Short CommunicationProcessing fluency effects: Can the content and presentation of participant information sheets influence recruitment and participation for an antenatal intervention?
Introduction
When we are able to process written information with ease, we assume the information will be easy to implement. For example, when exercise instructions are easy to read (e.g., font such as Arial), people are more willing to incorporate the exercises within their daily routine than when the same instructions are presented in a font that is more difficult to read (e.g., Brush Script MT [1]). Furthermore, labels or acronyms which are easy to read/pronounce (e.g., Chunta) elicit greater perceptions of familiarity and lower perceived risk than those which are difficult to read/pronounce (e.g., Tsiischili [2], [3]). The occurrence of these processing fluency effects may be due to our reliance on familiarity-based heuristics (i.e., a naïve mechanism by which fluently-processed material is interpreted to be more familiar) during cognitive operations [4]. If fluently processed material is judged as familiar, it is more likely to be accepted [5] and less likely to be scrutinised [6]. The present study will explore the implications of processing fluency effects in relation to something that is ubiquitous within efforts to advance and improve patient education and care: participant recruitment to intervention studies.
Participant information sheets (PISs) inform prospective participants about the nature of an intervention, ensuring methodological rigour and ethical requirements (i.e., informed consent) are upheld. Professional bodies in the UK [7], [8] have produced guidelines for the development of appropriate PISs and consent forms. However, recommended strategies included within these and other evidence-based guidelines for the clear communication of participation risks and benefits [9], [10] do not explicitly consider the potential impact of processing fluency effects.
Song and Schwarz [2], [11] suggested that professionals including policy makers and product manufacturers may want to harness fluency effects to not only emphasise specific advantages of purchasing certain products, but also warn consumers of potential hazards that might otherwise appear innocuous. Similarly, researchers and health professionals may find that fluency effects represent an effective and ethical means of presenting important intervention information to participants.
The study will explore if PIS title and font influences trainee midwives’ and pregnant women's initial perceptions (e.g., attractiveness, complexity, required effort, level of risk) of an antenatal intervention designed for pregnant women with a BMI ≥30 kg/m2. It was hypothesised that PISs presented using “fluent” (i.e., easy-to-process) written information would be perceived by participants as more attractive, less complex, less risky, and less effortful to implement compared with PISs presented using “awkward” (i.e., difficult-to-process) written information.
Section snippets
Design
This cross-sectional between-groups study involved randomisation at the level of the participant to one of four experimental conditions.
Sample
Pre-study and post hoc power calculations [12] indicated a total sample size of 32 (i.e., 16 participants per sub-sample) was sufficient. Participants (recruited over two weeks) were:
- (a)
Pregnant women with an antenatal booking BMI ≥30 kg/m2 receiving antenatal care in Greater Manchester, UK (n = 35);
- (b)
Trainee midwives (i.e., future gatekeepers to interventions for the
Results
A 4 (processing fluency condition) × 2 (population sub-sample) factorial multivariate analysis of variance (MANOVA) was conducted (means and standard deviations are presented in Table 1). The results indicated a significant effect for population sub-sample, Pillai's trace = .234, F5,58 = 3.55, p = .007, partial η2 = .23; a non-significant effect for fluency condition, Pillai's trace = .315, F15,180 = 1.41, p = .147, partial η2 = .11; and a significant interaction between population sub-sample and fluency
Discussion
The findings did not support the majority of the hypotheses. However, a significant difference was demonstrated for pregnant women in relation to perceptions of complexity. Specifically, if PISs were presented in a “fluent” font, pregnant women perceived the intervention to be less complex compared to when PISs included a title and font that were “awkward”. This supports previous reports of an inverse relationship between the fluency of written instructions and the perceived complexity of
Acknowledgments
The authors’ would like to thank Wendy Taylor for her assistance in recruiting participants and collecting data. We are also very grateful to the participants, the maternity unit, and our respective Universities for supporting this particular research study.
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Comparing the effects of a patient-designed-and-informed participant information leaflet in comparison with a standard, researcher-designed information leaflet on recruitment, retention and understanding: A study-within-a-trial
2022, Contemporary Clinical Trials CommunicationsCitation Excerpt :On the other hand, though research does indicate that PILs can often be lengthy [10] and, as a result, less likely to be read [6,11], it also indicates that reducing length is ineffective and may negatively impact comprehension due to, for example, a lack of clarity [12]. A limited body of research, yielding mixed results, has evaluated the effects of various manipulations to PIL development on recruitment and comprehension, such as out-sourcing for professionally-designed PILs [e.g.7]; using iterative, user-tested formats [e.g. 7; 13]; and comparing font adjustments [e.g. 14]. However, in practical terms, some of these manipulations can be costly with respect to both finances and time, which may not be feasible for trials limited by funding restrictions.
The power of the pen: Handwritten fonts promote haptic engagement
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