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

Shanshan Qiu; Yang Xia; Feng Tian; Yanfang Yang; Jijun Song; Liqin Chen; Hao Mei; Fan Jiang; Nan Bao; Shijian Liu

doi:10.1038/s41390-020-01227-2

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

Pediatr Res. 2021 Aug;90(2):411-418. doi: 10.1038/s41390-020-01227-2. Epub 2020 Nov 17.

Authors

Shanshan Qiu^#¹, Yang Xia^#¹, Feng Tian², Yanfang Yang³, Jijun Song⁴, Liqin Chen⁵, Hao Mei⁶, Fan Jiang⁷, Nan Bao¹, Shijian Liu⁸

Affiliations

¹ Department of Pediatric Neurosurgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
² Department of Pediatric Urinary Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
³ Department of Pediatric Urinary Surgery, Henan Children's Hospital Affiliated to Zhengzhou University, Henan, China.
⁴ Department of Clinical Laboratory, the Sixth People's Hospital Of Zhengzhou, Henan, China.
⁵ Department of Pediatric General Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁶ Department of Data Science, School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA.
⁷ Department of Developmental and Behavioral Pediatrics, Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁸ Pediatric Health Advocacy Institute, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China. liushijian@scmc.com.cn.

^# Contributed equally.

PMID: 33203966
DOI: 10.1038/s41390-020-01227-2

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.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adolescent Behavior*
Age Factors
Biological Specimen Banks
Cartoons as Topic*
Child
Child Behavior*
China
Comprehension
Female
Health Knowledge, Attitudes, Practice
Humans
Informed Consent*
Male
Patient Participation
Surveys and Questionnaires*
Tissue and Organ Procurement*
Video Recording*