Contributions to the literature

  • Communicating results of scientific studies, effects of interventions and health risk estimates, in addition to understanding key concepts of clinical epidemiology and interpreting evidence, account for a set of essential instruments to bridging the gap between science and practice.

  • There is still a lack of understanding about the exact types of strategies for communicating scientific evidence.

  • The findings of this manuscript, specifically the extensive and detailed list of strategies mapped out to communicate scientific evidence in health to managers and the population, may support the decision-making of stakeholders involved in the process of knowledge translation within the realms of evidence-informed policies.

Introduction

Within the context of evidence-informed policy (EIP), evidence syntheses should provide scientifically based information on health conditions, interventions, procedures, policies and programmes to meet the needs of health professionals, patients and public or private health managers. However, evidence obtained from scientific studies, especially from systematic reviews, other syntheses of multiple studies and clinical trials, is complex and often difficult for the general public to comprehend [1]. Health evidence needs to be communicated and disseminated in a manner that is clearly understood by decision-makers, especially in settings that demand rapid responses.

As an inherent component of health knowledge translation, communicating results of scientific studies, effects of interventions and health risk estimates, in addition to understanding key concepts of clinical epidemiology and interpreting evidence, represent a set of essential instruments to reduce the gap between science and practice. These needs have represented a challenge within the EIP worldwide.

Strategies for communication of evidence in health have the initial goal of increasing the understanding of the results of scientific research and should cover products, actions and approaches aligned to the needs of the manager (facing the demands for healthcare services) and the population (reliable information based on the best scientific evidence available) [2]. Nevertheless, the ultimate expected outcome of any effective communication, addressed to specific audiences, would be its clinical benefit (when considering individual health) and/or positive impact on health systems and organizations (when considering public health).

In this sense, expanding investment and improving skills in communication enables the identification of the best strategies to be used to overcome the barrier between evidence in health and managers and the population. Clear communication and active dissemination of health evidence to all relevant audiences in an understandable and accessible manner are essential to raise awareness of the importance of using scientific evidence, to support individual and population health-related decisions [1], and contribute to adherence to behaviours associated with positive health outcomes.

In the last decade, the advancement of digital and social media has reshaped the concept of health communication, introducing new, direct and powerful communication platforms and gateways between researchers and the public [2,3,4]. Various strategies such as plain language summaries and infographics have been devised and experimented for this purpose.

Some synthesis of strategies for communication of scientific evidence are available in the literature, including overviews of systematic reviews that address knowledge translation and general health communication strategies (for the population, health professionals and managers) [2, 5], systematic reviews restricted to communicating health benefits/risks [6,7,8] or teaching/learning strategies [9], narrative reviews [10, 11] and scoping reviews focused on communicating uncertainties [12]. No in-depth scoping review was identified with the objective of identify strategies for communicating scientific evidence on healthcare to managers and the population.

Thus, a mapping is necessary, through a scoping review, to identify the available strategies for communication of scientific evidence; the characteristics, barriers and facilitators for its implementation; the target audience and the context, as well as the gaps in the literature about its impact on healthcare. The results identified may constitute a valuable instrument for decision-making for sectors involved in promoting the use of scientific knowledge in decision-making processes related to the communication of evidence in the context of EIP.

Methods

Design and setting

This scoping review is a component of the project Apoio à Formulação e Implementação de Políticas Públicas de Saúde Informadas por Evidências (ESPIE), triennium 2021/2023, conducted at the Hospital Sírio-Libanês (São Paulo, Brazil), within the scope of the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS), in partnership with the Department of Science and Technology of the Secretariat of Science, Technology, Innovation and Strategic Inputs of the Ministry of Health. This review was planned and conducted according to the recommendations of the Joanna Briggs Institute Manual for scoping reviews [13].

The report of the review followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses – extension for scoping reviews (PRISMA-ScR) [14]. The review protocol was planned and prospectively made available in the MedRxiv pre-prints database. [15]

Methods for engaging the community and other stakeholders in the review

Stakeholder consultation was carried out throughout the development of the protocol, with the aim of increasing the applicability of its results and supporting the communication and translation of its results to the community. To this end, the following stakeholders were informally consulted: consumers (managers, health professionals and patients), experts in ‘knowledge translation’ and ‘health communication’ and information specialists.

Criteria for inclusion of studies

The question of interest for this review was structured using the acronym PCC, which then guided the eligibility criteria as follows:

  • P (population, condition): health managers and the general population.

  • C (concept): strategies for communicating scientific evidence to health managers and/or the community. In this review, scientific evidence was considered as information obtained from the results of scientific studies and used to support or refute a health recommendation or the planning of health systems and policies. Thus, strategies were considered as those aiming to translate scientific and/or methodological information in a format/content geared to ensure the understanding of health managers and society of terms, criteria, tools and approaches related to scientific evidence in health. Any strategy focused on the communication of scientific evidence for this target audience was considered, including, for example, communication strategies to support health managers in decision-making, communications used during the organization of services and/or health systems, communication strategies to encourage the use of scientific evidence in the decision-making process, to increase access to health information from the perspective of the population, strategies for adapting the knowledge obtained by evidence to the local context, and so on. Studies on individual professional–patient communication (including diagnosis, communication of bad news and specific recommendations on individual therapy or prevention, among others) or specific to a particular health condition were not considered. Studies addressing the process of knowledge translation were included only when they reported, implemented and/or evaluated strategies for communication of scientific evidence as part of this process. Studies specifically addressing evidence dissemination and implementation strategies were not included.

  • C (context): individual or public health; within public, private or supplementary health systems; at any level of care (health unit, neighbourhood, municipality, state, region or country).

Any primary (descriptive or analytical) or secondary study design was considered.

Searching for studies

A broad and sensitive literature search was conducted using structured search strategies, with relevant descriptors and synonyms, for the following databases on 8 September 2021: Campbell Collaboration, Cochrane Library (via Wiley), Excerpta Medica dataBASE (Embase, via Elsevier), Biblioteca Virtual em Saúde (BVS), Epistemonikos, Health Evidence, Health Systems Evidence, Medical Literature Analysis and Retrieval System Online (MEDLINE, via PubMed) and PDQ-Evidence. A structured electronic search was conducted in the following grey literature bases on 24 February 2022: Opengrey (https://opengrey.eu), Thesis Commons (https://thesiscommons.org/) and Open Access Theses and Dissertations (https://oatd.org/).

Structured electronic searches were conducted on the following repositories of preprints on 24 February 2022: Europe PMC (https://europepmc.org/) and Open Science Preprints (https://osf.io/preprints/).

Additional unstructured searches were conducted on the following sources related to evidence-informed policy or health education on 27 February 2022: Agency for Healthcare Research and Quality AHRQ/EUA, Guidelines and Measures (www.guidelines.gov), Centre for Reviews and Dissemination (CRD), Service Delivery and Organisation (https://www.york.ac.uk/crd/research/service-delivery/), Cochrane Effective Practice and Organization of Care (EPOC) (https://epoc.cochrane.org/), EPPI-Centre (https://eppi.ioe.ac.uk/cms/Default.aspx?tabid=56), Evidence Informed Policy and Practice in Education in Europe (EIPPEE) (http://www.eippee.eu/cms/Default.aspx?tabid=3179), European Observatory on Health Systems and Policies (https://eurohealthobservatory.who.int/), ECRAN Project. European Communication on Research Awareness Needs (http://www.ecranproject.eu/en), Evidence Informed Policy Networks (EVIPNet) (https://www.who.int/initiatives/evidence-informed-policy-network), Global Evaluation Initiative (https://www.globalevaluationinitiative.org/), Informed Health Choices (https://www.informedhealthchoices.org/), International Bibliography of the Social Sciences (IBSS) (https://about.proquest.com/en/products-services/ibss-set-c/), International Initiative for Impact Evaluation (3ie) (https://www.3ieimpact.org/), McMaster University's Health Forum (https://www.mcmasterforum.org/), Rx for Change (https://www.cadth.ca/rx-change), Supporting the use of Research Evidence (SURE) (https://epoc.cochrane.org/sites/epoc.cochrane.org/files/public/uploads/SURE-Guides-v2.1/Collectedfiles/sure_guides.html, The Alliance for Health Policy and Systems Research (https://ahpsr.who.int/) and What Works Centres (https://www.gov.uk/guidance/what-works-network).

Additional unstructured searches were conducted on the following sources related to health science communication on 24 February 2022: American Medical Writers Association (AMWA, https://www.amwa.org/), European Medical Writers Association (EMWA, https://www.emwa.org/) and International Society for Medical Publication Professionals (ISMPP, https://www.ismpp.org/). A manual search was performed in reference lists of relevant studies and through contact with experts in the field.

No language filter was applied. The search was restricted to the period from the year 2000 onwards, considering the advances and changes in the digital and social media that have occurred mainly in the last two decades. Full-length publications, abstracts presented at conferences and events, online reports, theses and dissertations were included. The structured search strategies are presented in Additional file 1.

Selecting studies

The study selection process was carried out in two phases using the Rayyan platform [16]. The first phase consisted of reading the titles and abstracts of all references retrieved by the search strategies and categorizing the studies into ‘potentially eligible’ or ‘eliminated’. The second phase consisted of reading in full the ‘potentially eligible’ studies to confirm their eligibility or exclude them in the second phase (the justifications for each exclusion in the second phase are presented). The two phases were conducted by two groups of independent researchers and inconsistencies in decisions to include or exclude studies were solved by a third researcher. The entire selection process is presented using a PRISMA flowchart.

Extracting data

Data on the of strategies identified and included in this review were extracted by two researchers independently and inconsistencies were solved by consulting a third researcher. The following data were collected for each included study: author, year of publication, type of publication (article/report, full text/ abstract), study design, name and description of the communication strategy, institution proposing the strategy and source of funding for the study. The following data were collected, when available, for each strategy identified:

  1. 1.

    Strategy main category and subcategories:

  2. 1.1

    communication of risk/benefit: including the subcategories communication of health risks and benefits under different numerical or nominal formats, health communication with positive (benefits, gains) or negative (losses) words/terms, verbal versus visual communication of the effects of interventions, communicating health risks and benefits with bar charts or bar charts and histograms, strategies for communication of health evidence and strategies for communicating risks and benefits in health with different animated graphical presentations.

  3. 1.2

    communication of uncertainty in health: including the subcategory communication of uncertainties about the effects of interventions on health.

  4. 1.3

    teaching/learning: including the subcategories communication/learning of key concepts related to the effects of health interventions, communication/learning resources from the IHC initiative on key concepts of evidence for health, communication/learning of key concepts of health evidence, educational podcasts from the IHC initiative on key health evidence concepts, training for parliamentarians on scientific health evidence and inclusion of stakeholders in the working group for preparing comparative effectiveness summaries.

  5. 1.4

    evidence synthesis frameworks using plain language: including the subcategories blogshots to communicate the results of systematic reviews, evidence synthesis summary template, plain language abstract, Cochrane plain language summaries, templates for plain language abstracts of systematic reviews, printed newsletters for communicating health evidence and systematic review summaries of evidence templates for policy-makers and health system managers.

  6. 1.5

    guidelines for elaborating/evaluating communication products: including the subcategories guidelines for designing and evaluating health evidence communication products (CDC Clear Communication Index) and tool for evaluating the quality of health texts in plain language.

  7. 1.6

    For this categorization, a new taxonomy was elaborated with an unstructured method, which is detailed in Additional file 2.

  8. 2.

    Target audience: health managers, population, both.

  9. 3.

    Type of strategy: language, content or format of the communication.

  10. 4.

    Health system and level of care for which the strategy was proposed or used (public or private health, primary or specialized care; others).

  11. 5.

    Approach to the strategy: textual communication (printed/online material), visual communication (graphic, illustrative with drawings), verbal communication (videos, podcasts) and others.

  12. 6.

    Strategy length: permanent or temporary.

  13. 7.

    Strategy status: proposed, implemented and not evaluated, or implemented and evaluated.

  14. 8.

    Costs for implementing the strategy (as predicted by the authors of the studies included).

  15. 9.

    Barriers and facilitators for implementing the strategy (as identified by the authors of the studies included).

For the scientific evidence communication strategies that were implemented and evaluated by the included studies, information on the results was collected. These strategies were subsequently classified, at the discretion of the reviewing authors, according to the feasibility of implementation, immediate or after the adoption of actions. This classification was performed considering facilities, costs, need for regulation or local policies, and regardless of the certainty of the available evidence.

The authors of the included studies could be contacted if additional information was needed.

Quality assessment/risk of bias of the included studies

As the aim of this scoping review is to map strategies presented in descriptive studies or to use pieces of analytical studies reporting strategies, no checklists or tools for assessing the methodological quality of the studies were applied, as recommended by the Joanna Briggs Institute for scoping reviews [13].

Synthesis and presentation of results

Strategies were classified using the categories determined based on the data described above. A narrative synthesis was presented using graphs and/or tables. Depending on the availability of information, descriptive statistics would be performed using Microsoft Excel® and/or STATA® software, but this was not undertaken due to the format and/or scarcity of the data presented.

Results

Search results

Structured searches in electronic databases resulted in 25 284 references and unstructured searches in additional sources retrieved 58 references, totaling 25 342 references. After removing 744 duplicates, 24 598 references were analyzed through titles and abstracts and 24 467 were eliminated for not meeting the eligibility criteria. Thus, in the second stage of the selection process, the full texts of 131 references were analyzed. Of these, 50 were excluded [17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66] and the reasons for exclusion are detailed in Additional file 3. One reference awaits classification because, despite a series of attempts, it was not possible to obtain the full paper and the abstract did not present enough information to allow confirmation of its eligibility [67].

At the end of the selection process, this review included 80 studies or documents (Fig. 1) [1, 2, 6,7,8,9,10,11,12, 68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124,125,126,127,128,129,130,131,132,133,134,135,136,137,138].

Fig. 1
figure 1

Flowchart of the study selection process

Full size image

Characteristics of the included studies

The main characteristics of the included studies/documents are detailed in Additional file 4. Studies with a descriptive design were the most frequent (28.8%), followed by systematic reviews (16.3%) and case studies (13.8%). The studies were funded by governmental institutions or non-governmental initiatives, in the areas of health (research and assistance) and education.

Results of included studies

Seventy-eight strategies were identified in the included studies and are presented in Additional file 5. All of the studies had the ultimate or intermediate goal of improving the comprehension of health information. None of these strategies were proposed for a specific health system or level of healthcare, and they were implemented in different scenarios (including school settings) and on a continual basis. The costs associated with the strategies were not provided by any of the studies.

Table 1 presents the main results of the strategies for communicating scientific evidence that were implemented and, to some extent, evaluated, regardless of the method used to evaluate such results (experimental study, survey, and so on).

Table 1 Main results of the strategies for communicating scientific evidence that were implemented and evaluated
Full size table

Regarding the target audience, 71.8% of the strategies were intended for the general population, 20.5% specifically for managers and 7.7% were applicable to both groups (Additional file 5).

According to the main category, communicating risks/benefits on health represented 29.5% of the strategies and encompassed different forms, nominal (categorical) or numerical (statistical), to communicate attributes or effects of health interventions or exposures. The 17 strategies in the ‘teaching/learning’ category, comprised structural actions in schools (many of them conducted by the IHC initiative), virtual environments (websites), and even in parliament (Table 1).

According to the status, more than half (52.6%) of the identified strategies had already been implemented and evaluated in some degree, 44.9% had already been implemented but not yet evaluated and 2.6% were merely proposed without any sort of implementation or evaluation (Additional file 5).

According to the delivery approach, 88.5% of the strategy had at least one textual component, 6.4% adopted an exclusively verbal approach of communication outreach and 2.6% a exclusively visual approach (Additional file 5).

As depicted in Additional file 5, the main barriers for implementing the proposed strategies are related to stakeholder time availability [73, 92, 107, 110], high speed of publication of new studies/growing volume of information [72, 77], language [76, 99, 104, 105, 121], conflicts of interest [78] and need for continuous update [97]. The main facilitator was online free access or social media access [2, 72, 97, 104, 105].

Discussion

This scoping review was developed to identify the evidence available on the strategies for communicating health scientific evidence to the public or managers, its characteristics and settings of implementation, as well as knowledge gaps. Overall, 80 studies, reports or other forms of information presentation were included which addressed 78 strategies. The most frequent strategies were those communicating risks and benefits in health, presenting textual delivery approach, implemented and, to some extent, evaluated. Although conclusions about effects are not the focus of a scoping review, among the strategies evaluated, those that appear to present some potential benefit are:

  • Risk/benefit communication: greater comprehension with natural frequencies than with percentages; greater comprehension with absolute risk than with relative risks and NNT; greater comprehension and behaviour change with numerical communication than with nominal communication; greater comprehension of mortality than of survival; communications with negative or loss content appear to be more useful for comprehension, satisfaction, and behaviour change than communications with positive or gain content; nominal communication can lead to overestimation of the risk of adverse events and can lead patients to make inappropriate decisions about whether or not to use a medication.

  • Evidence synthesis templates and other plain language documents: plain language summaries to communicate the results of Cochrane systematic reviews to the population were perceived to be more reliable, easier to find and understand, and better to support decisions than the original summaries.

  • Teaching/learning: the IHC initiative’s resources for communication and learning of key health evidence concepts appear to be effective in improving critical thinking skills in health immediately after their use; however, these effects were not observed after 1 year; theoretical–practical training for parliamentarians on scientific evidence in health seems to be a strategy with potential to raise awareness and improve the comprehension of this subgroup of managers on health-related evidence.

The main strengths of this scoping review involve a broad (across multiple sources of information) and sensitive (search strategies including also synonyms and free terms) search. As shown in Fig. 1, 24 598 references were screened in the first phase by reading titles and abstracts. Other features that endow methodological robustness are: the availability of a prospectively developed protocol, the selection and extraction of data in a duplicative and independent mode, and the adoption of methods recommended by the Joanna Briggs Institute Manual for scoping reviews [13].

One strength was the identification of communication strategies that used structuring learning approaches to continuously and progressively build a more favourable scenario for the population and managers to receive communication products. In this respect, the IHC initiative (https://www.informedhealthchoices.org/) and the ECRAN project (http://ecranproject.eu/) were particularly noteworthy.

For the categorization of communication strategies, different taxonomies have been identified in the literature that could be somewhat adapted for use in this scoping review [1, 99, 139, 140]. These taxonomies covered health communication in a broad sense, including mainly guidance on diagnostic, prophylactic and therapeutic conducts, many of them focusing on the individual and on the professional–patient relationship. Others had as the target audience mainly managers and health professionals, while others involved the whole process of knowledge translation and/or evidence implementation.

The particularities of health communication strategies with a specific focus on scientific evidence difficult reproducible and consistent adaptations from these aforementioned taxonomic tools. Thus, while conducting this scoping review, the authors developed, by means of an unstructured method, a proposal for a particular taxonomy for this scenario (Additional file 2). Although innovative, and having fulfilled its role within this scoping review, the proposed taxonomy has been applied for the first time and has not been formally evaluated, so limitations may be identified throughout its use hereafter.

When planning this review (protocol phase), there was no nominal definition of possible strategies. Along the construction of the search strategies, the term ‘risk communication’ and its synonyms were not used, but instead, less specific terms were used to sensitize the search. However, throughout the study selection process, a considerable number of studies specific to risk communication were identified. Thus, although 29.9% of the communication strategy included were specific to risk communication and health benefits, it is not possible to rule out that studies targeting this approach were not retrieved.

Another concern was that despite a number of different attempts (including messages to the authors, contacting experts and searching international libraries) it was not possible to obtain the full text of one of the identified studies [67]. The reading of the abstract did not allow us to confirm or refute the adequacy to the eligibility criteria and therefore this study remained as ‘awaiting classification’.

Some studies addressed combined strategies and it was not possible to quantify the exact number of different strategies addressed in the 78 strategies identified given a high rate of overlap of their components. To mitigate this shortcoming, we have chosen to present a detailed (and therefore longer than we would have preferred) table describing each strategy (Additional file 5).

Although 52.6% of the identified strategy were implemented and evaluated, much of these evaluations were characterized by opinions and satisfaction surveys. Few were evaluated through comparative studies capable of estimating their efficacy with more certainty and less bias. Additionally, the studies showed that most of the outcomes evaluated were limited to assessing comprehension, persuasion and customer satisfaction; few studies assessed health behaviour change, and none considered clinical outcomes.

Part of the strategies categorized as teaching/learning have been implemented and evaluated in African countries such as Rwanda [94], Uganda [110, 125, 126] and Botswana [78] which allowed us to evaluate the impact of these strategies, customer experience, barriers and facilitators in settings with limited financial and social resources.

As implications for practice, the identification of communication strategies that have been implemented and evaluated (Table 1) can support social, academic, governmental or non-governmental actions. Considering aspects such as feasibility, costs, need for regulation or local policies, regardless of the certainty of the available evidence, this review identified strategies that have already been evaluated in some way and that are potentially implementable in resource-scarce settings.

Strategies for communicating health risks and benefits, including attribute results and effects of interventions and exposures on health outcomes, were evaluated by studies with appropriate designs, with reliable results that could be implemented. An example is the benefit of communication using absolute frequencies and standardized decimal denominators (20 people out of 100 people using this drug might get diarrhea) rather than relative risk or NNT.

The elaboration and dissemination of communication products in parallel with scientific publications, and aimed at different audiences, is a reality (as exemplified by Cochrane’s plain language summary). This approach could be replicated and adopted by other organizations or scientific publishers, using results from reviews such as this one. In the same direction, the Brazilian Ministry of Health, in a recent initiative in partnership with the Escola Nacional de Administração (ENAP, National School of Administration), is producing prototype products for communicating scientific evidence in accessible language using design thinking methodology [141, 142].

As implications for forthcoming research, this scoping review identified a number of knowledge gaps that still need to be addressed by studies with appropriate designs and methods. These gaps include evidence on (i) the efficacy of communication strategies on outcome measures, such as behaviour change and clinical benefits related to the control or prevention of health conditions, (ii) the costs associated with implementing the strategies, (iii) effects of the strategies for low-income, lower sociocultural and/or resource-poor populations, and (iv) effects of the strategies for subgroups such as the elderly, adolescents and children.

Conclusions

This scoping review identified 80 studies, reports or other documents that addressed 78 strategies for communicating scientific health evidence to the population and/or managers. Some of these strategies have been implemented and evaluated, and may have some benefit in improving these audiences’ comprehension of evidence concepts and promoting behaviour change. The findings of this review have important potential for applicability in the area of evidence-informed policy, with direct application or adaptation of identified strategies to improve the communication of scientific evidence on healthcare to managers and the population. Future efforts are needed to evaluate the effects of evidence communication strategies on relevant clinical outcomes, identify the most appropriate strategies for different settings and contexts, and promote the use of those strategies that show benefits for individual or public health and health systems.