A series of papers highlighting innovative work carried out by the Cochrane Effective Practice and Organisation of Care Group and the World Health Organization on using reviews of qualitative research in guideline development processes has been published in Health Research Policy and Systems.
Cochrane is a non-governmental organization in official relations with WHO. The Cochrane Effective Practice and Organisation of Care (EPOC) Group, as well as other Cochrane contributors, has a long-standing relationship with WHO and works closely with them on guideline development. This fruitful collaboration had led to several innovations, such as the inclusion of qualitative evidence syntheses in WHO guideline processes and the development of GRADE-CERQual, an approach to assess the confidence of evidence from reviews of qualitative research.
EPOC produced Cochrane’s first qualitative evidence synthesis review, Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health, in 2013. This review was used in a WHO guideline on health worker task shifting, providing the panel with important information about the acceptability and feasibility of lay health worker programmes and complementing another review that focused on the effectiveness of these programmes.
Since then, WHO and Cochrane EPOC have continued to collaborate. Several WHO guidelines now include evidence from Cochrane qualitative evidence syntheses, and Cochrane EPOC is working closely with WHO to improve methods for this approach.
Now, a series of papers detailing this work has been published in Health Research Policy and Systems. The articles were commissioned by WHO in response to requests for direction on how to use qualitative evidence syntheses in guidelines and were authored by a team from WHO, Cochrane staff at the Norwegian Public Health Institute and the University of Central Lancashire.
Evidence-based guidelines, such as those produced by WHO, have traditionally focused on quantitative evidence from reviews of effectiveness. However, guideline panels also discuss issues such as the cost, acceptability and feasibility of an intervention and its potential implications for equity – though this has often been done in an unsystematic way. Reviews of qualitative research can help look at these more systematically.
The three new articles, each led by a different Cochrane EPOC editor, highlight different ways that using qualitative evidence synthesis can benefit guideline development.
“The papers discuss how qualitative evidence syntheses can be a powerful means of improving the relevance of guidelines, how they can help to integrate the views and experiences of all types of stakeholders – including groups who may not be otherwise represented in the decision-making process – and how they are also a useful source of information for implementation,” explains Claire Glenton, a Cochrane EPOC editor who led one of the papers. “They also highlight a number of issues for further development.”
The series showcases several Cochrane qualitative evidence syntheses and offers practical advice to others who want to include this type of evidence in guidelines, providing examples of what was done well, and the lessons learnt. The authors also highlight knowledge gaps for further research and practice.
Soo Downe, another EPOC editor who led one of the papers, emphasises the value of qualitative evidence synthesis for guidelines: “Health care is only useful if it meets the needs, values and beliefs of those it is designed for, and of those who have to use it. Qualitative insights are critical for ensuring that care is not only effective clinically, but useful practically.”
“This is a crucial safety issue as well as an issue of high quality, respectful, acceptable and affordable care. For the first time, this series provides guidance on how this essential but previously overlooked component of health care quality can be realised.”
This collaboration between EPOC and WHO has been a useful opportunity to explore how Cochrane reviews and qualitative evidence syntheses can be made as relevant as possible for this key target audience. WHO plans to continue to incorporate qualitative evidence syntheses into their guidelines and will keep working with Cochrane about how best to do this.
Later this year, several of the authors involved in this project are also organizing the QESymposium in Brazil. Simon Lewin, another Cochrane EPOC editor who led a paper in this series, is part of the Scientific Programme Advisory Committee and notes: “The symposium will explore the use of qualitative research in decision making processes tied to the Sustainable Development Goals, and we expect many of the issues raised in these papers to be discussed there.”
Access the papers
- Using qualitative evidence synthesis to inform guideline scope and develop qualitative findings statements (led by Soo Downe)
- Using qualitative evidence synthesis findings to inform evidence-to-decision frameworks and recommendations (led by Simon Lewin)
- Using qualitative evidence syntheses to develop implementation considerations and inform implementation processes (led by Claire Glenton)