Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.
Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
JAMA Pediatr. 2023 Sep 1;177(9):956-965. doi: 10.1001/jamapediatrics.2023.2686.
To ensure that youths can make informed decisions about their health, it is important that health recommendations be presented for understanding by youths.
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.
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.
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.
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.
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.
ClinicalTrials.gov Identifier: NCT05358990.
为了确保青少年能够对自己的健康做出明智的决定，重要的是要为青少年提供易于理解的健康建议。
比较数字简易语言推荐 (PLR) 格式与健康建议原始标准语言版本 (SLV) 对青少年的理解、可及性、可用性、满意度、实施意愿和偏好。
设计、设置和参与者：这是一项务实、分配隐蔽、盲法、优势随机临床试验，纳入了来自任何国家、年龄在 15 至 24 岁之间、有互联网访问权限且能够阅读和理解英语的个人。试验于 2022 年 5 月 27 日至 7 月 6 日进行，包括定性部分。
使用在线平台以 1:1 的比例随机分配青少年接受优化后的数字 PLR 或 2 种与 COVID-19 疫苗相关的健康建议的 SLV 格式之一；青年友好型 PLR 是与青年伙伴和顾问合作开发的。
主要结果是理解，通过回答 7 个理解问题的正确比例来衡量。次要结果包括可及性、可用性、满意度、偏好和预期行为。完成调查后，参与者表示有兴趣完成 1 对 1 的半结构化访谈，以反思他们更喜欢的数字格式 (PLR 或 SLV) 和他们的结果评估调查回应。
在最终分析的 268 名参与者中，有 137 名在 PLR 组（48.4%为女性），131 名在 SLV 组（53.4%为女性）。大多数参与者（233 [86.9%]）来自北美和南美。PLR 组和 SLV 组在理解得分方面没有显著差异（平均差异，5.2%；95%CI，-1.2%至 11.6%；P = .11）。参与者认为 PLR 更易于访问和使用（平均差异，0.34；95%CI，0.05-0.63），更令人满意（平均差异，0.39；95%CI，0.06-0.73），并且比 SLV 更倾向于 PLR（平均差异，4.8；95%CI，4.5-5.1[4.0 表示中立反应]）。在预期行为方面没有发现显著差异（平均差异，0.22（95%CI，-0.20 至 0.74）。面谈者（n = 14）同意 PLR 更容易理解，并提出了建设性的反馈意见，以进一步改进数字 PLR。
在这项随机临床试验中，与 SLV 相比，PLR 在理解得分方面没有产生统计学上的显著发现。青少年在可及性、可用性和满意度方面对其评价更高，这表明 PLR 可能更适合向青少年传达健康建议。访谈提供了进一步改进 PLR 格式的建议。
ClinicalTrials.gov 标识符：NCT05358990。
