Background It is difficult to communicate new and complex clinical evidence to physicians already experiencing information overload. Proper use of design principles may increase uptake of guidelines and other printed educational materials (PEM) and improve practice.

Objectives We aimed to determine whether physician-oriented PEMs are created in accordance with design principles.

Methods We analysed PEMs identified in a 2012 Cochrane review of their effect on professional and patient outcomes and developed a checklist of design principles based on a literature review of clinical guideline implementability. Two analysts independently evaluated each PEM to determine how design principles were applied.

Results Though the sample consisted of PEMs designed and developed to influence care, no single PEM scored well across all categories. Some PEMs failed to differentiate major recommendations and did not present them in a stepwise fashion. Most used clear and easy to read text, but highlighting was often inappropriate. Some algorithms lacked logic and consistency. Images were poorly designed and used, which may distract and confuse the reader.

Discussion Design principles are not consistently applied in the development of PEMs and improvements are needed to images, presentation of recommendations, and usability of algorithms. Improvements to the design of PEMs may influence their uptake by combating information overload and increasing their perceived ease of use and perceived usefulness.

Implications for Guideline Developers/Users Those who create guidelines and other PEMs consider some design principles, but do not implement them consistently. Our checklist can assist guideline developers in employing a range of design principles.