Development and evaluation of an augmented reality education program for pediatric research
Background: Children often have limited understanding of clinical research and what they might expect from participating in a clinical study. Studies, however, suggest that multimedia delivery of medical and research information may promote greater understanding and engagement compared with standard written approaches.
Aim: This study was designed to examine the effects of a novel interactive augmented reality (AR) program on children’s understanding of clinical research. Methods: Children (ages 7-13 yrs.) were randomized to receive basic information about clinical research using either a printed storybook (control) or the same storybook enhanced using a video-see-through augmented reality iPad program (AR) with embedded interactive quizzes. Children were interviewed to assess their understanding of the material before (pre-test) and after (post-test) receiving either of the randomized interventions. Both parents and children completed short surveys to measure their perceptions of the information delivery.
Results: 91 parent/child dyads were included in the analysis. There were no differences between the control and AR children's pre-test understanding of the research information. However, both groups demonstrated significant and similar improvements in post-test understanding. Parents of children in the AR group found the information to be of higher quality and greater clarity compared with the control group, and 91.7% of children in the AR group found the inclusion of interactive quizzes to be helpful. Both parents and children found the AR program very easy to use and 85.0 % and 71.2%, respectively, indicated that if recruited for a future study that they would prefer information delivered using some type of iPad AR program together with a discussion with the researcher.
Conclusions: Results demonstrated the importance of providing children and parents with information in an easy to read and visually compelling manner. Although both groups demonstrated improved understanding, children and their parents preferred the AR program and reported a preference for receiving information using computer-based technology. Given the seemingly insurmountable challenge of keeping children and families engaged in health research related information exchange, the use of AR would appear to provide a novel and effective vehicle for enhancing children's and parents assimilation and understanding of research (and medical) information and as a potential tool to optimize the informed consent and assent processes.
Relevance for patients: This study reinforces the importance in providing information to research participants and patients in an easy-to-read and visually salient manner. Although the augmented reality program used in this study did not result in an increased level of understanding, AR was deemed the preferred method of information delivery. It is hoped that the results of this study will serve as a platform for future studies.
[1] Bower M, Howe C, McCredie N, Robinson A, Grover D. Augmented Reality in Education-cases, Places and Potentials. Educ Media Int 2014;51:1-15.
[2] Barfield R, Church C. Informed Consent in Pediatric Clinical Trials. Curr Opin Pediatr 2005;17:20-4.
[3] Simon C, Siminoff L, Kodish E, Burant C. Comparison of the Informed Consent Process for Randomized Clinical Trials in Pediatric and Adult Oncology. J Clin Oncol 2004;22:2708-17.
[4] TaitAR, Voepel-Lewis T, Malviya S. Do They Understand? (Part I): Parental Consent for Children Participating in Clinical Anesthesia and Surgery Research. Anesthesiology 2003;98:603-8.
[5] TaitAR, Voepel-Lewis T, Malviya S. Do They Understand? (Part II): Assent of Children Participating in Clinical Anesthesia and Surgery Research. Anesthesiology 2003;98:609-14.
[6] Featherstone K, Donovan J. Why Don’t They Just Tell Me Straight, Why Allocate it? The Struggle to Make Sense of Participating in a Randomised Controlled Trial. Soc Sci Med 2002;55:709-19.
[7] Tait AR, Voepel-Lewis T, McGonegal M, Levine R. Evaluation of a Prototype Interactive Consent Program for Pediatric Clinical Trials: A Pilot Study. J Am Med Inf Assoc 2012;19:e43-5.
[8] TaitAR, Voepel-Lewis T, MoscucciM, Brennan-Martinez C, Levine R.Patient Comprehension of an Interactive, Computer- based Information Program for Cardiac Catheterization. Arch Intern Med 2009;169:1907-14.
[9] Hermann M. 3-Dimensional Computer Animation-a New Medium for Supporting Patient Education Before Surgery. Acceptance and Assessment of Patients Based on Prospective Randomized Study-picture Versus Text [German]. Chirug 2002;73:500-7.
[10] Tait AR, Voepel-Lewis T, Levine R. Using Digital Multimedia to Improve Parents’ and Children’s Understanding of Clinical Trials. Arch Dis Child 2016;100:589-93.
[11] Ally B, Gold C, Budson A. The Picture Superiority Effect in Patients with Alzheimer’s Disease and Mild Cognitive Impairment. Neuropsychologica 2009;47:595-8.
[12] Cherry K, Park D,Frieske D, Smith A. Verbal and Pictorial Elaborations Enhance Memory in Younger and Older Adults. Aging Neuropsychol Cogn 1996;3:15-29.
[13] Hockley W. The Picture Superiority Effect in Associatve Recognition. Memory Cogn 2008;36:1351-9.
[14] Additional Protections for Children Involved as Subjects in Research. Fed Regist 1983;43:786.
[15] Miller C, O’Donnell D, Searight H, Barbarash R. The Deaconess Informed Consent Comprehension Test: An Assessment Tool for Clinical Research Subjects. Pharmacotherapy 1996;16:872-8.
[16] TaitAR, Voepel-Lewis T, MalviyaS, PhilipsonS. Improving the Readability and Processability of a Pediatric Informed Consent Document: Effects on Parents’ Understanding. Arch PediatrAdolesc Med 2005;159:347-52.
[17] TaitAR, Voepel-Lewis T, Malviya S. Presenting Research Information to Children: A Tale of Two Methods. Anesth Analg 2007;105:358-64.
[18] Festinger D, Dugosh K, Croft J, Arabia P, Marlowe D. Corrected feedback: A Procedure to Enhance Recall of Informed Consent to Research Among Substance Abusing Offenders. Ethics Behav 2010;20:387-99.
[19] Kang H, McDermott B, Roediger H. Test Format and Corrective Feedback Modify the Effect of Testing on Long- term Retention. Eur J Cogn Psychol 2007;19:528-58.
[20] Schrand T. Tapping Into Active Learning and Multiple Intelligences with Interactive Multimedia: A Low- threshold Classroom Approach. Coll Teach 2008;56:78-84.
[21] Zhang D. Interactive Multimedia-based E-learning:AStudy of Effectiveness. Am J Distance Learn 2005;19:149-62.