title: Improving the user experience of patient versions of clinical guidelines: user testing of a Scottish Intercollegiate Guideline Network (SIGN) patient version.
abstract: BACKGROUND
  Guideline producers are increasingly producing versions of guidelines for the public, and knowledge of what the public want from them is also increasing. The aim of this study was to user test a patient version of a SIGN clinical guideline that was designed based on preliminary work for the DECIDE project. SIGN is the leading national guideline producer in Scotland.
  
  
  METHODS
  People with a diagnosis of glaucoma and non-professional carers were recruited from across Scotland. User testing was conducted using a think-aloud protocol method. Each session was conducted by one interviewer and one observer. All sessions were recorded and transcribed. The data was analysed, problems with the guideline were identified and resolved and key findings were themed using a user experience model.
  
  
  RESULTS
  Thirteen user testing sessions with people with glaucoma and one with a carer were conducted. Key facilitators of desirability and usability identified include clear branding as a patient version and a clearly described purpose, audience and contents page. Other facilitators include a "friendly" tone which is achieved by the use of colour, quotes, icons, simple language and charts, and brief chunked text. The value and usefulness of the patient guideline was influenced by its ability to: inform the public, link information to actions, and empower people in their interaction with healthcare professionals. Participants were disappointed by the lack of information on treatment in the patient version, which was outside its scope. Information on the evidence based guideline production process and the involvement of appropriately skilled professionals was key to the credibility of the guideline. Lack of awareness of guidelines and guideline producing bodies, is a potentially serious threat to findability/accessibility.
  
  
  CONCLUSIONS
  It is important for guideline producers to maximise the user experience of the public when they access patient versions of guidelines, particularly given the current low level of access and awareness. One size does not fit all and guideline producers need to strike a balance between keeping the patient version simple and providing sufficient information to facilitate shared decision making and empower the public. Guideline producers may find the results of this study useful in designing their own patient versions.
authors.affiliation: Healthcare Improvement Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, Scotland, UK. n.fearns@nhs.net.
authors.forename: Naomi
authors.initials: N
authors.lastname: Fearns
authors.affiliation: Healthcare Improvement Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, Scotland, UK. Karen.graham2@nhs.net.
authors.forename: Karen
authors.initials: K
authors.lastname: Graham
authors.affiliation: Healthcare Improvement Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, Scotland, UK. g_johnston@btopenworld.com.
authors.forename: Gordon
authors.initials: G
authors.lastname: Johnston
authors.affiliation: Healthcare Improvement Scotland, Gyle Square, 1 South Gyle Crescent, Edinburgh, EH12 9EB, Scotland, UK. duncan.service@nhs.net.
authors.forename: Duncan
authors.initials: D
authors.lastname: Service
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001364:Awareness; D017028:Caregivers / Q000523:psychology; D003657:Decision Making; D019317:Evidence-Based Medicine; D005260:Female; D005901:Glaucoma / Q000523:psychology / Q000628:therapy; D006282:Health Personnel; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D015588:Observer Variation; D010353:Patient Education as Topic / Q000379:methods / Q000592:standards*; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic / Q000592:standards*; D011369:Professional-Patient Relations; D058996:Quality Improvement; D012606:Scotland
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