Focus groups and interviews with the public led to the development of a template for a GRADE Plain Language Recommendation (PLR)

Published:September 14, 2021DOI:https://doi.org/10.1016/j.jclinepi.2021.09.018

      Abstract

      Objective

      Clear communication of health care recommendations to patients and the public is essential. Current work has focused on creating patient versions of guidelines without much attention to single recommendations. In this study, we built on previously conducted research to test a template and explore the public's perceptions of, and attitudes towards plain language guideline recommendations.

      Study Design and Setting

      We conducted four focus groups with people interested in healthy aging to obtain general attitudes, perceptions, and understanding of recommendations. We then conducted nine user-tests of Plain Language Recommendations developed from GRADE guidelines. We performed a directed content analysis, and finalized a template for a Plain Language Recommendation.

      Results

      We identified themes related to personalized information; strength of recommendations; support with health care and appointments; amount and credibility of information; and formatting. When recommendations were conditional, participants wanted more information about why and what to consider. The template for a Plain Language Recommendation is available in the GRADEpro software to facilitate automation.

      Conclusion

      We created a Plain Language Recommendation template to communicate specific information from guidelines to patients and the public. Broad application of the template is warranted and future research could measure the impact on understanding and behavior change.

      Keywords

      To read this article in full you will need to make a payment

      References

        • Loudon K
        • Santesso N
        • Callaghan M
        • Thornton J
        • Harbour J
        • Graham K
        • et al.
        Patient and public attitudes to and awareness of clinical practice guidelines: a systematic review with thematic and narrative syntheses.
        BMC Health Serv Res. 2014; 14: 321
        • Boylan S
        • Louie JC
        • Gill TP.
        Consumer response to healthy eating, physical activity and weight-related recommendations: a systematic review.
        Obes Rev. 2012; 13: 606-617
        • Dreesens D
        • Stiggelbout A
        • Agoritsas T
        • Elwyn G
        • Flottorp S
        • Grimshaw J
        • et al.
        A conceptual framework for patient-directed knowledge tools to support patient-centred care: Results from an evidence-informed consensus meeting.
        Patient Educ Couns. 2019; 102: 1898-1904
        • Schipper K
        • Bakker M
        • De Wit M
        • Ket JC
        • Abma TA.
        Strategies for disseminating recommendations or guidelines to patients: a systematic review.
        Implement Sci. 2016; 11: 82
        • Santesso N
        • Morgano GP
        • Jack SM
        • Haynes RB
        • Hill S
        • Treweek S
        • et al.
        Dissemination of clinical practice guidelines: a content analysis of patient versions.
        Med Decis Making. 2016; 36: 692-702
        • Horvath K
        • Semlitsch T
        • Jeitler K
        • Abuzahra ME
        • Posch N
        • Domke A
        • et al.
        Choosing wisely: assessment of current US top five list recommendations' trustworthiness using a pragmatic approach.
        BMJ Open. 2016; 6e012366
        • van der Weijden T
        • Boivin A
        • Burgers J
        • Schünemann HJ
        • Elwyn G.
        Clinical practice guidelines and patient decision aids: an inevitable relationship.
        J Clin Epidemiol. 2012; 65: 584-589
        • Atkins D
        • Best D
        • Briss PA
        • Eccles M
        • Falck-Ytter Y
        • Flottorp S
        • et al.
        Grading quality of evidence and strength of recommendations.
        BMJ. 2004; 328: 1490
        • O'Brien BC
        • Harris IB
        • Beckman TJ
        • Reed DA
        • Cook DA.
        Standards for reporting qualitative research: a synthesis of recommendations.
        Acad Med. 2014; 89: 1245-1251
        • Fearns N
        • Graham K
        • Johnston G
        • Service D.
        Improving the user experience of patient versions of clinical guidelines: user testing of a Scottish Intercollegiate Guideline Network (SIGN) patient version.
        BMC Health Serv Res. 2016; 16: 37
      1. Group G-I-NPW. G-I-N PublicToolkit: Patient and Public Involvement in Guidelines 2015. Available from: https://g-i-n.net/wp-content/uploads/2021/04/GIN-TOOLKIT-COMBINED-FINAL-2015.pdf, Accessed: 2021 October 06.

        • Rosenbaum SE
        • Glenton C
        • Nylund HK
        Oxman AD. User testing and stakeholder feedback contributed to the development of understandable and useful Summary of Findings tables for Cochrane reviews.
        J Clin Epidemiol. 2010; 63: 607-619
        • Hsieh HF
        • Shannon SE.
        Three approaches to qualitative content analysis.
        Qual Health Res. 2005; 15: 1277-1288
        • Wang X
        • Chen Y
        • Akl EA
        • Tokalić R
        • Marušić A
        • Qaseem A
        • et al.
        The reporting checklist for public versions of guidelines: RIGHT-PVG.
        Implement Sci. 2021; 16: 10
        • Liira H
        • Saarelma O
        • Callaghan M
        • Harbour R
        • Jousimaa J
        • Kunnamo I
        • et al.
        Patients, health information, and guidelines: a focus-group study.
        Scand J Prim Health Care. 2015; 33: 212-219
        • Perrier MJ
        • Martin Ginis KA
        Narrative interventions for health screening behaviours: a systematic review.
        J Health Psychol. 2017; 22: 375-393
        • Akl EA
        • Guyatt GH
        • Irani J
        • Feldstein D
        • Wasi P
        • Shaw E
        • et al.
        Might" or "suggest"? no wording approach was clearly superior in conveying the strength of recommendation.
        J Clin Epidemiol. 2012; 65: 268-275
      2. Lomotan EA, Michel G, Lin Z, Shiffman RN. How "should" we write guideline recommendations? Interpretation of deontic terminology in clinical practice guidelines: survey of the health services community. Qual Saf Health Care. 2010;19(6):509-13.

        • Neumann I
        • Santesso N
        • Akl EA
        • Rind DM
        • Vandvik PO
        • Alonso-Coello P
        • et al.
        A guide for health professionals to interpret and use recommendations in guidelines developed with the GRADE approach.
        J Clin Epidemiol. 2016; 72: 45-55
        • Santesso N
        • Rader T
        • Nilsen ES
        • Glenton C
        • Rosenbaum S
        • Ciapponi A
        • et al.
        A summary to communicate evidence from systematic reviews to the public improved understanding and accessibility of information: a randomized controlled trial.
        J Clin Epidemiol. 2015; 68: 182-190
        • Hibbard JH
        • Greene J.
        What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs.
        Health Aff (Millwood). 2013; 32: 207-214
        • Schulz PJ
        • Nakamoto K.
        Health literacy and patient empowerment in health communication: the importance of separating conjoined twins.
        Patient Educ Couns. 2013; 90: 4-11
        • Delgado P
        • Vargas C
        • Ackerman R
        • Salmeron L.
        Don't throw away your printed books: a meta-analysis on the effects of reading media on reading comprehension.
        Rev Educ Res. 2018; 25: 23-38