A randomized study of multimedia informational aids for research on medical practices: Implications for informed consent.
OBJECTIVE
Participant understanding is a key element of informed consent for enrollment in research. However, participants often do not understand the nature, risks, benefits, or design of the studies in which they take part. Research on medical practices, which studies standard interventions rather than new treatments, has the potential to be especially confusing to participants because it is embedded within usual clinical care. Our objective in this randomized study was to compare the ability of a range of multimedia informational aids to improve participant understanding in the context of research on medical practices.


METHODS
We administered a web-based survey to members of a proprietary online panel sample selected to match national US demographics. Respondents were randomized to one of five arms: four content-equivalent informational aids (animated videos, slideshows with voice-over, comics, and text) and one no-intervention control. We measured knowledge of research on medical practices using a summary knowledge score from 10 questions based on the content of the informational aids. We used analysis of variance and paired t-tests to compare knowledge scores between arms.


RESULTS
There were 1500 completed surveys (300 in each arm). Mean knowledge scores were highest for the slideshows with voice-over (65.7%), followed by the animated videos (62.7%), comics (60.7%), text (57.2%), and control (50.3%). Differences between arms were statistically significant except between the slideshows with voice-over and animated videos and between the animated videos and comics. Informational aids that included an audio component (animated videos and slideshows with voice-over) had higher knowledge scores than those without an audio component (64.2% vs 59.0%, p < .0001). There was no difference between informational aids with a character-driven story component (animated videos and comics) and those without.


CONCLUSIONS
Our results show that simple multimedia aids that use a dual-channel approach, such as voice-over with visual reinforcement, can improve participant knowledge more effectively than text alone. However, the relatively low knowledge scores suggest that targeted informational aids may be needed to teach some particularly challenging concepts. Nonetheless, our results demonstrate the potential to improve informed consent for research on medical practices using multimedia aids that include simplified language and visual metaphors.
1 Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA.
Stephanie A
SA
Kraft
2 Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA.
Melissa
M
Constantine
3 Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA.
David
D
Magnus
1 Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA.
Kathryn M
KM
Porter
3 Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA.
Sandra Soo-Jin
SS
Lee
4 Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Michael
M
Green
5 Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA.
Nancy E
NE
Kass
1 Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA.
Benjamin S
BS
Wilfond
3 Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA.
Mildred K
MK
Cho
D000328:Adult; D035843:Biomedical Research; D057186:Comparative Effectiveness Research; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007258:Informed Consent; D008297:Male; D008875:Middle Aged; D019212:Multimedia; D010353:Patient Education as Topic / Q000379:methods*; D064792:Pragmatic Clinical Trials as Topic; D011795:Surveys and Questionnaires; D014741:Video Recording
Research on medical practices; comparative effectiveness research; informed consent; multimedia; pragmatic clinical trials; research ethics; video