Article type
Abstract
Background: Acceptability, feasibility, and equity considerations are essential for health care decision-making. In guideline development, they often rely on findings from Qualitative Evidence Syntheses (QESs). Where recent, well-conducted QESs are unavailable, a new QES or evidence from multiple sources may need to be used. Assessing, combining, and contextualizing such evidence in a rigorous, timely manner can be challenging. We highlight how we approached this challenge in the Global Evidence - Local Adaptation (GELA) Project, a project aimed at enhancing the formulation of evidence-informed guideline recommendations for newborn and child health in Malawi, South Africa, and Nigeria.
Methods: We built on the GRADE evidence-to-decision (EtD) framework and ADOLOPMENT approach, GRADE CERQual, and emerging rapid QES methodology.
Results: GELA prioritized country-specific guideline questions through evidence scoping and stakeholder engagement. Scoping of existing guidelines and QESs for each question revealed 3 scenarios. First, global guidelines provided evidence from a recent, well-conducted QES that needed adapting to the local context. Second, relevant QESs were identified but needed updating or complementing. Third, no relevant QESs were available and a new QES was needed.
We developed a decision-tree to search, assess, supplement, and combine qualitative evidence in a timely manner (Figure 1). When a QES was available, we assessed its methodological rigor. We held meetings with national stakeholders to identify factors influencing global findings’ transferability and the need for new or additional evidence. Where new evidence was required, we conducted rapid QESs focused on acceptability, feasibility, and equity considerations. We consistently (re)applied GRADE-CERQual to assess our confidence in findings at the target country level. When combining findings from different sources, we considered the QESs’ quality and individual findings’ transferability, relevance, and confidence. We presented this evidence in the EtD framework’s acceptability, feasibility, and equity components for the guideline panel’s further use.
Conclusion: Building on existing methodological tools, we developed a rigorous and timely process for populating EtD frameworks with high-quality, contextually relevant qualitative evidence to inform guideline panel decisions. This replicable process holds the potential to better include the perspectives of patients, health professionals, and other evidence users in EtD-based clinical, health systems, and public health guidelines, ultimately enhancing their voice in health decision-making.
Methods: We built on the GRADE evidence-to-decision (EtD) framework and ADOLOPMENT approach, GRADE CERQual, and emerging rapid QES methodology.
Results: GELA prioritized country-specific guideline questions through evidence scoping and stakeholder engagement. Scoping of existing guidelines and QESs for each question revealed 3 scenarios. First, global guidelines provided evidence from a recent, well-conducted QES that needed adapting to the local context. Second, relevant QESs were identified but needed updating or complementing. Third, no relevant QESs were available and a new QES was needed.
We developed a decision-tree to search, assess, supplement, and combine qualitative evidence in a timely manner (Figure 1). When a QES was available, we assessed its methodological rigor. We held meetings with national stakeholders to identify factors influencing global findings’ transferability and the need for new or additional evidence. Where new evidence was required, we conducted rapid QESs focused on acceptability, feasibility, and equity considerations. We consistently (re)applied GRADE-CERQual to assess our confidence in findings at the target country level. When combining findings from different sources, we considered the QESs’ quality and individual findings’ transferability, relevance, and confidence. We presented this evidence in the EtD framework’s acceptability, feasibility, and equity components for the guideline panel’s further use.
Conclusion: Building on existing methodological tools, we developed a rigorous and timely process for populating EtD frameworks with high-quality, contextually relevant qualitative evidence to inform guideline panel decisions. This replicable process holds the potential to better include the perspectives of patients, health professionals, and other evidence users in EtD-based clinical, health systems, and public health guidelines, ultimately enhancing their voice in health decision-making.