User Perception of Attention Visualizations: Effects on Interpretability Across Evidence-Based Medical Documents

The attention mechanism is a core component of the Transformer architecture. Beyond improving performance, attention has been proposed as a mechanism for explainability via attention weights, which are associated with input features (e.g., tokens in a document). In this context, larger attention weights may imply more relevant features for the model's prediction. In evidence-based medicine, such explanations could support physicians' understanding and interaction with AI systems used to categorize biomedical literature. However, there is still no consensus on whether attention weights provide helpful explanations. Moreover, little research has explored how visualizing attention affects its usefulness as an explanation aid. To bridge this gap, we conducted a user study to evaluate whether attention-based explanations support users in biomedical document classification and whether there is a preferred way to visualize them. The study involved medical experts from various disciplines who classified articles based on study design (e.g., systematic reviews, broad synthesis, randomized and non-randomized trials). Our findings show that the Transformer model (XLNet) classified documents accurately; however, the attention weights were not perceived as particularly helpful for explaining the predictions. However, this perception varied significantly depending on how attention was visualized. Contrary to Munzner's principle of visual effectiveness, which favors precise encodings like bar length, users preferred more intuitive formats, such as text brightness or background color. While our results do not confirm the overall utility of attention weights for explanation, they suggest that their perceived helpfulness is influenced by how they are visually presented.