New series published to support the use of qualitative research in decision-making

CERQual (Confidence in the Evidence from Reviews of Qualitative Research)

26 January 2018: Qualitative research aims to explore people’s needs, values, perceptions and experiences of the world around them, including of health, illness, healthcare services, and more broadly of social systems and their policies and processes. Qualitative evidence is therefore very important for improving understanding on how, and whether, people perceive health interventions to be effective and acceptable – or more fundamentally, whether they work. Qualitative evidence is also fundamental to understand the factors influencing the implementation of health policies and interventions.

Qualitative evidence syntheses are a methodology used to combine and analyze evidence from individual qualitative studies that address similar research concepts across different contexts (e.g.: different settings, perspectives or phenomena). These methods have been increasingly used to inform WHO guideline development processes, and to support health policy and systems decisions worldwide.

In recognition of the need to guide researchers in combining and analysing findings from qualitative evidence syntheses, a series of ‘how-to’ papers about applying a new methodology for qualitative evidence syntheses, have been published in the journal Implementation Science. This new approach is called the GRADE-CERQual approach, which stands for ‘Confidence in the evidence from reviews of qualitative research’. The GRADE-CERQual approach aims to help researchers assess the extent to which a review finding from a qualitative evidence synthesis is a reasonable representation of the phenomenon of interest.

These papers were authored by the GRADE-CERQual core project group, which includes the WHO Department of Reproductive Health and Research and HRP staff, supported by the Alliance HPSR.

Assessing confidence

GRADE-CERQual measures confidence in evidence from qualitative evidence syntheses by assessing how well findings from these syntheses represent the phenomenon they are investigating. It does this through 4 areas of consideration: 1) methodological limitations, 2) coherence, 3) adequacy of data, and 4) relevance. A fifth area of ‘dissemination bias’ is currently being considered for addition to the assessment.

A similar approach has existed for assessing quantitative evidence for a long time, but this is the first time that an approach has been developed and used for qualitative evidence. The GRADE-CERQual approach will allow people to make transparent assessments of individual review findings – which in turn will help people make better informed decisions when creating health policies, introducing programmes, or making changes in health systems.

About the papers

The papers take the reader through the GRADE-CERQual approach step-by-step. In addition to explaining how the approach was created and developed, the papers aim to provide guidance on how to apply the approach, how to arrive at an overall assessment of confidence, and how to present key findings and confidence assessments.

Why qualitative evidence?

Decisions on health, social care and other interventions rely on the best available scientific evidence. Within the scientific community, there is broad agreement that a wide range of evidence is needed to inform decisions.

While quantitative evidence is crucial for accurately measuring results empirically, interventions may not work in practise if people do not view them as acceptable, ethical, accessible, feasible and cost-effective. In giving decision-makers a picture of the impact of interventions on people, qualitative evidence is very helpful in assessing whether interventions are acceptable and/or feasible – and are therefore invaluable to decision-makers for considerations around implementation.

As the authors of the introduction (add hyperlink) to the papers in Implementation Science comment, ‘This is particularly so for more complex interventions or policies as well as for programmes or policies whose implementation may impact across institutions and systems, such as across schools or across the education, health or social care system.’

GRADE-CERQual has been used in a number of RHR’s guidelines such as Optimizing health worker roles for maternal and newborn health (2012), Health worker roles in providing safe abortion care and post abortion contraception (2015), and the WHO recommendations on antenatal care for a positive pregnancy experience (2016).

Additional Resources