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Draft Guide to the Production and Provision of Information about Health and Healthcare Interventions
Section 7 - Eliciting and incorporating feedback on drafts
Once you have prepared your first draft, you need to work on improving it. The usual way to do this is to ask other people to comment on your first and subsequent drafts.
Whose opinions should be sought?
We suggest that members of your project team review the first draft to check that all the agreed main content areas have been covered, that the text seems relatively easy to read and that the 'tone' is appropriate.
Once you have addressed any initial concerns of your project team, you can ask other people with relevant expertise to comment on the draft and make suggestions about how it might be improved. It is important to do this because it is often harder to see the shortcomings in your own work than in someone else's. And if you only seek comments from members of your own team your package will only benefit from a limited range of perspectives and skills.
There is no real substitute for asking members of your intended audience to look at your draft and tell you whether they understand it, whether they think it covers all the important (relevant) issues, whether the tone and style is acceptable, and how they think it could be improved. As with all health service developments, input from its users is extremely important in the process.
Other people you should consider asking include: Clinicians, academics or researchers who have particular research-based expertise. These people are likely to be particularly well placed to comment on whether your information reflects the best available research evidence. Patients' representatives or staff from relevant voluntary organisations.
They are best placed to comment on whether the information reflects the range of experiences of people who live with particular conditions and/or have received the interventions. They could also suggest how the information might be made more acceptable and useful to its intended audience. Healthcare professionals with relevant expertise. People who deliver the types of interventions covered would be able to comment on context and how well it reflects current practice. People with expertise in information presentation or communication. Journalists, the Plain English Campaign and graphic designers, for example, should be able to help you to communicate your message more effectively. If you are using minority languages, communication symbols, or special formats, consult people, for example speech and language therapists, who are experienced users of these.
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It is probably worth asking several people from each category to comment. In terms of members of the intended audience, try to include people from different social backgrounds and with varying experiences of the subject.
If you know that some of the people you are thinking about consulting have strongly-held views about particular topics, consider including people with opposing views too. If you know that several different types of healthcare professionals work with the intended audience, try to ensure you get some feedback from each.
How should opinions be sought?
There are various ways to ask people to comment on drafts. Think carefully about which approaches are most likely to help them draw on their particular expertise, and feedback most constructively to you at minimum inconvenience to them. It might be appropriate to use different approaches to elicit the opinions of different groups of people. In some circumstances you might need to obtain approval from an ethics committee.
When seeking the views of members of your intended audience, you might consider the following points: Many people are not used to writing down their comments and opinions. Some have literacy problems. Group discussions may be more productive than postal requests for comments as they allow people to compare and contrast views, to develop critical ideas and to work together to identify areas of improvement. People may be reluctant to criticise an information package to someone who has been responsible for developing it. You may get more honest feedback if you invite people to talk to someone outside the team and clearly state that you would welcome comments to help you improve the package. 'Open' comments from a few people who have a variety of backgrounds and experiences might be of more use than 'closed' responses to structured questions from hundreds of respondents.
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One way of asking for feedback is to send people a copy of your draft asking for written comments about how it might be improved. Alternatively you could give people a copy and ask them to discuss it either individually or in a focus group.
You might ask specific questions about how to improve particular aspects of your information package. For example: Were there any parts that you had to read twice because they were hard to understand? If yes, please list them. Which sections did you find useful? Can you explain why? Which sections did you think were not very useful? Can you explain why? Can you think of any other topics that you would like covered? If yes, please describe them.
Other issues you might ask people to comment on include: The clarity of the information aims How well the package achieves its aims Whether the information provided is likely to be relevant, and addresses the questions that the intended audience want answered Whether there are any inaccuracies Whether important areas of uncertainty were appropriately identified and honestly dealt with Whether the information about different interventions is presented 'fairly' in a 'balanced' way Whether the style and the tone of the leaflet are appropriate and, if not, how they could be improved
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You might want to ask the people who comment on your draft to apply a specific quality checklist. Though useful, not all checklists will be suitable for the type of package you have developed and not all are designed to elicit suggestions about improvements.
It is important to those commenting to explain their criticisms and suggestions as fully as possible. You need to know why they think something is incorrect or inappropriate, or why their suggested alteration represents an improvement. If they think that your information is inaccurate, ask them to provide research evidence or references so that you can follow up their concerns.
The number of times feedback on drafts should be sought will vary depending on the nature of the topic and the kinds of response that you get.
We advise you to seek feedback on at least two drafts because suggestions made on an initial draft are likely to require information to be altered. It is important that everything is carefully checked.
Once you have a near-final draft, you might also try distributing it in a limited way and seeking feedback from the people who use it in a real life setting.
How should feedback be handled and used?
If you request comments, it obviously makes sense to consider any feedback seriously. However, it is not always possible to incorporate all the changes that people suggest - not least when different people suggest incompatible changes! It is important to distinguish between factual inaccuracies, concerns that important information has been omitted and matters of taste in the ways things are expressed. Try to be aware of any particular biases among your reviewers and consider their suggestions carefully.
When seeking information from a number of people, consider all their comments together before you start making changes to the text. You might find it helpful to discuss the comments at a project team meeting so you can agree how you will respond to them.
If possible, you might try to explain to reviewers why you have not made all of their suggested changes. This could be done in a standard thank you letter sent to all reviewers.
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