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

Boon, Michele Hilton, Thomson, Hilary, Shaw, Beth, Akl, Elie A., Lhachimi, Stefan K., López-Alcalde, Jesús, Klugar, Miloslav, Choi, Leslie, Saz-Parkinson, Zuleika, Mustafa, Reem A., Langendam, Miranda W., Crane, Olivia, Morgan, Rebecca L., Rehfuess, Eva, Johnston, Bradley C., Chong, Lee Yee, Guyatt, Gordon H., Schünemann, Holger J. and Katikireddi, Srinivasa Vittal (2021) 'Challenges in applying the GRADE approach in public health guidelines and systematic reviews: A concept paper from the GRADE Public Health Group'. Journal of Clinical Epidemiology, Vol 135, pp. 42-53.

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This paper explores the need for conceptual advances and practical guidance in the application of the GRADE approach within public health contexts.

Study Design and Setting
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 paper through thematic analysis and an iterative process of consultation and discussion conducted with members electronically and at three GRADE Working Group meetings.

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 prioritising health and ‘non-health’ outcomes; (3) interpreting outcomes and identifying a threshold for decision-making; (4) assessing certainty of evidence from diverse sources, including non-randomised 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.

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.

Item Type: Article
Subjects: WA Public Health > WA 100 General works
WA Public Health > Statistics. Surveys > WA 950 Theory or methods of medical statistics. Epidemiologic methods
Faculty: Department: Biological Sciences > Vector Biology Department
Digital Object Identifer (DOI):
Depositing User: Stacy Murtagh
Date Deposited: 10 Feb 2021 16:07
Last Modified: 04 Jun 2021 09:48


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