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

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 int...

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Autores principales: Gopinathan, Unni, Hoffman, Steven J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135442/
https://www.ncbi.nlm.nih.gov/pubmed/30233832
http://dx.doi.org/10.1136/bmjgh-2018-000716
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author Gopinathan, Unni
Hoffman, Steven J
author_facet Gopinathan, Unni
Hoffman, Steven J
author_sort Gopinathan, Unni
collection PubMed
description 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.
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spelling pubmed-61354422018-09-19 Institutionalising an evidence-informed approach to guideline development: progress and challenges at the World Health Organization Gopinathan, Unni Hoffman, Steven J BMJ Glob Health Research 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. BMJ Publishing Group 2018-09-08 /pmc/articles/PMC6135442/ /pubmed/30233832 http://dx.doi.org/10.1136/bmjgh-2018-000716 Text en © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Research
Gopinathan, Unni
Hoffman, Steven J
Institutionalising an evidence-informed approach to guideline development: progress and challenges at the World Health Organization
title Institutionalising an evidence-informed approach to guideline development: progress and challenges at the World Health Organization
title_full Institutionalising an evidence-informed approach to guideline development: progress and challenges at the World Health Organization
title_fullStr Institutionalising an evidence-informed approach to guideline development: progress and challenges at the World Health Organization
title_full_unstemmed Institutionalising an evidence-informed approach to guideline development: progress and challenges at the World Health Organization
title_short Institutionalising an evidence-informed approach to guideline development: progress and challenges at the World Health Organization
title_sort institutionalising an evidence-informed approach to guideline development: progress and challenges at the world health organization
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135442/
https://www.ncbi.nlm.nih.gov/pubmed/30233832
http://dx.doi.org/10.1136/bmjgh-2018-000716
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