Quo Vadis Cochrane visualisation?

September 2016 will mark the first anniversary of this blog – yay! Without better ideas regarding what to post next and there being no need to beat back eager volunteers throwing manuscripts at me with a stick, I thought it was high time we look back at what we’ve achieved thus far and where we might be headed next.

In my first post I envisaged recruiting like-minded individuals to take a crack at putting together some Cochrane infographics. I believe we can safely agree that this goal has been reached most spectacularly. My own feeble doodles were followed first by thoughts by Jo Weldon from Cochrane Oral Health on things to consider when putting together an infographic and then the first professional-looking product published on this here blog was by Carlos Cuello from McMaster on probiotics to prevent enterocolitis in preterm babies.

Then Jo Anthony and Holly Millward from Cochrane Comms heaped on more advice about what tools to use and what bits to include with helpful links. Next I jumped in again with something a little different, a GIF animation I made together with our institute’s graphic designer (have you seen the improved version?) about blunt vs. sharp needles to prevent needle stick injuries in surgical staff. Then Helen West from Cochrane Pregnancy and Childbirth broke the bank with truly exquisite examples of well thought out infographics about turning babies to reduce problems at childbirth that incorporated the official colour scheme and everything. Wow. The bar was set pretty high but then Paul Beirne from University College in Cork went beyond the static image with an animated video (Needle size for vaccination procedures in children and adolescents) equipped with a snazzy soundtrack featuring himself playing the guitar! Crikey! So clearly we’ve amassed a troop of eager volunteers willing to explain their thoughts and the production process behind the imagery they created. First point thoroughly ticked.

Secondly I hoped there would be something to present in Vienna once I got this ball rolling. There was. I managed to coax our institute’s graphic designer to put together that very convincing GIF animation I mentioned earlier. I subjected many fellow cochranites to it in Vienna and many kindly retweeted when I shared it on social media. But then the actual infographics meeting we managed to organise at the Colloquium was all rather ad hoc and more of an occasion to affirm the need for infographics and that there were people keen to put some together without being forced, threatened or even financially incentivised. Nonetheless, I declare the second point ticked as well. Even if we didn’t get our own session at a CochraneTech symposium or David McCandless giving a talk. I suppose one can’t have too much of a good thing.

My third and most ambitious point was to design and conduct an experiment to see if all the effort to visualise Cochrane review results actually pays off in that the end result is easier to understand and recall than, say, the abstract or PLS. Of course it’s fun and interesting as it is to us visually inclined nerds getting our jollies just by making infographics because it’s interesting. However, I’m sure none us would argue against it being even better if we could also achieve actual benefits outside our little coven with its secret handshake. Any success in this department? None whatsoever. Maybe I put off Shaun Treweek by mentioning him by name. I don’t know. But I still think it’s a great idea. So that’s the only agenda point I will be pushing in Seoul. What’s more, I’ve scribbled an infographic of sorts to illustrate what I mean. OK, it’s actually a poster but this will have to do for now.

Infographics RCT

This is what I want to do. Actually I think it would be rather silly not to since here we have an intervention that we would hope would have tangible effects, if not directly as health improvements but indirectly as increased knowledge. Does it? We’re not sure. How do we find out? We’re scientists so we conduct an experiment. How about any other avenues of development? How can we keep going forward with Cochrane infographics?

Here is my humble vision. 1) Let’s put together a training webinar accompanied by a Handbook of sorts. Miranda Cumpston and friends from Cochrane Training can surely help. 2) Let’s rig up a funding mechanism by which sufficiently well fleshed out ideas could be outsourced to paid designers. I discussed this with Julie Wood in Vienna and she was generally positive about the CEU setting aside something like GBP 5000 per annum. But then we didn’t manage to put anything on paper. This of course begs the questions of what is well fleshed out and who decides? Maybe there’s enough material there for a another post.

Now though I shake off the office dust for a spot of well-earned holiday. Should this experiment idea tickle your fancy please get in touch after I ooze back to the bureau on August 8th.

Cheerio!
Jani Ruotsalainen

Creating an animated video summary of a Cochrane review

After reading Jani’s blog post on creating Cochrane infographics I thought I would try and produce one for our most recent review: Needle size for vaccination procedures in children and adolescents. I soon encountered several obstacles created by the complexities of the review which involved:

  • multiple comparisons (long versus short needles, wide versus narrow needles)
  • multiple patient-relevant outcomes (immune response, pain, crying, local reactions, other adverse events after vaccination)
  • varying quality of evidence (GRADE) ratings across outcomes.

My attempts to address these issues resulted in a messy infographic that contained too many images and an excessive amount of explanatory text. I eventually abandoned the infographic and decided to create a video that would incorporate a voice-over to deliver additional information that could not be communicated by a static combination of images and text alone. You can have a look at the finished product below:

I developed the video in four stages:

Stage 1: Drafting the voice-over (narration) script for the video

I used the Plain Language Summary (PLS) of the review as a template for the voice-over script which I divided into four sections:

1) Introduction/Background
2) Review questions
3) Study characteristics and quality of the evidence
4) Key findings.

I drew up a table for each section that contained a draft of the voice-over script and an outline of appropriate visuals that could be used to communicate the key messages. It is essential to plan the narration and visuals for the video simultaneously because you will need to deliver the voice-over at a pace that will allow sufficient time for any accompanying images and text to appear on the screen. An extract from the table that I used for the Introduction/Background section is illustrated below:

pbeirnetablefinal

Once I had completed a Table for each section, I then read the entire voice-over script aloud from start to finish several times. Reading aloud is a great way to identify words and phrases that don’t ‘sound right’ and can also help to identify transitions from one sentence to the next that are not as smooth as they should be. After multiple edits I finally had a workable voice-over script for the video of about six minutes in duration.

Stage 2: Recording the voice-over script

I recorded the voice-over on my office PC using a basic USB microphone and Audacity® – a free software programme for sound recording and editing. During the recording I read the script at a relatively slow pace and tried to ensure that there were appropriate pauses where I intended new images or text to appear on the video. I carried out some basic post-recording editing using Audacity® to remove unwanted background noise (including the annoying ‘hum’ from the air-conditioning in the office). I saved the final voice-over as a WAV (Waveform Audio) file.

Stage 3: Making the video

I used Camtasia® screen capture and video-editing software to create the video. I have been using Camtasia® for several years and have found it one of the easiest video-creating tools to navigate and work creatively with (I should mention at this point that I have no vested interests to declare in relation to any products mentioned in this post!).

The first step in making the video involved importing the voice-over audio file and all of the images that I intended to use into Camtasia®. I obtained the images from multiple sources including creative commons license images located using Google images and free clip art sites such as clker.com. I also purchased some royalty-free images via subscriptions to shutterstock and PresenterMedia. I customised some of the images in PowerPoint (e.g. I ‘cropped’ some images to remove unwanted parts) before finally importing into Camtasia®.

Once the importation process was completed, I added the audio file to a ‘track’ on the ‘timeline’ (see below). I then added images to different tracks and positioned them on the timeline to ensure that they were appropriately synchronised with the voice-over. This process was very time-consuming but it was not technically difficult to do – Camtasia® has an intuitive, easy-to-use interface and the product website also includes numerous tutorials that show you how to navigate the various settings and use basic and advanced video editing techniques.

Paul Beirne's pic1

Deciding how to present the key findings of the review was one of the most challenging aspects of creating the video. I opted for a modified version of a Summary of Findings Table (see below) that contained details of the outcomes, the GRADE quality of evidence ratings and a narrative summary of the key findings. For simplicity, and in keeping with the presentation of results in the Plain Language Summary of our review, I did not include any numerical data in the table. I used Source Sans Pro typeface for the text in accordance with Cochrane branding guidelines.

Paul Beirne's pic2

Stage 4: Adding the finishing touches and producing the video

Having synchronised all images and accompanying text with the voice-over, I used editing tools in Camtasia® to add some visual effects, including ‘transitions’ to create a smoother flow between different sections of the video. I also inserted arrows and highlighted text at selected time points to draw the viewer’s attention to specific parts of the screen. At the beginning and end of the video I added a ‘handwriting effect’ created using the whiteboard software VideoScribe®. I saved the handwriting effect as a Quick Time Movie (.mov) file and then imported it into Camtasia®. Finally, to remove any ‘awkward silences’ at the start and finish of the video, I added a repetitive guitar riff which I played on my acoustic guitar and recorded directly into Camtasia®.

With the finishing touches added, I was now ready to produce and share the video. Camtasia® allows you to you to upload your video immediately on YouTube, Vimeo and Screencast.com, provided that you have already registered with these sites. You can also use Camtasia® to produce the file in several formats including MP4, WMV (Windows Media video), MOV (QuickTime movie), AVI (Audio Video Interleave video file), M4V (iPod, iPhone, iTunes compatible video) and GIF (animation file). I chose MP4 format as this offers a good quality video with a relatively small file size and it plays on most desktop browsers, smartphones and tablets.

Conclusion

The findings of some Cochrane reviews may be challenging to present in an infographic. As a previous contributor to Visually Cochrane has noted: “where there are multiple comparisons, lots of outcomes or no clear findings it becomes much more difficult to summarise the review visually.” In these circumstances an alternative approach is to consider combining images with narration in a video format. I hope this post has given you some useful hints regarding how to develop such a video. Other helpful tips for producing a Cochrane animated video can be found in another blog post in the Cochrane Community Archive.

Good luck in your creative endeavours!

Paul Beirne

Paul is a Cochrane review author and teaches epidemiology to public health students at University College Cork, Ireland.

Visualising data in a Cochrane infographic

I took up the challenge of producing an infographic for a Cochrane review, and decided to use the recently updated review: External cephalic version for breech presentation at term. My aim was to produce a visual outline of the summary of findings table and plain language summary for a lay audience. In this blogpost, I will focus on the process of creating meaningful visualisation of the data. This is the area that I found most challenging when producing the infographic, and I would like to explore how it can be done effectively. It’s difficult to strike the balance between simple communication and research complexity: It’s impossible to include every detail of a review in an infographic, but removing too much detail can distort the message of the original review beyond recognition.

Developing the infographic

The raw materials you start with are critical to the quality and clarity of the infographic you’re able to produce. The review I chose had an excellent plain language summary, written by Dr Elizabeth Wager. The review had clear conclusions that could be represented visually: two outcomes in the summary of findings table showed differences that could be turned into pictographs (vaginal cephalic birth not achieved and caesarean section), the other outcomes showed no difference between groups so could be summarised briefly (Apgar score <7 at 5 minutes, umbilical vein pH < 7.20, neonatal admission, and perinatal death). Where there are multiple comparisons, lots of outcomes, or no clear findings it becomes much more difficult to summarise the review visually. I was lucky that this review fitted the format of an infographic!

I used Piktochart, a free online tool, to product the infographic. Piktochart allows users to input data and produce graphs and charts. This function was very useful for producing the arrays of babies and women for a pictograph, which could be easily edited. I was mindful of sticking to the Cochrane brand guidelines, and keeping the layout clean and uncluttered. The design was influenced by Carlos Cuello’s infographic Probiotics and necrotizing enterocolitis in preterm babies, presented on this blog in September.

The infographic of ECV at term

ecv-at-term

Challenges in data visualisation

I faced two major issues with turning the review data on mode of delivery into a pictograph: How to accurately present meta-analysis in frequencies, and how to communicate uncertainty in the results. The review presents “vaginal cephalic birth not achieved” (phrased negatively to fit the conventions of RevMan). However, from a pregnant woman’s perspective “head first vaginal birth” is probably a more important and interesting outcome. Logically “not head-first vaginal birth” and “head-first vaginal birth” should add up to all births…. As all babies are born either by caesarean section, vaginal head-first delivery, or vaginal breech delivery, the neatest way to present the results of the review would be as a single grid for “type of birth” comparing these outcomes. Again, logically the three types of birth should add up to all births… However, my numbers didn’t add to up 100 out of 100 babies, as illustrated below: blog example (1)

After checking the numbers (several times!), I worked out why they didn’t add up. In a meta-analysis, the weighting assigned to studies is affected by the number of events for an outcome, as well as the size of the study. Therefore, switching an outcome around can completely change the weighting, and the final relative effect.

I wanted to present the outcomes that pregnant women would be most interested in, but also for the infographic to be consistent with the review. I decided to show the outcomes presented in the review as two separate outcomes (caesarean section and head first vaginal birth not achieved). I used colour to highlight the positive outcome “head first vaginal birth” in magenta, against light grey for “not head first vaginal birth” from the review, and framing the outcome both ways in the text (for example. “79 babies out of 100 did not have a head-first vaginal birth” and “21 babies out of 100 had a head-first vaginal birth”). To differentiate between the outcomes caesarean section and head first vaginal birth not achieved I used women icons in the caesarean pictograph, and baby icons in the head-first delivery pictograph.

I wasn’t sure whether and how to include confidence intervals on the infographic. Confidence intervals are important in the reporting of review findings, and affect our certainty in the result. However, they may not be well understood by the public and it’s not easy to present them visually without over-complicating the message of the infographic. I experimented with a few options, but decided to take the same approach as Carlos Cuello, including the confidence interval in the text and relating it to the role of chance.

Helen West, Cochrane Pregnancy and Childbirth

I’d welcome feedback on this infographic. In particular, I’d like to hear your views on the issues relating to data visualisation:
• how to get the right balance between simple communication and research complexity;
• how to accurately present meta-analysis in frequencies;
• how (and if) to include confidence intervals.

[Helen West is supported by an National Institute for Health Research (NIHR) Cochrane programme Grant (13/89/05) and Cochrane infrastructure funding to Cochrane Pregnancy and Childbirth. The views and opinions expressed herein are those of the author and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.]

Beyond rules and regulations

In the previous post Holly and Jo went a little deeper into what Cochrane infographics can be like and how you might go about creating your own. Their post provides guiding questions on the what and the how, i.e. the contents (pictures and text) and the tools with which to put them together.

However, I’m a little scared that all this helpful advice is seen more like stiff regulation that will be enforced with almighty force. Ye shall include the Cochrane logo, the correct font, colour scheme, punctuation, hyphenation, etc., etc. or thou shalt incur the wrath and furious vengeance of Cochrane! Sounds ominous, right? Well, thankfully Cochrane is not actually eager to smite anyone with stone tablets of truth or any other instruments. Biblical or otherwise. There is still plenty of room to play around and to try what might work as a Cochrane infographic. To illustrate the point, I attach here a proof of concept I put together with my colleagues Ella Smeds and Matti Gröhn from FIOH.

Blunt needles improved

This is an animated GIF explaining the main result of Cochrane Work review Blunt versus sharp suture needles for preventing percutaneous exposure incidents in surgical staff and its relevance. Not too shabby, eh?

What it still admittedly needs is GRADE (high quality evidence) and an explanation of the kinds of operations in which the intervention has been tried and tested successfully (abdominal operations, vaginal repair and hip replacement). Also a link to the actual review wouldn’t hurt either. However, even with its present imperfections it is quite formidable in lodging a simple message into the viewer’s mind. The gif is also small enough to be attached to a tweet. So, if Ella, Matti and I were to provide a word of advice, we would chisel these points on our stone tablets:

  • Come up with arresting imagery that grabs the viewer’s attention. Moving pictures are more effective than static ones.
  • Emphasize your facts and main message!
  • Keep your infographic small enough so it can piggyback on a tweet.
  • Work iteratively and, if possible, with people who have totally different backgrounds and sensibilities than yourself.
  • Forget all advice you’ve read and heard (especially if listed as bullet points) and just try out something!

I often describe Cochrane as a global semi-anarchistic network (i.e. not just anarchy in the UK). The great thing about such a loose network is that it has tremendous amounts of talent and potential sprinkled all over the world. We just need to tease it out and tap into it. Thankfully Cochrane has already made great headway in leveraging its members’ skills further with new tools like Task Exchange. Hopefully we can put it to good use also in connecting skills and ideas when it comes to Cochrane infographics. The sky (i.e. not heaven) really is the limit here.

Jani Ruotsalainen, Cochrane Work, FIOH
With the kind help of Ella Smeds and Matti Gröhn, FIOH

Exploring Cochrane infographics

Holly Millward and Jo Anthony from Cochrane Communications and External Affairs Department discuss infographics to communicate Cochrane evidence. This article has also been cross-posted on the Cochrane Community blog.

What are infographics?
Information graphics (‘infographics’ for short) are graphic visual representations of information, data, or knowledge, intended to present information quickly and clearly. They are an interesting and exciting way to represent graphic content to tell a story. You can also use pictures to highlight the story.

Why are infographics important?
Infographics are commonly used across a wide variety of content. They are simply using graphic design to visualize content that has long existed in other forms. While they may not work appropriately or be useful for all types of content, infographics can add valuable context to existing stories by using visuals to show relationships in data, anatomy, hierarchy, chronology, and geography.

In a nutshell, sometimes they can say so much more – and more effectively – than the written word.

How is Cochrane using infographics?
Many Cochrane groups are exploring ways of using infographics to translate health evidence. Visually Cochrane has been experimenting and discussing options for a while. Teams are using them to show Summary of Findings tables, report outcomes, and grade the quality of evidence. Other Cochrane Review Groups, Centres, Branches, and the Communications and External Affairs team are using infographics to disseminate key messages; to communicate the impact of Cochrane Reviews; and to improve understanding and reach to wider internal and external audiences. It’s a very exciting time!

How do you produce an infographic?
Before you create your infographic, be clear about:

  • Who do I want to reach?
  • What do I want to say?
  • What’s the best form for achieving this?

There are a variety of options for creating infographics, from PowerPoint to online tools to design software. We suggest that, if you are new to infographics, to make use of the online tools available such as Piktochart or Easel.ly. If you’re looking to advance your skills, Adobe Illustrator, InDesign, or Photoshop are good options for graphic designers and those familiar with creating infographics. To see an example of an infographic made in InDesign and Photoshop, click here.

Think about:

  • Do you want to use just graphics or a mixture of graphics and stock images?
  • Can you divide your content into sections using your brand colour pallette?
  • Can you add charts/graphics to help illustrate key figures?

And always remember to cite the reviews mentioned, and your group’s contact details!

Infographics are now just another format of visual content, so why not have a go! Here’s a link to the Cochrane how to guide on producing branded infographics.

Click on the example shown here on the right for a taste of what they can look like > > >Cochrane Translations Infographic latest VERSION

Additional information for creating your infographic:

https://visuallycochrane.net/2015/05/22/some-ideas-for-further-development/

https://visuallycochrane.net/2015/09/16/from-ideas-to-action-the-story-behind-one-cochrane-infographic/

http://www.bmj.com/infographics

https://github.com/joelkuiper/personograph

https://projects.exeter.ac.uk/infographics/thesis/index.php

From ideas to action – The story behind one Cochrane infographic

I feel lucky living in an era in which I can easily find people with whom I share common interests and who also get excited about ideas that I have always found fascinating. That’s how I got to know about this project. It is not hard to see its value and potential for translating evidence (knowledge) to patients and practically anyone who wants to understand evidence and our work in Cochrane. In my opinion Cochrane infographics is a perfect opportunity to help achieve the knowledge-to-action process or the “knowledge translation cycle”, as it is also known. This project implies integrating the right amount of science, technology, and art, so what’s not to like?

With a few paragraphs I would like to illustrate some of my experiences with drafting infographics for communicating evidence.

WHY?

I’ve always thought that one of the biggest challenges in healthcare is the adequate, ethically sound, responsible, and efficient communication of research evidence to consumers (patients, families, carers), policy-makers, and other stakeholders and decision-makers. Efforts like Cochrane training for consumers and Testing Treatments are just two examples that show how the public can and want to learn about how treatments work and how all kinds of interventions and diagnostic procedures are tested.

Visualization is a critical part of many learning processes involved in many daily life situations. Unfortunately we tend to forget the information we read, and also (and possibly worse) sometimes we tend to have erroneous perceptions about our own knowledge. We also suffer from cognitive biases such as illusory superiority, mistakenly assessing our ability to be much higher than is accurate. The anti-vaccination movement is a perfect example of this. It is deceptively easy to believe one has sufficient competence to gather all relevant information and synthesize it without letting one’s own biases affect the result. So I usually think of this not only as a problem of quantity but also of the quality of the knowledge being transmitted. What we have here with this blog is a good opportunity to give infographics a chance as an add-on for knowledge dissemination, so I decided to draft my first infographic.

DRAFTING MY INFOGRAPHIC

Although there is no unique guidance on this, in my opinion and in general terms it would be advisable to choose a topic that it is both relevant and newsworthy. What I mean is picking a “hot” topic currently discussed on the news, blogs, or one that in your opinion (or from the perspective of experts and other stakeholders) would require wider attention and adequate explanation to change things and reach better health outcomes.

I am a paediatrician, so on this occasion coming up with interesting subject matter was an easy choice. I decided to communicate to my peers and patients what is the evidence on the use of probiotics for the prevention of necrotizing enterocolitis (NEC), a condition that affects preterm babies’ bowels and can be potentially dangerous. I’ve been listening and reading about the use of probiotics for preventing this condition and saving lives so I decided it would be a good idea to recap the evidence in a user-friendly way. A recent Cochrane review was available so I directed my attention to what the review would say to a lay person about the condition (the “what” and “why”), the methods (the “how”), and results. This can easily be obtained from the plain language summary, which is basically a friendly summary explaining the condition and the results from the review. With an eye on what the reader should get out of it, I tried to complete the picture by making use of the summary of findings tables and the rest of the review to have a better understanding of the whole body of evidence.

One of the most important things to share is our confidence in the estimate (quality of the evidence) based on the GRADE assessment. This gives a sense of how confident we are that the research estimate we obtained is true. Also it is advisable to present absolute numbers using a pictographic representation with figures that are intuitive and easy to remember.

Putting the infographic together took about three hours of my time spread over several days (while sitting in the cafeteria, during a flight, or whilst having a coffee-break). I am a Mac user (no conflict of interest to declare) and my choice of tool for drafting infographics or designing figures for my Blog or other work is Keynote®. I’ve found this presentation software both powerful and flexible for those of us who cannot or will not go into the depths of designing using Adobe® Photoshop or other more professional tools. Please remember that this is only a draft! On Keynote you can throw in images in any format and it will grab them with ease and flexibility. You can use many types of fonts and tweaks with visually amazing results. I always use it for my presentations. You can even supercharge the software with other supplementary applications like Infographics®, which is an application with lots of pre-fabricated designs with which you can create your own. There are tons of other applications that you can find to practice your skills if you want, like visual.ly, Piktochart, easel.ly, among many others. However, none of these tools are actually compulsory. As many blog posts have already stated, a draft infographic draft can be easily created by using a pen and a piece of paper!

This is an exciting time as we can forget about committees and simply leverage the power of the crowd or hive mind to find and implement incremental improvements together. Now it is your chance to tell us what you think and what do you recommend. All comments and critique are more than welcome. Let’s do this together. Click the link below to open a pdf of my infographic.

Carlos Cuello (mucked about by Jani Ruotsalainen)

probiotics_NEC_infographicprobiotics_NEC_infographic

Some ideas for further development…

Exciting times are ahead for Cochrane, and the launch of an infographics product ties in perfectly with the recent rebranding. We are a world-leader in publishing independent, quality research for healthcare decision-making, and yet we’ve (so far!) struggled to become a household name synonymous with evidence patients can trust.

Working alongside Wikipedia to enhance and ensure healthcare pages reflect up-to-date evidence will certainly assist moving Cochrane in to the mainstream and away from the notion of dusty tomes that only clinicians and policymakers can make sense of, but creating infographics could potentially be the vehicle that places the headlines from our Cochrane reviews directly in the hands of those suffering from the conditions we study.

We need to define what are the key elements in Cochrane infographics that will assist decision-making while incorporating these very same elements in to a ‘sexy’ design that encourages people to share them. We should also consider what an efficient infographic production process might look like to get the evidence out there, and provide guidance for what an efficient dissemination strategy might look like.

Let’s break that down with a few ideas for further discussion…

Key elements

In terms of headlines, there needs to be the core outcome obviously (does the intervention work?), but we also need to be able to come up with a way of succinctly indicating overall risk. We could perhaps build on the Cochrane Risk of Bias threshold system where green indicates low risk of bias (i.e. everything A-OK), yellow means unclear (i.e. something iffy going on), and red means high risk of bias (i.e. serious problems). The result is a nice traffic light graph giving an overall impression of the included studies (see example below).

RoB summary example from Handbook

I’d particularly love to see the strength of evidence reflected in there too such as number of trials, number of participants, etc. It’s not only the right thing to do, as it acknowledges the contribution of all the patients who contributed to being able to determine whether the treatment works, but it also provides a more holistic view of the review process. To put this in context, would you personally trust the findings of a review with five studies conducted with 100 included patients as much as you would a review with 40 included studies and thousands of patients for making a decision about your own treatment?

We should be offering the public the opportunity to see this information clearly in the context of the headlines, and it also provides a talking point too. Furthermore, it’s also a nice way to clearly demonstrate the degree of work that has gone in to enormous reviews, and subtly indicate why the update hasn’t perhaps been published as soon as the public/clinicians/policymakers would have liked!

Design

Aside from adhering to the new brand guidelines, I imagine the infographics to be clean and bold, with the secondary colour (and incremental variant shades of it) drawn from the originating CRG’s own selected logo choice (cyan, green, magenta, orange, red, or teal).

Further to this, it’d be quite nice if the CRG’s logo was used perhaps rather than the generic Cochrane logo, as it’d be a good way to build each CRG’s public presence to encourage consumers under their scope to engage with them directly, and would reflect each logo used by individual CRG’s on their own social media accounts (the route many will ideally use to field queries relating to the reviews) and get conversation started all the quicker. Infographics may well be an ideal way for us to break down the barriers on the way of people accessing our research. They can also help the public connect who it was that produced which review, instead of assigning the credit to a rather faceless enormous global network.

I’ll come up with some visuals of alternative infographic layouts in the next couple of weeks (after a holiday first!), so that we can drive the conversation forward a bit more about what we do (and definitely don’t!) want to see reflected on infographics to accompany our reviews.

Production

It depends how people want to do this. Cochrane Review Groups are all unique with a degree of autonomy in their operation.

Considering this history of a DIY attitude, it would certainly be possible to produce a low-tech generic Word document template that MEs could enter the most salient details from a review in to predefined and preformatted fields that is then saved to PDF and converted (with clear instructions!) to JPEG for sharing as an image (the infographic).

Alternatively, I envisage the potential for Cochrane formulating a centralised team (working remotely, just like the copy editing team, and a named role in Archie to be incorporated in to the workflow system) of existing Cochranites with sufficient design skills to be drip fed reviews (supplied with the core content for inclusion in the infographic) at the point they’re sent for copy editing so that the infographic is ready at the point of publication.

This way, each review sent to the team would lead to an infographic with its own individual identity – looking distinct, whilst still coherent with the Cochrane brand – thereby increasing the likelihood of being shared repeatedly. Whereas the downside of the low-tech version would be to have fairly bland uniform visuals and a significant reliance on text to convey the message.

To assist in the efficiency of the production process, it’s probable that much of the iconography would be replicable across multiple reviews (e.g. blood droplets, syringes, anatomy sections [hand, heart, mouth etc.]) and therefore could be easily collated in a centralised repository to allow for quicker infographic composition.

Stylistically, if there are multiple audiences age-wise specific reviews want to appeal to, we could also look at a Cochrane Kids infographic product that is softer aesthetically (particularly in the choice of typeface and iconography) that parents can use to talk about healthcare with their children.

Dissemination

Shortened URLs are instrumental in delivering concise messages that users can reliably and quickly enter in their browser or share in a post (e.g. http://tiny.cc/triclosan); and would ideally be typed at the bottom of each infographic so that the address was embedded when shared.

Obviously, the more our reviews are linked to and read will inherently affect each Group’s potential to bump up their Impact Factor (and other metrics). Ideally, we would have our own shortened URL domain rather than relying on another company, and perhaps for simplicity the URL would reflect the Cochrane Database number for ID purposes.

A further benefit in doing this would be that when new iterations of the review are published, although a revised infographic would be issued the previous version would still link to the most up-to-date evidence should the review’s conclusions have changed at update.

Huge communities set up for sharing content already exist and it’s up to us to make sure we get our research out there, with undiluted and accurate headlines that are less likely to be spun by parties with competing interests or those simply looking to sensationalise for their own profit.

In addition to the usual heavy hitters (Twitter and Facebook), other social media communities have been building serious traction for some time too (Pinterest, Instagram, etc. [the list could go on and on…]), and once accounts have been set up, distribution to each of these could easily be managed from a single platform like Hootsuite.

Away from social media, MailChimp’s new photo campaign product Snap seems like the kind of email distribution vehicle editorial bases can make use of for little or no cost to approach other online communities.


Hopefully this post has provided some food for thought about the possibilities and direction Cochrane infographics could take. I’d love to hear your thoughts if you want to comment on the post.

Jo Weldon
Research Coordinator, Cochrane Oral Health Group

(with a little tinkering by Jani)