Article
The WHO-INTEGRATE EtD Framework: How can WHO criteria for going from evidence to recommendations be modified to better reflect complex multidisciplinary interventions?
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Authors
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Jan Stratil
- Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, LMU Munich; Pettenkofer School of Public Health, LMU Munich; Cochrane Public Health Europe
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Rob Baltussen
- Radboud University medical center, Nijmegen, Netherlands
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Inger Scheel
- Global Health Unit/Knowledge Centre for the Health Services, Norwegian Institute of Public Health, Oslo, Norway
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Jan Stratil
- Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie, LMU Munich; Pettenkofer School of Public Health, LMU Munich; Cochrane Public Health Europe
| Published: | March 6, 2018 |
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Outline
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Background: Guidelines of the World Health Organization (WHO) provide recommendations to support policy makers and programme managers in making informed decisions about clinical practice or public health issues. The factors determining direction and strength of a recommendation are laid out in an evidence to decision (EtD) framework and include quality of evidence, balance of benefits & harms, equity & human rights etc. Shortcomings in the current framework include a potentially limited applicability to complex interventions, unclear and potentially missing criteria, and the lack of an explicit theoretical foundation.
Objectives: This research project aims to systematically review existing EtD frameworks for health as well as decision criteria towards the development of a stronger conceptual framework to underpin the WHO decision criteria.
Methods: Alternative EtD frameworks for health were identified through a systematic forward and backward citation search. The frameworks were assessed against practical (e.g. ease of use, non-redundancy) and legitimacy (e.g. reflection of WHO norms and values, rigour of the development process) considerations. Decision criteria were identified through a systematic search for reviews reporting on such criteria. Screening and assessment were conducted independently by 2 analysts. WHO’s normative principles were extracted from key WHO documents as well as ethics, human rights and sustainability frameworks endorsed by WHO.
Results: We identified 2201 publications on EtD frameworks and included 13 in the assessment. After assessment of 2401 publications, 32 reviews on decision criteria were included and extracted. The best-evaluated framework, DECIDE, was compared against and adapted for WHO purposes according to the normative principles and the identified sets of criteria.
Conclusions: Future steps include key-informant interviews with developers of WHO guidelines, focus group discussions with health decision makers on four continents, and an exploration of how to best populate the criteria with evidence. The final result will be an EtD framework adapted to complex interventions and founded in WHO norms and values.
