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

BOON, M. H., H. THOMSON, B. SHAW, E. A. AKL, S. K. LHACHIMI, J. LOPEZ-ALCALDE, Miloslav KLUGAR, L. CHOI, Z. SAZ-PARKINSON, R. A. MUSTAFA, M. W. LANGENDAM, O. CRANE, R. L. MORGAN, E. REHFUESS, B. C. JOHNSTON, L. Y. CHONG, G. H. GUYATT, H. J. SCHUNEMANN and S. V. KATIKIREDDI. Challenges in applying the GRADE approach in public health guidelines and systematic reviews: a concept article from the GRADE Public Health Group. Journal of Clinical Epidemiology. NEW YORK: ELSEVIER SCIENCE INC, 2021, vol. 135, July 2021, p. 42-53. ISSN 0895-4356. Available from: https://dx.doi.org/10.1016/j.jclinepi.2021.01.001.

Basic information

• Original name: Challenges in applying the GRADE approach in public health guidelines and systematic reviews: a concept article from the GRADE Public Health Group
• Authors: BOON, M. H. (guarantor), H. THOMSON, B. SHAW, E. A. AKL, S. K. LHACHIMI, J. LOPEZ-ALCALDE, Miloslav KLUGAR (203 Czech Republic, belonging to the institution), L. CHOI, Z. SAZ-PARKINSON, R. A. MUSTAFA, M. W. LANGENDAM, O. CRANE, R. L. MORGAN, E. REHFUESS, B. C. JOHNSTON, L. Y. CHONG, G. H. GUYATT, H. J. SCHUNEMANN and S. V. KATIKIREDDI.
• Edition: Journal of Clinical Epidemiology, NEW YORK, ELSEVIER SCIENCE INC, 2021, 0895-4356.

Other information

• Original language: English
• Type of outcome: Article in a journal
• Field of Study: 30304 Public and environmental health
• Country of publisher: United States of America
• Confidentiality degree: is not subject to a state or trade secret
• WWW: URL
• Impact factor: Impact factor: 7.407
• RIV identification code: RIV/00216224:14110/21:00122119
• Organization unit: Faculty of Medicine
• Doi: http://dx.doi.org/10.1016/j.jclinepi.2021.01.001
• UT WoS: 000678570200006
• Keywords in English: GRADE; Public health; Guidelines; Nonrandomized studies; Health policy; Social determinants
• Tags: 14119612, 14119613, rivok
• Tags: International impact, Reviewed

Abstract

Background and Objective: This article explores the need for conceptual advances and practical guidance in the application of the GRADE approach within public health contexts. Methods: We convened an expert workshop and conducted a scoping review to identify challenges experienced by GRADE users in public health contexts. We developed this concept article through thematic analysis and an iterative process of consultation and discussion conducted with members electronically and at three GRADE Working Group meetings. Results: Five priority issues can pose challenges for public health guideline developers and systematic reviewers when applying GRADE: (1) incorporating the perspectives of diverse stakeholders; (2) selecting and prioritizing health and "nonhealth" outcomes; (3) interpreting outcomes and identifying a threshold for decision-making; (4) assessing certainty of evidence from diverse sources, including nonrandomized studies; and (5) addressing implications for decision makers, including concerns about conditional recommendations. We illustrate these challenges with examples from public health guidelines and systematic reviews, identifying gaps where conceptual advances may facilitate the consistent application or further development of the methodology and provide solutions. Conclusion: The GRADE Public Health Group will respond to these challenges with solutions that are coherent with existing guidance and can be consistently implemented across public health decision-making contexts. (C) 2021 The Author(s). Published by Elsevier Inc.