BMJ open · 2026
Optimising summary infographics for clinical practice guidelines on child health: qualitative user testing study with healthcare workers in Malawi, Nigeria and South Africa.
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Lubelwana Hafver Tandekile, Achille Frankie, Reinthaler Valerie, Nagraj Sumanth, Banda Susan, Odendaal Willem, Kallon Idriss I, Chibuzor Moriam, Arikpo Dachi, Chipojola Roselyn, Effa Emmanuel, Mbeye Nyanyiwe Masingi, Kredo Tamara, Leong Trudy Desirie D, Lewin Simon, Brand Amanda Salomé, Glenton Claire, Cooper Sara, Schmidt Bey-Marrié, Kyomuhendo Munabi-Babigumira Susan, Vandvik Per O, Agoritsas Thomas, Delvaux Nicolas
Аннотация
OBJECTIVES: To optimise the dissemination of clinical practice guideline (CPG) summary infographics on newborn and child health to healthcare workers (HCWs) in Malawi, Nigeria and South Africa.
DESIGN: Qualitative user testing using think-aloud interviews with local HCWs to identify their preferences for and barriers to using CPG summary infographics.
PARTICIPANTS: 26 HCWs involved in newborn and child healthcare, including participants from Lilongwe (n=8), Calabar (n=10) and Cape Town (n=8).
INTERVENTIONS: Draft CPG summary infographics on newborn and child health topics explored by participants during interviews.
PRIMARY AND SECONDARY OUTCOMES: Participants' perceptions of the infographics in terms of findability, usability, understandability, desirability, identification, accessibility, credibility, usefulness and value.
RESULTS: Most participants found the infographics easy to understand and appreciated the visual design. However, participants had difficulty interpreting the strength of recommendations and were sometimes unclear about the target population and distinction between interventions and comparators. Navigation and the use of medical terminology also presented challenges, while some images did not reflect the local clinical environments. Perceptions of usefulness varied across guideline topics and countries.
CONCLUSIONS: User testing identified important barriers to the use of CPG summary infographics. Feedback informed revisions to the infographics before final dissemination, including clarifying the meaning of recommendation strength, adjusting terminology, bringing key content to the foreground and refining imagery. Early engagement with end users in the development of CPG dissemination products can help ensure that recommendations are clearly conveyed and that the content and visuals are appropriate to local clinical contexts and needs.
DESIGN: Qualitative user testing using think-aloud interviews with local HCWs to identify their preferences for and barriers to using CPG summary infographics.
PARTICIPANTS: 26 HCWs involved in newborn and child healthcare, including participants from Lilongwe (n=8), Calabar (n=10) and Cape Town (n=8).
INTERVENTIONS: Draft CPG summary infographics on newborn and child health topics explored by participants during interviews.
PRIMARY AND SECONDARY OUTCOMES: Participants' perceptions of the infographics in terms of findability, usability, understandability, desirability, identification, accessibility, credibility, usefulness and value.
RESULTS: Most participants found the infographics easy to understand and appreciated the visual design. However, participants had difficulty interpreting the strength of recommendations and were sometimes unclear about the target population and distinction between interventions and comparators. Navigation and the use of medical terminology also presented challenges, while some images did not reflect the local clinical environments. Perceptions of usefulness varied across guideline topics and countries.
CONCLUSIONS: User testing identified important barriers to the use of CPG summary infographics. Feedback informed revisions to the infographics before final dissemination, including clarifying the meaning of recommendation strength, adjusting terminology, bringing key content to the foreground and refining imagery. Early engagement with end users in the development of CPG dissemination products can help ensure that recommendations are clearly conveyed and that the content and visuals are appropriate to local clinical contexts and needs.