Developing and Testing a Multimedia Presentation of a Health-state Description

Abstract

Quality-adjustment weights for health states are an essential component of cost-utility anal ysis (CUA). Quality-adjustment weights are obtained by presenting large numbers of subjects with multiattribute descriptions of health states for rating. Comprehending multiattribute health states is a difficult task for most respondents. The authors hypothesized that multimedia (MM) presentation using computers might facilitate this task better than would a paper-based text (Text). To test this hypothesis, they developed closely matched MM and Text descriptions of health states in the first-person narrative style, and developed a method of testing the presentation of a health state. Subjects were randomized to exposure to either MM or Text and subject recall of the health state and recognition of features of the health state were tested. How well defined the preferences of the subjects were after each presentation method was assessed by having the subjects mark on a double-anchored visual-analog scale the "best" and "worst" they believed the quality of life in the health state might be. MM subjects had better recall (11.85 vs 9.44 of a total of 24 meaning units, p = 0.098) and better recognition (4.71 vs 4.22, p = 0.08). The average interval between the "best" and "worst" ratings was shorter for the MM subjects (2.19 cm vs 3.26 cm, p = 0.12). The results suggest that: 1) MM presentation results in better recall and recognition, indicating better transfer of information; 2) MM presentation appears to result in better definition of preferences (a smaller preference interval), suggesting better integration of information into subject preference; and 3) recall and recognition testing of a health-state description can identify material in the description that has an unintended impact on the respondents. Key words: cost-utility analysis; communication medium; quality-adjustment weights; multimedia; health-state de scription. (Med Decis Making 1994;14:336-344)