Institutionalising an evidence-informed approach to guideline development: progress and challenges at the World Health Organization

Abstract

This study explored experiences, perceptions and views among World Health Organization (WHO) staff about the changes, progress and challenges brought by the guideline development reforms initiated in 2007. Thirty-five semistructured interviews were conducted with senior WHO staff. Sixteen of the interviewees had in-depth experience with WHO’s formal guideline development process. Thematic analysis was conducted to identify key themes in the qualitative data, and these were interpreted in the context of the existing literature on WHO’s guideline development processes. First, the reforms were seen to have transformed and improved the quality of WHO’s guidelines. Second, independent evaluation and feedback by the Guidelines Review Committee (GRC) was described to have strengthened the legitimacy of WHO’s recommendations. Third, WHO guideline development processes are not yet designed to systematically make use of all types of research evidence needed to inform decisions about health systems and public health interventions. For example, several interviewees expressed dissatisfaction with the insufficient attention paid to qualitative evidence and evidence from programme experience, and how the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process evaluates the quality of evidence from non-randomised study designs, while others believed that GRADE was just not properly understood or applied. Fourth, some staff advocated for a more centralised quality assurance process covering all outputs from WHO’s departments and scientific advisory committees, especially to eliminate strategic efforts aimed at bypassing the GRC’s requirements. Overall, the ‘culture change’ senior WHO staff called for over 10 years ago appears to have gradually spread throughout the organisation. However, at least two major challenges remain: (1) ensuring that all issued advice benefits from independent evaluation, monitoring and feedback for quality and (2) designing guideline development processes to better acquire, assess, adapt and apply the full range of evidence that can inform recommendations on health systems and public health interventions.

Bridging the Gap between Theory, Practice, and Policy: A Decision-Making Process Based on Public Health Evidence Feasible in Multi-Stage Research on Biological Risk Factors in Poland

“…The present analysis, divided into status diagnoses (Stages 1 and 2) and decision-making processes (Stage 3) was an attempt to systemize information about the extent of the risks associated with BBI and the essential stages of analysis for the preparation of further stages (i.e., proposed solutions). This is consistent with a methodological “mixed research approach” represented by other researchers in public health and healthcare policy [ 38 , 39 , 40 , 41 , 42 ]. Through its use of qualitative inquiry, the current study aimed to understand the extent to which the identified problems and opinions are common among the group of participating experts.…”

Prioritization approaches in the development of health practice guidelines: a systematic review

“…The development of high-quality guidelines is a rigorous and complex process that requires an average of two to three years per guideline [1]. Due to the rapid accumulation of new evidence, guideline development should be followed by revisions and update as necessary [2].…”

Bridging the Gap between Theory, Practice, and Policy: A Decision-making Process Based on Public Health Evidence Feasible in Multistage Research on Biology Risk Factors in Poland

“…The present analysis, divided into status diagnosis (stages 1 and 2) and decision-making processes (stage3), was an attempt to systemize information about the extent of the risks associated with BBI and the essential stages of analysis for the preparation of further stages (i.e., proposed solutions). This is consistent with a methodological "mixed research approach" represented by other researchers in the field of public health and healthcare policy [36][37][38][39][40]. Rather than employing quantitative methods to measure a phenomenon, the current study aimed to understand the extent to which the identified problems and opinions are common among the group of participating experts.…”