The recent focus on health equity and diversity in clinical research is long overdue and of critical importance to the future of medical advancements.

For communities of colour, however, their willingness to participate in clinical trials has been marred by a history of mistreatment and abuse. To overcome their justifiable mistrust, the industry must be sensitive to the cultural needs of specific communities and provide relevant resources for each cohort it wants to recruit. In all cases, the information provided should reflect the patients’ culture, age, educational attainment and other factors key to engagement and learning. Educational resources that are provided in a familiar format with a storyline and art direction that is reflective of the target consumer group can play vital roles in achieving a successful action-oriented communication plan.

Clinical research has the power to bridge gaps in health equity, increase access to (and utilisation of) healthcare and address traditional social determinants of health. With investments upwards of $2bn required to research and develop a single drug, the importance of a diverse and educated participant pool cannot be overstated. With recruitment and retention numbers problematically low, investing in an informed and engaged patient is critical to ensuring a successful trial in which an investigational therapy is appropriately studied among a broad base of participants.

Enter animation as a culturally sensitive and effective educational resource. A familiar format that brings to life the written word in a way to ensure the patient can successfully act upon the instruction provided.

With its unique ability to overcome literacy and comprehension barriers, animation can serve a critical role in pre- and post-consent patient education – ensuring patients can make informed decisions regardless of their age, educational attainment or ethnic group.

Impact of Investigators’ Struggle to Recruit and Retain Participants

Studies have shown that 85% of trials under-enroll, with 50% of trials enrolling one or zero patients.^{1, 2} Time lost seeking to reach sample size and other recruitment challenges causes delays in 80% of trials.1 Patient recruitment is estimated to account for 40% of a clinical trial’s budget, and delays during the recruitment process can result in lost revenue totaling $600,000 to $8m per day for every day the study is delayed.²

Participant retention is equally essential to the success of a clinical trial. 85% of trials fail to retain enough patients, and the average dropout rate is approximately 30% across all trial types.²

Bridging Health Literacy Gaps

A focus on increasing health literacy by deploying understandable study resources should be leveraged to avoid drug development delays and ensure safe, effective and affordable treatments are made available to the patient communities that need them.

Animation is one example of a cost-effective solution that can be adapted to better serve disparate groups and, as such, improve recruitment, compliance and retention.

Fear of the unknown, especially in a clinical trial, can have a ripple effect downstream; clear and concise information can alleviate some retention issues. Clear communication is key to helping patients absorb and process the information needed to understand and manage their condition and trial expectations. Educational resources are also beneficial to caregivers who are concerned for the welfare of their loved ones and likely in need of information about their condition and the trial.

However, individual patients and caregivers have different degrees of health literacy. Common health literacy gaps can be caused by language barriers (speaking a different native language or being less than fluent), comprehension barriers due to lack of familiarity with medical terminology and anxiety, which can prevent a patient from absorbing and understanding information they would normally comprehend. The way in which trial information is presented can mean the difference between successful enrollment and retention and overall participant satisfaction.

Leveraging Animation to Bridge Health Literacy Gaps and Improve Trial Design, Management and Delivery

Animation has been proven to help patients and caregivers absorb and retain vital information and can calm fears and increase engagement, leading to improved healthcare literacy, patient experience and trial data quality. In a study of animations about clinical trial participation for cancer patients and survivors, a total of 1,194 participants answered questions about the effects of animated educational content compared to brochures both with and without visuals. The materials described placebos, randomisation, the required steps to enrol in a clinical trial and the ways in which patients were protected throughout a clinical trial.

The results showed that animations improved knowledge of and attitudes toward clinical trials in general, and that animations were more effective in presenting information than brochures.

The animations were particularly effective in improving motivation and overcoming health literacy barriers.⁵

The ‘why’ behind the use of animation techniques and its superior effectiveness lies in information processing methods in the human brain. Studies show that 40-80% of what a person hears is immediately forgotten, and the remaining 50% is recalled incorrectly. After three hours, only 25% of what was originally heard is recalled; after three days, merely 15%.

This makes verbal communication a very inadequate method of transferring information that needs to be retained accurately.

Even written or read information is quickly forgotten; after three hours, 72% of what was read is recalled, and after three days, this drops to 10% – even lower than heard information. Therefore, clinical research teams should not merely rely on printed information when seeking to communicate effectively, especially with younger patient populations whose reading comprehension levels vary greatly.

The percentage of recall and retention jumps dramatically when visuals and/or motion graphics are integrated with spoken or written information. The human brain processes images 60,000 times faster than text alone. When comparatively studied, introducing visuals leads to 80% of information being retained after three hours and an incredible 65% retention and recall after three days. The biggest advantage of using animation is the duration of accurate recall even after an extended period of time.6 Animation is an amazing tool for bridging the knowledge and understanding gaps in health literacy because it is visually engaging, accessible and memorable.

Creating content in a format that people prefer increases the value of this tool even more. Videos and animation have quickly become the preferred method of sharing and learning, with the average person now spending around 100 minutes a day watching online videos. 82% of consumer internet
traffic will be videos by the end of this year.⁵

Similarly, two-thirds of people say they prefer watching a short video to learn about a product or service than reading an article/website/post online, viewing an infographic, downloading an eBook, reading something in print, attending a webinar, or speaking to someone.⁷

The Animation Creative Process

Animation can be a powerful tool to bridge language and comprehension gaps, demonstrating ideas and information visually, often without the need for any audio or text. It can bring complex concepts to life, delivering emotion alongside a message, humanizing the healthcare experience for patients, caregivers and healthcare professionals.

When animation is done well, it can enable viewers to immediately relate to the characters and content, enhancing comprehension and retention of information and enabling viewers to act. This medium can be leveraged to boost engagement and improve patient experience before, during and after participation in a trial.

This benefit for patients can also improve the efficacy and speed of the trial, leading to more robust, complete trial data and lessening the chances of costly delays. The value of this approach to clinical trial participation cannot be overstated; if patients can connect to information in a way that carries them from recruitment all the way through participation and follow-up, engagement and completion rates for trials can be drastically improved.

There are six key steps to help ensure the efficient completion and optimal impact of any animated video used in clinical trials:

Step 1: Understand Your Objectives and Your Audience’s Needs

Scientific, business and audience demographic information is gathered, understood and synthesized. Sponsors and stakeholders identify the story’s objectives and clarify scientific and participant information. What do patients need to understand and what should they do with the information?

This is an essential step in preparation for creating a story that will bring the science to life for the target audience.

Step 2: Outline and Develop the Story

Base medical information is fleshed out to identify the main components of the story while still ensuring all necessary details are conveyed. Understanding the audience helps to convey the science in a way that ensures anyone in that audience will grasp the message and meaning. At that point, script and characters can be developed; these can be embodied with recognizable, relatable, consistent thematic elements that will carry throughout a story and reiterate essential information over a significant length of time. A ‘scratch track’ or recorded reading of the script is done to determine the length and cadence of the story.

Step 3: Visualize the Key Elements

Main scenes and action are blocked out visually in a black and white storyboard, outlining the elements and key frames of the story from beginning to end. The storyboard can then be brought to life through animatics adding rudimentary motion and transitions to the storyboards. This step helps to determine the overall visual flow and ensure all the visual elements are scientifically accurate and appropriately represented.

Step 4: Establish a Unique and Impactful Style

The animators put colour and finishing touches on some key scenes to determine and solidify the desired style for all characters, scientific elements, copy labels, etc. This allows all stakeholders the opportunity to refine any visual details before the animation process begins. These style boards are the blueprint that the animators will follow when creating the final deliverable.

Step 5: Voice-Over and Sound Design

During the animation process, music and sound effects will be selected and the appropriate individual will be chosen to voice-over the video content. This can be done in any language or accent desired to enhance the understanding of the content. The right voice, music and sound effects can elevate the overall impact of any animated story.

Step 6: Composite and Complete

The final animation will be delivered in two stages. First, a rough cut to ensure any outstanding needs can be addressed, and then the final cut in whatever format is needed to be approved and utilized.

Animating the Future of Clinical Trials

Bringing healthcare information to life via animation provides engaging, targeted and effective communication. Its value in equipping different patient and caregiver groups – regardless of age, health literacy, language or other demographics – with the knowledge required to make informed decisions makes it an essential and exciting communication tool. Proper use of animation can streamline recruitment measures by explaining clinical trials, simplifying complex study protocols, and as such, reduce participant dropout by reducing fear and anxiety, boosting interest and engagement by delivering recognisable, consistent messaging and guidance throughout the patient pathway.

These improvements will result in faster, more cost-effective completion of trials, and, ultimately, better treatment options for underserved patient populations.