Literacy can be evaluated both for printed and digital materials. The Suitability of Assessment Materials scale (Doak et al., 1996) assesses both readability and comprehension of printed materials, including dimensions such as content (e.g., purpose and scope), literacy demand (e.g. reading level), graphics (e.g. relevance of illustrations), layout and typography (e.g. subheadings use), learning, stimulation and motivation (e.g. self-efficacy), and cultural appropriateness (e.g. cultural images). It is the most cited method for assessing the accessibility of patient materials beyond reading level (Ryan et al., 2014). When considering an online tool, the eHealth Literacy Scale (Norman and Skinner, 2006) is the most used screening tool to measure knowledge, comfort, and perceived skills at finding, evaluating, and applying e-health information to health problems (Kim and Xie, 2017), providing important clues on users’ comfort and skill in using information technology for health information.
Other factors, besides absence of bias and readability, found to be relevant before launching a health education tool are accessibility, usefulness, comprehensiveness, credibility, and interactivity (Kim and Xie, 2017). These components are essential to all target populations. Interactive tools, for example, were found to be more effective than static contents not only in adolescents but also in older adults, and people with low socio-economic status (Kim and Xie, 2017), and medical health professionals (Car et al., 2019).
Design is also a very important aspect of educational resources and often neglected because researchers are unfamiliar with it. There are existing guidelines that consider how learning is facilitated, and engagement can be boosted through illustrations and charts, target audience familiarity with characters when using videos, and the speed of audio. The US Department of Health and Human Services web design and usability guidelines include strength of evidence for each recommendation (U.S. Department of Health and Human Services & U.S. General Services Administration, 2006). If the educational resource consists mainly of videos (for example, when producing a national campaign), it is worth using specific video guidelines (e.g. Brame, 2016). When considering developing a decision aid for people facing fertility treatment and its options, the research team should use the quality criteria from the International Patient Decision Aid Standards (IPDAS, Elwyn et al., 2006; Volk et al., 2013).
The design of a resource will influence engagement with it. In the context of fertility education, engagement refers to a desire and capability to actively participate by interacting with the designed resource or tool to optimise reproductive decision-making. It is the responsibility of the research team to devise educational resources that motivates users to take action (Hou, 2012). Engagement is critical in individual digital change behaviour interventions, where attrition is high, almost half of the material provided is not accessed, and interventions are evaluated by participants as too time-demanding (Car et al., 2019). Testing a beta version or pilot testing of any resource will help reduce these risks. When conducting a pilot study, both quantitative and qualitative research can make significant contributions and have different advantages (Creswell, 2015), and in most cases, the use of mixed methods will maximise the benefits. Having participants test the resource will show that engagement goes far beyond their ability to use technology, which often does not correlate with behaviour change (Michie et al., 2017). Pilot results will help establish the minimum engagement required for the desired change in behaviour for a particular educational resource, as it has been shown that change points vary according to intervention types (Michie et al., 2017).
The need for developing and deploying fertility education has emerged in this century as profound changes in the transition to parenthood and family configurations have occurred. This paper provides guidance for developing educational tools to increase fertility awareness and literacy, and facilitate decision-making by individuals. Key messages include:
Recruitment of end-users as co-creators should consider racial, ethnic, and socioeconomic disparities to ensure inclusiveness and equity. Understudied populations such as men, single mothers by choice, and the LGBTQ+ population should be included in the development of generic or specific interventions to address existing gaps in fertility knowledge and education.
M.V.M., E.K., R.S., and E.M. designed the study. M.V.M. drafted most part of the manuscript, with contributions from E.K., R.S., M.M-R., E.M., K.H., and J.H. All authors made significant contributions critically revising the manuscript and approved the final version for submission.
J.H. has received consultancy fees from Gedeon Richter, Haleon, and Natural Cycles. J.H. has also received payment for talks and travel support from Bayer, Merck, Gedeon Richter and Cook IVF. J.H. also receives author royalties for the book ‘Your Fertile Years’. The other authors have no conflicts of interest to declare.
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The Fertility Guide from Balance Fertility is your definitive guide to help you on your fertility journey. It provides reliable, evidence-based information on all aspects of reproductive health for men and women. The Fertility Guide helps you to optimise your health, achieve your goals for a family and navigate any treatment you may need.
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