By Helen Osborne, M.Ed., OTR/L
President of Health Literacy Consulting
On Call Magazine, February 28, 2008

Your grandmother has arthritis and is desperately seeking a cure. She recalls reading that someone (she can’t remember who) in some newspaper (she can’t recall which one) said that shark cartilage is helpful. You know this is not the case and that using shark cartilage is really just a scam. So you tell her several times, “Grandma, it is not true that shark cartilage helps arthritis.” A week later, though, she is even more convinced that shark cartilage is what she needs.

Your grandmother isn’t necessarily getting senile. She’s simply experiencing a memory problem that affects almost everyone. According to Ian Skurnik, PhD, an associate professor of business administration at the University of Virginia in Charlottesville, it’s common for people to recall false information as true. For people to remember information accurately, he says, they need to recall both the “claim” — the core piece of information — and its “context” — the situation in which they heard it. For most people, remembering the claim is easy, especially if they hear it more than once. Memory of context, however, fades quickly, which means people lose details such as how or where they heard something. Unfortunately, such details help us determine, among other things, whether what we are remembering is true or false.

Why we default to truth

If the result of such lapses is that we sometimes forget the punch line to a joke, it’s only a minor annoyance. But when it comes to health information, not fully recalling both the claim and its context can have major implications. For example, Skurnik talks about “Sally,” who is convinced she remembers something negative about flu shots. The problem is she can’t recall if it was her doctor who told her or a neighbor, or whether she read it in The Boston Globe or National Enquirer. Despite an unambiguous public health campaign that makes it clear the flu vaccine is safe, Sally is convinced there are problems and doesn’t get the shot.

Skurnik says it’s common for people to “default to truth” or assume information is true because it feels familiar. As time passes, this feeling of familiarity tends to get stronger, and people become more convinced the information is true. Skurnik, who has researched the phenomenon, says this happens even when people initially knew the information was false.

One study Skurnik and colleagues conducted focused specifically on older adults. What they found was that the more often older adults were told a certain claim was false, the more likely they were, after a three-day delay, to remember it as true. “Repetition can backfire over time,” the researchers concluded. In another study, the same researchers found that many young adults have a similar response. The key difference is that it takes younger adults longer — seven days, rather than three — to rebound from perceptions of false to true.

Helping patients sort true from false

People’s tendency to recall false information as true poses a challenge for health communicators. Skurnik acknowledges that this can be tricky and offers several tips health providers can use to help people take away accurate information.

• State information in positive rather than negative ways. Often patients are given instructions with bulleted “do/don’t do” lists. But readers may have difficulty with not-to-do items, remembering the gist of the message but not the negative words like “don’t” or “avoid.” Skurnik recommends wording information in positive ways whenever possible. An example might be writing “wear protective clothing when you go out in the sun” rather than “avoid prolonged skin exposure to sunlight.”
• Emphasize true rather than false. Don’t start with misinformation even if you intend to correct it. Instead, emphasize what is true. When you must repeat false information, put it in the middle of a document and not at the beginning or end, which are places where people tend to pay most attention.
• Appreciate that spoken information is more difficult to remember than written. Skurnik says that spoken information places a greater demand on a person’s working memory. (See “How memory affects health understanding” to learn more about working memory.) This is because listeners must be consistently attentive rather than absorbing information at their own pace or having the chance to review it later. Given that content familiarity tends to last longer than contextual details, it is especially important to discuss information in positive ways.
• Use external aids to improve accurate recall. To aid recall, Skurnik recommends the use of memory aids such as note taking, supplemental reading material, or using another person as a “second set of ears.” Memory aids can help to offset the fact that people may remember just bits and pieces of claims, especially when the situation — or context — is rushed, harried, or otherwise distracting, as is often the case in a clinical setting.

How to find out more:

Ian Skurnik, PhD, is associate professor of business administration at the University of Virginia in Charlottesville, Virginia. He can be reached at skurniki@darden.virginia.edu

Skurnik I, Yoon C, Park D C, Schwarz N (2005), “How Warnings About False Claims Become Recommendations.” Journal of Consumer Research: Vol. 31:713-724.

Helen Osborne, MEd, OTR/L, is president of Health Literacy Consulting. Her column appeared regularly in On Call. You can contact her by e-mail at Helen@healthliteracy.com.