In a previous message today we saw the US National Institutes for Health Checklist for Communicating Science and Health Research to the Public.
A different but related checklist is offered by HIFA members Claire Glenton, Simon Lewin and colleagues: A checklist for people communicating evidence-based information about the effects of healthcare interventions. This is a critical aspect of research communication that we have barely touched on. It is also an area where research can be easily misrepresented or misunderstood.
Citation, abstract, recommendations and a (perhaps provocative) comment from me below.
CITATION: BMJ Open 2020 Jul 21;10(7):e036348. doi: 10.1136/bmjopen-2019-036348.
Development of a checklist for people communicating evidence-based information about the effects of healthcare interventions: a mixed methods study
Andrew D Oxman, Claire Glenton, Signe Flottorp, Simon Lewin, Sarah Rosenbaum, Atle Fretheim
PMID: 32699132 PMCID: PMC7375421 DOI: 10.1136/bmjopen-2019-036348
ABSTRACT
Objectives: To make informed decisions about healthcare, patients and the public, health professionals and policymakers need information about the effects of interventions. People need information that is based on the best available evidence; that is presented in a complete and unbiased way; and that is relevant, trustworthy and easy to use and to understand. The aim of this paper is to provide guidance and a checklist to those producing and communicating evidence-based information about the effects of interventions intended to inform decisions about healthcare.
Design: To inform the development of this checklist, we identified research relevant to communicating evidence-based information about the effects of interventions. We used an iterative, informal consensus process to synthesise our recommendations. We began by discussing and agreeing on some initial recommendations, based on our own experience and research over the past 20-30 years. Subsequent revisions were informed by the literature we examined and feedback. We also compared our recommendations to those made by others. We sought structured feedback from people with relevant expertise, including people who prepare and use information about the effects of interventions for the public, health professionals or policymakers.
Results: We produced a checklist with 10 recommendations. Three recommendations focus on making it easy to quickly determine the relevance of the information and find the key messages. Five recommendations are about helping the reader understand the size of effects and how sure we are about those estimates [these five seem to have expanded to eight in the list below]. Two recommendations are about helping the reader put information about intervention effects in context and understand if and why the information is trustworthy.
Conclusions: These 10 recommendations summarise lessons we have learnt developing and evaluating ways of helping people to make well-informed decisions by making research evidence more understandable and useful for them. We welcome feedback for how to improve our advice.
CHECKLIST FOR COMMUNICATING EFFECTS
Make it easy for your target audience to quickly determine the relevance of the information, and to find the key messages.
- Clearly state the problem and the options (interventions) that you address, using language that is familiar to your target audience—so that people can determine whether the information is relevant to them.
- Present key messages up front, using language that is appropriate for your audience and make it easy for those who are interested to dig deeper and find information that is more detailed.
- Report the most important benefits and harms, including outcomes for which no evidence was found—so that there is no ambiguity about what was found for each outcome that was considered.
For each outcome, help your target audience to understand the size of the effect and how sure we can be about that; and avoid presentations that are misleading.
- Explicitly assess and report the certainty of the evidence.
- Use language and numerical formats that are consistent and easy to understand.
- Present both numbers and words and consider using tables to summarise benefits and harms, for instance, using Grading of Recommendations Assessment, Development and Evaluation (GRADE) summary of finding tables or similar tables.
- Report absolute effects.
- Avoid misleading presentations and interpretations of effects.
- Help your audience to avoid misinterpreting continuous outcome measures.
- Explicitly assess and report the credibility of subgroup effects.
- Avoid confusing ‘statistically significant’ with ‘important’ or a ‘lack of evidence’ with a ‘lack of effect’.
Help your target audience to put information about the effects of interventions in context and to understand why the information is trustworthy.
- Provide relevant background information, help people weigh the advantages against the disadvantages of interventions and provide a sufficient description of the interventions.
- Tell your audience how the information was prepared, what it is based on, the last search date, who prepared it and whether the people who prepared the information had conflicts of interest.
COMMENT (NPW): The 'five recommendations about helping the reader understand the size of effects and how sure we are about those estimates' seem to have expanded to eight in the actual checklist. Notwithstanding, it is notable that all 10/13 recommendations are about providing information, and none of them are about persuading the reader to take action.
My takeaway from this whole discussion is that the motivation for effective research communication is (or should be) all (or nearly all) about providing reliable information and understanding, and it is not (or should not be) about persuading changes in policy and practice. (The latter is advocacy - researchers may choose also to be advocates, but I would suggest that their primary role is to inform and be understood.)
To stimulate further discussion, I would propose that policymakers need balanced information from health research. They do not need individual primary researchers to persuade them to act on the basis of 'their' research findings.
So, where should financial and political support be provided to improve the effectiveness of research communication? I would argue that it should be directed more to improve balanced information and understanding (especially through research synthesis), and relatively less to strengthen researchers' ability to effect policy change (especially from a single primary study).
I look forward to hear your thoughts.
Best wishes, Neil
Joint Coordinator, HIFA Communicating health research https://www.hifa.org/projects/new-effective-communication-health-researc...
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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health movement (Healthcare Information For All - www.hifa.org ), a global community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. HIFA brings stakeholders together to accelerate progress towards universal access to reliable healthcare information. HIFA is administered by Global Healthcare Information Network, a UK based non-profit in official relations with the World Health Organization. Twitter: @hifa_org neil@hifa.org
