to imagine that they had been diagnosed with early stage breast cancer and needed to choose between two surgical treatments (lumpectomy with radiation or mastectomy). Participants were randomly assigned to view one of four versions of a Web decision aid. Two versions of the decision aid included videos of interviews with patients and physicians or videos of interviews with physicians only. To distinguish between the effect of narratives and the effect of videos, we created two text versions of the Web decision aid by replacing the patient and physician interviews with text transcripts of the videos. Participants could freely browse the Web decision aid until they developed a treatment preference. We recorded participants’ eye movements using the Tobii 1750 eye-tracking system equipped with Tobii Studio software. A priori, we defined 24 areas of interest (AOIs) in the Web decision aid. These AOIs were either separate pages of the Web decision aid or sections within a single page covering different content. Results We used multilevel modeling to examine the effect of narrative presence, narrative format, and their interaction on information search. There was a significant main effect of condition, P=.02; participants viewing decision aids with patient narratives spent more time searching for information than participants viewing the decision aids without narratives. The main effect of format was not significant, P=.10. However, there was a significant condition by format interaction on fixation duration, P<.001. When comparing the two video decision aids, participants viewing the narrative version spent more time searching for information than participants viewing the control version of the decision aid. In contrast, participants viewing the narrative version of the text decision aid spent less time searching for information than participants viewing the control version of the text decision aid. Further, narratives appear to have a global effect on information search; these effects were not limited to specific sections of the decision aid that contained topics discussed in the patient stories. Conclusions The observed increase in fixation duration with video patient testimonials is consistent with the idea that the vividness of the video content could cause greater elaboration of the message, thereby encouraging greater information search. Conversely, because reading requires more effortful processing than watching, reading patient narratives may have decreased participant motivation to engage in more reading in the remaining sections of the Web decision aid. These findings suggest that the format of patient stories may be equally as important as their content in determining their effect on decision making. More research is needed to understand why differences in format result in fundamental differences in information search.

Examination of Dual vs. Single Monitor Use during Common Office Tasks

Previous studies have found that using multiple monitors increases productivity, but there are also documented drawbacks to increased monitor count and/or size. The purpose of this study was to determine whether increases in productivity hold true with newer technology, like wide flat-screens, in the multitasking context. Sixty participants were asked to complete several tasks commonly completed in an office environment. These tasks were performed on four different monitor configurations: a single and dual 17” monitor(s) and single and dual 22” monitor(s). Participants located information from several documents and compiled this information into a new document. Dependent variables measured included efficiency, effectiveness, and satisfaction. Results indicated a performance benefit for dual monitor usage, regardless of monitor size. Participants most preferred using dual 22” monitors and least preferred a single 17” monitor.

The Effect of Location and Congruency of Text Ads on Information Search

Almost half of all advertising revenues are attributed to the sponsored links on pages generated by search engines (IAB, 2008). This drives the need to better understand how users view and search the contents of a search engine results page that includes sponsored links. In the current study, we manipulated whether target information was located in sponsored links at the top or on the right side of a search result page. We also manipulated the congruency of the sponsored ad content. Results indicate that the target location influenced search performance but not recall. Congruency, on the other hand, did not influence search performance or recall. Also, task success did not influence recall. This might indicate that location is a stronger determinant for search task success than the semantic relevance of the sponsored links with the search query. Target location influenced fixations on the main results, top and side sponsored links.

Eye Movements on a Single-Column and Double-Column Text Web Page

This study examines user eye movement patterns of a single-column and double-column text web page. The results show a higher number of fixations for information in a second column of an article than for the same information in the lower portion of a single column. In addition, the typical “F” pattern appeared in the left column of the double-column layout, but not in the right column. Users also had more fixations on page elements outside of the textual content, such as ads, when they were browsing than when they were searching.

Eye-Tracking Patterns of Web Portal Browsing

This paper reports on the scan patterns of users browsing a 2-column and 3-column web portal page. Consistent scanning patterns for each of the 2-column and 3-column web portal pages were found. Users typically fixated the portal channel in the upper left of the 2-column layout and in the top, center channel of the 3-column page. Implications including the likelihood and efficiency of portal users finding information on portal pages are discussed.

Gaze Pattern Differences Between Objective and Subjective Search of E-Commerce Web Pages

Both users and retailers benefit from optimizing e-commerce web pages for consumers who freely browse, subjectively search (e.g., “Find a gift for your uncle.”), or objectively search (e.g., “Find the laptop.”) for merchandise online. However, search behavior of e-commerce web pages under these conditions is not well understood. We studied how gaze patterns were modulated by search task on 12 e-commerce web pages. Search for objectively defined targets yielded larger saccade amplitudes than when freely browsing or subjectively searching. Furthermore, users fixated product images more often than product text or navigation regions when searching for particular items. On the other hand, search for subjectively defined gifts led to longer fixation durations of navigation regions, in particular. These findings show that search behavior of e-commerce web pages is influenced by consumer objectives and concurs with classic findings from the scene perception literature about the influences of top-down goals on eye movements.

The effect of text versus video presentations of patient narratives in a web-based patient decision aid

Over the past several years the Internet has developed a more prominent role as a source for medical patients to search for health related information. The current study examined the use of web-based patient decision aids and how the format of patient narratives influenced treatment preferences and knowledge about the treatments options. Fifty-three women viewed a web-based decision aid with patient narratives displayed in a full-video format, full-text (no video) format, no patient video format, or no patient text format. The patient narrative format had no influence on knowledge or treatment preference, but time spent viewing specific webpages within the decision aid was predictive of treatment choice. Participants that spent more time viewing the lumpectomy webpage were significantly more likely to prefer lumpectomy with radiation, while participants who spent more time viewing the mastectomy webpage were significantly more likely to prefer mastectomy. These results suggest that a confirmation bias may be present.