A dissemination plan and a detailed communication strategy were written to guide the dissemination of the study. These documents expressed the goals of dissemination, identified target audiences and credible messengers, developed key messages and set out the activities that we planned to undertake. See Appendix 7 for the dissemination plan.
Audiences
Stakeholder mapping was used to assess the power, influence and interest of each stakeholder. Neurosurgeons involved in the trial, emergency medicine consultants and paramedics working in high-income countries emerged as the priority target audiences for the first stage of dissemination activity. This process helped to hone the communication strategy and ensured that resources were allocated efficiently to maximise impact.
Messengers
Informal interviews were conducted with medical practitioners in the UK to understand where they typically access information on medical research and what sources they view as respected and credible. Interview respondents described the difficulty of keeping up to date with the large volume of new research being published. Interviewees explained that they increasingly relied on informal, online sources of medical information rather than on journal articles. One online source highlighted was FOAMed (Free Open Access Medical education), a collection of open access medical education resources. Contributors to these informal education resources summarise and appraise important journal articles and present the information in a variety of formats including blogs, podcasts and videos.
Mediums
Publications and conferences
The trial results were published on an open access basis in The Lancet.24 The results were also presented at two large international conferences72,73 on the same date to coincide with the publication of the journal article.
Media
A list of the key online, print and broadcast media outlets based in the UK and the USA was compiled. Selected journalists were given 5 days’ notice of the press release. The press release was issued to other media outlets 3 days in advance of the results paper. The press were provided with a media pack comprising a quote sheet, statistics on the impact of TBI in the UK and globally, and an animation explaining the trial and study results. Two short films were also produced: one featuring interviews with the trial chief investigator, a trial neurosurgeon and a trial participant, and the other focusing solely on the experiences of the trial participant. High-resolution stills from the films were provided.
Furthermore, in order to encourage content production, journalists were offered access to a large London trauma hospital for filming, interviews with one of the study participants and the trial investigators, and B-roll footage.
Social media
A social media pack, containing suggested tweets, newsletter copy and Facebook (Facebook, Inc., Menlo Park, CA, USA) and Instagram (Facebook, Inc., Menlo Park, CA, USA) posts, was shared with trial sites and charity collaborators. The study funders, which have a large social media following and influence, were given advance notice of the results to enable them to plan their social media activity and to sign off on the branding. FOAMed medical influencers also had advance notice of the results and access to the trial investigators for questions and interviews.
Out-takes
Press coverage
Online
Between 1 September 2019 and 24 October 2019, CRASH-3 had more than 500 mentions across online global news sources. The majority of mentions were from UK-based media sites, with just over 10% from US media sources.
Most media sites cross-posted the CRASH-3 team press release or used the resources that we provided. The British Broadcasting Corporation (BBC) conducted its own interviews, including one with a study participant.
Although there was a lot of mainstream digital media coverage of CRASH-3, including in The Guardian, the Independent and the Daily Mail, a number of the articles with broader reach were in science-specific publications such as Medical News Today, WebMD and BBC Health.
Unexpectedly, a number of regional papers also featured the story. Although they have a lower reach individually, cumulatively this resulted in broad coverage.
Broadcast media
There were 86 broadcast pieces featuring CRASH-3 between 1 September and 24 October 2019. The majority were covered by the BBC as well as various radio stations in the USA, the Pakistani news channel City 42 Pakistan and the Kurdish news channel Rudaw.
Social media
Between 1 October 2019 and 31 October 2019, there were over 2000 mentions of CRASH-3 on Twitter (Twitter, Inc., San Francisco, CA, USA). Over one-quarter of the mentions originated from UK sources (28%), followed by the USA (12%) and Canada (10%).
Twitter activity from The Lancet and the Department for International Development achieved the highest reach. The Wellcome Trust, the National Institute for Health Research and the MRC, which funded the study, also featured in the top 10 posters by reach. FOAMed channels were particularly successful in achieving a large and targeted reach. The Resus Room podcast, which is a FOAMed site, had > 16,000 downloads of their podcast on CRASH-3.
What worked well
Advance notice of results
Certain media contacts, including the BBC, the study funders and FOAMed medical influencers, were given advance notice of the trial results. This allowed them to plan media and social media content and share the results on our behalf:
CRASH 3 has been our most popular episode ever (approximately 10% greater than previous, which is a jump from what we expect) . . . From experience, advertising the paper prior to publication in the way that was done makes a large impact on its reach and it is something that we plan to continue with future papers that we will be covering.
Know your audience
Interviews with medical professionals during the development of the communication strategies identified FOAMed as a credible information source for our key audiences. Owing to their large social media following, FOAMed contributors proved to be our most successful targeted route for dissemination. As well as access to the results paper prior to the publication of the article, medical influencers were also given complete creative and intellectual freedom on the interpretation of the results.
Flexible content
A variety of resources were developed, including short videos, photographs, infographics and animations, allowing content to be shared through different channels. Permission was also given to adapt the resources, making it much easier for busy communications teams to work with and share our material. UK Aid Direct (© 2019 UK Aid Direct) made a branded version of one of the videos that we produced to tie in with an ongoing campaign that it was running. In addition, by offering a filming site and interviews with a study participant and trial investigators, we supported others to develop their own content.
What we learned
Choose content carefully
An animation explaining the trial results was created to support the dissemination of the study; however, the animation was costly to produce and generated little engagement. The infographics, on the other hand, were inexpensive to make and were shared widely. Owing to the long lead time required for producing an animation, it was commissioned prior to knowledge of the trial results. Consequently, the messaging was not as strong as we would have liked. It is possible that a high-tech video explaining the mechanism of action of TXA would have been a more successful angle.
Consider patient case studies for dissemination as part of trial design
The BBC interviewed one of the study participants as part of its coverage of the trial. This provided the human interest element to the story and was well received. Studies should consider cultivating a case study portfolio of trial participants who would be interested in speaking about their experiences. This could be achieved by giving study participants the option, in the participant information sheet, to opt in to communications from the trial team.
Make the most of collaborators
Most hospitals have communications teams that are keen to share information relating to research in which they have been involved. Support from communications teams to share trial results on social media can be helpful to target messages to relevant local and regional hospital staff and decision-makers.
Debate can be good
There was a lack of consensus among FOAMed contributors on the conclusions that were drawn from the results of the trial. This, in turn, generated further discussion, debate and social media activity. The CRASH-3 team did not directly engage in these debates, but several of our trial collaborators who are active on social media responded to the comments and questions tweeted. Individuals who are respected in their field, active on Twitter and defenders of your work, can become your social media champions.
Think outside the box
Although it is important to utilise existing tried-and-tested dissemination approaches, this field benefits from a willingness to innovate, take risks and try new things. Gamifcation is an area of growing interest in medical education. One idea we are exploring is designing a mobile app-based (application-based) game aimed at medical practitioners to explain the mechanism of action of TXA.