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Peer-reviewedCC BY 4.0BMJ Open

Optimising summary infographics for clinical practice guidelines on child health: qualitative user testing study with healthcare workers in Malawi, Nigeria and South Africa

  • Tandekile Lubelwana Hafver1
  • Frankie Achille1
  • Valerie Reinthaler1
  • Sumanth Nagraj1
  • Susan Banda2,3
  • Willem Odendaal3,4,5
  • Idriss I Kallon6
  • Moriam Chibuzor7
  • Dachi Arikpo7
  • Roselyn Chipojola8
  • Emmanuel Effa7
  • Nyanyiwe Masingi Mbeye8
11 more authors
  • Tamara Kredo5,6,9,10
  • Trudy Desirie D Leong5
  • Simon Lewin5,11
  • Amanda Salomé Brand12
  • Claire Glenton13
  • Sara Cooper9
  • Bey-Marrié Schmidt5
  • Susan Kyomuhendo Munabi-Babigumira13
  • Per O Vandvik1,14
  • Thomas Agoritsas1,15,16
  • Nicolas Delvaux1,17
17 affiliations
  1. 1MAGIC Evidence Ecosystem Foundation, Oslo, Norway
  2. 2School of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Southern Region, Malawi
  3. 3HIV and Other Infectious Diseases Research Unit, Medical Research Council of South Africa, Cape Town, South Africa
  4. 4Department of Psychiatry, Stellenbosch University, Stellenbosch, WC, South Africa
  5. 5Health Systems Research Unit, South African Medical Research Council, Cape Town, Western Cape, South Africa
  6. 6Division of Epidemiology and Biostatistics, Stellenbosch University, Stellenbosch, South Africa
  7. 7Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
  8. 8Evidence Informed Decision-Making Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
  9. 9Cochrane South Africa, South African Medical Research Council, Cape Town, Western Cape, South Africa
  10. 10Division of Clinical Pharmacology, Department of Medicine, Stellenbosch University, Stellenbosch, Western Cape, South Africa
  11. 11Norwegian University of Science and Technology, Trondheim, Norway
  12. 12Centre for Evidence-based Health Care, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
  13. 13Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
  14. 14Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Oslo, Norway
  15. 15Division of General Internal Medicine & Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Geneva, Switzerland
  16. 16Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
  17. 17Department of Public Health and Primary Care, KU Leuven, Leuven, Flanders, Belgium
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Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{hafver2026optimising,
  title = {{Optimising summary infographics for clinical practice guidelines on child health: qualitative user testing study with healthcare workers in Malawi, Nigeria and South Africa}},
  author = {Tandekile Lubelwana Hafver and Frankie Achille and Valerie Reinthaler and Sumanth Nagraj and Susan Banda and Willem Odendaal and Idriss I Kallon and Moriam Chibuzor and Dachi Arikpo and Roselyn Chipojola and Emmanuel Effa and Nyanyiwe Masingi Mbeye and Tamara Kredo and Trudy Desirie D Leong and Simon Lewin and Amanda Salomé Brand and Claire Glenton and Sara Cooper and Bey-Marrié Schmidt and Susan Kyomuhendo Munabi-Babigumira and Per O Vandvik and Thomas Agoritsas and Nicolas Delvaux},
  journal = {BMJ Open},
  year = {2026},
  month = oct,
  doi = {10.1136/bmjopen-2026-122446},
  url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-122446},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Optimising summary infographics for clinical practice guidelines on child health: qualitative user testing study with healthcare workers in Malawi, Nigeria and South Africa
AU  - Tandekile Lubelwana Hafver
AU  - Frankie Achille
AU  - Valerie Reinthaler
AU  - Sumanth Nagraj
AU  - Susan Banda
AU  - Willem Odendaal
AU  - Idriss I Kallon
AU  - Moriam Chibuzor
AU  - Dachi Arikpo
AU  - Roselyn Chipojola
AU  - Emmanuel Effa
AU  - Nyanyiwe Masingi Mbeye
AU  - Tamara Kredo
AU  - Trudy Desirie D Leong
AU  - Simon Lewin
AU  - Amanda Salomé Brand
AU  - Claire Glenton
AU  - Sara Cooper
AU  - Bey-Marrié Schmidt
AU  - Susan Kyomuhendo Munabi-Babigumira
AU  - Per O Vandvik
AU  - Thomas Agoritsas
AU  - Nicolas Delvaux
PY  - 2026
DA  - 2026/10/05
JO  - BMJ Open
DO  - 10.1136/bmjopen-2026-122446
UR  - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-122446
AB  - 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.
SN  - 2044-6055
SN  - 2044-6055
ER  -