When a security firm in London offered free Wi-Fi to people in a busy public area, nobody paid attention to an unusual condition in the online contract that users were signing. The user agreement contained a condition called the “Herod Clause,” which stated that users would have to give away their first newborn child in exchange for free Internet. This prank was orchestrated by the security firm in order to see just how many people read the terms and conditions before accepting them. It seems no one did.
This issue is not uncommon. We always accept terms and conditions without reading them. The commonality of Wi-Fi and internet use made this contractual relationship between the two parties a negligible concern.
What does this scenario have to do with research ethics?
We pay a great deal of attention to the language and understandability of an informed consent. When it is too long, we shorten it. When it is too short, we request more details. Depending on the complexity of the research, an informed consent can be several pages long. This can be a hurdle to research participants, particularly if they have language and/or cognitive challenges.
But John T. Wilbanks, Chief Commons Officer of SAGE Bionetworks, proposed a new concept during his keynote speech in the AER 2014 conference in Baltimore. His talk was on utilizing multimedia icons in a smartphone app to explain the research being consented upon in a simplified manner. The icons are basic drawings, comfortable to the human eye and easy to understand.
It seems to me that the long nuisance sentences can be replaced with representative icons making the consent process easy to comprehend. Of course, there is room for words to elaborate on these concepts. For example, if the participant feels he/she needs more information, then he/she can click on the “tell me more” button to see the full language of that portion of the consent document.
After listening to Wilbanks’s talk, I began to imagine traffic signs consisting of text instead symbols, or airplane safety cards with only text instructions instead of the their simple drawings. It seems we can enhance the understandability of the informed consent by employing intelligently designed icons, rather than battling with language. This is a new concept which is certainly worth exploring.
Suhail Al-Amad, DClinDent (Melb); FRACDS-Oral Med, Assistant Professor of Oral Medicine, University of Sharjah, UAE and Adjunct Senior Lecturer in Forensic Odontology, Monash University, Australia.