The design of an orthodontic patient information leaflet: a cross-sectional, mixed methods study involving surveys, a knowledge test and eye-tracking

Background: Patient Information Leaflets (PILs) are widely used to support verbal communication during orthodontic consent. For a PIL to be effective, it must present information clearly and support patient understanding and recall. A commonly used orthodontic PIL in the UK is the British Orthodontic Society's (BOS) PIL "Orthodontic Treatment: What are the risks?". Aim and objectives: To evaluate this orthodontic PIL, compared to a simpler Designed to Smile PIL, with regards to: 1) Design clarity; 2) Free text comments on the design and content; 3) Knowledge after reading the PIL; 4) Time spent looking at various aspects of the PIL. Methods: Students of non-medicine or dentistry programmes viewed the orthodontic PIL electronically with simultaneous eye-tracking. Immediately afterwards, they completed a survey capturing their clarity of design rating, feedback on the design and content, and knowledge of the PIL content. This was repeated for a simpler Designed to Smile PIL. Results: 36.8% rated the orthodontic PIL as "very clear" compared to 66% for the Designed to Smile PIL. Suggested improvements included breaking-up large blocks of text, using more images, and including descriptions of patient experience. 48.9% (SD = 9.0) of questions were answered correctly regarding content in the orthodontic PIL; significantly lower than the simpler Designed to Smile PIL (80%; SD = 11.3%) (P < 0.001). Eye-tracking indicated that participants spent more time looking at images in the orthodontic PIL (median = 22.2% of time) compared to the Designed to Smile PIL (median = 8.2%) (P < 0.001). Conclusions: The Designed to Smile PIL was deemed clearer than the orthodontic PIL. Suggestions for improvement included using more images and breaking-up large sections of text. Knowledge was relatively poor after reading the orthodontic PIL. Participants spent longer looking at the images in the orthodontic PIL compared to the Designed to Smile PIL.