Refining reporting guidelines using behaviour change theory

The lasting legacy of most medical research is the written account. When writing up their work, researchers often omit information that readers — including clinicians, reviewers, patients, and other researchers — need to fully understand, appraise, replicate, or apply the research. Reporting guidelines try to solve this problem. They are community-created recommendations of information to include when writing up research so that everybody can use it. The first reporting guideline was created almost 30 years ago, and many more have been created since. Most leading medical journals ask authors to adhere to reporting guidelines, yet adherence remains low in almost all medical fields. When authors do not adhere to reporting guidelines their work is less transparent, less valuable, contributes less to patient outcomes and has potential to inadvertently harm by distorting the evidence base. The aim of my thesis is to understand why authors do not adhere to reporting = guidelines when writing up medical research, and to address these reasons with the intention of increasing adherence in the future. I began my thesis with this clear aim but without a route to get there. My first step was a qualitative synthesis (chapter 3) of research exploring authors experiences of reporting guidelines, and I discovered authors’ adherence to reporting guidelines is influenced by features of the guidelines themselves, but also the system that surrounds them including the websites that disseminate them and the people and policies of the broader scholarly ecosystem. I probed this system further with a review of quantitative surveys and an evaluation of a key dissemination website (chapters 4 & 5). Given the complexity of the system and the complexity of the behaviour in question, I realised I would need a framework to help me make sense of them. I decided to use the Behaviour Change Wheel (chapter 6), a well established and evidenced framework for designing and defining complex behaviour change interventions. I led workshops and focus groups (chapters 7 & 8) to guide stakeholders through frameworks’ steps and, ultimately, ended up identifying 32 influences that needed to change, and 128 ideas of how to change them. These ideas were applicable to guideline developers, the EQUATOR Network, journals, publishers, funders, ethics committees, and institutions. I decided that redesigning reporting guidelines and EQUATOR’s website would be an effective, affordable, acceptable, and equitable way to realise many of the generated ideas. I defined 63 intervention components and managed to incorporate 46 into a prototype website that included a redesigned reporting guideline (the Standards for Reporting Qualitative Research) and the EQUATOR Network’s home page (chapter 9). I then explored authors experiences of using this prototype through in-depth interviews, observation, think aloud, and writing appraisals (chapter 10) and I identified 53 possible areas for improvement. My key outputs include a design blueprint for user-friendly reporting guideline resources, and an online platform for creating and hosting resources following this blueprint. This platform will benefit guideline developers who typically lack the money, time, and skills to create user friendly resources. A future feasibility study and parallel process evaluation will explore the acceptability and usability of this platform amongst authors submitting to journals, in preparation for a future evaluation to determine whether my redesign leads to more authors adhering to reporting guidelines successfully.