Table 1 Summary of modifications & rationale of changes from original to final versions

Comprehension

Both Parts

Redundant text

Simplified text by removing redundant messaging and/or unnecessary words

Repetition of words

Repetitive words removed to be concise

Used written numeracy (e.g. 51 out of 100) and proportions (e.g. 51%)

Used proportions (e.g. 51%) only for simplification

Use of Jargon/ Scientific / Academic language

Used “plain language”

Inconsistent use of terms

Consistency and terms matched EQ-5D-5L scale

Long sentence structure

Simple sentence structure used

Limited instructions. Part one instructions on how to understand the figure were hidden. Patients needed to click on the link labelled, “? Help me understand this chart” to reveal the information on interpretation.

Part two had limited instructions on how to interpret the visualized change in levels or categories of problems before and after surgery.

Part one instructions on how to understand the figure was placed in the narrative above the figure.

Part two added instructions on how to interpret the visualized change in levels or categories of problems before and after surgery.

Part one

Icons were shown separate from the text that described the levels or categories of problems.

Two boxes were used: One box was used in the text/narrative and a second box was used in figure.

No instructions on how to interpret the information in the box.

Icons are linked to the text describing levels or categories of problems for easy understanding.

One box used around the icons and text.

Included instructions on how to interpret the information in the box.

Two lines of icon used, making it difficult to discern count and levels or categories of problems (i.e. proportions) spread over 2 lines in the figure.

One line of icons with each icon representing 2 people to better visualize proportions.

Included footnote information on how to interpret proportions:

* Each figure [icon] represents 2 people.

Used a waffle chart where each icon represents 1 person to better visualize proportions.

No additional information on how to interpret proportions was included.

Part two

Use of icons (i.e. cross-sectional) made it difficult to discern change in levels or categories of problems before and after surgery; implies a static categorization.

Removed icons.

Used Sankey Chart (i.e. longitudinal) to better represent change in levels or categories of problems before and after surgery.

Removed icons.

Used Sankey Chart (i.e. longitudinal) and stacked bars to better represent change in levels or categories of problems before and after surgery.

Used a greater slope of curves indicating magnitude of change.

Used less slope of curves indicating magnitude of change.

Placement of labels.

-External to slope of change

-Percentages listed first followed by the label

Placement of labels.

-Embedded into the stacked bars

-Percentages listed second after label

There was no recall of a patient’s EQ-5D-5L data on the level or category of problems before surgery. This limited people’s ability to assess their potential probability of change from before to after surgery.

We used narrative recall of EQ-5D-5L data on the level or category of problems before surgery.

We used visual recall of EQ-5D-5L level or category of problems before surgery.

Usefulness of content

Part one

Used internationally accepted ‘Male’ icon for figure.

Used gender-neutral icons (i.e. head and shoulders for body)

Visual appeal

Both parts

Difficult to discern change of level or category with current colors of icons

Intentional use of color. We used shades of blue to represent less problems (i.e. neutral/calming type color) and yellow, orange, and dark orange to represent more problems (i.e. ‘warning’ type colors).

Original default colors

Used ABJHI Branding (i.e. color palette)