Communicating information about "what not to do" to consumers

Background: Americans devote more resources to health care than any other developed country, and yet they have worse health outcomes and less access. This creates a perfect set of opportunities for Consumer Reports, a nonprofit consumer advocacy and multimedia organization known for its focus on individual consumers in markets where significant amounts of misinformation is in play. Consumer Reports uses comparisons/ratings based on the best available data to "level" the market playing field. While our early efforts to inform consumers of overuse and underuse in health care were successful, we sensed there were opportunities to have greater impact. Over a 5-year period, with the help of many partners, Consumer Reports learned more about how to communicate "what not to do" to consumers, ultimately enhancing the effectiveness of this difficult message. Analysis: Consumer Reports began an in-depth examination of the overuse of health services in 2010 with an exploratory review of the cognitive psychology literature. Lessons learned from this review were used in the presentation of subsequent ratings of heart disease and cancer screening tests. Surveys showed surprising gaps in the prevention/screening knowledge of healthy, low-risk Consumer Reports subscribers aged 40 to 60 years. Of these subscribers, 44% reported engaging in heart screening tests that received the lowest ratings from the U.S. Preventive Services Task Force and from Consumer Reports. At the same time professional societies and the ABIM (American Board of Internal Medicine) Foundation created Choosing Wisely (R), a campaign focused on identifying lists of health tests and treatments not to do. Consumer Reports joined the Choosing Wisely campaign as the consumer "translator" and organizer of a network of consumer organizations with access to tens of millions of consumers. Over the past year, Consumer Reports has conducted multiple qualitative evaluations of content related to overuse of health services. Ratings of cancer screening tests were released in 2013 in an article readers reported as one of the most heavily read articles in the magazine's recent history. Conclusions: Telling consumers that more is not better is not a popular or easy message to deliver. The message is most likely to be "sticky" but is best received if it comes from trusted sources (e. g., physicians), focuses on safety when justified, is communicated in plain language, and uses both mass media and individual consumer approaches. Changing the culture of health care in an era of health reform is an essential part of the transformation needed if we are to allocate finite resources fairly in hopefully fair markets while assuring that better quality products and services at lower prices dominate.