False Calm and False Alarm: A Qualitative Study of Confusion and Misinterpretation of a Laboratory Results Graph

Health consumers (i.e., citizens), increasingly review their personal health information on patient portals. However, health information, especially graphs, can be difficult to interpret and use. To investigate reporting attributes that confused participants, what they misinterpreted, and their follow-up intentions, we examined participants' (N = 24) think-aloud responses to a laboratory system graph depicting lab values over time. Overall, 18 participants expressed confusion at least once and 12 misinterpreted one or more aspects of the graph. Common areas of confusion included axis labelling and the significance of value changes. Confusion led to misinterpretation (e.g., incorrect date, more than two results depicted, change was not important). The findings underscore the need for improved graph design. To enhance user performance with laboratory graphs, we recommend implementing generic design principles for graphs and exploring potential strategies unique to this context (e.g., standardized Y axes values, personalized reference ranges, inclusion of explanatory text). This research emphasizes the importance and value of user-centered design for improving health information for citizens.