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Using a cartoon questionnaire to improve consent process in children: a randomized controlled survey

Abstract

Objective

The aim of the study was to evaluate the effectiveness of an audio and animated cartoon questionnaire (AACQ) at improving consent process in child for biospecimen donation.

Methods

A multi-center randomized and controlled survey was performed at two pediatric hospitals in China from 2019 to 2020. Children aged from 7 to 18 years in the pediatric surgery wards were invited to investigate the participants’ willingness and attitudes for donating biospecimens. A total of 264 children, including 119 in the AACQ group and 145 in the TQ group, and 67 parents of children were analyzed. A separate knowledge test was acquired in the questionnaires.

Results

Our findings showed that the response rate of the AACQ group (89.85%) was significantly higher than that of the TQ group (68.44%; p < 0.001). AACQ can improve the child’s understanding, increase children’s engagement in biospecimen donation, reduced the differences in selected characteristics affecting children understanding, and enhanced their risk awareness of donating biospecimens. We also found that increasing pain and privacy disclosure were the most popular concern among children for the refusal to donate biospecimens.

Conclusions

AACQ is an effective and standardized tool of content delivery to children from the surgical wards. Children who fully understood of biospecimen donation are suggested to participate in the consent signing.

Impact

  • Using audio and animated cartoon questionnaire is a more effective and standardized tool of content delivery to children.

  • This study expanded the use of an animated cartoon to a children’s survey. Audio and animated cartoon questionnaire (AACQ) can improve the child’s understanding, increase children’s engagement in biospecimen donation compared to text questionnaire (TQ) group, and enhanced their risk awareness of donating biospecimens.

  • More AACQ should be used with children in the future to effectively deliver content to children and improve children’s participation in the survey.

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Fig. 1: Flowchart of randomization, allocation, and data collection of participants.
Fig. 2: The production process of cartoon questionnaire production.
Fig. 3: Difference of correction rates between children of the AACQ group and children of the TQ group.
Fig. 4: Difference of attitudes toward different kinds of biospecimens.

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Acknowledgements

We are grateful to all participants. We thank LetPub (www.letpub.com) for its linguistic assistance during the preparation of this manuscript. This research was sponsored by the National Science Foundation of China [81872637, 81728017, 81974231], Shanghai Municipal Commission of Health and Family Planning [201840324, 20164Y0095], Program of National Science and Technology Commission for association of diabetes and nutrition in adolescent [2016YFC1305203], Medical and Engineering Cooperation Project of Shanghai Jiao Tong University [YG2017ZD15], The Project of Shanghai Children’s Health Service Capacity Construction [GDEK201708], Science and Technology Development Program of Pudong Shanghai New District [PKJ2017-Y01], Shanghai Professional and Technical Services Platform [18DZ2294100], Shanghai Science and Technology Commission of Shanghai Municipality [17411965300, 17XD1402800, 18411962800], 2019 Science and Technology Innovation -Biomedical Supporting Program of Shanghai Science and Technology Committee [19441904400], Biological Sample Bank and Database Platform of Henan Children’s Hereditary Diseases [182102310415], the Foundation of National Facility for Translational Medicine, Shanghai [TMSK-2020-124], and the Key Subject Program for Clinical Nutrition from Shanghai Municipal Health Commission [2019ZB0103].

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S.Q. and Y.X. designed the study, participated in its implementation, analyzed, and wrote the initial draft of the manuscript; F.T., Y.Y., J.S., and L.C. collected data and carried out the initial analyses; H.M. and F.J. reviewed the study results; N.B. and S.L. conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed the manuscript. All authors approved the final manuscript and agreed to be responsible for all aspects of the work.

Corresponding author

Correspondence to Shijian Liu.

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The authors declare no competing interests.

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Written informed consent was obtained from each patient and his/her parent.

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Qiu, S., Xia, Y., Tian, F. et al. Using a cartoon questionnaire to improve consent process in children: a randomized controlled survey. Pediatr Res (2020). https://doi.org/10.1038/s41390-020-01227-2

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