Beyond Readability: Tailoring Informed Consent Communications for Digital Health Research (Preprint)

Abstract

BACKGROUND Readability is important to consider when developing informed consent communications for prospective research participants, but not the most important consideration. Other factors to consider relate to the specific learning preferences and literacy needs of people recruited to participate in research, as their level of education, cultural background and health literacy can influence understanding of the consent. Research teams should consider taking a human-centered approach when developing consent communications to promote understanding among prospective participants by attending to their unique needs. OBJECTIVE This study was conducted to explore how factors related to readability, topic, and participant demographic characteristics play into preferences for different versions of consent material describing aspects of digital health research. These factors are important to consider as not attending to some details that matter to a specific subgroup of prospective participants may run the risk of systematically excluding people from research. METHODS People eligible to participate in a digital health study were recruited to review 31 paragraph length sections of a consent form, referred to as “text snippets,” for an existing digital health study that was approved for use by an institutional review board (IRB). Participants (N=79) were surveyed and asked to choose among two variations of the text snippets, either indicating a preference for the IRB approved original or a version that was modified by three members of the research team with a goal of improving readability. RESULTS Our qualitative analysis found that participants preferred shorter snippets, in general, but the snippets also elicited new questions not addressed by the original consent material. This observation is supported by our quantitative analysis, which found that participants were more likely to prefer the modified text when the character length of the original was longer and particularly for sections of a consent communication explaining study risks. Our analysis also found significant differences by participant demographic and background characteristics. Specifically, gender, age, level of physical activity, and ethnicity all played into preferences for the consent material. CONCLUSIONS The findings point toward new ways of evaluating informed consent materials: 1- for responsiveness to specific prospective participant populations and 2- effectiveness at eliciting informed questions from people considering participation. Researchers run the risk of not including study information that matters to specific subgroups of prospective study participants. We discuss how creating partnerships with prospective participants to prototype informed consent materials, specifically study procedures and risks, can be a way to identify those details before launching a study. Furthermore, future research should go beyond “readability” to explore alternate measures of evaluating consent materials, such as the likelihood that the consent material and communication procedures will elicit “informed questions” for the research team. CLINICALTRIAL N/A