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. 2023 Sep 1;177(9):956-965.
doi: 10.1001/jamapediatrics.2023.2686.

Plain Language vs Standard Format for Youth Understanding of COVID-19 Recommendations: A Randomized Clinical Trial

Lisa Stallwood  1 , Adrian Sammy  1 , Matthew Prebeg  2 , Jacqueline Relihan  2 , Ami Baba  1 , Rana Charide  3   4   5   6   7 , Shahab Sayfi  3   8 , Sarah A Elliott  9   10 , Lisa Hartling  9   10 , Matthew Munan  9 , Dawn P Richards  11   12 , Joseph L Mathew  13 , Tamara Kredo  14   15   16 , Lawrence Mbuagbaw  3   4   5   6   7   16   17   18   19   20 , Ashley Motilall  3   4   5   6   7 , Shannon D Scott  21 , Miloslav Klugar  22 , Tamara Lotfi  3   4   5   6   7 , Adrienne L Stevens  3   4   5   6   7   23 , Kevin Pottie  8   24 , Holger J Schünemann  3   4   5   6   7   25 , Nancy J Butcher  1   26 , Martin Offringa  1   27   28 ; RecMap Members
Collaborators, Affiliations

Plain Language vs Standard Format for Youth Understanding of COVID-19 Recommendations: A Randomized Clinical Trial

Lisa Stallwood et al. JAMA Pediatr. .

Abstract

Importance: To ensure that youths can make informed decisions about their health, it is important that health recommendations be presented for understanding by youths.

Objective: To compare understanding, accessibility, usability, satisfaction, intention to implement, and preference of youths provided with a digital plain language recommendation (PLR) format vs the original standard language version (SLV) of a health recommendation.

Design, setting, and participants: This pragmatic, allocation-concealed, blinded, superiority randomized clinical trial included individuals from any country who were 15 to 24 years of age, had internet access, and could read and understand English. The trial was conducted from May 27 to July 6, 2022, and included a qualitative component.

Interventions: An online platform was used to randomize youths in a 1:1 ratio to an optimized digital PLR or SLV format of 1 of 2 health recommendations related to the COVID-19 vaccine; youth-friendly PLRs were developed in collaboration with youth partners and advisors.

Main outcomes and measures: The primary outcome was understanding, measured as the proportion of correct responses to 7 comprehension questions. Secondary outcomes were accessibility, usability, satisfaction, preference, and intended behavior. After completion of the survey, participants indicated their interest in completing a 1-on-1 semistructured interview to reflect on their preferred digital format (PLR or SLV) and their outcome assessment survey response.

Results: Of the 268 participants included in the final analysis, 137 were in the PLR group (48.4% female) and 131 were in the SLV group (53.4% female). Most participants (233 [86.9%]) were from North and South America. No significant difference was found in understanding scores between the PLR and SLV groups (mean difference, 5.2%; 95% CI, -1.2% to 11.6%; P = .11). Participants found the PLR to be more accessible and usable (mean difference, 0.34; 95% CI, 0.05-0.63) and satisfying (mean difference, 0.39; 95% CI, 0.06-0.73) and had a stronger preference toward the PLR (mean difference, 4.8; 95% CI, 4.5-5.1 [4.0 indicated a neutral response]) compared with the SLV. No significant difference was found in intended behavior (mean difference, 0.22 (95% CI, -0.20 to 0.74). Interviewees (n = 14) agreed that the PLR was easier to understand and generated constructive feedback to further improve the digital PLR.

Conclusions and relevance: In this randomized clinical trial, compared with the SLV, the PLR did not produce statistically significant findings in terms of understanding scores. Youths ranked it higher in terms of accessibility, usability, and satisfaction, suggesting that the PLR may be preferred for communicating health recommendations to youths. The interviews provided suggestions for further improving PLR formats.

Trial registration: ClinicalTrials.gov Identifier: NCT05358990.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Hartling reported receiving grants from the Canadian Institutes of Health Research (CIHR) during the conduct of the study. Dr Richards reported receiving funding from McMaster University and Five02 Labs Inc and fees for involvement as a patient partner on the research team during the conduct of the study. Dr Mathew reported receiving grants to the institution from McMaster University Canada Research during the conduct of the study and serving on the board of the Guidelines International Network. Ms Motilall reported receiving grants from the CIHR during the conduct of the study. Dr Lotfi reported receiving grants from the CIHR during the conduct of the study. Dr Schünemann reported receiving grants from the CIHR during the conduct of the study and being cochair of the Grading of Recommendations Assessment, Development and Evaluation working group. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. CONSORT Diagram
PLR indicates plain language recommendation; SLV, standard language version.
Figure 2.
Figure 2.. Risk Differences and Total Mean Difference for Correct Responses to 7 Questions Measuring Understanding
Squares represent risk differences, and horizonal lines represent 95% CIs. PLR indicates plain language recommendation.
See this image and copyright information in PMC

Comment in

References

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