Picture versus words: A comparison of pictorial and verbal informed assent formats

Background for the Study: Informed consent is a process of obtaining permission from the participant to participate in research. Involving children in a research requires them to give their “assent” for participation. Informed assent is obtained from children even after their guardians have given consent for participation. Studies have shown that children have difficulty understanding the key elements of research process such as right to withdraw from the study or the meaning of “harm” involved in the research process. Further, the studies have also propounded that using child-friendly methods such as using pictures and simple language would facilitate children's understanding. Objectives: In this study, pictorial and verbal assent formats were compared find out which format is suitable for children's understanding of informed assent with respect to research. Methods: A sample of 389 school going children and adolescents of both the gender, ranging from 7 to 16 years were considered for the study. The sample was randomly divided into two groups, where for one group (n = 197), pictorial assent format was administered and another group (n = 192), verbal assent format was administered. The pictorial assent format was developed for the study by the corresponding author. Results and Conclusions: Analysis revealed that there was a significant level of interaction between gender and the two assent formats. Males were able to understand pictorial assent format better compared to the females, whereas females were able to understand verbal assent format better than the males, when age and education were considered as covariates. Further, it was found that as age increases there is better understanding of research processes in both the formats. Hence, while the process of obtaining assent for participation in research, age of child must be considered and with respect to gender differences males tend to prefer pictorial formats whereas females tend to prefer verbal formats.