To be successful in communication, one should always do their homework. Knowing your audience is essential to ensuring that your message is well-received and most importantly, understood. We will discuss six factors that can impact the effectiveness of your message. How to present to adult learners, gauging the level of understanding of clinical trials, literacy, language barriers, culture, and learning styles. When presenting to adults, it is important to be mindful that the information presented must be made relevant to them. How this study impact them, their community, a loved one? Be clear about the expectations, exactly what will be asked of them, how many visits will be required? How much time should they plan for? Adults need to feel actively involved in the process. Engage the individual or audience allowing for them to share their own thoughts or experiences as it might relate to the project. Research America conducted a nationwide survey of adults. The survey found that while 90 percent of respondents agreed that clinical trials are important, only 18 percent said they or someone in their family had ever participated. Well, there are many reasons for these statistics. Eighty-six percent of the respondents said it would be important to their clinical trial participation to have an expert guide them through the clinical trial process. In the same survey, 90 percent of respondents stated that it would be important for them to understand potential risks and benefits. The research world is a world of acronyms and initialisms, NIH, CDC, FDA, CTSA, EHR. These alphabet soup can be confusing and overwhelming. Do your best to avoid using these common abbreviations and always spell out what you are discussing and provide an explanation or definition of what you were talking about. The same rule applies to clinical jargon. MRIs, EKGs, CAT scans, these are all examples of procedures that need more explanation to head off any concerns potential participants might have about participating in your study. If adults feel confused or unsure about a term or procedure, they may not feel comfortable asking for clarification. This uncertainty could in turn affect one's willingness to participate. While institutional review boards work diligently to ensure that consent documents meet all of the requirements for human protections, we still have a lot of work to do to ensure every individual understands exactly what their participation will entail. Another important element of getting to know your audience is health literacy. According to healthy people 2010, health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. This includes an individual's ability to understand appointment slips, follow instructions on medication labels, obtain information about an illness, participate in discussions of informed consent, and enroll in health insurance plans. In addition to health literacy, your presentation should take into account numeracy. Numeracy is the ability to understand and use numbers in daily life. Numeracy skills are needed to understand and interpret laboratory values, risk and probability, medication instructions, nutrition and exercise information. The information you are presenting should be tailored to meet the level of health literacy and numeracy for the particular group you might be working with. A person or community's level of comfort for participating in a clinical trial can greatly be impacted by their understanding of what is being asked of them. Let's take a few minutes to watch a video on the importance of health literacy. So, you don't like to go to the hospital where they give you a lot of papers to fill out? Paperwork to fill out. Paperwork? Yes. Why is that? Because I can't read that well. Because you can't read that well. What does it feel like when somebody hands you a lot of paperwork and you can't read? You feel like you in another continent. When you enter a doctor's office, the first thing, and if first-time patient here, they'll give you a clipboard. Sometimes, that is very discouraging for a patient who cannot read. Some of the words that [inaudible] placed in all of that is that several things or one thing it's just a language that I'm not familiar with. If the patient was transferred to the facility and to any and all insurance companies or other third parties paying are obligated to pay. This is not making any sense. So, what you do you come out of that examination room, what this intelligent woman or man thinking? God, I hope I don't make a mistake with my mouth because I did not understand anything he or she saying to me. When your children have fever, what do you usually give them? Motrin or tama. Normally, Motrin because that's what my doctor recommended. How old is your daughter? She is four. She's four, okay. I want to give her four to five tablespoon and a half. So, you give her tablespoon and a half and then it says discontinue. Yes. What does that mean? I don't know. How many times do you take these thyroid pills? Once a day. Okay. Do you take one each of these? Okay. So, you take two thyroid pills? No, I take one time. I'm more likely got to missed up when I got revealed. Then, are these stickers helpful? No. Don't even look at them. Don't even look at them. What do you take that medicine for? I don't know for sure. [inaudible] The 2006 National Assessment of Adult Literacy shows that 53 percent of Americans surveyed had an intermediate level of health literacy while 36 percent of those who responded were just at a basic or below basic level of health literacy. This data just further demonstrates how important it is to know your audience and tailor your message accordingly. The next element crucial to getting to know your audience is language barriers. Nearly 25 million people in the US, nine percent have limited English proficiency. Twenty-one percent speak another language at home and of these, about 44 percent do not speak English well. People with limited English proficiency do not speak English as a primary language and have limited ability to read, speak, write, or understand English. As the diversity of the United States continues to grow, this is an area we must be mindful of when recruiting in communities. Limited English proficient patients remain under-represented in clinical research. Specifically, researchers often decide to simply exclude them from their enrollment in their study as a way of avoiding problems and hassles related to language barriers. Among the reasons cited by researchers for excluding limited English proficient people were difficulties translating study documents and problems with recruiting, training, and paying bilingual staff. Investing in this service can help to ensure you will reach a wider audience and as a result, a more diverse representation of the people in your study. In addition to translation and interpretation options, be mindful that many people may have difficulty reading and comprehending health information in their own native language. Translation of documents must take into account literacy in native languages. There are tools available to help guide you through the process of meeting the needs of diverse populations. The cultural and linguistically appropriate service standards published in 2001 by the Office of Minority Health elevated the issues of cultural competency and the health care setting to national attention consisting of a series of nationally recommended standards on cultural competency. Class has helped define a central characteristics of cultural competency for healthcare institutions providing key indicators by which individual organizations can be assessed. The purpose of the class standards is to contribute to the elimination of racial and ethnic health disparities and improve the health of all Americans. In terms of language access, four of the class standards are not just ideals, they are mandated by law and have implications for the clinical trial setting. Those standards are; offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all healthcare and services. Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing. Ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided. Provide easy to understand print and multimedia materials and signage in the languages commonly used by the populations in the service area. Specifically, these four standards should prompt sites to identify a policy on providing language access services for patients who need them, a policy about when an interpreter must be present, a policy about use of certified interpreters versus use of conveniently linguistically available staff, and a procedure for establishing if a patient needs language assistance, a procedure for identifying the patient's language, a policy on allowing children, family, or friends to interpret. With a diversity of languages of course comes a diversity of cultures. Two people who speak Spanish may still have very different cultural nuances than inform how they see and experience the world. The same could be said for an Irish Catholic in the Northeast and an American Indian in the West. We are all shaped by the places we are raised and the people who raise us. Culture is the social norms that can bind us and also make us unique. To understand a community's culture, you must get to know the community you will be working in. Take the time to identify respected leaders, key organizations, and valued businesses. Meet with individuals from the community and take the opportunity to learn about the community's history, what they see as their assets, and what types of challenges they are experiencing. Ask about the culture of the community, learn the do's and don'ts, ask for feedback on the best places and ways to connect with the community. When developing your presentation or materials, keep in mind what images, colors, and terms are most appropriate when working in that particular community. The last piece of getting to know your audience is learning styles. When developing materials or presentations, you should take into account the four key types of learning styles: visual learners, auditory learners, reading writing learners, and kinesthetic learners. To meet the different needs of different learners, your presentations and materials should always include engaging and relevant visuals. Visuals can include photos of people similar to the community you're working in, photos of tasks that might help to explain a procedure, or even photos of your research team to help introduce them to the community. For auditory learners, your speech should be engaging and have inflection. Include videos where appropriate. Be creative. Make a short video of a team member introducing themselves and giving a tour of the place they'll come to for the study. For your readers and writers, have on hand printed documents including fliers, brochures, or study posters that can allow them to follow along or take notes while you were presenting. Kinesthetic learners learn best when they are hands on opportunities. Consider role-playing part of the enrollment process when giving a large group presentation. This can be interacted and also show what participation in the study might look like.
