Pictures speak louder than numbers: on communicating medical risks to immigrants with limited non-native language proficiency
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Updated: Jun 4, 2026
Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Published on: February 16, 2011
Rocio Garcia-Retamero1, Mandeep K Dhami
1Center for Adaptive Behavior and Cognition, Max Planck Institute for Human Development, Berlin, Germany. rretamer@ugr.es
Background And Objectives:
Medical risk communication has been infrequently studied in immigrants with limited non-native language proficiency, even though they may be at greatest risk of illness. In a study, we examined to what extent Polish immigrants to the UK have difficulties in understanding treatment risk reduction expressed as ratios either in their native language or in a non-native language (English). We further investigated whether this population can be aided by using visual displays to enhance comprehension.
Design, Setting, And Participants:
A survey was conducted in the UK in spring, 2009, involving a sample of Polish immigrants (n = 96).
Outcome Measures:
Estimates of treatment risk reduction, confidence in estimates, and perceptions of treatment effectiveness.
Results:
When assessing treatment risk reduction, participants often paid too much attention to the number of treated and non-treated patients who died (i.e. numerators) and insufficient attention to the overall number of treated and non-treated patients (i.e. denominators). This denominator neglect was especially noticeable when treatment risk reduction was not expressed in participants' native language. However, provision of visual aids in addition to the numerical information about risk reduction proved to be an effective method for eliminating denominator neglect. The visual aids drew participants' attention to the overall number of treated and non-treated patients and helped them to make more accurate risk estimates.
Conclusions:
When communicating risks to immigrants with limited non-native language proficiency, we should move beyond the simple, direct translation of health messages that are already being used with the indigenous population to messages that are more appropriate. The use of materials that include visual aids is an effective method of communicating medical risk information to immigrant populations.
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