Understanding How Language, Design, and Processing Fluency Affect Cognition

Abstract

Judgment and decision-making in a healthcare context often involve complex information and difficult tradeoffs. In order to understand key concepts and receive help with difficult decisions, patients may turn to written materials, like informed consent forms. Unfortunately, these materials can actually increase confusion. This dissertation explores the relationship between written health materials and cognitive processes, specifically comprehension, memory, judgment, and decision-making. The first goal was to investigate how language and design affect cognition for informed consent forms. We developed a Standard informed consent form and two Enhanced versions that had simplified language and modified design, and compared comprehension and memory between the three versions. As written health materials undergo changes to make their content more accessible to readers, they also become more fluent. The second goal was to explore how this fluency affects judgments and decision-making, especially for materials that have a negative valence. This question was studied in the context of two competing fluency theories, the Hedonic Fluency Model and the Fluency Amplification Model. We manipulated the fluency of various materials, including medications, diseases, and risks, and asked participants to make several judgments about the fluent and disfluent materials. Our results highlight the complexities and nuances that characterize fluency’s effects.