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
Use of systematic reviews in WHO recommendations
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“Expert opinion has been acknowledged as a crucial element in this evaluation process [Oxman, Lavis and Fretheim (2007), Hack et al. (2011)].”
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Diarrhoeal diseases in low- and middle-income countries : trends, management and control
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“Nowadays, expert opinion is widely acknowledged as a crucial element in this evaluation process (Oxman et al. , 2007; Hack et al. , 2011).”
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Scott-Samuel, A., Ardern, K., & Birley, M. (2013) · Oxford University Press eBooks · doi:10.1093/med/9780199586301.003.0005 · Cited by 3
Priorities and ethics in health care
Griffiths, S. M., Martin, R., & Sinclair, D. D. A. D. (2013) · Oxford University Press eBooks · doi:10.1093/med/9780199586301.003.0002 · Cited by 3
Guidelines of the International Federation of Red Cross and Red Crescent Societies: an overview and quality appraisal using AGREE II
Veegaete, A. V., Borra, V., Buck, E. D. J. D., & Vandekerckhove, P. G. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-011744 · Cited by 3
The impact of systematic reviews on health care policy in England
Bunn, F. (2010) · University of Hertfordshire Research Archive (University of Hertfordshire) · Cited by 3
Engaging communities in participatory research and action
Minkler, M., & Chang, C. (2013) · Oxford University Press eBooks · doi:10.1093/med/9780199586301.003.0020 · Cited by 3
Understanding data, information, and knowledge
Tennison, B. (2013) · Oxford University Press eBooks · doi:10.1093/med/9780199586301.003.0007 · Cited by 3
Scoping public health problems
Bammer, G. (2013) · Oxford University Press eBooks · doi:10.1093/med/9780199586301.003.0001 · Cited by 3
REQUIREMENTS FOR THE ASSESSMENT OF PHARMACOKINETIC, PHARMACODYNAMIC AND MIXED POPULATION MODELS AND SOME TOPICAL CONSIDERATIONS: A SEMINAR
Rossini, L., & Rossini, P. (2007) · Cited by 3
A continuous improvement agenda for WHO’s normative and standard-setting functions
Askie, L., Bartolomeos, K. K., Farrar, J., & Sheikh, M. R. (2024) · Bulletin of the World Health Organization · doi:10.2471/blt.24.292540 · Cited by 3
Translating goals, indicators, and targets into public health action
Jenkin, R. A., Jorm, C. M., & Frommer, M. S. (2020) · Oxford University Press eBooks · doi:10.1093/med/9780198800125.003.0030 · Cited by 1
“Going into the black box”: a policy analysis of how the World Health Organization uses evidence to inform guideline recommendations
Ingold, H., Gomez, G. B., Stückler, D., Vassall, A., & Gafos, M. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1292475 · Cited by 2
“In 2006, WHO faced criticism for not adhering to its own “Guidelines for Guidelines,” as recommendations were found to be based on expert opinion rather than systematic evidence-based methods (2, 3).”
Background
Best management of threatened preterm labour – how to implement the evidence into practice
Berghella, V. (2010) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2010.02674.x · Cited by 2
Psychopharmacological Treatment Options for Global Child and Adolescent Mental Health: The WHO Essential Medicines Lists
Kratochvil, C. J., Kutcher, S., Murphy, A. L., & Gardner, D. M. (2008) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e3181825ae1 · Cited by 2
The Role of Causal Beliefs in Technology-Supported Policy
Blanzieri, E. (2012) · IFAC Proceedings Volumes · doi:10.3182/20120611-3-ie-4029.00033 · Cited by 2
Evaluating health care systems
McKee, M., Khoshaba, B., & Karanikolos, M. (2013) · Oxford University Press eBooks · doi:10.1093/med/9780199586301.003.0043 · Cited by 2
Lost in Translation: Piloting a Novel Framework to Assess the Challenges in Translating Scientific Uncertainty From Empirical Findings to WHO Policy Statements
Benmarhnia, T., Huang, J. Y., & Jones, C. M. (2017) · International Journal of Health Policy and Management · doi:10.15171/ijhpm.2017.28 · Cited by 2
Improving equity
Friel, S. (2013) · Oxford University Press eBooks · doi:10.1093/med/9780199586301.003.0041 · Cited by 2
Introduction
Murashov, V. V., & Howard, J. (2011) · Nanostructure science and technology · doi:10.1007/978-1-4419-7853-0_1 · Cited by 2
Qualitative methods
Mallinson, S., Popay, J., & Williams, G. H. (2013) · Oxford University Press eBooks · doi:10.1093/med/9780199586301.003.0009 · Cited by 2
The WHO EMF Project: Legitimating the Imaginary of Global Harmonization of EMF Safety Standards
Mercer, D. (2016) · Engaging Science Technology and Society · doi:10.17351/ests2016.41 · Cited by 2
Use of evidence in WHO recommendations
Kelly, J., Campbell, H., Bar‐Zeev, N., Tamburlini, G., & Duke, T. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61407-x · Cited by 2
Use of evidence in WHO recommendations
Peterson, H. B., Curtis, K. M., Glasier, A. F., & Hagenfeldt, K. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61406-8 · Cited by 2
A unified approach to infection control: hand hygiene as the entrance door
Pittet, D., & Allegranzi, B. (2008) · Healthcare Infection · doi:10.1071/hi08014 · Cited by 2
Thermal Protection of Newborns: The World Health Organization Guidelines Need to Include Clear and Feasible Options for Low-Resource Settings
Daga, S. (2021) · European Journal of Clinical Medicine · doi:10.24018/clinicmed.2021.2.6.154 · Cited by 1
“are not based on systematic reviews of the best available evidence, as well as for the quality of some of its guidelines [2].”
Background
Public health in poorer countries
Banatvala, N., & Heymann, E. P. (2013) · Oxford University Press eBooks · doi:10.1093/med/9780199586301.003.0032 · Cited by 1
Funding and delivering health care
Dixon, A. (2013) · Oxford University Press eBooks · doi:10.1093/med/9780199586301.003.0035 · Cited by 1
Issue Brief: Engaging Civil Society in Supporting Research Use in Health Systems
Lavis, J. N., McCutchen, B., & Bopardikar, A. (2009) · MacSphere (McMaster University) · doi:10.71548/904 · Cited by 1
Self-citation
Assuring screening programmes
Raffle, A. E., Barratt, A., & Gray, J. A. M. (2013) · Oxford University Press eBooks · doi:10.1093/med/9780199586301.003.0022 · Cited by 1
Information technology and informatics
Detmer, D. E. (2013) · Oxford University Press eBooks · doi:10.1093/med/9780199586301.003.0008 · Cited by 1

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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