David Sinclair1, Rachel Isba1, Tamara Kredo2, Babalwa Zani2, Helen Smith3, Paul Garner1
1 Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom,
2 South African Cochrane Centre, Cape Town, South Africa,
2 South African Cochrane Centre, Cape Town, South Africa,
3 Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
PloS ONE - May 31, 2013 - Volume 8 - Issue 5 - e63715
Available online at: http://bit.ly/13g8zrG
“……Research in 2007 showed that World Health Organization (WHO) recommendations were largely based on expert opinion, rarely used systematic evidence-based methods, and did not follow the organization's own “Guidelines for Guidelines”. In response, the WHO established a “Guidelines Review Committee” (GRC) to implement and oversee internationally recognized standards. We examined the impact of these changes on WHO guideline documents and explored senior staff's perceptions of the new procedures.
Methods and Findings
We used the AGREE II guideline appraisal tool to appraise ten GRC-approved guidelines from nine WHO departments, and ten pre-GRC guidelines matched by department and topic. We interviewed 20 senior staff across 16 departments and analyzed the transcripts using the framework approach. Average AGREE II scores for GRC-approved guidelines were higher across all six AGREE domains compared with pre-GRC guidelines.
The biggest changes were noted for “Rigour of Development” (up 37.6%, from 30.7% to 68.3%) and “Editorial Independence” (up 52.7%, from 20.9% to 73.6%).
The biggest changes were noted for “Rigour of Development” (up 37.6%, from 30.7% to 68.3%) and “Editorial Independence” (up 52.7%, from 20.9% to 73.6%).
Four main themes emerged from the interviews:
(1) high standards were widely recognized as essential for WHO credibility, particularly with regard to conflicts of interest;
(2) views were mixed on whether WHO needed a single quality assurance mechanism, with some departments purposefully bypassing the procedures;
(3) staff expressed some uncertainties in applying the GRADE approach, with departmental staff concentrating on technicalities
while the GRC remained concerned the underlying principles were not fully institutionalized;
(4) the capacity to implement the new standards varied widely, with many departments looking to an overstretched GRC for technical support.
Conclusions
Since 2007, WHO guideline development methods have become more systematic and transparent. However, some departments are bypassing the procedures, and as yet neither the GRC, nor the quality assurance standards they have set, are fully embedded within the organization….”
Also available Online: http://bit.ly/ZHwjXi
Appendix S1. Draft Interview Guide.
Appendix S2. Full AGREE II appraisal scores for pre- and post-GRC guidelines.
Appendix S3. AGREE II appraisal scores for three recent guidelines that did not seek GRC approval.
Table S1.Theme 1: High standards essential for credibility.
Table S2. Theme 2: Mixed views on the need for a single quality assurance process.
Table S3.Theme 3: Uncertainties about applying the GRADE methods.
Table S4. Theme 4: Variable capacity to implement the new standard.
