Assessing how much confidence to place in findings from qualitative evidence syntheses: a new version of the CERQual tool

Tags: Oral
Munthe-Kaas H1, Glenton C2, Lewin S3, Carlsen B4, Colvin C5, Noyes J6, Rashidian A7, Booth A8, Garside R9, - TCWG10
1Norwegian Knowledge Centre for the Health Services, Norway, 2Norwegian branch, Nordic Cochrane Centre, Norwegian Knowledge Centre for the Health Services, Norway, 3Global Health Unit, NOKC and Health Systems Research Unit, Medical Research Council of South Africa, Norway, 4Uni Rokkansenteret, Norway, 5School of Public Health and Family Medicine, University of Cape Town, South Africa, 6School of Healthcare Sciences, Bangor University, United Kingdom, 7National Institute of Health Research , Iran, 8School of Health and Related Research, University of Sheffield, United Kingdom, 9European Cetnre for Environment and Human Health, University of Exeter Medical School, United Kingdom, 10Various, International


Qualitative evidence syntheses are increasingly used to bring together findings from qualitative studies. However, it is difficult to use these findings to inform decisions because the methods to assess how much confidence to place in these synthesis findings are poorly developed.


To describe a new version of a tool for assessing how much confidence to place in the evidence from qualitative research reviews.


The Confidence of the Evidence from Reviews of Qualitative research (CERQual) tool was developed through the review of existing tools; working group discussions; and piloting of the tool on several qualitative evidence syntheses.


CERQual bases the assessments of confidence on four components: (1) the methodological quality of the individual studies contributing to a review finding, was assessed by using a quality-assessment tool for qualitative studies (2) the coherence of each review finding, assessed by looking at the extent to which the finding is based on data that is similar across multiple individual studies and/or incorporates (plausible) explanations for any variations across individual studies (3) the relevance of a review finding, assessed by determining to what extent the evidence supporting a review finding is applicable to the context specified in the review question (4) the sufficiency of data supporting a review finding, assessed by an overall determination of the degree of richness and/or scope of the evidence and quantity of data supporting a review finding. After assessing each component, an overall judgement of the confidence in each review finding is made. The confidence can be judged as high, moderate, low, or very low. This assessment should be described and justified in a transparent manner, preferably in a summary of qualitative findings table that includes narrative statements.


CERQual provides a transparent method for assessing the confidence of evidence from reviews of qualitative research. Like the GRADE approach, it may facilitate the use of these findings alongside reviews of effects and in guideline development processes.