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Processing fluency effects: Can the content and presentation of participant information sheets influence recruitment and participation for an antenatal intervention?

https://doi.org/10.1016/j.pec.2014.11.005Get rights and content

Highlights

  • Font influenced pregnant women's perceptions of an antenatal intervention.

  • The easier the font was to read, the less complex the intervention was perceived.

  • The mere presentation of participant information may impact participant recruitment.

  • The findings have implications for the ethical recruitment of hard-to-reach groups.

  • The font of written information may also determine adherence to interventions.

Abstract

Objective

To assess the extent to which the title and font of participant information sheets (PISs) can influence pregnant women's and trainee midwives’ perceptions of an antenatal intervention.

Methods

Pregnant women (n = 35) and trainee midwives (n = 36) were randomly presented with one of four PISs where the title and font of the PIS had been manipulated to create four experimental conditions (i.e., Double Fluent; Double Awkward; Fluent Title-Awkward Font; Awkward Title-Fluent Font). After reading the PIS, participants rated their perceptions of the intervention (i.e., Attractiveness, Complexity, Expected Risk, Required Effort) using five-point Likert scales.

Results

A 4 × 2 factorial multivariate analysis of variance revealed that pregnant women rated the Double Awkward condition as significantly more complex than the Double Fluent (p = .024) and Awkward Title-Fluent Font (p = .021) conditions.

Conclusion

Font influenced pregnant women's ratings of intervention complexity.

Practice implications

Results have implications for ethical recruitment, and in turn, the optimisation of corresponding interventions.

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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