Article type
Abstract
Background
The Global Evidence, Local Adaptation (GELA) project aims to develop evidence-informed guideline recommendations for newborn and young child health in Malawi, Nigeria, and South Africa, underpinned by the GRADE-ADOLOPMENT approach. Applying a state-of-the-art Evidence-to-Decision (EtD) framework-based approach to adapting and contextualizing guidelines created unique challenges and experiences given the resource-constrained and diverse national decision-making systems and settings.
Objective
We provide a critical reflection on key issues, solutions, and lessons experienced when applying the GRADE-ADOLOPMENT methodology in low- and middle-income country (LMIC) settings, from the perspective of the lead research partners implementing the evidence synthesis and recommendation development work packages.
Methods
To customize, guide and operationalize GELA’s approach to guideline adaptation for each country’s guideline questions, we applied a prototype GELA adolopment algorithm. This was developed by tailoring and further unpacking the GRADE-ADOLOPMENT approach through iterative discussions among GELA working groups, partner meetings, and project presentations. We critically reflected on our application of guideline adaptation processes during the project across guideline questions and teams using an experiential learning cycle and to inform further improvements.
Results
Key experiential guideline adaption issues encompassed (1) the maturity of and relationships between the national researcher (supply) and decision-maker (demand) systems and (2) evidence synthesis decision-making complexities regarding source guidelines, partially addressed guideline questions, and scoping and synthesizing qualitative and economic evidence. Concrete lessons and solutions from these LMICs include the need for evidence advocacy and evidence champions, using "best bet" guideline repositories and tiered approaches to scoping and adapting qualitative and economic evidence. Additionally, dedicated contextual expertise and buy-in by all stakeholders, advanced evidence synthesis and guideline methods, and leadership topics within and across country teams are essential requirements.
Conclusion
GRADE-ADOLOPMENT is an EtD framework–based approach that required flexibility when implemented in emergent evidence-into-policy settings by guideline teams and decision-makers new to the approach. We identified key issues, solutions, and lessons when applying this approach in resource-constrained and different evidence supply-and-demand systems in South Africa, Malawi, and Nigeria. Cross-country evidence-support collaborations and capacity development of guideline synthesis teams are pivotal to strengthening and institutionalizing a domestic evidence culture and capacity for effective and efficient evidence into policy processes.
The Global Evidence, Local Adaptation (GELA) project aims to develop evidence-informed guideline recommendations for newborn and young child health in Malawi, Nigeria, and South Africa, underpinned by the GRADE-ADOLOPMENT approach. Applying a state-of-the-art Evidence-to-Decision (EtD) framework-based approach to adapting and contextualizing guidelines created unique challenges and experiences given the resource-constrained and diverse national decision-making systems and settings.
Objective
We provide a critical reflection on key issues, solutions, and lessons experienced when applying the GRADE-ADOLOPMENT methodology in low- and middle-income country (LMIC) settings, from the perspective of the lead research partners implementing the evidence synthesis and recommendation development work packages.
Methods
To customize, guide and operationalize GELA’s approach to guideline adaptation for each country’s guideline questions, we applied a prototype GELA adolopment algorithm. This was developed by tailoring and further unpacking the GRADE-ADOLOPMENT approach through iterative discussions among GELA working groups, partner meetings, and project presentations. We critically reflected on our application of guideline adaptation processes during the project across guideline questions and teams using an experiential learning cycle and to inform further improvements.
Results
Key experiential guideline adaption issues encompassed (1) the maturity of and relationships between the national researcher (supply) and decision-maker (demand) systems and (2) evidence synthesis decision-making complexities regarding source guidelines, partially addressed guideline questions, and scoping and synthesizing qualitative and economic evidence. Concrete lessons and solutions from these LMICs include the need for evidence advocacy and evidence champions, using "best bet" guideline repositories and tiered approaches to scoping and adapting qualitative and economic evidence. Additionally, dedicated contextual expertise and buy-in by all stakeholders, advanced evidence synthesis and guideline methods, and leadership topics within and across country teams are essential requirements.
Conclusion
GRADE-ADOLOPMENT is an EtD framework–based approach that required flexibility when implemented in emergent evidence-into-policy settings by guideline teams and decision-makers new to the approach. We identified key issues, solutions, and lessons when applying this approach in resource-constrained and different evidence supply-and-demand systems in South Africa, Malawi, and Nigeria. Cross-country evidence-support collaborations and capacity development of guideline synthesis teams are pivotal to strengthening and institutionalizing a domestic evidence culture and capacity for effective and efficient evidence into policy processes.