Abstract
Background: The development of reliable, high quality health-related guidelines depends on explicit and transparent processes, methods aimed at minimising risks of bias and the inclusion of all relevant expertise and perspectives. While the methodological aspects of guidelines have been a focus to improve their quality, less is known about the social processes involved, for example, how guideline group members interact and communicate with one another, and how the evidence is considered in informing recommendations. With this in in mind, we aimed to empirically examine the perspectives and experiences of the key participants involved in developing public health guidelines for the Australian National Health and Medical Research Council (NHMRC). Design: This study was conducted using constructivist grounded theory as described by Charmaz, which informed our sampling, data collection, coding and analysis of interviews with key participants involved in developing public health guidelines. Setting: Australian public health guidelines commissioned by the NHMRC. Participants: Twenty experts that were involved in Australian NHMRC public health guideline development, including working committee members with content topic expertise (n=16) and members of evidence review groups responsible for evaluating the evidence (n=4). Results: Public health guideline development in Australia is a divided process. The division is driven by 3 related factors: the divergent disciplinary background and expertise that each group brings to the process; the methodological limitations of the framework, inherited from clinical medicine, that is used to assess the evidence; and barriers to communication between content experts and evidence reviewers around respective roles and methodological limitations. Conclusion: Our findings suggest several improvements for a more functional and unified guideline development process: greater education of the working committee on the methodological process employed to evaluate evidence, improved communication on the role of the evidence review groups and better facilitation of the process so that the evidence review groups feel their contribution is valued.
Highlights
Due to the large number of organisations and governments that produce guidelines, end-users are often presented with contradictory recommendations and guidelines of varying quality.[1,2] In order to improve the quality of guidelines, several organisations around the world such as the World Health Organization (WHO),[3] the National Institute for Health and Care Excellence,[4] and the United States Community Preventive Services Task Force[5] have developed standards and criteria for their development
The methods experts and content area experts interviewed for our study agree that rigorous methods should be used to develop public health guidelines that are considered valid and trustworthy
Our findings suggest that more attention needs to be given to the social processes influencing guideline development in order for the experts to achieve this shared goal
Summary
The WHO Handbook for Guideline Development, 2nd Edition requires that the process for developing a recommendation is explicit, transparent, and uses methods aimed to minimise risk of bias; the guideline development group includes all relevant expertise and perspectives, and that recommendations consider benefits and harms as well as other relevant factors.[3] Currently in Australia, there are standards for guidelines approved by the National Health and Medical Research Council (NHMRC) and guidance to achieve these standards is being developed.[6,7]. GRADE (The Grading of Recommendations Assessment, Development and Evaluation) is widely endorsed as a methodology for clinical guideline development worldwide, including by the WHO and NHMRC.[3] GRADE allows for a transparent rating of the quality of evidence and rates the confidence in effect estimates for benefits and harms as high, moderate, low, or very low.[8] GRADE has been optimised for evaluating clinical interventions and randomised controlled trials
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