title: Use of Videos Improves Informed Consent Comprehension in Web-Based Surveys Among Internet-Using Men Who Have Sex With Men: A Randomized Controlled Trial.
abstract: Web-based surveys are increasingly used to capture data essential for human immunodeficiency virus (HIV) prevention research. However, there are challenges in ensuring the informed consent of Web-based research participants.
  
  
  
  The aim of our study was to develop and assess the efficacy of alternative methods of administering informed consent in Web-based HIV research with men who have sex with men (MSM).
  
  
  
  From July to September 2014, paid advertisements on Facebook were used to recruit adult MSM living in the United States for a Web-based survey about risk and preventive behaviors. Participants were randomized to one of the 4 methods of delivering informed consent: a professionally produced video, a study staff-produced video, a frequently asked questions (FAQs) text page, and a standard informed consent text page. Following the behavior survey, participants answered 15 questions about comprehension of consent information. Correct responses to each question were given a score of 1, for a total possible scale score of 15. General linear regression and post-hoc Tukey comparisons were used to assess difference (P<.001) in mean consent comprehension scores. A mediation analysis was used to examine the relationship between time spent on consent page and consent comprehension.
  
  
  
  Of the 665 MSM participants who completed the comprehension questions, 24.2% (161/665) received the standard consent, 27.1% (180/665) received the FAQ consent, 26.8% (178/665) received the professional consent video, and 22.0% (146/665) received the staff video. The overall average consent comprehension score was 6.28 (SD=2.89). The average consent comprehension score differed significantly across consent type (P<.001), age (P=.04), race or ethnicity (P<.001), and highest level of education (P=.001). Compared with those who received the standard consent, comprehension was significantly higher for participants who received the professional video consent (score increase=1.79; 95% CI 1.02-2.55) and participants who received the staff video consent (score increase=1.79; 95% CI 0.99-2.59). There was no significant difference in comprehension for those who received the FAQ consent. Participants spent more time on the 2 video consents (staff video median time=117 seconds; professional video median time=115 seconds) than the FAQ (median=21 seconds) and standard consents (median=37 seconds). Mediation analysis showed that though time spent on the consent page was partially responsible for some of the differences in comprehension, the direct effects of the professional video (score increase=0.93; 95% CI 0.39-1.48) and the staff-produced video (score increase=0.99; 95% CI 0.42-1.56) were still significant.
  
  
  
  Video-based consent methods improve consent comprehension of MSM participating in a Web-based HIV behavioral survey. This effect may be partially mediated through increased time spent reviewing the consent material; however, the video consent may still be superior to standard consent in improving participant comprehension of key study facts.
  
  
  
  Clinicaltrials.gov NCT02139566; https://clinicaltrials.gov/ct2/show/NCT02139566 (Archived by WebCite at http://www.webcitation.org/6oRnL261N).
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
authors.forename: Eric William
authors.identifier: 0000-0003-0244-7458
authors.initials: EW
authors.lastname: Hall
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
authors.forename: Travis H
authors.identifier: 0000-0003-1133-4762
authors.initials: TH
authors.lastname: Sanchez
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
authors.forename: Aryeh D
authors.identifier: 0000-0003-1138-6458
authors.initials: AD
authors.lastname: Stein
authors.affiliation: Department of Health Behavior and Biological Sciences, School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, GA, United States.
authors.forename: Rob
authors.identifier: 0000-0002-9239-2640
authors.initials: R
authors.lastname: Stephenson
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
authors.forename: Maria
authors.identifier: 0000-0002-3245-0175
authors.initials: M
authors.lastname: Zlotorzynska
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
authors.forename: Robert Craig
authors.identifier: 0000-0003-0753-2790
authors.initials: RC
authors.lastname: Sineath
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
authors.forename: Patrick S
authors.identifier: 0000-0002-7728-0587
authors.initials: PS
authors.lastname: Sullivan
mesh_terms: D000293:Adolescent; D000328:Adult; D032882:Comprehension; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D007258:Informed Consent; D020407:Internet; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D014741:Video Recording; D055815:Young Adult
keywords: HIV; informed consent; surveys and questionnaires