Tweet, tweet + blogshot, or tweet + picture: results from a Twitter pilot study

I was once tasked with designing a qualitative study that asked administrators, nurses, and doctors about their accountability. Not an easy thing to do, as this subject is very complex and each group would see accountability very differently. In the end, having the interview participant draw out a diagram or edit a prepared one greatly helped (more here and here). Diagrams work well as a data collection method because they sit between the open-endedness of a visual and the linear flow of text (more here and here) and borrow the benefits (and disadvantages) of both sides. Cochrane Blogshots, which consist of a few lines of text summing up a Cochrane Review’s Plain Language Summary and an image, seemed to me to also sit on a spectrum between text on one side and the visual on the other.

When looking at the impact of blogshots on Twitter, it seemed reasonable to compare them to the two opposite sides of the spectrum, i.e. just text and just an image. Looking at engagement on Twitter, some say that tweets with images get up to 150% more retweets and 89% more favorites and infographics being 40 times more likely to share on social networks. So where would blogshots fit into this? Would blogshots borrow the benefits of text and pictures and be ‘better’ than both? Or would they borrow both the benefits and disadvantages of both and be in the middle?

Tasked with a quarter to look into blogshots deeper, we set up a pilot study to test how well blogshots performed. The long term plan was to hand off a tried and tested concept to other Cochrane groups to scale-up.  We had five data sets each with a tweet with just text, a tweet containing a blogshot, and a tweet containing a picture. We controlled for a variety of things:

  • Order of presentation: Perhaps the audience responds more favourable to the first tweet they see. Hence we changed the order of the three tweets for each dataset.
  • Time of day: All tweets were be sent at the same time: 9pm AEST, which is 12noon BST and 7am EDT.
  • Day of the week: Traffic varies depending on the day of the week. All tweets from the same data set were sent on the same day of the week.
  • Content of tweet: standardized wording and standard #cochraneevidence hashtag were used. We did not use any topic-based hashtags or tag any Twitter account.
  • Link to Review: We used a new and different link for each of the 15 tweets so that we could track who is clicking through to the review.
  • Accompanied material: Each of the five data sets were tweeted without an image, with a picture, and with a blogshot. The picture used was the same one used in the blogshot.
  • Topic: Interest in a tweet/picture/blogshot may be mostly driven if someone is interested in the subject matter. Working with Cochrane UK, we selected general interest reviews from their Evidence for Everyday Health Choices blogshot series to maximize general appeal.
  • Blogshot quality: Cochrane UK has taken the lead in blogshot production. We used only blogshots created by Cochrane UK to ensure an equal quality standard.
  • Only English: Blogshots are translated into many languages. Given the scale of this study we focused on English blogshots.

And so out went 15 tweets on the main Cochrane twitter account: five with just text, five with text and an image, and five with text and a blogshot.


Here are the results (highest scores highlighted):


C: clicks, L: likes, RT: retweets

Our small-scale study suggests that sharing a blogshot on average almost doubles the click-throughs, likes, and retweets that you get over a text-only tweet. However, sharing a related picture with text in a tweet on average triples the click-throughs and likes, and doubles retweets.

We hope that the Cochrane Community views this as a ‘proof of concept’ or ‘pilot stage’ study on which to base larger studies. This may be done by several people or groups working together and combining evidence, or several smaller studies done separately. Ideally it would also be good to have a sample of non-English tweets and perhaps a sample from a specialized audience, like a particular Review Group or Field.

It should also be noted that these measures really only look at engagement i.e. that people took notice of the tweets and then performed an action which makes them visible to us. It is hard to know if people understood the information within them or if they did something with that information offline. Unpacking the difference between engagement versus uptake and how it relates to impact is definitely a whole blog post in itself!

Overall I think the lesson is that presenting Cochrane visually is important. Every Cochrane-related post on social media should have an image accompanying it. This can be a photo or a blogshot, but the important thing is to include something other than just text. This should be standard practice across all Cochrane accounts.

CEAD looks forward to hearing from you on your thoughts about this pilot study and other plans to share Cochrane evidence visually.

Muriah Umoquit
Cochrane Internal Communications and Content Officer

Infographic Abstracts

“To abstract is to draw out the essence of a matter. To abstract in art is to separate certain fundamentals from irrelevant material which surrounds them.”  ― Ben Shahn

Abstracts are arguably the most important part of any publication, particularly a systematic review or guideline.  The most important because often that is all most readers read or have access to. In today’s world where most new science is behind a paywall, abstracts are currently the only truly open access conduit for new findings. Therefore abstracts should present data in the most user-friendly of form, meaning infographics.

forest-plot-of-trees_laurel-grahamThis is not an argument for pine tree icons instead of forest plots:  this is an argument for infographic summaries in PubMed and really every database that provides abstracts of clinical publications.

Visualized data will capture readers’ attention when they would otherwise just skim over text and miss salient outcomes. A big red bar across a prescription bottle or a 3-D pie chart with dead rats on a slice sends a clear message: “Don’t feed your rats pills!”

As the old adage goes: “Images speak louder than words”, wait that’s actions….

No matter. Messaging must be direct, correct, succinct, and graphic. Especially in this age of social media, short attention spans, and economizing.


In a world where emoticons and text messages impart vital information, science is at a disadvantage. When findings might as well be written in hieroglyphics, infographics can be the 21st century’s Rosetta stone decoding the results for all. For all because it has been discovered that researchers often rely on bits and pieces of data just like the public rather than finding and reading all of the relevant data.

Nicholas et al.’s study reported on a survey of more than 1,000 transaction logs (equalling 17, 000 sessions) in ScienceDirect. Results showed 20% of researchers only read abstracts. Apparently, they were relying on only the abstract’s data to determine suitability. This is particularly disconcerting because ScienceDirect provides links to full-text, dependent on the subscriptions of the institution the researcher is affiliated with. Even worse is the fact that many abstracts do not include measures of absolute effect. A study by King et al. found that in 96 Cochrane and 94 non-Cochrane reviews only 34 (22.5%) reported absolute measures. Sadly Agarwal et al. found that authors seldom report the most patient-important outcomes and absolute effect measures in systematic review abstracts. As King et al remind us, Peer-reviewed reporting checklists of studies, CONSORT and STROBE, recommend publishing both absolute and relative measures of effect whenever possible. The Cochrane Handbook also reminds us that absolute measures are useful when determining an intervention’s likely benefits and likely harms.

Jo Weldon, research coordinator for the Cochrane Oral Health Group, began the discussion of standards in her blog post; she recommended infographics feature: central outcome (does the intervention work?), indicating overall risk, strength of evidence, the publishing Cochrane Review Group’s logo,  and shortened URLs.

A next step could be reviewing PRISMA’s abstract reporting standards and translating those to universal symbols for example. All areas reported in an abstract cannot and do not need to be represented in an infographic, but many can and should be.

Laurel Graham, Evidence-based Dentistry Manager at American Academy of Pediatric Dentistry, Cochrane Innovations
Follow me on Twitter: @forestplot


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.

Jani Ruotsalainen

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 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:

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.


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.


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, Piktochart,, 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)


Introducing the start of Cochrane infographics

Let’s begin at the beginning

Infographics in Cochrane – what’s that supposed to mean? Well, it’s an idea. I could claim it as my own but I’m sure that there are many others who have had similar Heureka-moments years ago. For example, see this poster presented in Hyderabad. Also infographics as a whole have been around for centuries already. Especially when it comes to health issues, one has to mention Florence Nightingale’s elegant creation depicting causes of death in the Crimean war. So I stay well clear of declaring any originality in that department. What then is all the fuss about? My idea, or vision, or inspiring mental itch if you will, is that it would be really cool to have a visual format for presenting results of Cochrane reviews, something like an intuitive pictorial Plain Language Summary. As there aren’t ready off-the-shelf solutions, it is up to us cochranites to roll our sleeves and put something together ourselves. So, the second half of my idea is to leverage the enthusiasm of individuals, to lure likeminded people together and see what happens with a loosely defined target. Pretty much the same way Cochrane began in the first place.

Why should I keep reading?

I propose embracing a bravely anarchist approach where anyone can participate according to their interests and, to some degree, skills. This means no committees and only the bare minimum of steering. Wikipedia is perhaps the best living proof of the power of the hive mind. Why not try a similar model? Talking of proposals, who the hell am I anyway to be making any? Am I a designer? No. Am I journalist? No. I’m just an Average Joe Managing Editor plagued by curiosity. I harbor no delusions of joining the pantheon of design gods like David MacCandless who can do wonders already (see for yourself). I just want to see what we can come up with for Cochrane. Can we formulate some kinds of templates or iconography that Cochrane groups can then easily use to put together their own infographics? That’s what I want to find out.

Who exactly is doing what here?

To help me in this quest I’ve enlisted a number of Cochrane colleagues including CochraneTech (the propeller-heads) and the communications people (can’t think of a fitting stereotype to illustrate). Next I welcome YOU to join us. What we have agreed in our little coven so far is that we set up this blog as a sandbox, a common playground where any interested party can join in by commenting on posts and by posting their own improved versions. We now kick things off with a little something we put together earlier. I made a rough sketch and Jacob Riis from CochraneTech kindly made it look pretty. It tries to depict the main result of this Cochrane review and some supporting facts to better convince the reader. What do you think? Does it have the right things in it? Can you visualize risk in some better way? Should we stick to just the results? Please jump in and enter your comments below.
Visually Cochrane 1st draft infographic blunt needles-page-001Blunt-needles

Is there a method in this madness?

The long term vision here is to push a few drafts through this anarchistic unplanned development process to be able to present the results at the annual Cochrane Colloquium in Vienna. Then later we can even run an experiment to compare PLS, podcasts and whatever visual delights we manage to whip up in terms of how people understand and recall their contents. There’s already similar project afoot in Aberdeen by Shaun Treweek and friends. It will be interesting to see if we can get similar results. And so, without further ado, join me and together we will rule the galaxy… erm…sorry… I mean we will make some cool infographics! Woohoo!

Jani Ruotsalainen
Managing Editor, Cochrane Work