Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 2: how to make an overall CERQual assessment of confidence and create a Summary of Qualitative Findings table

Abstract

BackgroundThe GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative research) approach has been developed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group. The approach has been developed to support the use of findings from qualitative evidence syntheses in decision making, including guideline development and policy formulation.CERQual includes four components for assessing how much confidence to place in findings from reviews of qualitative research (also referred to as qualitative evidence syntheses): (1) methodological limitations, (2) coherence, (3) adequacy of data and (4) relevance. This paper is part of a series providing guidance on how to apply CERQual and focuses on making an overall assessment of confidence in a review finding and creating a CERQual Evidence Profile and a CERQual Summary of Qualitative Findings table.MethodsWe developed this guidance by examining the methods used by other GRADE approaches, gathering feedback from relevant research communities and developing consensus through project group meetings. We then piloted the guidance on several qualitative evidence syntheses before agreeing on the approach.ResultsConfidence in the evidence is an assessment of the extent to which a review finding is a reasonable representation of the phenomenon of interest. Creating a summary of each review finding and deciding whether or not CERQual should be used are important steps prior to assessing confidence. Confidence should be assessed for each review finding individually, based on the judgements made for each of the four CERQual components. Four levels are used to describe the overall assessment of confidence: high, moderate, low or very low. The overall CERQual assessment for each review finding should be explained in a CERQual Evidence Profile and Summary of Qualitative Findings table.ConclusionsStructuring and summarising review findings, assessing confidence in those findings using CERQual and creating a CERQual Evidence Profile and Summary of Qualitative Findings table should be essential components of undertaking qualitative evidence syntheses. This paper describes the end point of a CERQual assessment and should be read in conjunction with the other papers in the series that provide information on assessing individual CERQual components.Electronic supplementary materialThe online version of this article (10.1186/s13012-017-0689-2) contains supplementary material, which is available to authorized users.

Perceptions and experiences of labour companionship: a qualitative evidence synthesis

“…We used the CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in the review findings (Colvin 2018; Glenton 2018; Lewin 2018a; Lewin 2018b; Munthe‐Kaas 2018; Noyes 2018). This approach, building on the GRADE approach (Schünemann 2017), and the Cochrane tool for assessing risk of bias (Higgins 2017), for Cochrane systematic reviews of interventions, is becoming the standard to assess confidence in the findings from qualitative evidence syntheses (Ames 2017; Bohren 2015a; Colvin 2013; Lewin 2015; Munabi‐Babigumira 2017; Odendaal 2015).…”

Clinical research nurses’ expectations and realities of their role: A qualitative evidence synthesis

“…It is argued that even if a study is assessed to be of low quality, it may still provide new insights (Noyes, Popay, Pearson, Hannes, & Booth, 2008). Moreover, our appraisal of each study was included as one of four components in assessing our confidence in the findings from the review (Lewin, Bohren, et al, 2018b a,b) (Table 4).…”

“…Following this, OH and MD grouped related codes into logical descriptive themes. In An assessment of confidence in the review findings was undertaken by OH and MD using GRADE-CERQual (Confidence in Evidence of Reviews of Qualitative Research) (Lewin, Bohren, et al, 2018b;Lewin, Booth, et al, 2018a) (Table 4). A CERQual assessment allows the researcher to judge confidence in each of the review findings and also in the findings overall guided by four elements; methodological limitations, coherence, adequacy of data and relevance (Lewin, Bohren, et al, 2018b;Lewin, Booth, et al, 2018a).…”

Informing the measurement of wellbeing among young people living with HIV in sub-Saharan Africa for policy evaluations: a mixed-methods systematic review

“…Finally, we interpreted the themes across studies to develop a line-of-argument synthesis describing how all themes interacted to shape wellbeing. We evaluated the quality of the qualitative evidence synthesis using the GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative research) approach [88]. This approach includes an assessment of the methodological limitations, coherence, relevance, and adequacy.…”