Comparing the usability of the World Health Organization's conventional tuberculosis guidelines to the eTB recommendations map: A two-arm superiority randomised controlled trial

Micayla Matthews; Tamara Lotfi; Nancy Santesso; Mark Loeb; Dominik Mertz; Zain Chagla; Anisa Hajizadeh; Thomas Piggott; Bart Dietl; Holger J Schünemann

doi:10.1371/journal.pgph.0001166

Comparing the usability of the World Health Organization's conventional tuberculosis guidelines to the eTB recommendations map: A two-arm superiority randomised controlled trial

PLOS Glob Public Health. 2022 Oct 14;2(10):e0001166. doi: 10.1371/journal.pgph.0001166. eCollection 2022.

Authors

Micayla Matthews^{1

2}, Tamara Lotfi^{1

2}, Nancy Santesso^{1

2}, Mark Loeb^{1

2}, Dominik Mertz^{1

3}, Zain Chagla^{1

3}, Anisa Hajizadeh^{1

4}, Thomas Piggott¹, Bart Dietl⁵, Holger J Schünemann^{1

2

6}

Affiliations

¹ McMaster University Department of Health Research Methods, Evidence and Impact, Hamilton, Ontario, Canada.
² McMaster University Michael G. DeGroote Cochrane Canada and GRADE Centre, Hamilton, Ontario, Canada.
³ Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
⁴ Department of Primary Care, Oxford University, Oxford, United Kingdom.
⁵ Evidence Prime Incorporated, Hamilton, Ontario, Canada.
⁶ Department of Biomedical Sciences, Humanitas University, Milano, Italy.

Abstract

Best practices for the dissemination of global health guidelines has not undergone rigorous research. We used a new approach to digitizing World Health Organization (WHO) global tuberculosis guideline recommendations (eTB RecMap) and compared its usability to the conventional method of accessing TB recommendations using the WHO website. We conducted a two-arm superiority randomised controlled trial using a survey among global stakeholders who were past or planned future users of TB guidelines, recommendations, or policy advice. We assigned participants randomly (1:1) to complete an activity using the WHO eTB RecMap or the conventional website. The primary outcome was the accessibility of information and secondary outcomes understanding, satisfaction, and preference for one of the two formats. Between February 26 and August 29, 2021, we received 478 responses from stakeholders, of whom 244 (122 per group) were eligible and provided analysable results. Participants rated the eTB RecMap as more accessible, on average, when compared to the conventional website (on a seven-point scale, the mean difference {MD} was 0.9; 95% confidence interval {CI}: 0.6, 1.2; p < 0.001) and were more likely to correctly answer understanding questions. This is the first trial comparing digitized dissemination formats of health guideline recommendations. Stakeholders rated the WHO eTB RecMap as more accessible than the conventional WHO website for the tested recommendations. They also understood presented information better. The findings support better usability of TB information through the eTB RecMap and contribute to the effort to end the TB epidemic. Trial registration: This trial was registered with ClinicalTrials.gov (NCT04745897) on February 9, 2021.

Copyright: © 2022 Matthews et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Associated data

ClinicalTrials.gov/NCT04745897

Grants and funding

HJS’ institution received funding from the WHO for developing the eTB RecMap and fees for WHO tuberculosis guideline development and related educational activities. This trial was not funded by the WHO, but through internal research grants available to HJS. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.