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Miksad RA, Calip GS. Future of Cancer Treatment Guidelines: Integrating Real-World Insights for Equitable Cancer Care. JCO Clin Cancer Inform 2024; 8:e2400081. [PMID: 38959447 DOI: 10.1200/cci.24.00081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 05/09/2024] [Indexed: 07/05/2024] Open
Affiliation(s)
| | - Gregory S Calip
- Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA
- AbbVie, Inc., North Chicago, IL
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Ingold H, Gomez GB, Stuckler D, Vassall A, Gafos M. "Going into the black box": a policy analysis of how the World Health Organization uses evidence to inform guideline recommendations. Front Public Health 2024; 12:1292475. [PMID: 38584925 PMCID: PMC10995388 DOI: 10.3389/fpubh.2024.1292475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/29/2024] [Indexed: 04/09/2024] Open
Abstract
Background The World Health Organization (WHO) plays a crucial role in producing global guidelines. In response to previous criticism, WHO has made efforts to enhance the process of guideline development, aiming for greater systematicity and transparency. However, it remains unclear whether these changes have effectively addressed these earlier critiques. This paper examines the policy process employed by WHO to inform guideline recommendations, using the update of the WHO Consolidated HIV Testing Services (HTS) Guidelines as a case study. Methods We observed guideline development meetings and conducted semi-structured interviews with key participants involved in the WHO guideline-making process. The interviews were recorded, transcribed, and analysed thematically. The data were deductively coded and analysed in line with the main themes from a published conceptual framework for context-based evidence-based decision making: introduction, interpretation, and application of evidence. Results The HTS guideline update was characterized by an inclusive and transparent process, involving a wide range of stakeholders. However, it was noted that not all stakeholders could participate equally due to gaps in training and preparation, particularly regarding the complexity of the Grading Recommendations Assessment Development Evaluation (GRADE) framework. We also found that WHO does not set priorities for which or how many guidelines should be produced each year and does not systematically evaluate the implementation of their recommendations. Our interviews revealed disconnects in the evidence synthesis process, starting from the development of systematic review protocols. While GRADE prioritizes evidence from RCTs, the Guideline Development Group (GDG) heavily emphasized "other" GRADE domains for which little or no evidence was available from the systematic reviews. As a result, expert judgements and opinions played a role in making recommendations. Finally, the role of donors and their presence as observers during GDG meetings was not clearly defined. Conclusion We found a need for a different approach to evidence synthesis due to the diverse range of global guidelines produced by WHO. Ideally, the evidence synthesis should be broad enough to capture evidence from different types of studies for all domains in the GRADE framework. Greater structure is required in formulating GDGs and clarifying the role of donors through the process.
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Affiliation(s)
- Heather Ingold
- Department of Global Health and Development, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Unitaid, Global Health Campus, Geneva, Switzerland
| | - Gabriela B. Gomez
- Department of Global Health and Development, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Stuckler
- Department of Social Sciences and Politics, Bocconi University, Milan, Italy
| | - Anna Vassall
- Department of Global Health and Development, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mitzy Gafos
- Department of Global Health and Development, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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3
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Pilar M, Elwy AR, Lushniak L, Huang G, McLoughlin GM, Hooley C, Nadesan-Reddy N, Sandler B, Moshabela M, Alonge O, Geng E, Proctor E. A Perspective on Implementation Outcomes and Strategies to Promote the Uptake of COVID-19 Vaccines. FRONTIERS IN HEALTH SERVICES 2022; 2:897227. [PMID: 36925818 PMCID: PMC10012688 DOI: 10.3389/frhs.2022.897227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022]
Abstract
Recent articles have highlighted the importance of incorporating implementation science concepts into pandemic-related research. However, limited research has been documented to date regarding implementation outcomes that may be unique to COVID-19 vaccinations and how to utilize implementation strategies to address vaccine program-related implementation challenges. To address these gaps, we formed a global COVID-19 implementation workgroup of implementation scientists who met weekly for over a year to review the available literature and learn about ongoing research during the pandemic. We developed a hierarchy to prioritize the applicability of "lessons learned" from the vaccination-related implementation literature. We identified applications of existing implementation outcomes as well as identified additional implementation outcomes. We also mapped implementation strategies to those outcomes. Our efforts provide rationale for the utility of using implementation outcomes in pandemic-related research. Furthermore, we identified three additional implementation outcomes: availability, health equity, and scale-up. Results include a list of COVID-19 relevant implementation strategies mapped to the implementation outcomes.
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Affiliation(s)
- Meagan Pilar
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - A. Rani Elwy
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Larissa Lushniak
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Grace Huang
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Gabriella M. McLoughlin
- College of Public Health, Temple University, Philadelphia, PA, United States
- Implementation Science Center for Cancer Control and Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Cole Hooley
- School of Social Work, Brigham Young University, Provo, UT, United States
| | - Nisha Nadesan-Reddy
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Brittney Sandler
- Bernard Becker Medical Library, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Olakunle Alonge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elvin Geng
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Enola Proctor
- Shanti K. Khinduka Distinguished Professor Emerita, Brown School, Washington University in St. Louis, St. Louis, MO, United States
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4
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Tikka C, Verbeek J, Hoving JL, Kunz R. Evidence-informed decision about (de-)implementing return-to-work coordination to reduce sick leave: a case study. Health Res Policy Syst 2022; 20:19. [PMID: 35164766 PMCID: PMC8842546 DOI: 10.1186/s12961-022-00823-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Coordination of return to work (RtW) is implemented in many countries, but a Cochrane review found no considerable effect on workers’ sick leave compared to usual care. The aim of the study is to analyse how the evidence from this review can be used for decisions about (de-)implementing RtW coordination in a country-specific setting, using Finland as an example. Methods We conducted a systematic literature search and online survey with two groups of experts to compare interventions included in the Cochrane review to Finnish RtW practice using content analysis methods. We applied the evidence-to-decision (EtD) framework criteria to draw conclusions about (de-)implementing RtW coordination in Finland, including benefits, harms and costs of the intervention compared to usual care. Results We included seven documents from the literature search and received data from 10 of 42 survey participants. RtW coordination included, both in Finland and in the review, at least one face-to-face meeting between the physician and the worker, a workers’ needs assessment, and an individual RtW plan and its implementation. Usual care focuses on medical treatment and may include general RtW advice. RtW coordination would be cost-saving if it decreases sick leave with at least 2 days compared to usual care. The evidence in the Cochrane review was mainly of low certainty, and the effect sizes had relatively wide confidence intervals. Only a new, high-quality and large randomized controlled trial (RCT) can decrease the current uncertainty, but this is unlikely to happen. The EtD framework did not provide arguments for further implementation or for de-implementation of the intervention. Conclusions Interventions evaluated in the Cochrane review are similar to RtW coordination and usual care interventions in Finland. Considering all EtD framework criteria, including certainty of the evidence and costs, de-implementation of RtW coordination interventions in Finland seems unnecessary. Better evidence about the costs and stakeholders’ values regarding RtW coordination is needed to improve decision-making. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00823-4.
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Affiliation(s)
- Christina Tikka
- Finnish Institute of Occupational Health, Neulaniementie 4, 70101, Kuopio, Finland.
| | - Jos Verbeek
- Department of Public and Occupational Health, Amsterdam UMC, Location AMC, University of Amsterdam, Coronel Institute of Occupational Health, Cochrane Work Review Group, Amsterdam, North Holland, The Netherlands
| | - Jan L Hoving
- Department of Public and Occupational Health, Amsterdam UMC, Location AMC, University of Amsterdam, Coronel Institute of Occupational Health, Cochrane Work Review Group, Amsterdam, North Holland, The Netherlands
| | - Regina Kunz
- Research Unit Evidence-based Insurance Medicine, Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
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Davies L, Beard D, Cook JA, Price A, Osbeck I, Toye F. The challenge of equipoise in trials with a surgical and non-surgical comparison: a qualitative synthesis using meta-ethnography. Trials 2021; 22:678. [PMID: 34620194 PMCID: PMC8495989 DOI: 10.1186/s13063-021-05403-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/26/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Randomised controlled trials in surgery can be a challenge to design and conduct, especially when including a non-surgical comparison. As few as half of initiated surgical trials reach their recruitment target, and failure to recruit is cited as the most frequent reason for premature closure of surgical RCTs. The aim of this qualitative evidence synthesis was to identify and synthesise findings from qualitative studies exploring the challenges in the design and conduct of trials directly comparing surgical and non-surgical interventions. METHODS A qualitative evidence synthesis using meta-ethnography was conducted. Six electronic bibliographic databases (Medline, Central, Cinahl, Embase and PsycInfo) were searched up to the end of February 2018. Studies that explored patients' and health care professionals' experiences regarding participating in RCTs with a surgical and non-surgical comparison were included. The GRADE-CERQual framework was used to assess confidence in review findings. RESULTS In total, 3697 abstracts and 49 full texts were screened and 26 published studies reporting experiences of patients and healthcare professionals were included. The focus of the studies (24/26) was primarily related to the challenge of recruitment. Two studies explored reasons for non-compliance to treatment allocation following randomisation. Five themes related to the challenges to these types of trials were identified: (1) radical choice between treatments; (2) patients' discomfort with randomisation: I want the best treatment for me as an individual; (3) challenge of equipoise: patients' a priori preferences for treatment; (4) challenge of equipoise: clinicians' a priori preferences for treatment and (5) imbalanced presentation of interventions. CONCLUSION The marked dichotomy between the surgical and non-surgical interventions was highlighted in this review as making recruitment to these types of trials particularly challenging. This review identified factors that increase our understanding of why patients and clinicians may find equipoise more challenging in these types of trials compared to other trial comparisons. Trialists may wish to consider exploring the balance of potential factors influencing patient and clinician preferences towards treatments before they start recruitment, to enable issues specific to a particular trial to be identified and addressed. This may enable trial teams to make more efficient considered design choices and benefit the delivery of such trials.
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Affiliation(s)
- Loretta Davies
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, OX3 7LD, UK.
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, OX3 7LD, UK
| | - Jonathan A Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, OX3 7LD, UK
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Headington, Oxford, OX3 7LD, UK
| | | | - Francine Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Yang Y, Ma Y, Lu J, Du S, Zhang J, Meng H, Chen Z, Zhang Q, Zhang X, Shi W, Girolamo F, Cepeda S, Kang J. Evaluation of the reporting quality of clinical practice guidelines on gliomas using the RIGHT checklist. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1002. [PMID: 34277802 PMCID: PMC8267264 DOI: 10.21037/atm-21-2604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/03/2021] [Indexed: 11/29/2022]
Abstract
Background The reporting quality of clinical practice guidelines (CPGs) for gliomas has not yet been thoroughly assessed. The International Reporting Items for Practice Guidelines in Healthcare (RIGHT) statement developed in 2016 provides a reporting framework to improve the quality of CPGs. We aimed to estimate the reporting quality of glioma guidelines using the RIGHT checklist and investigate how the reporting quality differs by selected characteristics. Methods We systematically searched electronic databases, guideline databases, and medical society websites to retrieve CPGs on glioma published between 2018 and 2020. We calculated the compliance of the CPGs to individual items, domains and the RIGHT checklist overall. We performed stratified analyses by publication year, country of development, reporting of funding, and impact factor (IF) of the journal. Results Our search revealed 20 eligible guidelines. Mean overall adherence to the RIGHT statement was 54.6%. Eight CPGs reported more than 60% of the items, and five reported less than 50%. All guidelines adhered to the items 1a, 3, 7a, 13a, while no guidelines reported the items 17 or 18b (see http://www.right-statement.org/right-statement/checklist for a description of the items). Two of the seven domains, “Basic information” and “Background”, had mean reporting rates above 60%. The “Review and quality assurance” domain had the lowest mean reporting rate, 12.5%. The reporting quality of guidelines published in 2020, guidelines developed in the United States, and guidelines that reported funding tended to be above average. Conclusions The reporting quality of CPGs on gliomas is low and needs improvement. Particular attention should be paid on reporting the external review and quality assurance process. The use of the RIGHT criteria should be encouraged to guide the development, reporting and evaluation of CPGs.
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Affiliation(s)
- Yongjie Yang
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
| | - Yanfang Ma
- School of Chinese Medicine of Hong Kong Baptist University, Kowloon Tong, Hong Kong, China
| | - Jingli Lu
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
| | - Shuzhang Du
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
| | - Jingmin Zhang
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
| | - Haiyang Meng
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
| | - Zhe Chen
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
| | - Qiwen Zhang
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
| | - Xiaojian Zhang
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
| | - Wenyin Shi
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Francesco Girolamo
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari School of Medicine, Bari, Italy
| | - Santiago Cepeda
- Department of Neurosurgery, University Hospital Río Hortega, Valladolid, Spain
| | - Jian Kang
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
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Meneses-Echavez JF, Rosenbaum S, Rada G, Flottorp S, Moberg J, Alonso-Coello P. Users' experiences with an interactive Evidence to Decision (iEtD) framework: a qualitative analysis. BMC Med Inform Decis Mak 2021; 21:169. [PMID: 34034723 PMCID: PMC8146986 DOI: 10.1186/s12911-021-01532-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/13/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Evidence to Decision (EtD) frameworks bring clarity, structure and transparency to health care decision making. The interactive Evidence to Decision (iEtD) tool, developed in the context of the DECIDE project and published by Epistemonikos, is a stand-alone online solution for producing and using EtD frameworks. Since its development, little is known about how organizations have been using the iEtD tool and what characterizes users' experiences with it. This missing information is necessary for any teams planning future developments of the iEtD tool. METHODS This study aimed to describe users' experiences with the iEtD and identify main barriers and facilitators related to use. We contacted all users registered in the iEtD via email and invited people who identified themselves as having used the solution to a semi-structured interview. Audio recordings were transcribed, and one researcher conducted a directed content analysis of the interviews guided by a user experience framework. Two researchers checked the content independently for accuracy. RESULTS Out of 860 people contacted, 81 people replied to our introductory email (response rate 9.4%). Twenty of these had used the tool in a real scenario and were invited to an interview. We interviewed all eight users that accepted this invitation (from six countries, four continents). 'Guideline development' was the iEtD use scenario they most commonly identified. Most participants reported an overall positive experience, without major difficulties navigating or using the different sections. They reported having used most of the EtD framework criteria. Participants reported tailoring their frameworks, for instance by adding or deleting criteria, translating to another language, or rewording headings. Several people preferred to produce a Word version rather than working online, due to the burden of completing the framework, or lack of experience with the tool. Some reported difficulties working with the exportable formats, as they needed considerable editing. CONCLUSION A very limited number of guideline developers have used the iEtD tool published by Epistemonikos since its development. Although users' general experiences are positive, our work has identified some aspects of the tool that need improvement. Our findings could be also applied to development or improvement of other solutions for producing or using EtD frameworks.
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Affiliation(s)
| | - Sarah Rosenbaum
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Gabriel Rada
- Epistemonikos Foundation, Santiago, Chile
- UC Evidence Center, Cochrane Chile Associated Center, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Signe Flottorp
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jenny Moberg
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute (IIB Sant Pau-CIBERESP), Barcelona, Spain
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Wang YY, Liang DD, Lu C, Shi YX, Zhang J, Cao Y, Fang C, Huang D, Jin YH. An exploration of how developers use qualitative evidence: content analysis and critical appraisal of guidelines. BMC Med Res Methodol 2020; 20:160. [PMID: 32552780 PMCID: PMC7302150 DOI: 10.1186/s12874-020-01041-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 06/04/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Clinical practice guidelines have become increasingly widely used to guide quality improvement of clinical practice. Qualitative research may be a useful way to improve the quality and implementation of guidelines. The methodology for qualitative evidence used in guidelines development is worthy of further research. METHODS A comprehensive search was made of WHO, NICE, SIGN, NGC, RNAO, PubMed, Embase, Web of Science, CNKI, Wanfang, CBM, and VIP from January 1, 2011 to February 25, 2020. Guidelines which met IOM criteria and were focused on clinical questions using qualitative research or qualitative evidence, were included. Four authors extracted significant information and entered this onto data extraction forms. The Appraisal of Guidelines for Research and Evaluation (AGREE II) tool was used to evaluate the guidelines' quality. The data were analyzed using SPSS version 17.0 and R version 3.3.2. RESULTS Sixty four guidelines were identified. The overall quality of the guidelines was high (almost over 60%). Domain 1 (Scope and Purpose) was ranked the highest with a median score of 83% (IQ 78-83). Domain 2 (Stakeholder involvement) and Domain 5 (Applicability) were ranked the lowest with median scores of 67% (IQ 67-78) and 67% (IQ 63-73) respectively. 20% guidelines used qualitative research to identify clinical questions. 86% guidelines used qualitative evidence to support recommendations (mainly based on primary studies, a few on qualitative evidence synthesis). 19% guidelines applied qualitative evidence when considering facilitators and barriers to recommendations' implementation. 52% guideline developers evaluated the quality of the primary qualitative research study using the CASP tool or NICE checklist for qualitative studies. No guidelines evaluated the quality of qualitative evidence synthesis to formulate recommendations. 17% guidelines presented the level of qualitative research using the grade criteria of evidence and recommendation in different forms such as I, III, IV, very low. 28% guidelines described the grades of the recommendations supported by qualitative and quantitative evidence. No guidelines described the grade of recommendations only supported by qualitative evidence. CONCLUSIONS The majority of the included guidelines were high-quality. Qualitative evidence was mainly used to identify clinical questions, support recommendations, and consider facilitators and barriers to implementation of recommendations'. However, more attention needs to be paid to the methodology. For example, no experts proficient in qualitative research were involved in guideline development groups, no assessment of the quality of qualitative evidence synthesis was included and there was lack of details reported on the level of qualitative evidence or grade of recommendations.
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Affiliation(s)
- Yun-Yun Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, The Second Clinical College, Wuhan University, Wuhan, China
- Center for Evidence-Based and Translational Medicine, Wuhan University, Wuhan, China
| | - Dan-Dan Liang
- School of Nursing and Health, Henan University, Kaifeng, China
- Department of surgery, Huaihe Hospital of Henan University, Kaifeng, China
- Center for Evidence-based Medicine, Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, China
| | - Cui Lu
- Emergency Department, Tianjin TEDA hospital, Tianjin, China
| | - Yue-Xian Shi
- School of Nursing, Peking University, Beijing, China
| | - Jing Zhang
- First Clinical College of Wuhan University, Wuhan, China
| | - Yue Cao
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, The Second Clinical College, Wuhan University, Wuhan, China
- Center for Evidence-Based and Translational Medicine, Wuhan University, Wuhan, China
| | - Cheng Fang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, The Second Clinical College, Wuhan University, Wuhan, China
- Center for Evidence-Based and Translational Medicine, Wuhan University, Wuhan, China
| | - Di Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Evidence-Based Medicine and Clinical Epidemiology, The Second Clinical College, Wuhan University, Wuhan, China
- Center for Evidence-Based and Translational Medicine, Wuhan University, Wuhan, China
| | - Ying-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
- Department of Evidence-Based Medicine and Clinical Epidemiology, The Second Clinical College, Wuhan University, Wuhan, China.
- Center for Evidence-Based and Translational Medicine, Wuhan University, Wuhan, China.
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Steels S, Van der Zande M, van Staa TP. The role of real-world data in the development of treatment guidelines: a case study on guideline developers' opinions about using observational data on antibiotic prescribing in primary care. BMC Health Serv Res 2019; 19:942. [PMID: 31805940 PMCID: PMC6896760 DOI: 10.1186/s12913-019-4787-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 11/28/2019] [Indexed: 11/30/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is a prominent threat to public health. Although many guidelines have been developed over the years to tackle this issue, their impact on health care practice varies. Guidelines are often based on evidence from clinical trials, but these have limitations, particularly in the breadth and generalisability of the evidence and evaluation of the guidelines’ uptake. The aim of this study was to investigate how national and local guidelines for managing common infections are developed and explore guideline committee members’ opinions about using real-world observational evidence in the guideline development process. Methods Six semi-structured interviews were completed with participants who had contributed to the development or adjustment of national or local guidelines on antimicrobial prescribing over the past 5 years (from the English National Institute for Health and Care Excellence (NICE)). Interviews were audio recorded and transcribed verbatim. Data was analysed thematically. This also included review of policy documents including guidelines, reports and minutes of guideline development group meetings that were available to the public. Results Three key themes emerged through our analysis: perception versus actual guideline development process, using other types of evidence in the guideline development process, and guidelines are not enough to change antibiotic prescribing behaviour. In addition, our study was able to provide some insight between the documented and actual guideline development process within NICE, as well as how local guidelines are developed, including differences in types of evidence used. Conclusions This case study indicates that there is the potential for a wider range of evidence to be included as part of the guideline development process at both the national and local levels. There was a general agreement that the inclusion of observational data would be appropriate in enhancing the guideline development process, as well providing a potential solution for monitoring guideline use in clinical practice, and improving the implementation of treatment guidelines in primary care.
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Affiliation(s)
- Stephanie Steels
- Health e-Research Centre, Farr Institute, School of Health Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | | | - Tjeerd Pieter van Staa
- Health e-Research Centre, Farr Institute, School of Health Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Oxford Road, Manchester, M13 9PL, UK.,Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
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10
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Ames HMR, Glenton C, Lewin S, Tamrat T, Akama E, Leon N. Clients' perceptions and experiences of targeted digital communication accessible via mobile devices for reproductive, maternal, newborn, child, and adolescent health: a qualitative evidence synthesis. Cochrane Database Syst Rev 2019; 10:CD013447. [PMID: 31608981 PMCID: PMC6791116 DOI: 10.1002/14651858.cd013447] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Governments and health systems are increasingly using mobile devices to communicate with patients and the public. Targeted digital client communication is when the health system transmits information to particular individuals or groups of people, based on their health or demographic status. Common types of targeted client communication are text messages that remind people to go to appointments or take their medicines. Other types include phone calls, interactive voice response, or multimedia messages that offer healthcare information, advice, monitoring, and support. OBJECTIVES To explore clients' perceptions and experiences of targeted digital communication via mobile devices on topics related to reproductive, maternal, newborn, child, or adolescent health (RMNCAH). SEARCH METHODS We searched MEDLINE (OvidSP), MEDLINE In-Process & Other Non-Indexed Citations (OvidSP), Embase (Ovid), World Health Organization Global Health Library, and POPLINE databases for eligible studies from inception to 3-6 July 2017 dependant on the database (See appendix 2). SELECTION CRITERIA We included studies that used qualitative methods for data collection and analysis; that explored clinets' perceptions and experiences of targeted digital communication via mobile device in the areas of RMNCAH; and were from any setting globally. DATA COLLECTION AND ANALYSIS We used maximum variation purposive sampling for data synthesis, employing a three-step sampling frame. We conducted a framework thematic analysis using the Supporting the Use of Research Evidence (SURE) framework as our starting point. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. We used a matrix approach to explore whether potential implementation barriers identified in our synthesis had been addressed in the trials included in the related Cochrane Reviews of effectiveness. MAIN RESULTS We included 35 studies, from a wide range of countries on six continents. Nineteen studies were conducted in low- and middle-income settings and sixteen in high-income settings. Some of the studies explored the views of people who had experienced the interventions, whereas others were hypothetical in nature, asking what people felt they would like from a digital health intervention. The studies covered a range of digital targeted client communication, for example medication or appointment reminders, prenatal health information, support for smoking cessation while pregnant, or general sexual health information.Our synthesis showed that clients' experiences of these types of programmes were mixed. Some felt that these programmes provided them with feelings of support and connectedness, as they felt that someone was taking the time to send them messages (moderate confidence in the evidence). They also described sharing the messages with their friends and family (moderate confidence).However, clients also pointed to problems when using these programmes. Some clients had poor access to cell networks and to the internet (high confidence). Others had no phone, had lost or broken their phone, could not afford airtime, or had changed their phone number (moderate confidence). Some clients, particularly women and teenagers, had their access to phones controlled by others (moderate confidence). The cost of messages could also be a problem, and many thought that messages should be free of charge (high confidence). Language issues as well as skills in reading, writing, and using mobile phones could also be a problem (moderate confidence).Clients dealing with stigmatised or personal health conditions such as HIV, family planning, or abortion care were also concerned about privacy and confidentiality (high confidence). Some clients suggested strategies to deal with these issues, such as using neutral language and tailoring the content, timing, and frequency of messages (high confidence).Clients wanted messages at a time and frequency that was convenient for them (moderate confidence). They had preferences for different delivery channels (e.g. short message service (SMS) or interactive voice response) (moderate confidence). They also had preferences about message content, including new knowledge, reminders, solutions, and suggestions about health issues (moderate confidence). Clients' views about who sent the digital health communication could influence their views of the programme (moderate confidence).For an overview of the findings and our confidence in the evidence, please see the 'Summary of qualitative findings' tables.Our matrix shows that many of the trials assessing these types of programmes did not try to address the problems we identified, although this may have been a reporting issue. AUTHORS' CONCLUSIONS Our synthesis identified several factors that can influence the successful implementation of targeted client communication programmes using mobile devices. These include barriers to use that have equity implications. Programme planners should take these factors into account when designing and implementing programmes. Future trial authors also need to actively address these factors and to report their efforts in their trial publications.
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Affiliation(s)
- Heather MR Ames
- Norwegian Institute of Public HealthPostboks 222 SkøyenOsloNorway0213
| | - Claire Glenton
- Norwegian Institute of Public HealthPostboks 222 SkøyenOsloNorway0213
| | - Simon Lewin
- Norwegian Institute of Public HealthPostboks 222 SkøyenOsloNorway0213
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070Cape TownSouth Africa7505
| | - Tigest Tamrat
- World Health OrganizationDepartment of Reproductive Health and Research20 Avenue AppiaGenevaSwitzerlandCH‐1211
| | - Eliud Akama
- University of WashingtonSeattleWashingtonUSA
| | - Natalie Leon
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070Cape TownSouth Africa7505
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Glenton C, Lewin S, Lawrie TA, Barreix M, Downe S, Finlayson KW, Tamrat T, Rosenbaum S, Tunçalp Ö. Qualitative Evidence Synthesis (QES) for Guidelines: Paper 3 - Using qualitative evidence syntheses to develop implementation considerations and inform implementation processes. Health Res Policy Syst 2019; 17:74. [PMID: 31391071 PMCID: PMC6686245 DOI: 10.1186/s12961-019-0450-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/04/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND This is the third in a series of three papers describing the use of qualitative evidence syntheses (QES) to inform the development of clinical and health systems guidelines. WHO has recognised the need to improve its guideline methodology to ensure that decision-making processes are transparent and evidence based, and that the resulting recommendations are relevant and applicable to end users. In addition to the standard data on effectiveness, WHO guidelines increasingly use evidence derived from QES to provide information on acceptability and feasibility and to develop important implementation considerations. METHODS WHO convened a group drawn from the technical teams involved in formulating 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. As members of WHO guideline technical teams, our aim in this paper is to explore how we have used findings from QES to develop implementation considerations for these guidelines. RESULTS For each guideline, in addition to using systematic reviews of effectiveness, the technical teams used QES to gather evidence of the acceptability and feasibility of interventions and, in some cases, equity issues and the value people place on different outcomes. This evidence was synthesised using standardised processes. The teams then used the QES to identify implementation considerations combined with other sources of information and input from experts. CONCLUSIONS QES were useful sources of information for implementation considerations. However, several issues for further development remain, including whether researchers should use existing health systems frameworks when developing implementation considerations; whether researchers should take confidence in the evidence into account when developing implementation considerations; whether qualitative evidence that reveals implementation challenges should lead guideline panels to make conditional recommendations or only point to implementation considerations; and whether guideline users find it helpful to have challenges pointed out to them or whether they also need solutions. Finally, we need to explore how QES findings can be incorporated into derivative products to aid implementation.
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Affiliation(s)
| | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - María Barreix
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Soo Downe
- University of Central Lancashire, Preston, United Kingdom
| | | | - Tigest Tamrat
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | | | - Özge Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Lewin S, Glenton C, Lawrie TA, Downe S, Finlayson KW, Rosenbaum S, Barreix M, Tunçalp Ö. Qualitative Evidence Synthesis (QES) for Guidelines: Paper 2 - Using qualitative evidence synthesis findings to inform evidence-to-decision frameworks and recommendations. Health Res Policy Syst 2019; 17:75. [PMID: 31391119 PMCID: PMC6686513 DOI: 10.1186/s12961-019-0468-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/06/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND WHO 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. METHODS WHO 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. RESULTS We 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. CONCLUSIONS This 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.
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Affiliation(s)
- Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | | | - Soo Downe
- University of Central Lancashire, Preston, United Kingdom
| | | | | | - María Barreix
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Özge Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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France EF, Cunningham M, Ring N, Uny I, Duncan EAS, Jepson RG, Maxwell M, Roberts RJ, Turley RL, Booth A, Britten N, Flemming K, Gallagher I, Garside R, Hannes K, Lewin S, Noblit GW, Pope C, Thomas J, Vanstone M, Higginbottom GMA, Noyes J. Improving reporting of meta-ethnography: The eMERGe reporting guidance. J Adv Nurs 2019; 75:1126-1139. [PMID: 30644123 PMCID: PMC7594209 DOI: 10.1111/jan.13809] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 06/22/2018] [Accepted: 07/03/2018] [Indexed: 01/26/2023]
Abstract
AIMS The aim of this study was to provide guidance to improve the completeness and clarity of meta-ethnography reporting. BACKGROUND Evidence-based policy and practice require robust evidence syntheses which can further understanding of people's experiences and associated social processes. Meta-ethnography is a rigorous seven-phase qualitative evidence synthesis methodology, developed by Noblit and Hare. Meta-ethnography is used widely in health research, but reporting is often poor quality and this discourages trust in and use of its findings. Meta-ethnography reporting guidance is needed to improve reporting quality. DESIGN The eMERGe study used a rigorous mixed-methods design and evidence-based methods to develop the novel reporting guidance and explanatory notes. METHODS The study, conducted from 2015 - 2017, comprised of: (1) a methodological systematic review of guidance for meta-ethnography conduct and reporting; (2) a review and audit of published meta-ethnographies to identify good practice principles; (3) international, multidisciplinary consensus-building processes to agree guidance content; (4) innovative development of the guidance and explanatory notes. FINDINGS Recommendations and good practice for all seven phases of meta-ethnography conduct and reporting were newly identified leading to 19 reporting criteria and accompanying detailed guidance. CONCLUSION The bespoke eMERGe Reporting Guidance, which incorporates new methodological developments and advances the methodology, can help researchers to report the important aspects of meta-ethnography. Use of the guidance should raise reporting quality. Better reporting could make assessments of confidence in the findings more robust and increase use of meta-ethnography outputs to improve practice, policy, and service user outcomes in health and other fields. This is the first tailored reporting guideline for meta-ethnography. This article is being simultaneously published in the following journals: Journal of Advanced Nursing, Psycho-oncology, Review of Education, and BMC Medical Research Methodology.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Kate Flemming
- Department of Health SciencesUniversity of YorkYorkUK
| | | | | | | | - Simon Lewin
- Global Health UnitNorwegian Institute of Public Health and Health Systems Research UnitOsloNorway,South African Medical Research CouncilCapetownSouth Africa
| | | | | | | | | | - Gina M. A. Higginbottom
- School of Health Sciences & Centre for Evidence Based Health CareThe University of NottinghamNottinghamUK
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France EF, Cunningham M, Ring N, Uny I, Duncan EAS, Jepson RG, Maxwell M, Roberts RJ, Turley RL, Booth A, Britten N, Flemming K, Gallagher I, Garside R, Hannes K, Lewin S, Noblit GW, Pope C, Thomas J, Vanstone M, Higginbottom GMA, Noyes J. Improving reporting of meta-ethnography: the eMERGe reporting guidance. BMC Med Res Methodol 2019; 19:25. [PMID: 30709371 PMCID: PMC6359764 DOI: 10.1186/s12874-018-0600-0] [Citation(s) in RCA: 218] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS The aim of this study was to provide guidance to improve the completeness and clarity of meta-ethnography reporting. BACKGROUND Evidence-based policy and practice require robust evidence syntheses which can further understanding of people's experiences and associated social processes. Meta-ethnography is a rigorous seven-phase qualitative evidence synthesis methodology, developed by Noblit and Hare. Meta-ethnography is used widely in health research, but reporting is often poor quality and this discourages trust in and use of its findings. Meta-ethnography reporting guidance is needed to improve reporting quality. DESIGN The eMERGe study used a rigorous mixed-methods design and evidence-based methods to develop the novel reporting guidance and explanatory notes. METHODS The study, conducted from 2015 to 2017, comprised of: (1) a methodological systematic review of guidance for meta-ethnography conduct and reporting; (2) a review and audit of published meta-ethnographies to identify good practice principles; (3) international, multidisciplinary consensus-building processes to agree guidance content; (4) innovative development of the guidance and explanatory notes. FINDINGS Recommendations and good practice for all seven phases of meta-ethnography conduct and reporting were newly identified leading to 19 reporting criteria and accompanying detailed guidance. CONCLUSION The bespoke eMERGe Reporting Guidance, which incorporates new methodological developments and advances the methodology, can help researchers to report the important aspects of meta-ethnography. Use of the guidance should raise reporting quality. Better reporting could make assessments of confidence in the findings more robust and increase use of meta-ethnography outputs to improve practice, policy, and service user outcomes in health and other fields. This is the first tailored reporting guideline for meta-ethnography. This article is being simultaneously published in the following journals: Journal of Advanced Nursing, Psycho-oncology, Review of Education, and BMC Medical Research Methodology.
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Affiliation(s)
- Emma F France
- University of Stirling, Stirling, UK.
- NMAHP Research Unit, Unit 13 Scion House, Stirling University Innovation Park, Stirling, FK9 4NF, UK.
| | - Maggie Cunningham
- University of Stirling, Stirling, UK
- NMAHP Research Unit, Unit 13 Scion House, Stirling University Innovation Park, Stirling, FK9 4NF, UK
| | | | | | - Edward A S Duncan
- University of Stirling, Stirling, UK
- NMAHP Research Unit, Unit 13 Scion House, Stirling University Innovation Park, Stirling, FK9 4NF, UK
| | | | - Margaret Maxwell
- University of Stirling, Stirling, UK
- NMAHP Research Unit, Unit 13 Scion House, Stirling University Innovation Park, Stirling, FK9 4NF, UK
| | - Rachel J Roberts
- University of Stirling, Stirling, UK
- NMAHP Research Unit, Unit 13 Scion House, Stirling University Innovation Park, Stirling, FK9 4NF, UK
| | | | | | | | - Kate Flemming
- Department of Health Sciences, University of York, York, UK
| | | | | | | | - Simon Lewin
- Global Health Unit Norwegian Institute of Public Health and Health Systems Research Unit, Oslo, Norway
- South African Medical Research Council, Capetown, South Africa
| | - George W Noblit
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | | | | | - Gina M A Higginbottom
- School of Health Sciences & Centre for Evidence Based Health Care, The University of Nottingham, Nottingham, UK
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France EF, Cunningham M, Ring N, Uny I, Duncan EA, Jepson RG, Maxwell M, Roberts RJ, Turley RL, Booth A, Britten N, Flemming K, Gallagher I, Garside R, Hannes K, Lewin S, Noblit GW, Pope C, Thomas J, Vanstone M, Higginbottom GMA, Noyes J. Improving reporting of meta-ethnography: The eMERGe reporting guidance. Psychooncology 2019; 28:447-458. [DOI: 10.1002/pon.4915] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 06/22/2018] [Accepted: 07/03/2018] [Indexed: 01/22/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Kate Flemming
- Department of Health Sciences; University of York; York UK
| | | | | | | | - Simon Lewin
- Global Health Unit Norwegian Institute of Public Health and Health Systems Research Unit; Oslo Norway
- South African Medical Research Council; Capetown South Africa
| | - George W. Noblit
- University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | | | | | | | - Gina M. A. Higginbottom
- School of Health Sciences & Centre for Evidence Based Health Care; The University of Nottingham; Nottingham UK
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Community and Drug Distributor Perceptions and Experiences of Mass Drug Administration for the Elimination of Lymphatic Filariasis: A Rapid Review of Qualitative Research. ADVANCES IN PARASITOLOGY 2018; 103:117-149. [PMID: 30878056 DOI: 10.1016/bs.apar.2018.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
STUDY OBJECTIVES This article presents findings from a rapid review of qualitative research conducted to inform decision makers about community and drug distributor perceptions and experiences of mass drug administration campaigns for the elimination of lymphatic filariasis. We focused on questions related to acceptability of the mass drug administration campaigns within these groups and their thoughts around the feasibility of planning and carrying out the campaigns. METHODS We carried out a systematic search in five databases to identify potential studies. We included studies that focused on community members and drug distributors and used qualitative methods for data collection and analysis. We conducted a thematic framework analysis using the Supporting the Use of Research Evidence framework. Due to time constraints, one author conducted the screening, extraction and data analysis. FINDINGS Studies found that communities lack knowledge and information about lymphatic filariasis and the mass drug administration campaigns and that this can have an impact on how many community members choose to take medication. Health workers often had a good understanding that lymphatic filariasis was a problem in their setting, of its cause and mode of transmission and that hydrocele and elephantiasis had the same cause. However, this knowledge was not as prevalent amongst community drug distributors who often had misconceptions surrounding the topic. Furthermore, studies found that the length, timing, level of community and health system involvement, access to care for side effects, inadequate numbers of drug distributors and supervisors and motivation of drug distributors influenced participation in mass drug administration campaigns. Finally, the inadequate training of drug distributors could influence community trust in the mass drug administration program and the drug distributor themselves if there was a perception that the person was uninformed or not trained to carry out their tasks.
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Lewin S, Glenton C. Are we entering a new era for qualitative research? Using qualitative evidence to support guidance and guideline development by the World Health Organization. Int J Equity Health 2018; 17:126. [PMID: 30244675 PMCID: PMC6151925 DOI: 10.1186/s12939-018-0841-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/10/2018] [Indexed: 11/10/2022] Open
Abstract
Qualitative approaches are one of several methodologies utilised within the social sciences. New developments within qualitative methods are widening the opportunities for using qualitative evidence to inform health policy and systems decisions. In this commentary, we discuss how, in our work with the World Health Organization (WHO), we have explored ways of broadening the types of evidence used to develop evidence-informed guidance for health systems.Health systems decisions are commonly informed by evidence on the effectiveness of health system interventions. However, decision makers and other stakeholders also typically have additional questions, including how different stakeholders value different outcomes, the acceptability and feasibility of different interventions and the impacts of these interventions on equity and human rights. Evidence from qualitative research can help address these questions, and a number of WHO guidelines are now using qualitative evidence in this way. This growing use of qualitative evidence to inform decision making has been facilitated by recent methodological developments, including robust methods for qualitative evidence syntheses and approaches for assessing how much confidence to place in findings from such syntheses. For research evidence to contribute optimally to improving and sustaining the performance of health systems, it needs to be transferred easily between different elements of what has been termed the 'evidence ecosystem'. This ecosystem includes primary and secondary evidence producers, guidance developers and those implementing and evaluating interventions to strengthen health systems. We argue that most of the elements of an ecosystem for qualitative evidence are now in place - an important milestone that suggests that we are entering a new era for qualitative research. However, a number of challenges and constraints remain. These include how to build stronger links between the communities involved in the different parts of the qualitative evidence ecosystem and the need to strengthen capacity, particularly in low and middle income countries, to produce and utilise qualitative evidence and decision products informed by such evidence. We invite others who want to support the wider use of qualitative evidence in decision processes to look for opportunities in their settings to put this into practice.
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Affiliation(s)
- Simon Lewin
- Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213 Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Cochrane EPOC Group, Norwegian Institute of Public Health, Oslo, Norway
| | - Claire Glenton
- Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213 Oslo, Norway
- Cochrane Norway, Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213 Oslo, Norway
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Gopinathan U, Hoffman SJ. Institutionalising an evidence-informed approach to guideline development: progress and challenges at the World Health Organization. BMJ Glob Health 2018; 3:e000716. [PMID: 30233832 PMCID: PMC6135442 DOI: 10.1136/bmjgh-2018-000716] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 11/05/2022] Open
Abstract
This study explored experiences, perceptions and views among World Health Organization (WHO) staff about the changes, progress and challenges brought by the guideline development reforms initiated in 2007. Thirty-five semistructured interviews were conducted with senior WHO staff. Sixteen of the interviewees had in-depth experience with WHO's formal guideline development process. Thematic analysis was conducted to identify key themes in the qualitative data, and these were interpreted in the context of the existing literature on WHO's guideline development processes. First, the reforms were seen to have transformed and improved the quality of WHO's guidelines. Second, independent evaluation and feedback by the Guidelines Review Committee (GRC) was described to have strengthened the legitimacy of WHO's recommendations. Third, WHO guideline development processes are not yet designed to systematically make use of all types of research evidence needed to inform decisions about health systems and public health interventions. For example, several interviewees expressed dissatisfaction with the insufficient attention paid to qualitative evidence and evidence from programme experience, and how the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process evaluates the quality of evidence from non-randomised study designs, while others believed that GRADE was just not properly understood or applied. Fourth, some staff advocated for a more centralised quality assurance process covering all outputs from WHO's departments and scientific advisory committees, especially to eliminate strategic efforts aimed at bypassing the GRC's requirements. Overall, the 'culture change' senior WHO staff called for over 10 years ago appears to have gradually spread throughout the organisation. However, at least two major challenges remain: (1) ensuring that all issued advice benefits from independent evaluation, monitoring and feedback for quality and (2) designing guideline development processes to better acquire, assess, adapt and apply the full range of evidence that can inform recommendations on health systems and public health interventions.
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Affiliation(s)
- Unni Gopinathan
- Department of Global Health, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Oslo Group on Global Health Policy, Department of Community Medicine and Global Health and Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, Ontario, Canada
| | - Steven J Hoffman
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, and McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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Moberg J, Oxman AD, Rosenbaum S, Schünemann HJ, Guyatt G, Flottorp S, Glenton C, Lewin S, Morelli A, Rada G, Alonso-Coello P. The GRADE Evidence to Decision (EtD) framework for health system and public health decisions. Health Res Policy Syst 2018; 16:45. [PMID: 29843743 PMCID: PMC5975536 DOI: 10.1186/s12961-018-0320-2] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 04/26/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To describe a framework for people making and using evidence-informed health system and public health recommendations and decisions. BACKGROUND We developed the GRADE Evidence to Decision (EtD) framework for health system and public health decisions as part of the DECIDE project, in which we simultaneously developed frameworks for these and other types of healthcare decisions, including clinical recommendations, coverage decisions and decisions about diagnostic tests. DEVELOPING THE FRAMEWORK Building on GRADE EtD tables, we used an iterative approach, including brainstorming, consultation of the literature and with stakeholders, and an international survey of policy-makers. We applied the framework to diverse examples, conducted workshops and user testing with health system and public health guideline developers and policy-makers, and observed and tested its use in real-life guideline panels. FINDINGS All the GRADE EtD frameworks share the same basic structure, including sections for formulating the question, making an assessment and drawing conclusions. Criteria listed in the assessment section of the health system and public health framework cover the important factors for making these types of decisions; in addition to the effects and economic impact of an option, the priority of the problem, the impact of the option on equity, and its acceptability and feasibility are important considerations that can inform both whether and how to implement an option. Because health system and public health interventions are often complex, detailed implementation considerations should be made when making a decision. The certainty of the evidence is often low or very low, but decision-makers must still act. Monitoring and evaluation are therefore often important considerations for these types of decisions. We illustrate the different components of the EtD framework for health system and public health decisions by presenting their application in a framework adapted from a real-life guideline. DISCUSSION This framework provides a structured and transparent approach to support policy-making informed by the best available research evidence, while making the basis for decisions accessible to those whom they will affect. The health system and public health EtD framework can also be used to facilitate dissemination of recommendations and enable decision-makers to adopt, and adapt, recommendations or decisions.
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Affiliation(s)
- Jenny Moberg
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway
| | - Andrew D. Oxman
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway
| | - Sarah Rosenbaum
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway
| | | | - Gordon Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Signe Flottorp
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway
| | - Claire Glenton
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway
| | - Simon Lewin
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Angela Morelli
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway
| | - Gabriel Rada
- Evidence-Based Health Care Program, Pontificia Universidad Católica de Chile, Santiago, Chile
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Lewin S, Bohren M, Rashidian A, Munthe-Kaas H, Glenton C, Colvin CJ, Garside R, Noyes J, Booth A, Tunçalp Ö, Wainwright M, Flottorp S, Tucker JD, Carlsen B. Applying GRADE-CERQual to qualitative evidence synthesis findings-paper 2: how to make an overall CERQual assessment of confidence and create a Summary of Qualitative Findings table. Implement Sci 2018; 13:10. [PMID: 29384082 PMCID: PMC5791047 DOI: 10.1186/s13012-017-0689-2] [Citation(s) in RCA: 256] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative research) approach has been developed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group. The approach has been developed to support the use of findings from qualitative evidence syntheses in decision making, including guideline development and policy formulation. CERQual includes four components for assessing how much confidence to place in findings from reviews of qualitative research (also referred to as qualitative evidence syntheses): (1) methodological limitations, (2) coherence, (3) adequacy of data and (4) relevance. This paper is part of a series providing guidance on how to apply CERQual and focuses on making an overall assessment of confidence in a review finding and creating a CERQual Evidence Profile and a CERQual Summary of Qualitative Findings table. METHODS We developed this guidance by examining the methods used by other GRADE approaches, gathering feedback from relevant research communities and developing consensus through project group meetings. We then piloted the guidance on several qualitative evidence syntheses before agreeing on the approach. RESULTS Confidence in the evidence is an assessment of the extent to which a review finding is a reasonable representation of the phenomenon of interest. Creating a summary of each review finding and deciding whether or not CERQual should be used are important steps prior to assessing confidence. Confidence should be assessed for each review finding individually, based on the judgements made for each of the four CERQual components. Four levels are used to describe the overall assessment of confidence: high, moderate, low or very low. The overall CERQual assessment for each review finding should be explained in a CERQual Evidence Profile and Summary of Qualitative Findings table. CONCLUSIONS Structuring and summarising review findings, assessing confidence in those findings using CERQual and creating a CERQual Evidence Profile and Summary of Qualitative Findings table should be essential components of undertaking qualitative evidence syntheses. This paper describes the end point of a CERQual assessment and should be read in conjunction with the other papers in the series that provide information on assessing individual CERQual components.
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Affiliation(s)
- Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Meghan Bohren
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Information, Evidence and Research Department, Eastern Mediterranean Regional Office, World Health Organization, Cairo, Egypt
| | | | | | - Christopher J. Colvin
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Ruth Garside
- European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK
| | - Jane Noyes
- School of Social Sciences, Bangor University, Bangor, UK
| | - Andrew Booth
- School of Health & Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Megan Wainwright
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Joseph D. Tucker
- University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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Toews I, Booth A, Berg RC, Lewin S, Glenton C, Munthe-Kaas HM, Noyes J, Schroter S, Meerpohl JJ. Further exploration of dissemination bias in qualitative research required to facilitate assessment within qualitative evidence syntheses. J Clin Epidemiol 2017; 88:133-139. [PMID: 28433676 DOI: 10.1016/j.jclinepi.2017.04.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 02/06/2017] [Accepted: 04/12/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To conceptualise and discuss dissemination bias in qualitative research. RESULTS It is likely that the mechanisms leading to dissemination bias in quantitative research, including time lag, language, gray literature, and truncation bias also contribute to dissemination bias in qualitative research. These conceptual considerations have informed the development of a research agenda. CONCLUSION Further exploration of dissemination bias in qualitative research is needed, including the extent of non-dissemination and related dissemination bias, and how to assess dissemination bias within qualitative evidence syntheses. We also need to consider the mechanisms through which dissemination bias in qualitative research could occur to explore approaches for reducing it.
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Affiliation(s)
- Ingrid Toews
- Cochrane Germany, Medical Center, Faculty of Medicine, University of Freiburg, Breisacher Str. 153, 79110 Freiburg, Germany
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Rigmor C Berg
- Norwegian Institute of Public Health, Pilestredet Park 7, N-0176 Oslo, Norway
| | - Simon Lewin
- Norwegian Institute of Public Health, Pilestredet Park 7, N-0176 Oslo, Norway; Health Systems Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg 7505, South Africa
| | - Claire Glenton
- Norwegian Institute of Public Health, Pilestredet Park 7, N-0176 Oslo, Norway
| | | | - Jane Noyes
- School of Social Sciences, Bangor University, Bangor, Gwynedd ll57 2DG, UK
| | | | - Joerg J Meerpohl
- Cochrane Germany, Medical Center, Faculty of Medicine, University of Freiburg, Breisacher Str. 153, 79110 Freiburg, Germany; Cochrane France, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité - U1153, Inserm/Université Paris Descartes, Hôpital Hôtel-Dieu, 1 place du Parvis Notre Dame, 75181 Paris Cedex 04, France.
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Guise A, Seguin M, Mburu G, McLean S, Grenfell P, Islam Z, Filippovych S, Assan H, Low A, Vickerman P, Rhodes T. Integrated opioid substitution therapy and HIV care: a qualitative systematic review and synthesis of client and provider experiences. AIDS Care 2017; 29:1119-1128. [PMID: 28281354 DOI: 10.1080/09540121.2017.1300634] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
People who use drugs in many contexts have limited access to opioid substitution therapy and HIV care. Service integration is one strategy identified to support increased access. We reviewed and synthesized literature exploring client and provider experiences of integrated opioid substitution therapy and HIV care to identify acceptable approaches to care delivery. We systematically reviewed qualitative literature. We searched nine bibliographic databases, supplemented by manual searches of reference lists of articles from the database search, relevant journals, conferences, key organizations and consultation with experts. Thematic synthesis was used to develop descriptive themes in client and provider experiences. The search yielded 11 articles for inclusion, along with 8 expert and policy reports. We identify five descriptive themes: the convenience and comprehensive nature of co-located care, contrasting care philosophies and their role in shaping integration, the limits to disclosure and communication between clients and providers, opioid substitution therapy enabling HIV care access and engagement, and health system challenges to delivering integrated services. The discussion explores how integrated opioid substitution therapy and HIV care needs to adapt to specific social conditions, rather than following universal approaches. We identify priorities for future research. Acceptable integrated opioid substitution therapy and HIV care for people who use drugs and providers is most likely through co-located care and relies upon attention to stigma, supportive relationships and client centred cultures of delivery. Further research is needed to understand experiences of integrated care, particularly delivery in low and middle income settings and models of care focused on community and non-clinic based delivery.
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Affiliation(s)
- Andy Guise
- a Department of Global Public Health , University of California San Diego , San Diego , USA.,b Department of Public Health and Policy , London School of Hygiene and Tropical Medicine , London , UK
| | - Maureen Seguin
- c Centre for Research on Drugs and Health Behaviour , London School of Hygiene and Tropical Medicine , London , UK
| | - Gitau Mburu
- d Program Impact Unit , International HIV/AIDS Alliance , Brighton , UK.,e Department of Health Research , University of Lancaster , Lancaster , UK
| | - Susie McLean
- d Program Impact Unit , International HIV/AIDS Alliance , Brighton , UK
| | - Pippa Grenfell
- c Centre for Research on Drugs and Health Behaviour , London School of Hygiene and Tropical Medicine , London , UK
| | - Zahed Islam
- f Management Sciences for Health , Dhaka , Bangladesh
| | - Sergii Filippovych
- g Treatment, Procurement and Supply Management Department , International HIV/AIDS Alliance Ukraine , Kyiv , Ukraine
| | - Happy Assan
- h Tanzanian Network of People who Use Drugs , MDM Drop in centre , Dar es Salaam , Tanzania
| | - Andrea Low
- i International Center for AIDS Care and Treatment Programs , Columbia University , New York , USA
| | - Peter Vickerman
- j School of Social and Community Medicine , University of Bristol , Bristol , UK
| | - Tim Rhodes
- c Centre for Research on Drugs and Health Behaviour , London School of Hygiene and Tropical Medicine , London , UK
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