Graphical abstracts increase engagement but have uncertain effects on article access and citations in medical research: a systematic review

Purpose: Graphical abstracts have become a routine tool for disseminating research through social media and scholarly repositories. However, evidence regarding their effectiveness remains inconsistent. A key question is whether increased engagement translates into substantive readership or, ultimately, citation.Methods: We conducted a systematic review that synthesized 22 studies, including 8 randomized controlled trials and 14 observational or survey-based studies. Outcomes were grouped into four domains: social media engagement, article access, citation and altmetric impact, and reader perception. Certainty ratings were assigned using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.Results: Eighteen studies (81.8%) measured engagement, and all but one reported higher impressions, retweets/reposts, likes, or overall engagement for graphical abstracts than for text-only posts. Among seven studies that measured access, three reported significantly higher click-throughs or article access. Citation outcomes were more heterogeneous. Only one study demonstrated a sustained citation advantage, whereas most found no difference or a slight disadvantage. Certainty ratings indicated moderate confidence for engagement and low to very low confidence for access and citation.Conclusion: Evidence drawn predominantly from Twitter/X indicates that graphical abstracts reliably increase early engagement, but whether this engagement extends to article access or citation remains inconsistent and uncertain.