Challenges in applying the GRADE approach in public health guidelines and systematic reviews: a concept article from the GRADE Public Health Group

Abstract

HJS is co-chair of the GRADE Working Group but has no direct financial conflict of interest. BCJ: As part of his recruitment to Texas A&M University, BCJ receives funds from Texas A&M AgriLife Research to support investigator-initiated research related to saturated and polyunsaturated fats. Support from Texas A&M AgriLife institutional funds are from interest and investment earnings, not a sponsoring organization, industry, or company. MK declares the following affiliation with the following organizations that could be perceived as a direct or indirect conflict of interest: Director of

Addressing Challenges When Applying GRADE to Public Health Guidelines: A Scoping Review Protocol and Pilot Analysis

“…The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews [ 7 , 8 ] and will be informed mostly by the previous work of the GRADE Public Health group [ 5 ]. The Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews (PRISMA-ScR [ 9 ]) will be used, bearing in mind the recently updated PRISMA 2020 [ 10 ] with changes relevant to scoping reviews described in the chapter on scoping reviews in the JBI manual on evidence synthesis [ 7 ].…”

“…Challenges include: incorporating diverse perspectives in guideline panels, selecting and prioritizing outcomes (especially non-health outcomes), interpreting outcomes and identifying a threshold for decision-making, assessing the certainty of evidence from diverse sources, and addressing implications for decision-makers (e.g., concerns about conditional recommendations, or strong ones based on very low certainty of the evidence) [ 5 ].…”

“…The GRADE Public Health Group (the Group) was approved by the GRADE Guidance Group in October 2017 to improve the methodology of applying GRADE in the development of public health guidelines [ 5 ]. The Group conducted a scoping review investigating the experiences of applying GRADE in public health and existing research activity in this area [ 5 ].…”

“…The GRADE Public Health Group (the Group) was approved by the GRADE Guidance Group in October 2017 to improve the methodology of applying GRADE in the development of public health guidelines [ 5 ]. The Group conducted a scoping review investigating the experiences of applying GRADE in public health and existing research activity in this area [ 5 ]. The result was an overview of current scientific knowledge in the field and the challenges identified in the literature and by experts, which include difficulties incorporating diverse perspectives in guideline panels, selecting outcomes (especially non-health outcomes), interpreting outcomes and identifying a threshold for decision-making, assessing the certainty of evidence from diverse sources, and addressing implications for decision-makers (e.g., concerns about conditional recommendations, or strong ones based on very low certainty of evidence) [ 5 ].…”

“…The Group proposed the following solutions to answer the identified challenges: to identify the training needs of public health guideline developers (and their stakeholders) in understanding and using the GRADE concept; to develop and disseminate detailed examples of the application of GRADE to public health topics; to adapt GRADE training materials for public health and public policy audiences [ 5 ]. This paper mainly addresses the second proposed solution and aims to provide both concrete examples of how GRADE is currently being used in public health guidelines and a discussion on which parts of the current GRADE guidance need to be adapted to public health topics.…”