Cited by 287Clinical practice guidelines implementationHealth Policy Implementation ScienceDelphi Technique in Research

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Use of evidence in WHO recommendations

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Oxman, Andrew D, Lavis, John N, Fretheim, Atle·2007·The Lancet

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Abstract

Background WHO regulations, dating back to 1951, emphasise the role of expert opinion in the development of recommendations. However, the organisation's guidelines, approved in 2003, emphasise the use of systematic reviews for evidence of effects, processes that allow for the explicit incorporation of other types of information (including values), and evidence-informed dissemination and implementation strategies. We examined the use of evidence, particularly evidence of effects, in recommendations developed by WHO departments.Methods We interviewed department directors (or their delegates) at WHO headquarters in Geneva, Switzerland, and reviewed a sample of the recommendation-containing reports that were discussed in the interviews (as well as related background documentation). Two individuals independently analysed the interviews and reviewed key features of the reports and background documentation.Findings Systematic reviews and concise summaries of findings are rarely used for developing recommendations. Instead, processes usually rely heavily on experts in a particular specialty, rather than representatives of those who will have to live with the recommendations or on experts in particular methodological areas.Interpretation Progress in the development, adaptation, dissemination, and implementation of recommendations for member states will need leadership, the resources necessary for WHO to undertake these processes in a transparent and defensible way, and close attention to the current and emerging research literature related to these processes.

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Background
Local adaption of intrapartum clinical guidelines, United Republic of Tanzania
Maaløe, N., Meguid, T., Housseine, N., Tersbøl, B. P., Nielsen, K. K., Bygbjerg, I. C., & van Roosmalen, J. (2019) · Bulletin of the World Health Organization · doi:10.2471/blt.18.220830 · Cited by 27
Using RIGHT (Reporting Items for Practice Guidelines in Healthcare) to evaluate the reporting quality of WHO guidelines
Wang, X., Zhou, Q. X., Chen, Y., Yang, N., Pottie, K. C., Xiao, Y., Tong, Y., Yao, L., Wang, Q., Yang, K., et al. (2020) · Health Research Policy and Systems · doi:10.1186/s12961-020-00578-w · Cited by 27
Development of a Farsi translation of the AGREE instrument, and the effects of group discussion on improving the reliability of the scores
Rashidian, A., & Nooraie, R. Y. (2011) · Journal of Evaluation in Clinical Practice · doi:10.1111/j.1365-2753.2011.01649.x · Cited by 25
Development of Evidence-Based Health Policy Documents in Developing Countries: A Case of Iran
Imani-Nasab, M. H., Seyedin, H., Majdzadeh, R., Yazdizadeh, B., & ‎Salehi, M. (2014) · Global Journal of Health Science · doi:10.5539/gjhs.v6n3p27 · Cited by 24
Predictors of dentists’ behaviours in delivering prevention in primary dental care in England: using the theory of planned behaviour
Yusuf, H., Kolliakou, A., Ntouva, A., Murphy, M., Newton, T., Tsakos, G., & Watt, R. G. (2015) · BMC Health Services Research · doi:10.1186/s12913-016-1293-x · Cited by 24
“Evidence has shown that there is a gap between the availability of evidence-based clinical guidelines and their implementation in daily practice [20].”
Background
Methods Regimes in Global Governance: The Politics of Evidence-Making in Global Health
Littoz‐Monnet, A., & Uribe, J. (2023) · International Political Sociology · doi:10.1093/ips/olad005 · Cited by 23
Getting to grips with GRADE—perspective from a low-income setting
English, M., & Opiyo, N. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.07.016 · Cited by 23
“[4] Oxman A, Lavis J, Fretheim A.”
The Use of Research Evidence in Two International Organizations' Recommendations about Health Systems
Hoffman, S. J., Lavis, J. N., & Bennett, S. (2009) · Healthcare policy · doi:10.12927/hcpol.2009.21005 · Cited by 23
“HEALTHCARE POLICY Vol.5 No.1, 2009 [73] The Use of Research Evidence in Two International Organizations’ Recommendations about Health Systems Tobacco Control World Health Organization.”
InfluentialSelf-citation
Correction: World Health Organization Guideline Development: An Evaluation
Sinclair, D., Isba, R., Kredo, T., Zani, B., Smith, H. J. J., & Garner, P. (2013) · PLoS ONE · doi:10.1371/annotation/fd04e7c6-0d40-4d2c-a382-c5ad10074c99 · Cited by 23
The use of evidence in public governmental reports on health policy: an analysis of 17 Norwegian official reports (NOU)
Innvær, S. (2009) · BMC Health Services Research · doi:10.1186/1472-6963-9-177 · Cited by 22
Senior GRADE methodologists encounter challenges as part of WHO guideline development panels: an inductive content analysis
Alexander, P. E., Li, S., Gionfriddo, M. R., Stoltzfus, R. J., Neumann, I., Brito, J. P., Djulbegović, B., Montori, V. M., Schünemann, H. J., & Guyatt, G. H. (2015) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2015.09.003 · Cited by 22
The Evidence-Informed Policy Network (EVIPNet) in Chile: lessons learned from a year of coordinated efforts
Mansilla, C., Herrera, C. A., Basagoitı́a, A., & Tomás Pantoja, C. (2017) · Revista Panamericana de Salud Pública · doi:10.26633/rpsp.2017.36 · Cited by 21
Assumptions of global beneficence: Health-care disparity, the WHO and the outcomes of integrative health-care policy at local levels in the Philippines
Kadetz, P. I. (2011) · BioSocieties · doi:10.1057/biosoc.2010.43 · Cited by 20
The suitability of sham treatments for use as placebo controls in trials of spinal manipulative therapy: a pilot study.
Lougee, H., Johnston, R., & Thomson, O. P. (2013) · Journal of Bodywork & Movement Therapies · doi:10.1016/j.jbmt.2012.06.005 · Cited by 21
“The execution of well-designed sham-controlled treatments in methodically rigorous RCTs is fundamental in identifying specific therapeutic effects (Miller and Rosenstein, 2006; Oxman et al., 2007; Hartman, 2009).”
Method
Identification of prognostic factors and assessment methods on the evaluation of non-specific low back pain in a biopsychosocial environment: A scoping review
Draper‐Rodi, J., Vogel, S. K., & Bishop, A. (2018) · International journal of osteopathic medicine · doi:10.1016/j.ijosm.2018.07.001 · Cited by 22
Adapting valid clinical guidelines for use in primary care in low and middle income countries
Rashidian, A. (2008) · Primary Care Respiratory Journal · doi:10.3132/pcrj.2008.00055 · Cited by 19
The World Health Organization work and experiences in combating female genital mutilation in Addis Ababa, Ethiopia
Mladonova, A. (2007) · NORA - Norwegian Open Research Archives · Cited by 19
Transparency: A central principle underpinning trustworthy guidelines
Ford, N. P., Thomas, R., & Grove, J. T. (2021) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2021.11.025 · Cited by 18
“In 2007, WHO established a Guideline Review Committee in response to criticism that WHO guidelines were not based on the best available evidence and relied on expert opinion [2] .”
WHO policy development processes for a new vaccine: case study of malaria vaccines
Milstien, J. B., Cárdenas, V., Cheyne, J., & Brooks, A. (2010) · Malaria Journal · doi:10.1186/1475-2875-9-182 · Cited by 18
“This publication emphasizes the use of systematic reviews for evidence of effects for a policy option (such as a treatment protocol or use of a preventive intervention) and of evidence-based dissemination and implementation strategies [11,12].”
Background
Are current standards of reporting quality for clinical trials sufficient in addressing important sources of bias?
Mills, E. J., Ayers, D., Chou, R., & Thorlund, K. (2015) · Contemporary Clinical Trials · doi:10.1016/j.cct.2015.07.019 · Cited by 18
Development of rapid guidelines: 2. A qualitative study with WHO guideline developers
Flórez, I. D., Morgan, R. L., Falavigna, M., Kowalski, S. C., Zhang, Y., Etxeandia‐Ikobaltzeta, I., Santesso, N. A., Wiercioch, W., & Schünemann, H. J. (2018) · Health Research Policy and Systems · doi:10.1186/s12961-018-0329-6 · Cited by 19
“There is no reason to believe that a rapid process solely relying on expert opinion would avoid the concerns previously identified with regular guidelines at WHO [6].”
Background
New guidance on recommended HIV testing and counselling
Tarantola, D. J. M., & Gruskin, S. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61102-7 · Cited by 18
Scientific Advisory Committees at the World Health Organization: A Qualitative Study of How Their Design Affects Quality, Relevance, and Legitimacy
Gopinathan, U., Hoffman, S. J., & Ottersen, T. (2018) · Global Challenges · doi:10.1002/gch2.201700074 · Cited by 17
The contribution of observational studies in supporting the WHO ‘treat all’ recommendation for HIV/AIDS
Ford, N. P., Penazzato, M., Vitória, M., Doherty, M. C., Davies, M., Zaniewski, E., Tymejczyk, O., Egger, M., & Nash, D. (2018) · Journal of Virus Eradication · doi:10.1016/s2055-6640(20)30346-0 · Cited by 17
“wHO adopted the GRADe approach in 2008, following public criticism that many wHO guidelines at the time relied too heavily or exclusively on expert opinion [19].”
MethodInfluential
Educating osteopaths to be researchers – What role should research methods and statistics have in an undergraduate curriculum?
Licciardone, J. C. (2008) · International journal of osteopathic medicine · doi:10.1016/j.ijosm.2008.03.003 · Cited by 17
The quality of care in post-soviet Uzbekistan: are health reforms and international efforts succeeding?
Asadov, D. A., & Aripov, T. (2009) · Public Health · doi:10.1016/j.puhe.2009.09.013 · Cited by 16
Mitigating Inequalities of Influence among States in Global Decision Making
Hoffman, S. J. (2012) · Global Policy · doi:10.1111/j.1758-5899.2011.00153.x · Cited by 16
Quality of WHO guidelines on snakebite: the neglect continues
Bhaumik, S., Jagadesh, S., & Lassi, Z. S. (2018) · BMJ Global Health · doi:10.1136/bmjgh-2018-000783 · Cited by 16
“About a decade ago, the WHO initiated a mechanism to oversee quality assurance through the formation of the Guideline Review Committee in response to public outcry over guidelines being based on expert opinion.(14) These changes have led to improvements in guideline quality.”
Background
A roadmap for strengthening evidence-informed health policy-making in Iran: protocol for a research programme
Sajadi, H. S., Majdzadeh, R., Yazdizadeh, B., Mohtasham, F., Mohseni, M. M., Doshmangir, L., & Lavis, J. N. (2019) · Health Research Policy and Systems · doi:10.1186/s12961-019-0455-9 · Cited by 16
Self-citation
Guías de práctica clínica en el Perú: evaluación de su calidad usando el instrumento AGREE II
Canelo‐Aybar, C., Balbin-Ramon, G. J., Perez-Gomez, Á., & Flórez, I. D. (2016) · Revista Peruana de Medicina Experimental y Salud Pública · doi:10.17843/rpmesp.2016.334.2559 · Cited by 16

Authors: Oxman, A. D., Lavis, J. N., & Fretheim, A.
Affiliations: Nasjonalt Kunnskapssenter for Helsetjenesten (NO)
McMaster University (CA)
Corresponding author: Oxman, Andrew D
ORCID: Oxman, Andrew D
Lavis, John N
Fretheim, Atle
Venue: The Lancet
Publisher: Elsevier BV
Published: 2007-06
Volume: 369
Issue: 9576
Pages: 1883-1889
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/s0140-6736(07)60675-8
OpenAlex: W2112003434
Cited by: 287
References: 32
Citations by year: 2026: 2 · 2025: 2 · 2024: 9 · 2023: 6 · 2022: 2 · 2021: 7 · 2020: 6 · 2019: 9 · 2018: 12 · 2017: 10 · 2016: 14 · 2015: 16 · 2014: 18 · 2013: 81 · 2012: 14
FWCI: 23.26
Type: journal article
Language: en
Open access: green
hdl.handle.net
Licence: other-oa
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Lancet (publishedVersion)
PubMed (publishedVersion)
BIBSYS Brage (BIBSYS (Norway)) (acceptedVersion)
NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Social Sciences › Sociology and Political Science › Delphi Technique in Research
Keywords: World Health Organization, health advice, evidence use, systematic reviews, expert opinion, evidence-informed decision-making, WHO guidelines, dissemination and implementation
MeSH terms: Expert Testimony, Health Planning Guidelines, Health Policy, Humans, Interviews as Topic, Physician Executives, World Health Organization, Evidence-Based Medicine

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