Applying GRADE-CERQual to interpretive review findings: Reflections from a Cochrane meta-ethnography on childhood vaccination acceptance

Article type
Authors
Cooper S1, Leon N2, Schmidt B3, Swartz A4, Wiysonge C5, Colvin C6, Engel M
1South African Medical Research Council, Cape Town, Western Cape, South Africa; School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
2South African Medical Research Council, Cape Town, Western Cape, South Africa; Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
3University of the Western Cape, Cape Town, Western Cape, South Africa
4School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa; Institute of Medical and Biomedical Education, St George’s University of London, London, London, UK
5Vaccine Preventable Diseases Programme, World Health Organization Regional Office for Africa, Brazzaville, Congo
6School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa; Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
Abstract
"Background: GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) was developed to support the use of review findings from qualitative evidence syntheses (QES) within policy-and decision-making. To date, the approach has mainly been applied to aggregative synthesis methodologies and descriptive review findings. Current GRADE-CERQual guidance suggests there is a need for testing with more diverse review methods and outputs, to provide important insights for the evolution of the approach.

Objectives: This presentation aims to contribute to this evolution by reflecting on our experiences of applying GRADE-CERQual to the findings that emerged from a Cochrane meta-ethnography on childhood vaccination acceptance. Specifically, we describe both the similarities as well as the differences, challenges and dilemmas we experienced when applying the approach to the more interpretive versus more descriptive findings that emerged from our review.

Results: We found that we were able to apply the core criteria and principles of GRADE-CERQual in ways that were congruent with the methodologies and epistemologies of a meta-ethnographic approach and associated interpretive findings. We also found that the practical application processes were similar for the more descriptive versus interpretive findings. The main differences we experienced related to the level of demand placed on the evidence supporting the review finding and the level of complexity involved with the decisions. Compared to the more descriptive findings, the more interpretive findings required supporting data that was richer, thicker, more contextually situated and methodologically stronger for us to have the same level of confidence in them. Making the assessments for the more interpretive findings also involved greater dilemmas and more complicated forms of judgement, particularly for the component of coherence. We provide practical examples to illustrate these complexities and how we approached them.

Conclusions: Our experiences of applying GRADE-CERQual to more interpretive review findings generated various challenges and quandaries which we highlight, and hope will offer a platform for further engagement. This could enhance the usability of GRADE-CERQual and in turn the kinds of knowledge that count within health decision-making, with ultimate positive effect on patients and other evidence users.
There was no involvement of the public and/or consumers"