Improving the adaptability of WHO evidence-informed guidelines for nutrition actions: results of a mixed methods evaluation

Abstract

BackgroundOver the past decade, the World Health Organization (WHO) has implemented a standardized, evidence-informed guideline development process to assure technically sound and policy-relevant guidelines. This study is an independent evaluation of the adaptability of the guidelines produced by the Evidence and Programme Guidance unit, at the Department of Nutrition for Health and Development (NHD). The study systematizes the lessons learned by the NHD group at WHO.MethodsWe used a mixed methods approach to determine the adaptability of the nutrition guidelines. Adaptability was defined as having two components; methodological quality and implementability of guidelines. Additionally, we gathered recommendations to improve future guideline development in nutrition actions for health and development. Data sources for this evaluation were official documentation and feedback (both qualitative and quantitative) from key stakeholders involved in the development of nutrition guidelines. The qualitative data was collected through a desk review and two waves of semi-structured interviews (n = 12) and was analyzed through axial coding. Guideline adaptability was assessed quantitatively using two standardized instruments completed by key stakeholders. The Appraisal Guideline for Research and Evaluation questionnaire, version II was used to assess guideline quality (n = 6), while implementability was assessed with the electronic version of the GuideLine Implementability Appraisal (n = 7).ResultsThe nutrition evidence-informed guideline development process has several strengths, among them are the appropriate management of conflicts of interest of guideline developers and the systematic use of high-quality evidence to inform the recommendations. These features contribute to increase the methodological quality of the guidelines. The key areas for improvement are the limited implementability of the recommendations, the lack of explicit and precise implementation advice in the guidelines and challenges related to collaborative work within interdisciplinary groups.ConclusionsOverall, our study found that the nutrition evidence-informed guidelines are of good methodological quality but that the implementability requires improvement. The recommendations to improve guideline adaptability address the guideline content, the dynamics shaping interdisciplinary work, and actions for implementation feasibility. As WHO relies heavily on a standardized procedure to develop guidelines, the lessons learned may be applicable to guideline development across the organization and to other groups developing guidelines.

The advantages and limitations of guideline adaptation frameworks

“…The refinement of the current adaptation frameworks and the process of guideline adaptation would be an important step forward in changing health behaviour (of clinicians and general population alike) and the grand quest of improving global health. The idea of increasing the adaptability of guidelines has been a recent focus of WHO [ 35 ]. The effect of integrating adaptation methods such as optimized adaptation frameworks into the implementation sections of source recommendation documents (e.g., WHO guidelines) would be an important area to explore in future studies.…”

Comparison of Challenges and Problems Encountered in the Practice of Exclusive Breast Feeding by Primiparous and Multiparous Women in Rural Areas of Sindh, Pakistan: A Cross-Sectional Study

“…The UNICEF (United Nations International Children Education Fund) and WHO (World Health Organization) recommend exclusive breastfeeding (EBF) for the first six months of life [1]. EBF is defined as feeding infants only breast milk and no other drink or food, not even water, for the first six months of life.…”

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

“…However, this view does not account for potential crowding out effects of UCTs, i.e., unintended negative effects of UCT provision on other types of financial assistance during disasters. [15]. They suggested that difficulties encountered in their evaluation may reflect limitations of GRADE guidance, specifically citing NRS, time requirements, and wording or strength of recommendations as issues.…”