Using Qualitative Evidence in Decision Making for Health and Social Interventions: An Approach to Assess Confidence in Findings from Qualitative Evidence Syntheses (GRADE-CERQual)

Lewin, Simon; Glenton, Claire; Munthe‐Kaas, Heather Menzies; Carlsen, Benedicte; Colvin, Christopher J.; Gülmezoglu, Metin; Noyes, Jane; Booth, Andrew; Garside, Ruth; Rashidian, Arash

doi:10.1371/journal.pmed.1001895

Cited by 617 publications

(679 citation statements)

References 36 publications

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“…(See protocol example Box 5). Selection of studies may be based on relevance alongside consideration of quality [79]. Relevance refers to the potential of qualitative studies to inform a Cochrane intervention review.…”

Section: Methodsmentioning

confidence: 99%

“…The context in which healthcare is delivered extends to "a variety of settings, communities, and cultures that are all influenced by economic, social, political, fiscal, historical, and psychosocial factors" [34,79]. A recent concept analysis has sought to untangle the complexity that surrounds the term [35].…”

Section: Developing An Understanding Of Contextmentioning

confidence: 99%

“…However, as mentioned above, definitions of what constitutes "relevant context" are both contested and review-specific and should be informed by the subsequent claims to be made by any individual review [35,38,79].…”

Section: Searching To Explore the Evidence Basementioning

confidence: 99%

“…The Confidence in the Evidence from Reviews of Qualitative research approach (CERQual) [79], which seeks to offer a transparent assessment process analogous to the use of GRADE [80] for effectiveness reviews, is now being used in Cochrane qualitative protocols to appraise review findings [41] [77].…”

Section: Assessment Of Confidence In the Evidence From Reviews Of Quamentioning

confidence: 99%

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Cochrane Qualitative and Implementation Methods Group guidance series—paper 2: methods for question formulation, searching, and protocol development for qualitative evidence synthesis

Harris

Booth

Cargo

et al. 2018

Journal of Clinical Epidemiology

Self Cite

129

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This paper updates previous Cochrane guidance on question formulation,searching and protocol development, reflecting recent developments in methods for conducting qualitative evidence syntheses to inform Cochrane intervention reviews. Examples are used to illustrate how decisions about boundaries for a review are formed via an iterative process of constructing lines of inquiry, and mapping the information available to ascertain whether evidence exists to answer questions related to effectiveness, implementation, feasibility, appropriateness, economic evidence, and equity. The process of question formulation allows reviewers to situate the topic in relation to how it informs and explains effectiveness, using the criterion of meaningfulness, appropriateness, feasibility and implementation. Questions related to complex questions and interventions can be structured by drawing on an increasingly wide range of question frameworks. Logic models and theoretical frameworks are useful tools for conceptually mapping the literature to illustrate the complexity of the phenomenon of interest. Further, protocol development may require iterative question formulation and searching. Consequently, the final protocol may function as a guide rather than a prescriptive route-map, particularly in qualitative reviews that ask more exploratory and open ended questions.Keywords: Systematic reviews, question formulation, Cochrane Collaboration, methods, qualitative evidence synthesis. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Word count: 4014 words excluding tables and references Key findings:Tools and methods are recommended to assist reviewers in developing protocols, which accommodate alternative approaches to question formulation and searching and protocol development for qualitative evidence synthesis. What this adds to what was known?Questions within qualitative and implementation systematic review protocols may be indicative, allowing more detailed questions to be formulated when more information is needed on specific aspects of the review. A broader range of question formats is presented, to reflect the need for reviews that explore and generate theory. What is the implication and what should change now?This guidance provides examples of protocols for qualitative evidence synthesis that are flexible, to allow the incorporation of open-ended and exploratory review questions and iterative searching methods. 'recontextualise' effectiveness. Recontextualising requires considering effectiveness research in relation to issues in society [4] to enable a decision-maker to make an informed decision about whether an intervention is likely to be useful and whether that intervention is applicable to their local population. Qualitative research produces contingent and experiential knowledge on why interventions work the way that they do (or fail to work) [5]. Further, implementation questions provide information on how the implementation process produces...

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Section: Methodsmentioning

confidence: 99%

Section: Developing An Understanding Of Contextmentioning

confidence: 99%

Section: Searching To Explore the Evidence Basementioning

confidence: 99%

Section: Assessment Of Confidence In the Evidence From Reviews Of Quamentioning

confidence: 99%

See 2 more Smart Citations

Cochrane Qualitative and Implementation Methods Group guidance series—paper 2: methods for question formulation, searching, and protocol development for qualitative evidence synthesis

Harris

Booth

Cargo

et al. 2018

Journal of Clinical Epidemiology

Self Cite

129

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“…[29][30][31] The CCA method allowed the researcher maintain an emic perspective for analysis. The categories were tested using this conceptual and theoretical framework.…”

Section: Rigor and Quality Of The Studymentioning

confidence: 99%

Smoking cessation assisted by primary healthcare professionals

Codern-Bové

2016

JNEP

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Background: The effectiveness of smoking cessation treatments has been well studied, but most smokers quit without assistance from a health professional. To further improve our understanding of how primary healthcare efforts can benefit patients who attempt to quit, we need a deeper understanding of how the process unfolds when assisted by a primary healthcare professional and how this is experienced by the smoker. Objective: To construct an emergent model of the smoking cessation process assisted by a primary healthcare professional. Methods: Data were collected from video recordings of primary healthcare professionals in office sessions to promote smoke cessation in Barcelona Province (Catalonia, Spain). Thirteen smokers and their primary healthcare professionals engaged in 24 preparatory sessions and 23 follow-up sessions. Data were analysed according to Constant Comparative Analysis Method along with conceptual and theoretical frameworks. Results: Smoking cessation is a social process that is shaped by interactions and relationships with primary healthcare professionals. Four categories explain the process: 1) Feeling addicted and wanting help to quit smoking; 2) Preparing to quit smoking: anticipating abstinence; 3) Managing smoking abstinence: a positive or transitional process; and 4) Controlling the urge to smoke: a central process in smoking cessation. Conclusions: Primary healthcare professionals treat smoking behaviours as a health problem and supervise the process of enabling the smoker to learn how to control the urge to smoke. Learning to control smoking abstinence is not always enough to enable the individual to reorganize and restructure daily life without cigarettes. Primary healthcare professionals should be encouraged to incorporate not only logic and scientific evidence but also the subjectivity of the patient's attitude into efforts to better respond to the changing, complex nature of the smoking cessation process.

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Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: a qualitative evidence synthesis

Karimi‐Shahanjarini

Shakibazadeh

Rashidian

et al. 2019

Cochrane Database of Systematic Reviews

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This review aims to explore factors affecting the implementation of initiatives to substitute doctors with nurses in primary care. The review has following specific objectives: • To identify, quality appraise and synthesise qualitative evidence on barriers and facilitators to the implementation of interventions to substitute doctors with nurses in primary care. • To integrate the findings of this review of qualitative evidence with those of the relevant Cochrane review of effects, so as to enhance and extend understanding of how these complex interventions work and how context impacts on implementation. • To identify hypotheses for subgroup analyses of future updates of the Cochrane systematic review of the effectiveness of substituting doctors with nurses. 1 Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: qualitative evidence synthesis (Protocol)

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Using Qualitative Evidence in Decision Making for Health and Social Interventions: An Approach to Assess Confidence in Findings from Qualitative Evidence Syntheses (GRADE-CERQual)

Abstract: Simon Lewin and colleagues present a methodology for increasing transparency and confidence in qualitative research synthesis.

Cited by 617 publications

References 36 publications

Cochrane Qualitative and Implementation Methods Group guidance series—paper 2: methods for question formulation, searching, and protocol development for qualitative evidence synthesis

Cochrane Qualitative and Implementation Methods Group guidance series—paper 2: methods for question formulation, searching, and protocol development for qualitative evidence synthesis

Smoking cessation assisted by primary healthcare professionals

Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: a qualitative evidence synthesis

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