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

Background: The Global Evidence, Local Adaptation (GELA) project aimed to strengthen decision makers’ capacity to use global research evidence and develop locally relevant clinical practice guidelines (CPGs) for newborn and child health in Malawi, Nigeria and South Africa. However, such guidelines will only improve care if they are effectively communicated to end users. This study aimed to explore healthcare workers’ (HCWs) preferences for, and barriers to, using CPG summary infographics in the three countries. Methods: We developed draft summary infographics for each of the CPGs produced in the GELA project. We then conducted qualitative user-testing interviews, encouraging participants to ‘think aloud’ while reviewing the infographics. Interviews were conducted in hospital units for newborns and children in Lilongwe (Malawi; n=8), Calabar (Nigeria; n=10) and Cape Town (South Africa; n=8). Participants included HCWs involved with newborn and childcare (e.g., paediatricians, nurses, dieticians, midwives, medical researchers/lecturers). Learnings from the interviews were used to optimize the final infographics. Results: Most participants found the infographics easy to understand and navigate and appreciated the visual design. They particularly valued the sections on implementation considerations, though some requested more detailed information. The section explaining how the recommendations were developed enhanced the perceived credibility of the products. A key challenge was communicating the strength of recommendation (weak or strong), which many participants found confusing. Similarly, participants were often unclear about who the recommendations apply to and the distinction between interventions and comparators. Visuals were the first elements to attract attention, though some participants noted that some aspects of the images did not reflect their work environments accurately. Conclusions: User testing in Malawi, South Africa, and Nigeria demonstrated that CPG infographics on child health topics are potentially useful as quick reference tools for HCWs. However, participants raised concerns about navigation, structure and medical jargon. Some were uncertain about the target patients the recommendations apply to, and the meaning of recommendation strength. Perceptions of infographic usefulness varied across topic and country, underscoring the importance of stakeholder engagement during development.