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1. Convene a working team and solicit stakeholder input early
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Phase 1 – Focus groups
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English-speaking RA patients
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Spanish-speaking RA patients
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Cantonese-speaking RA patients
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Rheumatologists
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2. Identify key concepts to be communicated
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Focus groups provide feedback on main areas of content:
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• Broad category of medicines for RA
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• Benefits of DMARDs across mono- and combination therapies
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• Talking with the doctor about RA drugs
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• Learning about risks
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• Ways to reduce risk
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• Cost
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3. Map concepts to a behavioral theory, such as social cognitive theory and construct a brief intervention to support the use of written materials
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Phase 1 -social cognitive theory suggests that materials should:
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• improve knowledge
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• positively influence outcome expectations
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• emphasize facilitators of behavior change
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• address impediments to behavior change
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• facilitate the creation of goals
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4. Carefully design materials using low-literacy principles
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Phase 2: adopt AHRQ summary guide for low literate, limited English language proficient patients
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• Use illustrations
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• ≥ 14 pt font
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• Adequate white space
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5. Refine materials using input from the target population
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Phase 2
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• In-depth, semi-structured interviews
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• Review adapted guides with patient advisory board
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6. Assess success of efforts in target audience and learn from failures
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Phase 3 – pilot test of decision aid, evaluate acceptability and outcomes of knowledge and decisional conflict
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