This study was conducted between October 2024 and May 2025 at the University of Birmingham. The process of CoMICs creation, aligned with the knowledge-to-action framework, has been described in detail in our previous publication [7]. To inform the adoption of CoMICs for guideline dissemination, we conducted a structured exploratory literature review using PubMed. The search strategy focused on 3 intersecting themes: dissemination methods, barriers to the uptake of clinical guidelines, and health care professional behaviors. The review was limited to English-language articles involving health care professionals but included studies from all publication years to ensure comprehensive coverage. Key findings highlighted the limitations of traditional dissemination techniques, such as printed materials, educational sessions, and audit-feedback cycles, and underscored the need for more engaging and accessible formats, particularly in time-pressured clinical environments [4]. These insights shaped the rationale for the CoMICs approach. A 4-part audiovisual series was created to convey the core content of the Joint European Society of Endocrinology and Endocrine Society guideline on GIAI. The primary focus of this work is qualitative, centered on the co-design and evaluation of CoMICs. The literature review served as a supporting framework for this study. Each video distilled key diagnostic, therapeutic, and follow-up recommendations into concise, visually engaging episodes. Crucially, medical students played an active role throughout the ten-step CoMICs development process, which included the following:

This process not only supported the technical production of CoMICs but also served as a structured educational opportunity, exposing students to academic publishing, clinical content curation, and interdisciplinary teamwork in endocrinology. The CoMICs videos were disseminated through multiple online platforms to maximize reach and engagement. All videos were uploaded to YouTube (Google LLC) as the primary hosting platform and shared via social media channels, including X (X Corp, formerly Twitter), Instagram (Meta Platforms, Inc), and WhatsApp (Meta Platforms, Inc) groups within the CoMICs network. The posts were accompanied by short educational captions and reposted by CoMICs members on the aforementioned platforms to enhance discoverability.

In parallel, a patient-facing version of the CoMICs series was developed to improve health literacy and access among lay audiences. These 4 short videos were co-designed with individuals living with adrenal insufficiency and deliberately avoided technical language. Patient advocates provided feedback throughout script development, ensuring clarity, relevance, and the inclusion of relatable, everyday examples. Practical guidance on symptom recognition, treatment adherence, and self-management was integrated.

To further enhance accessibility, multilingual versions were created. Medical students fluent in English and another language of interest to this project produced initial transcripts, which were then reviewed by native speakers with clinical or health communication experience. This ensured that idiomatic clarity, cultural appropriateness, and medical accuracy were preserved across language versions. Languages for the multilingual video adaptations were selected pragmatically based on the connections within the CoMICs network and the availability of fluent volunteer translators. This approach ensured linguistic accuracy while allowing culturally relevant adaptations for each audience. This process enhanced the reach and relevance of the CoMICs series to non–English-speaking audiences, promoting global health equity [10].

Purposive sampling was used to recruit participants with direct involvement in the CoMICs project or relevant expertise. These included the following:

Among the CoMICs team members interviewed, there were 10 medical students and 2 physicians. The medical students were in their penultimate or final year of study, while the 2 physicians included 1 foundation physician and 1 honorary research clinical fellow. All participants demonstrated an interest in endocrinology, having been active members of the CoMICs initiative for at least 1 year and engaged in ongoing development of the CoMICs guideline. Their participation reflected both their exploratory career interests and commitment to evidence-based knowledge dissemination.

Semistructured interviews explored participants’ experiences with clinical guidelines, perceptions of the CoMICs format, and the personal or professional impact of their involvement. Students were also asked to reflect on how the experience shaped their views on endocrinology, academic collaboration, and the role of creative dissemination in medicine. The interview guide was aligned with the 2 objectives of the study and focused on clarity, usability, coproduction dynamics, and suggestions for future improvement. All interviews were audio-recorded and transcribed verbatim. Saturation was considered reached when participants could no longer provide additional insights or perspectives relevant to the research questions.

The study was reviewed and received ethics approval from the Science, Technology, Engineering, and Mathematics Committee at the University of Birmingham (ERN_2965-Aug2024). All data were anonymized to safeguard the participants’ information. Written informed consent was obtained from all participants before the interview, in accordance with institutional guidance and the approved ethics protocol. Participation was voluntary, and participants were not compensated for their time.

Interview data were analyzed using reflexive thematic analysis following the six-phase framework by Braun and Clarke [10]:

The 4-part guideline CoMICs series for health care professionals has accumulated 1218 views on YouTube and 1331 views on X (as of November 22, 2025) since its creation. The patient and public versions were created in English, Bengali, Serbian, Tamil, Greek, Georgian, and Brazilian Portuguese and have been viewed 1884 times on YouTube and 2420 times on X (as of November 22, 2025) since their creation. The final CoMICs videos are publicly accessible via YouTube (Multimedia Appendix 1).

This study represents a novel contribution to the field of clinical guideline dissemination and medical education. To the best of our knowledge, it is among the first to explore the cocreation of audiovisual, narrative-based clinical resources—CoMICs—that are not only grounded in evidence-based guidelines but also designed for multilingual and multicultural relevance. Unlike previous CoMICs initiatives that focused on broad health topics and social media engagement, this study uniquely evaluates the transformation of a single clinical guideline into structured audiovisual outputs and examines the educational impact of the cocreation process on medical students. The visual structure of CoMICs supports the cognitive load theory by minimizing extraneous load and enabling learners to process guideline content more efficiently [11]. Previous reviews have emphasized the limited effectiveness of traditional dissemination methods (eg, printed guidelines and lectures) unless paired with contextual relevance, interactivity, and credible authorship [5,7,12,13]. CoMICs address these limitations through visual storytelling, coproduction with guideline authors, and multilingual delivery, making them a more adaptable and engaging format for real-world use. This aligns with emerging innovative dissemination practices, which emphasize concise, visually driven formats to improve the reach and uptake of health evidence [14].

Furthermore, this study supports growing calls in the health care education literature for multifaceted, user-driven dissemination models [15]. Notably, CoMICs serve not only as tools to improve practitioner guideline uptake but also as platforms for early-career professional development. Medical students involved in the production process gained firsthand experience in academic endocrinology, communication, interprofessional collaboration, and health education. Such active involvement can foster future interest in both clinical specialties and research careers—an impact rarely explored in the dissemination literature.

Our findings can be contextualized within dissemination science frameworks. The Framework for Knowledge Transfer by Lavis et al [16] proposes that effective dissemination depends on 5 core questions: what should be transferred, to whom, by whom, how, and with what effect. CoMICs directly addresses each of these domains: it condenses evidence-based guideline messages (what), targets medical students and patients (to whom), involves credible experts and peers (by whom), delivers content through short multilingual videos and social media (how), and measures engagement and understanding (with what effect). By mapping CoMICs to these principles, our approach provides a structured, theoretically grounded model for disseminating evidence through digital media.

The strength of this study lies in its dual-impact design, which simultaneously addresses the challenges of guideline dissemination and supports the development of future academic clinicians. The cocreative model provided students with meaningful, mentored engagement in real-world implementation efforts, resulting in a finished product with practical utility for health care professionals and patients alike. The inclusion of multilingual and culturally relevant content further extends CoMICs’ global reach, especially in resource-limited or linguistically diverse health care settings. Additionally, by capturing reflections from both clinical experts and student collaborators, the study offers a rich, balanced qualitative perspective on how innovation, collaboration, and mentorship can enhance both educational quality and clinical relevance.

We did not measure actual changes in clinical behavior or patient outcomes. While the findings indicate strong potential, objective evidence of impact remains limited. Moreover, because the interviewees were directly involved in developing the resources, positive bias may have influenced responses, potentially limiting the generalizability of the findings. It is also important to note that quantitative metrics, such as video views and engagement figures, were included solely to contextualize the qualitative findings, as the primary aim of this study was to explore the co-design experience rather than to evaluate dissemination outcomes. Furthermore, evaluating the broader impact of CoMICs on students and patients who viewed the content was beyond the scope of this work. Future research [1-7] should focus on guideline adherence, decision-making confidence, and quality of patient care. Several user-generated insights, such as using the videos as “quick refreshers before clinics” or “during breaks or commutes,” suggest practical pathways for future implementation. These patterns indicate that CoMICs could be integrated into just-in-time learning strategies, on-shift clinical preparation, and student revision routines. Future work should examine how such informal use cases can be systematically incorporated into guideline uptake workflows and clinical education pathways.

CoMICs offer a practical and engaging solution to barriers in guideline dissemination, improving accessibility and relevance through visual storytelling and multilingual adaptation. Importantly, involving medical students in their creation fosters early exposure to academic endocrinology and professional skill development, supporting interest in research and specialty careers. Future work should focus on evaluating clinical outcomes, cost-effectiveness, and integration into wider implementation systems, ensuring scalability across specialties and settings.