By Pankaja Kulabkar
Become “patient-centric.” “Partner” with patients. Enhance “patient experience.” These are the buzzwords in the health industry today. As writers, how do we meet these expectations when we write for patients?
Patients represent a wide audience across cultures, literacy rates, abilities, and age. How can we write so that the content appeals to them all? The exercise becomes even more difficult when we write to motivate patients to participate in clinical trials. A clinical trial is a research process, it is not a treatment. Patients do not see any obvious reason for participating in clinical trials.
There are many challenges, but this article focuses on just one—the literacy challenge. The literacy challenge confronts all countries, including the developed countries.
Getting Maximum Response from Patients
If our audience consists of both literate and illiterate readers, how should we write for a patient audience that includes both? What communication modes should we follow so that they both understand what we say? What style should we adopt so that both find the content appealing?
The key lies in understanding patients’ vulnerabilities and expectations and in addressing them. Let’s meet a patient now. She is Rina. Rina has Type 2 Diabetes and lives in India. Her grandmother is visiting her. While Rina is well-educated, Grandma is illiterate. We’ll take a quick look at how they respond to clinical trial information.
One Day in Rina and Grandma’s Life
It is Monday morning and Rina is getting ready to go to work. The newspaper has just been delivered and Grandma picks it up from the floor. Her attention is drawn to a picture on the front page. Grandma asks Rina what the picture is about. Rina looks at the picture and realizes that it is an advertisement. She reads the newspaper advertisement aloud (see Figure 1).
Rina goes to work. In the evening, she has an appointment with her doctor. Grandma accompanies her. As they step into the hospital premises, Grandma points to a poster and says, “This picture is of the same doctor that we saw in the newspaper today. Is the poster about the same clinical trial?” Rina looks up at the poster, reads what the poster says, and nods in affirmation.
At the clinic, a video is playing about clinical trials. Both Grandma and Rina watch the video.
Rina and Grandma take the bus back home. As they walk down from the bus stop to their house, they see a crowd in their neighborhood park. What’s the matter, they wonder. As they walk toward the crowd, they realize that the crowd is watching a street-play. (A street-play is a traditional form of communication in India. This is an effective and low-cost mode of communication. There are no stage props. Performers perform in public places. The play is short. Catchy tunes and humor are often used to attract and retain people’s attention.)
They join the crowd and watch the street-play. The scenes are similar to what they have seen on the video at the doctor’s clinic. After watching for a while, Grandma whispers to Rina, “The play is about a clinical trial.” After the play is over, the actors distribute flyers about the clinical trial.
Let’s now see how to make clinical trial information easy and appealing for patients like Rina and Grandma.
Make Patients Feel Important
John Dewey, the famous philosopher, said that the deepest urge in human nature is the “desire to be important.” Patients are no exception to this need. All that patients usually get are instructions on how to lead their lives, what to eat, and what not to do. At best, they may get some sympathy from others. That is all. Does anyone take the effort to make them feel important? Not really.
If there is any process in the world that depends for its existence upon patients, it is a clinical trial. If patients do not join clinical trials, we will have no clinical trials at all. Without clinical trials, there will be no new medicines in the market. This is not a situation we want to be in.
We need patients to be interested in joining clinical trials. The key is to involve patients and make them feel important. The “desire to be important” is felt by all, regardless of where people are on the literacy scale. But how do we make patients feel important?
Involve Patients in Designing the Content
As technical communicators, we know the importance of audience analysis for effective documentation. Let’s take the effort to understand what patients want, their vulnerabilities, and what motivates them.
For example, while interacting with patients with hearing loss, we learn how difficult it is for them to watch videos without sign language and text. Or while interacting with patients with low literacy, we sense their discomfort when asked to read something. These insights help us to plan and implement better communication strategies.
After developing prototypes, we must go back to patients to get their feedback. This makes patients feel important. If we incorporate their ideas, we must give them credit. Let them feel that the ideas are theirs. Patients will then feel closer to the message.
Talk in their Terms
Patients have their share of problems. If we want to gain their attention, we need to say what they want to hear. One way is to tell them that we need their help to improve the lives of people who are in a similar situation as they are. This will do two things. The strategy will make patients feel important. Our plea will also help them relate to others afflicted by the same health problem or disease. We then have a higher chance of getting their attention to our message.
Empathize with Patients
Patients listen to instructions day after day. Everyone tells them how to lead their lives. Let’s not make clinical trial information yet another piece of instruction. A conversational and friendly style does wonders.
Let’s now improve upon the newspaper advertisement.Right from the title, the advertisement’s focus is upon patients. The title and the introduction do not talk about what the clinical trial or doctors need. Instead, the advertisement talks about the challenges patients face. It talks about the clinical trial’s quest to help patients lead a better life and urges patients to be a partner in this quest.
Appeal to Patients’ Nobler Motives
Clinical trial information is different from instructions that appear on medicines. Patients take medicines to get better. The purpose of the instructions is to help patients take the medicine correctly. Imperative language and tone may be fine here.
But clinical trials are different. Patients do not have to participate in clinical trials to get better. Imperative language and tone will not work here. To get them interested in participating in clinical trials, we need to appeal to their good will, nobler motives, and altruism.
Encourage Patients to Talk to Those with Clinical Trial Experience
Your organization may have contact details for patients who have prior clinical trial experience and are willing to share their experience with others. Encourage your patient audience to talk to them.
Instead of “selling” the clinical trial idea to patients, give them references of people to whom they can talk. Let them discuss, analyze, and then own the decision to consider participating in clinical trials.
Here is a television advertisement script for a Type 2 diabetes clinical trial that shows this rhetorical technique.
Keep the Content Short
Printed material is easy to distribute among patients, but do keep the content short. Bullets are often used in printed material. Experts say that the short-term memory of even well-educated and well-trained adults seldom stores more than seven items.
Include a Mix of Communication Modes
A mix of both printed and audio-visual modes is a good strategy when our audience includes both literate and illiterate patients. In our example, we saw that Grandma did not understand the printed material, but she could easily interact with the video and street-play.
Address their Special Needs
Patients have special needs. For example, we want to reach out to patients with visual disorders. Imagine patients sitting in an eye clinic with eye drops administered and eyes closed. Will videos work in this scenario? Obviously not. Instead, audios with some soothing music in the background would be more effective. And audios work both with literate and illiterate patients.
Use the Same Theme Across Communication Modes
A patient audience recognizes content better when we use the same theme, examples, and images across the communication modes for the same clinical trial. In our example, Grandma instantly recognized the picture on the poster because she had already seen the picture in the newspaper advertisement. She could not read the text on the poster, yet the picture helped her associate the poster with the clinical trial.
Include Culture-specific Themes and Pictures
If we want our audience to relate to the content and remember it, use themes and pictures that are culture specific. These help people connect to the message. If we want our message to appeal to patients across the literacy scale, let’s remember the simple rule: “Be sensitive to patients’ needs and give them the importance they deserve. Remember, clinical trials just cannot exist without patients.”
DR. PANKAJA KULABKAR is currently working on clinical trial documentation and loves sharing her experiences with the STC community. She will be delighted to hear from you on this article at pankaja.kulabkar@yahoo.com.
Acknowledgement: I am grateful to Makarand Pandit for his candid feedback on the draft. The article grew from a presentation I gave at the STC (India) annual conference last year. Several people gave me valuable input. I am particularly thankful to Ramesh Aiyyangar, Elisabeth Otto, Chanchal Das, Mugdha Kulkarni, Ajay and Madhavi Phatak, Suneeta Palnitkar, and Yamini Nafde.
Disclaimer: The names in the article are fictitious.
Thank you for your article. It was helpful while at the same time reminding me of the time that I spent in India.