Abstract
BackgroundWHO has recognised the need to improve its guideline methodology to ensure that guideline decision-making processes are transparent and evidence based, and that the resulting recommendations are relevant and applicable. To help achieve this, WHO guidelines now typically enhance intervention effectiveness data with evidence on a wider range of decision-making criteria, including how stakeholders value different outcomes, equity, gender and human rights impacts, and the acceptability and feasibility of interventions. Qualitative evidence syntheses (QES) are increasingly used to provide evidence on this wider range of issues. In this paper, we describe and discuss how to use the findings from QES to populate decision-making criteria in evidence-to-decision (EtD) frameworks. This is the second in a series of three papers that examines the use of QES in developing clinical and health system guidelines.MethodsWHO convened a writing group drawn from the technical teams involved in its recent (2010–2018) guidelines employing QES. Using a pragmatic and iterative approach that included feedback from WHO staff and other stakeholders, the group reflected on, discussed and identified key methods and research implications from designing QES and using the resulting findings in guideline development.ResultsWe describe a step-wise approach to populating EtD frameworks with QES findings. This involves allocating findings to the different EtD criteria (how stakeholders value different outcomes, equity, acceptability and feasibility, etc.), weaving the findings into a short narrative relevant to each criterion, and inserting this summary narrative into the corresponding ‘research evidence’ sections of the EtD. We also identify areas for further methodological research, including how best to summarise and present qualitative data to groups developing guidelines, how these groups draw on different types of evidence in their decisions, and the extent to which our experiences are relevant to decision-making processes in fields other than health.ConclusionsThis paper shows the value of incorporating QES within a guideline development process, and the roles that qualitative evidence can play in integrating the views and experiences of relevant stakeholders, including groups who may not be otherwise represented in the decision-making process.
Highlights
WHO has recognised the need to improve its guideline methodology to ensure that guideline decisionmaking processes are transparent and evidence based, and that the resulting recommendations are relevant and applicable
As members of technical teams responsible for producing evidence for WHO guidelines, we describe lessons learnt from our experiences and areas in which further research and development are needed
These reflections and feedback led us to identify three key areas that each became a focus for one of the papers in the series, namely how Qualitative evidence syntheses (QES) methods need to be adapted for the context of producing guidelines; how to use findings from QES to populate EtD frameworks; and how to use QES findings to develop implementation considerations and inform implementation guidance and processes
Summary
WHO has recognised the need to improve its guideline methodology to ensure that guideline decisionmaking processes are transparent and evidence based, and that the resulting recommendations are relevant and applicable. Decision-makers typically have a range of questions when deciding whether to recommend or implement a particular health intervention, including the effectiveness of the intervention, its acceptability and feasibility, equity impacts and the resources needed for implementation [1] Efforts to address these questions have led to interest across a number of settings, including within guideline development agencies, in expanding the evidence base used to inform decisions on health interventions [2]. The WHO Handbook for Guideline Development stipulates that evidence on a number of questions is required to inform a WHO guideline recommendation [4] These questions include how people affected by the intervention value different outcomes, the effectiveness, acceptability and feasibility of the intervention, and equity implications.
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