Screen Shot 2019-09-01 at 18.40.44.pngCITATION: Qualitative Evidence Synthesis (QES) forGuidelines: Paper 2–Using qualitativeevidence synthesis findings to informevidence-to-decision frameworks andrecommendations. Simon Lewin, Claire Glenton, Theresa A. Lawrie, Soo Downe, Kenneth W. Finlayson, Sarah Rosenbaum, María Barreix and Özge Tunçal


Background: WHO has recognised the need to improve its guideline methodology to ensure that guideline decision-making processes are transparent and evidence based, and that the resulting recommendations are relevant andapplicable. To help achieve this, WHO guidelines now typically enhance intervention effectiveness data with evidenceon a wider range of decision-making criteria, including how stakeholders value different outcomes, equity, gender andhuman rights impacts, and the acceptability and feasibility of interventions. Qualitative evidence syntheses (QES) are increasingly used to provide evidence on this wider range of issues. In this paper, we describe and discuss how to usethe findings from QES to populate decision-making criteria in evidence-to-decision (EtD) frameworks. This is the second in a series of three papers that examines the use of QES in developing clinical and health system guidelines.

Methods: WHO convened a writing group drawn from thetechnical teams involved in its recent (2010–2018) guidelines employing QES. Using a pragmatic and iterative approach thatincluded feedback from WHO staff and other stakeholders, the group reflected on, discussed and identified key methods and research implications from designing QES and usingthe resulting findings in guideline development.

Results: We describe a step-wise approach to populating EtD frameworks with QES findings. This involves allocatingfindings to the different EtD criteria (how stakeholders value different outcomes, equity, acceptability and feasibility,etc.), weaving the findings into a short narrative relevant to each criterion, and inserting this summary narrative intothe corresponding ‘research evidence’ sections of the EtD. We also identify areas for further methodological research, including how best to summarise and present qualitative data to groups developing guidelines, how these groupsdraw on different types of evidence in their decisions, and the extent to which our experiences are relevant to decision-making processes in fields other than health.

Conclusions: This paper shows the value of incorporating QES within a guideline development process, and the roles that qualitative evidence can play in integrating the views and experiences of relevant stakeholders, including groups who may not be otherwise represented in the decision-making process.

Best wishes, Neil

Coordinator, HIFA Project on Evidence-Informed Policy and Practice