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Abstract
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 (Citation1972) 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.
Acknowledgments
This project was supported by the Appalachia Cancer Network, grant U01 CA86096 from the National Cancer Institute.
Notes
1 Metaphorical language refers to implied comparisons between two dissimilar entities that result in the qualities of one entity being transferred to the other. Metaphors and similes have three components, where A is referred to as the target or tenor, B is called the source or vehicle because it carries meaning to A, and the shared characteristic between A and B labeled the ground (Sopory & Dillard, Citation2002). The persuasive influence of metaphor resides in the cognitive processes associated with decoding a nonliteral comparison, not in the structure of the words themselves (Hitchon, Citation1997). To be consistent with the previous literature, the term metaphorical language, which encompasses both metaphors and similes, is frequently simplified to metaphor in this article.
β = Unstandardized regression coefficients (standard error).
*p < .05. **p < .01. ***p < .001.
β = Unstandardized regression coefficients (standard error).
*p < .05. **p < .01. ***p < .001.
