Advertisement

Letter to the editor in response to “No difference in knowledge obtained from infographic or plain language summary of a Cochrane systematic review: three randomized controlled trials” by Buljan et al. (2017)

      Buljan et al. [
      • Buljan I.
      • Malički M.
      • Wager E.
      • Puljak L.
      • Hren D.
      • Kellie F.
      • et al.
      No difference in knowledge obtained from infographic or plain language summary of a Cochrane systematic review: three randomized controlled trials.
      ] conducted three randomized controlled trials to examine the effect of different summary formats (i.e., scientific abstract, plain language summary (PLS), and infographic) of a Cochrane systematic review on knowledge acquired, reading experience, and perceived user-friendliness of three groups (i.e., students, consumers, and doctors). As researchers in knowledge translation (KT), we were interested in this innovative and useful study. However, we have identified some issues that are worth considering.
      First, this study found that the infographic was equally effective for knowledge acquisition than other knowledge summary formats and that participants preferred this format. However, the authors conclude that PLS should be privileged over infographic. To justify this conclusion, they use the argument of cost effectiveness without providing data in its support. Also, this recommendation disregards the fact that because infographic is more appealing, it is more likely to be read by a nonscientific public. We can hypothesize that positive reading experience and perceived user-friendliness would encourage more effective KT. We argue that the authors should have accentuated this point. Thus, we believe that a more nuanced title would have been more appropriate.
      Second, we have some concerns with the methodology. First, we cannot judge the quality of the infographic used in the study because it is not easily accessible. The authors do not mention if the infographic was built on existing knowledge regarding best practices [
      • Szołtysik M.
      Processes of creating infographics for data visualization.
      ,
      • Yildirim S.
      Infographics for educational purposes: their structure, properties and reader approaches.
      ] aligned with communication theories, instructional design strategies, or information design principles [
      • Evergreen S.D.H.
      Death by boredom: The role of visual processing theory in written evaluation communication.
      ,
      • Majooni A.
      • Masood M.
      • Akhavan A.
      An eye-tracking study on the effect of infographic structures on viewer’s comprehension and cognitive load.
      ,
      • Tetlan L.
      • Marschalek D.
      How humans process visual information: a focused primer for designing information.
      ]. Because there are no established conventions on how to develop an infographic to communicate a complex message, it becomes essential to specify if the infographic was co-created with potential users, pretested, and validated by specialists. Moreover, the authors do not mention if specific sections of the infographic may have limited the overall participants' understanding.
      Third, the three knowledge summary formats must contain the same information to rigorously interpret the results. More specifically, the infographic used by Buljan et al. [
      • Buljan I.
      • Malički M.
      • Wager E.
      • Puljak L.
      • Hren D.
      • Kellie F.
      • et al.
      No difference in knowledge obtained from infographic or plain language summary of a Cochrane systematic review: three randomized controlled trials.
      ] comprises more text, details, and numbers than the PLS format. In addition, the infographic presents charts containing data not presented in the PLS. We wonder if this discrepancy created cognitive overload, consequently affecting participants' knowledge acquisition. We also question the impact of the participants' learning style and visual literacy, potential confounding variables, on the findings. Other methodological elements that might have affected the results are worth exploring. For example, the participants' level of knowledge on the systematic review content before the intervention was not measured; and the authors did not measure the retention of knowledge in the longer term.
      Finally, we argue the need to rethink the false delineation between text- and visual-based formats because they are not mutually exclusive. Instead, we must try to understand what is the optimal combination between text and visuals and what types of visuals and storytelling techniques (in combination with plain language or not) facilitate the understanding of various messages for multiple audiences. The KT field emphasizes the importance of developing knowledge formats based on the target audience's preferences [
      • Cairney P.
      • Kwiatkowski R.
      How to communicate effectively with policymakers: combine insights from psychology and policy studies.
      ,
      • Davidson B.
      Storytelling and evidence-based policy: lessons from the grey literature.
      ].
      We suggest reproducing this study in multiple contexts, being transparent about strengths and limitations of knowledge formats used, and using a complementary qualitative approach to better understand participants' experience and preferences.

      References

        • Buljan I.
        • Malički M.
        • Wager E.
        • Puljak L.
        • Hren D.
        • Kellie F.
        • et al.
        No difference in knowledge obtained from infographic or plain language summary of a Cochrane systematic review: three randomized controlled trials.
        J Clin Epidemiol. 2017; https://doi.org/10.1016/j.jclinepi.2017.12.003
        • Szołtysik M.
        Processes of creating infographics for data visualization.
        in: Complexity in Information Systems Development. Springer, Cham2017: 167-184
        • Yildirim S.
        Infographics for educational purposes: their structure, properties and reader approaches.
        Turk Online J Educ Technol-TOJET. 2016; 15: 98-110
        • Evergreen S.D.H.
        Death by boredom: The role of visual processing theory in written evaluation communication.
        (PhD thesis) Western Michigan University, 2011
        • Majooni A.
        • Masood M.
        • Akhavan A.
        An eye-tracking study on the effect of infographic structures on viewer’s comprehension and cognitive load.
        Inf Vis. 2017; https://doi.org/10.1177/1473871617701971
        • Tetlan L.
        • Marschalek D.
        How humans process visual information: a focused primer for designing information.
        Visible Lang. 2016; 50: 65
        • Cairney P.
        • Kwiatkowski R.
        How to communicate effectively with policymakers: combine insights from psychology and policy studies.
        Palgrave Commun. 2017; 3: 37
        • Davidson B.
        Storytelling and evidence-based policy: lessons from the grey literature.
        Palgrave Commun. 2017; 3: 17093

      Linked Article