Wording Approaches to Convey the Strength of Recommendations in Health Guidelines

NCT07854548 | Terminated

• 1 other identifier: 18107
• Study Type: interventional
• Target: 741
• Locations: 1 country
• Sites: 1

Brief Summary

Recommendations from health organizations rest on a scale. On this scale, some recommendations can be "stronger" than others. This "strength" should be easily understood by everyone, including members in the public and healthcare professionals. The survey results will help us find a better way to phrase recommendations.

Conditions

Guideline Development

Keywords

wording; strength; recommendation

Outcome Measures

Primary Outcomes (1)

• Understanding of the Strength and Direction of Recommendation

  The primary outcome is understanding of the correct interpretation of recommendation strength and direction. This will be assessed with three multiple-choice questions where answer options represent interpretations for strong-for, conditional-for, conditional-against, and strong-against recommendation statements, as indicated by GRADE. Each question has 1 correct answer. Scores will be assessed per-question and aggregate (maximum score of 3/3 suggesting correct understanding versus minimum 0/3 suggesting poor understanding).

  During a single survey session (approximately 10 minutes)

Secondary Outcomes (2)

• Intended Behaviour

  During a single survey session (approximately 10 minutes)

• Preference

  During a single survey session (approximately 10 minutes)

Study Arms (3)

GRADE approach ("recommends" and "suggest")

EXPERIMENTAL

Recommendation statements structured as follows: The guideline panel recommends… The guideline panel suggests…

Other: GRADE approach ("recommends" and "suggest")

New approach ("strongly recommends" and "conditionally recommends")

EXPERIMENTAL

Recommendation statements structured as follows: The guideline panel strongly recommends… The guideline panel conditionally recommends…

Other: New approach ("strongly recommends" and "conditionally recommends")

Alternate approach ("should" and "may")

EXPERIMENTAL

Recommendation statements structured as follows: * should be used * may be used

Other: Alternate approach ("should" and "may")

Interventions

GRADE approach ("recommends" and "suggest") OTHER

"recommend" (strong) and "suggest" (conditional) Example: The guideline panel recommend(s)/suggest(s) \[against\] \[the intervention\], rather than \[the comparator\], for \[indication\].

GRADE approach ("recommends" and "suggest")

New approach ("strongly recommends" and "conditionally recommends") OTHER

"strongly recommend" (strong) and "conditionally recommend" (conditional) Example: The guideline panel strongly recommend(s)/conditionally recommend(s) \[against\] \[the intervention\], rather than \[the comparator\], for \[indication\].

New approach ("strongly recommends" and "conditionally recommends")

Alternate approach ("should" and "may") OTHER

"should" (strong) and "may" (conditional) Example: \[The intervention\] should/may \[not\] be \[verb\], rather than \[the comparator\], for \[indication\]

Alternate approach ("should" and "may")

Eligibility Criteria

• Age: 16 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Individuals of 16 years or older of age
• Ability to read and understand English
• Previous use of, or intention to use, health guidelines or recommendations (e.g., intention to access clinical or public health guidelines, recommendations, or policy advice)

You may not qualify if:

• Previous participation in this study

Sponsors & Collaborators

• McMaster University: lead

Study Sites (1)

McMaster University

Hamilton, Ontario, Canada

Location

MeSH Terms

Interventions

GRADE Approach; Suggestion

Intervention Hierarchy (Ancestors)

Patient Outcome Assessment; Outcome Assessment, Health Care; Outcome and Process Assessment, Health Care; Health Care Evaluation Mechanisms; Quality of Health Care; Health Care Quality, Access, and Evaluation; Hypnosis; Mind-Body Therapies; Complementary Therapies; Therapeutics; Psychotherapy; Behavioral Disciplines and Activities

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: September 1, 2025
• First Posted: October 2, 2026
• Study Start: August 1, 2025
• Primary Completion: December 30, 2025
• Study Completion: December 30, 2025
• Last Updated: October 2, 2026

Record last verified: 2026-08

Data Sharing

• IPD Sharing: Will not share

Locations

CA (1)