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

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10 thoughts on “From ideas to action – The story behind one Cochrane infographic

    • Thanks Julie. I think Carlos presents the main selling point (effect of the intervention) very nicely with the isotype chart (the babies). Overall, the colour scheme is pleasant and there’s enough interesting details to keep the reader engaged. However, I would consider cutting the amount of text even further. Same as with presentations, it’s good to replace full sentences with bullet points. Finally, if some of the non-visual (i.e. text) elements could be upgraded to a little snazzier format (even if by sacrificing a little more text) then we’d have a winner here. Hands down. Although this is still the best Cochrane infographic I’ve yet seen. Good job!

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    • Thanks Joel! Looks very useful. Is it possible to change the unit icon? I know there has been some discussion about whether it’s appropriate that what is commonly perceived as a male icon represents all humans. I suppose Carlos’ infographic skirts the issue (pun entirely accidental) with the androgynous babies.

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      • It’s entirely configurable! There are 11 included icons you can set with icon.style, which admittedly all look similar (may update the default set soon). Or you can supply your own picture (provided you know how to convert vector graphics to the R grImport native XML, but that’s fairly straight forward!)

        Joel

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  1. Nice. I also liked how you highlight the confidence we have in the information. I’d probably cut to the chase earlier and present the main findings but whether this is a good idea or not is something that can be tested. Indeed, one of he great thing about infographics (apart from their visual appeal) is that it is easy to imagine how we could test them with real users, including looking at alternative ways of presenting the information. I could easily imagine that some visual presentations work better for some review groups than others.

    I’m going to try and bring another infographic for a review being done in Aberdeen to the Colloquium and would be good to discuss at your infographics discussion.

    Oh, I use Infographics by Jumsoft (https://itunes.apple.com/us/app/infographics/id577411683?mt=12) with Keynote on the Mac, quite good for ideas although I suspect a real designer is needed rather than simply a collection of templates.

    Cheers,

    Shaun

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  2. Hi Jani, thanks for setting up this blog. I’ll definitely be keeping an eye on how things develop at Cochrane in terms of infographics. I’ve been interested in the use of infographics to present health research data for a while (it was the subject of my PhD in fact, which is available here:
    https://projects.exeter.ac.uk/infographics/thesis/index.php

    I now work for the BMJ creating (mostly interactive) infographics, which are all freely available here:
    http://www.bmj.com/infographics

    I, like others, also very much liked how you expressed the quality of evidence in your first graphic. I think you could even be more detailed, explaining how this score was achieved. We’ve experimented with similar ideas in a couple of graphics. This, on treatments for IBS, had a similar 4-point quality scale, but we also tried to explain the background for the scores:
    http://www.bmj.com/content/350/bmj.h1622/infographic
    I can imagine something interactive in which you could explore exactly which trials contributed to this score working well…

    Anyway, keep up the good work! Cochrane clearly need to give you a team including a graphic designer and an interaction designer at least, so that you can explore the full potential of infographics and dataviz 🙂

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  3. Pingback: Exploring Cochrane infographics | visually cochrane

  4. Pingback: Visualising data in a Cochrane infographic | visually cochrane

  5. Pingback: Quo Vadis Cochrane visualisation? | visually cochrane

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