Background: One aim of the SUPPORT (SUPporting Policy-relevant Reviews and Trials) Collaboration (an EC FP6 project) is to inform maternal and child health policy in LMIC by preparing summaries of current best evidence. Objectives: To design a structured summary of systematic reviews to meet the needs of policymakers and program managers in LMIC. Methods: In September 2007, we identified relevant reviews in The Cochrane Library, MEDLINE and EMBASE and chose seven reviews for piloting. These were summarized and formatted focusing on the needs of LMIC policy makers. We then conducted individual user-tests with policymakers from LMIC and used the findings to inform a revised design of the structured summaries. Results: We conducted 18 user-tests in South Africa, Uganda, Argentina, Chile, China and Colombia, recruiting health policy makers and program managers. We observed wide variations in the understanding of the purpose and scope of the summaries, ranging from a good grasp of content to complete confusion. Some did not understand what a systematic review was or what kind of information could be expected from a summary of research. Many wanted information that was beyond the summary scope, including recommendations and cost information. Several expressed a need for shorter bottom-line presentations, while some wanted more extensive information on topics such as background or descriptions of interventions. Substantial language barriers were observed in a few locations, and many reacted negatively to the use of unfamiliar terms and abbreviations. The sections most appreciated were the front page (key messages) and the section on applicability, equity and scaling up. Based on the feedback from usertesting, the summary format was redesigned to establish clearer expectations of content, help readers find and interpret results more quickly, and provide richer references for further reading. Conclusions: User-testing exposed barriers that LMIC policymakers might experience trying to make sense or use of evidence summaries. This is an important step in creating summaries of research that are in line with the needs of this target group.