Theme 1: “This paper makes it hard for me to show that I am capable of making decisions”
The theme reflects the OPDG adaptations to support participant ability to obtain, understand, and use factual information. The theme reflects the needs of participants to have accessible, user-friendly tools. As several participants reported, their experience with Western care systems and settings did not foster their full participation when accessing and using care. During the initial iterations of the OPDG adaptation, participants were observed to often be looking silently at the paper until asked their views on the readability of the OPDG. Myrna described her difficulties with the OPDG when she stated, “It’s a little confusing, okay. The lists – it does not make sense.” Others voiced similar issues, with comments such as “I am not sure of what this means” or sometimes simply asking the facilitator, “what should I put?” To address these issues, participants identified several essential adaptations: a) use of plain language; b)adjustments to print size to better identify transitions to each new section; c) decreases to concept density (creation of extra white space by decreases in text density through-out text; provision of space for notes in section 4; removal of repetitive wording in section 4); d) a more logical layout of the OPDG text (alignment of the section 3 list with section 4, boxing lists in section 4 together to make information appear more manageable).