We thank Mc Sween-Cadieux et al. [[1]Mc Sween-Cadieux E. Fillol A. Ridde V. Dagenais C. Letter to the editor in response to «No difference in knowledge obtained from infographic or plain language summary of a Cochrane systematic review: three randomized controlled trials» by Buljan et al.in: J Clin Epidemiol. 2017Google Scholar] for their interest in our research into infographics for Cochrane systematic reviews. Their comments and observations are very interesting, and we are glad to have an opportunity to address their concerns. Mc Sween-Cadieux et al. make a good point when observing that we have not provided data on cost effectiveness of plain language summary (PLS) compared with infographics. We could not formally calculate the cost of producing the two formats, but we reasonably estimated (as stated in the Discussion section of the article) that the production of an infographic would be more expensive than writing or editing a PLS because infographic production would require a good written template first (PLS) before the work on the visual design. Also, PLS is often written by authors whereas infographics will always require specialist input. The infographic we used was a part of an initiative of the Cochrane Pregnancy and Childbirth Group, which has recently launched an infographic series [[2]Cochrane Pregnancy and Childbirth.http://pregnancy.cochrane.org/whats-newDate accessed: February 14, 2018Google Scholar]. The development of the infographics was undertaken as part of a United Kingdom National Institute for Health Research-funded project and was based on existing evidence, as described by one of the authors in her blog [[3]Visually Cochrane: A sandbox for creating infographics.https://visuallycochrane.net/2016/02/01/visualising-data-in-a-cochrane-infographic/Date accessed: February 15, 2018Google Scholar]. Although we found a statistically significant difference in reading experience, meaning that the participants preferred the infographic format compared with PLS, this difference was very small (only a few points on a scale from 10 to 50 points) which poses the question of "clinical", i.e., practical relevance. This was discussed in the article and was the reason for the title and interpretation of the findings. In our study, we used not only three different populations but also two different approaches. The trial involving students tested the formats in a controlled situation, where the time for reading the formats and for answering the questionnaire was limited. In the trials involving doctors and consumers, we tested understanding of the formats in a real-world setting, with no time limits for any part of the survey. The questions about the possible effect of more information contained in an infographic or whether some specific sections in the infographic presentation might have influenced participants' understanding cannot be easily answered using an experimental approach such as the one used in our study. To address those questions, we used a qualitative approach and are currently analyzing the results from focus groups of students, consumers, and doctors who were presented with different versions of infographics and PLSs to identify barriers to understand different summary formats for Cochrane systematic reviews. We agree that there are numerous variables which may influence users' level of understanding of the presented information, and, as we have already stated in our article, variables such as learning styles and visual literacy could provide valuable information concerning users' preferences and abilities and could be explored in future trials. Recent research, for example, questions the impact of learning styles on learning [4Newton P.M. Miah M. Evidence-based higher education – is the learning styles 'myth' important?.Front Psychol. 2017; 8: 444Crossref PubMed Scopus (92) Google Scholar, 5Willingham D.T. Hughes E.M. Dobolyi D.G. The scientific status of learning styles theories.Teach Psychol. 2015; 42: 266-271Crossref Scopus (154) Google Scholar]. We did not include additional variables in the current trial primarily because the experimental setup was already complex and long, requiring significant effort from the participants, which left only those participants who were more motivated; including more tasks for the participants might be too demanding and potentially further increase the dropout rate and affect the quality of the results. Furthermore, the randomization ensured that there were no differences between the groups in knowledge about Cochrane or systematic reviews in general. We did not assess long-term retention of knowledge and indicated this as a possible topic for future research. In our study, the students had a 20-minute break between reading the summary format and taking the knowledge test whereas the consumers and doctors could take the knowledge test right after a brief numeracy test. As shown in the Results section, the students had significantly lower knowledge scores on all formats compared with other groups. As there was no difference in the knowledge score or reading experience between the infographics and PLS groups, it seemed that the amount of information remembered decreased with time, regardless of the format. We agree that it is important to know preferences of different audiences, and, as already mentioned, we are currently using a qualitative approach to determine the factors that would define the most suitable summary formats for Cochrane systematic reviews. As stated in our article, our study was performed in a single country and using a single Cochrane systematic review and thus has a limited generalizability. The results we obtained may also be influenced by specific characteristics of local respondents, particularly in view of their numerical and visual literacy, as well as their learning style. To address this, we are currently collaborating with colleagues from other Cochrane centers to replicate the study using other Cochrane systematic reviews for different populations in different countries. Letter to the editor in response to "No difference in knowledge obtained from infographic or plain language summary of a Cochrane systematic review: three randomized controlled trials" by Buljan et al. (2017)Journal of Clinical EpidemiologyVol. 100PreviewBuljan et al. [1] conducted three randomized controlled trials to examine the effect of different summary formats (i.e., scientific abstract, plain language summary (PLS), and infographic) of a Cochrane systematic review on knowledge acquired, reading experience, and perceived user-friendliness of three groups (i.e., students, consumers, and doctors). As researchers in knowledge translation (KT), we were interested in this innovative and useful study. However, we have identified some issues that are worth considering. Full-Text PDF

Response to letter to the editor by Mc Sween-Cadieux et al. (2017)