Article type
Year
Abstract
Background: Childhood obesity is a main public health challenge. Children who are overweight or obese are at greater risk of poor health in adolescence and also in adulthood. Thus, the regional government of Lower Austria wanted to implement an evidence-based decision process involving stakeholders and experts whether or not to implement a life-style intervention program for obese children/adolescents.
Objectives: To describe the challenges of implementing an evidence-based decision process using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and DECIDE (Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence) frameworks at a regional level involving local stakeholders without prior knowledge of evidence-based or other research methods.
Methods: We used GRADE and DECIDE to appraise and communicate the quality of evidence and the strength of recommendations. To assess the relative importance of the desirable and undesirable outcomes we conducted two focus groups (one with overweight children/adolescents and one with parents of these). Scientific experts and relevant stakeholders selected and prioritized outcomes. We carried out an umbrella review to critically appraise, synthesise and grade the current evidence and guided a shared evidence-based recommendation making process with all stakeholders.
Results: Using GRADE for a complex public health question at a regional level was challenging: we had to convey to experts and stakeholders that prioritizing outcomes is necessary for decision making and we had to disentangle the large number of prioritized outcomes and map them to potentially quantifiable outcomes. Last but not least, the heterogeneity of outcome measures reported in the literature required the adaptation of the GRADE system to rating the quality of evidence.
Conclusions: Although using the GRADE and DECIDE frameworks at a regional level involving stakeholders without research training was challenging, it provided a structured and well received method to reach a conclusion about implementation of a life-style intervention program for obese children/adolescents.
Objectives: To describe the challenges of implementing an evidence-based decision process using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and DECIDE (Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence) frameworks at a regional level involving local stakeholders without prior knowledge of evidence-based or other research methods.
Methods: We used GRADE and DECIDE to appraise and communicate the quality of evidence and the strength of recommendations. To assess the relative importance of the desirable and undesirable outcomes we conducted two focus groups (one with overweight children/adolescents and one with parents of these). Scientific experts and relevant stakeholders selected and prioritized outcomes. We carried out an umbrella review to critically appraise, synthesise and grade the current evidence and guided a shared evidence-based recommendation making process with all stakeholders.
Results: Using GRADE for a complex public health question at a regional level was challenging: we had to convey to experts and stakeholders that prioritizing outcomes is necessary for decision making and we had to disentangle the large number of prioritized outcomes and map them to potentially quantifiable outcomes. Last but not least, the heterogeneity of outcome measures reported in the literature required the adaptation of the GRADE system to rating the quality of evidence.
Conclusions: Although using the GRADE and DECIDE frameworks at a regional level involving stakeholders without research training was challenging, it provided a structured and well received method to reach a conclusion about implementation of a life-style intervention program for obese children/adolescents.