Focus groups and interviews with the public led to the development of a template for a GRADE Plain Language Recommendation (PLR)

J Clin Epidemiol. 2021 Sep 15;141:18-25. doi: 10.1016/j.jclinepi.2021.09.018. Online ahead of print.


Objective: Clear communication of health care recommendations to patients and the public is essential. Current work has focused on creating patient versions of guidelines without much attention to single recommendations. In this study, we built on previously conducted research to test a template and explore the public's perceptions of, and attitudes towards plain language guideline recommendations.

Study design and setting: We conducted four focus groups with people interested in healthy aging to obtain general attitudes, perceptions, and understanding of recommendations. We then conducted nine user-tests of Plain Language Recommendations developed from GRADE guidelines. We performed a directed content analysis, and finalized a template for a Plain Language Recommendation.

Results: We identified themes related to personalized information; strength of recommendations; support with health care and appointments; amount and credibility of information; and formatting. When recommendations were conditional, participants wanted more information about why and what to consider. The template for a Plain Language Recommendation is available in the GRADEpro software to facilitate automation.

Conclusion: We created a Plain Language Recommendation template to communicate specific information from guidelines to patients and the public. Broad application of the template is warranted and future research could measure the impact on understanding and behavior change.

Keywords: GRADE; Guideline; Patient attitudes; Patient knowledge; Plain language; Recommendation.