Metaphor Use and Health Literacy: A Pilot Study of Strategies to Explain Randomization in Cancer Clinical Trials

• Published in: Journal of health communication 2011-01, Vol.16 (1), p.3-16
• Main Authors: Krieger, Janice L., Parrott, Roxanne L., Nussbaum, Jon F.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Attention; Behavior; Biological and medical sciences; Cancer; Clinical trials; Clinical Trials, Phase III as Topic; Cultural Characteristics; Doctors; Female; Health education; Health Literacy; Health technology assessment; Humans; Information; Information processing; Low income; Low income groups; Medical research; Medical sciences; Metaphor; Middle Aged; Miscellaneous; Neoplasms - therapy; Patient Education as Topic - methods; Patient Participation - statistics & numerical data; Physician-Patient Relations; Pilot Projects; Poverty; Public health. Hygiene; Public health. Hygiene-occupational medicine; Randomized Controlled Trials as Topic; Rural areas; Rural Population - statistics & numerical data; Videotape Recording; Women
• ISSN: 1081-0730; 1087-0415
• DOI: 10.1080/10810730.2010.529494

Patients often have difficulty understanding what randomization is and why it is needed in Phase III clinical trials. Physicians commonly report using metaphorical language to convey the role of chance in being assignment to treatment; however, the effectiveness of this strategy as an educational tool has not been explored. Guided by W. McGuire's ( 1972 ) information-processing model, the purpose of this pilot study was to explore effects of metaphors to explain randomization on message acceptance and behavioral intention to participate in a Phase III clinical trial among a sample of low-income, rural women (N = 64). Participants were randomly assigned to watch a video that explained randomization using 1 of 3 message strategies: a low-literacy definition, standard metaphor (i.e., flip of a coin), or a culturally derived metaphor (i.e., sex of a baby). The influence of attention on behavioral intentions to participate in clinical trials was partially moderated by message strategy. Under conditions of low attention, participants in the culturally derived metaphor condition experienced significantly higher intentions to participate in clinical trials compared with participants in the standard metaphor condition. However, as attention increased, differences in intentions among the conditions diminished. Having a positive affective response to the randomization message was a strong, positive predictor of behavioral intentions to participate in clinical trials. The authors discuss the theoretical and practical implications of these findings.