Article type
Year
Abstract
Background:
Health guidance development is a key normative function of the World Health Organization (WHO). Within the WHO system, while guidance is primarily developed by headquarters or regional offices, it could be developed and shared for adaptation/adoption at many levels (global, regional and country office). Priorities too could be generated at different levels.
Objectives:
In this study, we identify the elements of a framework that would assist decision-makers in prioritizing topics where guidance is needed and in adopting/adapting guidance to their own context; paying particular attention to differences by level of decision-making (global/regional/national/sub-national) and type of health guidance (clinical/public health/health system).
Methods:
We conduct a critical interpretive synthesis (CIS) by using formal literature searches and an inductive process to interpret meaning from the evidence reviewed. We connected with key content experts for input at multiple stages throughout the CIS process. We conformed to the PRISMA guidelines and registered this study in PROSPERO. We searched 13 academic and grey literature databases. We conducted title and abstract screening and full-text screening using pre-defined criteria and extracted included studies using a pre-defined data-extraction form. We coded included studies in NVIVO v12 to support thematic analysis and inform a best-fit framework.
Results:
We identified 2,763 unique records in our search, and forty-two studies and grey literature documents were included for extraction, coding, and thematic analysis. Included documents addressed adaptation (51%), adoption (42%), contextualization (33%), prioritization (28%), and implementation (60%) of health guidance. The themes included: 1) transparency in guideline prioritization and recommendation development is important for adoption, adaptation and implementation; 2) WHO headquarters should generate guidance that is more implementable; 3) contextualization of health guidance from global to local should be a continuous process to facilitate implementation 4) GRADE ADOLOPMENT and the tool in GRADEpro could support contextualization/implementation of guidance; and 5) alternate pathways exist for health guideline contextualization/implementation. We present a framework for conceptualizing different types of guidance across different levels in the formal WHO system, including the use of methodologies such as formal prioritization tools and GRADE adolopment to facilitate movement of guidance and eventual implementation.
Discussion:
This CIS presents a conceptual framework for health guidance prioritization and adoption/adaptation in the WHO system. We identify that the GRADE adolopment methodology could serve to support the framework we present. This framework has relevance to the WHO system to support effective collaboration on health guidance prioritization and adoption/adaptation.
Consumer Involvement: we worked with guideline and WHO
Health guidance development is a key normative function of the World Health Organization (WHO). Within the WHO system, while guidance is primarily developed by headquarters or regional offices, it could be developed and shared for adaptation/adoption at many levels (global, regional and country office). Priorities too could be generated at different levels.
Objectives:
In this study, we identify the elements of a framework that would assist decision-makers in prioritizing topics where guidance is needed and in adopting/adapting guidance to their own context; paying particular attention to differences by level of decision-making (global/regional/national/sub-national) and type of health guidance (clinical/public health/health system).
Methods:
We conduct a critical interpretive synthesis (CIS) by using formal literature searches and an inductive process to interpret meaning from the evidence reviewed. We connected with key content experts for input at multiple stages throughout the CIS process. We conformed to the PRISMA guidelines and registered this study in PROSPERO. We searched 13 academic and grey literature databases. We conducted title and abstract screening and full-text screening using pre-defined criteria and extracted included studies using a pre-defined data-extraction form. We coded included studies in NVIVO v12 to support thematic analysis and inform a best-fit framework.
Results:
We identified 2,763 unique records in our search, and forty-two studies and grey literature documents were included for extraction, coding, and thematic analysis. Included documents addressed adaptation (51%), adoption (42%), contextualization (33%), prioritization (28%), and implementation (60%) of health guidance. The themes included: 1) transparency in guideline prioritization and recommendation development is important for adoption, adaptation and implementation; 2) WHO headquarters should generate guidance that is more implementable; 3) contextualization of health guidance from global to local should be a continuous process to facilitate implementation 4) GRADE ADOLOPMENT and the tool in GRADEpro could support contextualization/implementation of guidance; and 5) alternate pathways exist for health guideline contextualization/implementation. We present a framework for conceptualizing different types of guidance across different levels in the formal WHO system, including the use of methodologies such as formal prioritization tools and GRADE adolopment to facilitate movement of guidance and eventual implementation.
Discussion:
This CIS presents a conceptual framework for health guidance prioritization and adoption/adaptation in the WHO system. We identify that the GRADE adolopment methodology could serve to support the framework we present. This framework has relevance to the WHO system to support effective collaboration on health guidance prioritization and adoption/adaptation.
Consumer Involvement: we worked with guideline and WHO